ATTENDANCE OF STROKE PATIENTS AT PHYSIOTHERAPY SESSIONS, UNIVERSITY COLLEGE HOSPITAL, IBADAN: IMPLICATIONS FOR HEALTH EDUCATION

Abstract

Stroke, usually defined as a cerebrovascular accident, manifests in hemiplegia. lt is one of the most disabling complications of cardio-vascular diseases, including hypertension, and occurs mainly among the middle aged and elderly. A major component of orthodox stroke management is physiotherapy. Unfortunately, orthodox management has not been popular among many patients, who seek alternative treatments more congruent with their cultural beliefs about the condition. These behaviours often lead to complications that inhibit full recovery. Stroke patients, at University College Hospital Ibadan are usually seen daily by the physiotherapist during hospitalization. On discharge, however, patients are referred to the Physiotherapy Department to continue with physiotherapy. A minimum of 12 weekly appointments are made when patients first book for the service. This study aimed at documenting patient attendance behaviour at the recommended physiotherapy sessions and determining factors that may be associated with the level of attendance. The results were intended to provide a basin for improving patient health education at the Physiotherapy Department. Two research methodologies were employed. First on historical cohort study was conducted using all available patient records in the Physiotherapy Department from 1982 through 1991. Secondly qualitative research using in-depth interviews was conducted with the 15 physiotherapists in the Department and all (20) current stroke patients. Over one-third of patients who reported to the Department to book an appointment subsequently did not show up at all for treatment. The review of 313 records of those who actually attended found that only 20.1% of patients completed the 12 sessions recommended by the Department, with a mean attendance of 6.0 sessions. Christians had a significantly better attendance record than Moslems. Those who came early (within two weeks of referral) for their first appointment, attended better than late arrivals. Neither sex, occupation, side of hemiplegia nor level of function at commencement of out-patient sessions were associated with attendance. Early attendance at the first out-patient session was positively associated with Christian religion and those with civil service/professional occupations. In-depth Interviews shed light on cultural beliefs not found in the records. Some known hypertensive patients thought their stroke was associated with neglect of their condition, while others believed it happened following evil action. Almost all engaged in alternative therapy including the services of spiritual and indigenous healers. Patients Identified problems such as cost of treatment, transportation difficulties, perceived delay in improvement and staff attitudes as reasons for curtailing physiotherapy. The results imply a need for detailed education on stroke rehabilitation through physiotherapy during hospitalization and at the time when first appointment is booked, to encourage early attendance and to answer questions about cause, prognosis and cost of therapy.