DEVELOPMENT AND EVALUATION OF EFFECTS OF A PRIMARY HEALTH CARE-BASED PHYSIOTHERAPY PROTOCOL ON SELECTED INDICES OF STROKE RECOVERY

Abstract

Stroke rehabilitation is traditionally carried out in various hospital and rehabilitation settings. Evidence is accruing that post-stroke patients can also benefit from treatments based in the community or at primary health care centres. There is however dearth of Primary health Care-based Physiotherapy Protocol (PHCPP) for enhancing recovery post- stroke. This study was designed to develop, and evaluate the effects of a PHCPP on selected indices of stroke recovery. The physiotherapy evidence database was used to identify treatment approaches and modalities with proven efficacy. These established treatment approaches were synthesised to develop the PHCPP. The PHCPP was then used in a quasi-experimental research involving 56 consenting individuals with first incident stroke, consecutively recruited and randomly assigned into either the Primary Health are Group (PHCG, n⁼29) or the Home Group (HG. n⁼27). Fifty-two individuals comprising 25 PHCG and 27 HG participants completed the study. Participants in the PHCG and HG were treated at a primary health centre and their homes respectively, twice weekly for 10 consecutive weeks using PHCPP. Motor function ability, postural balance and community reintegration were assessed using the Modified Motor Assessment Scale (MMAS, obtainable score 0 to 48), Short Form of Postural Assessment Scale for Stroke (SEPASS, obtainable score 0 to 15) and Reintegration to Normal Living Index (RNLI, obtainable score 0 to 100%) respectively, before intervention and thereafter fortnightly, Walking Speed and quality or life were assessed using a stopwatch and Health Related Quality of Life in Stroke Patients (HRQLISP, obtainable score 0 to 100%) respectively. before and at week 10 of intervention. Data were analysed using descriptive statistics, t-test and general linear model for repeated measures at p⁼ 0.05. The MPHCG (60,6±10.2 years) and HG (61.7±8.4 years) were comparable in age. Within- subjects multivariate analysis, after controlling for gender, showed a significant increase in the MMAS scores for the PHCG (22.9+15.1) and HG (19.9±16.4) at pre-intervention to 34.7+11.7 and 36.6±10.3 respectively at week I0. There was a significant increase in SFPASS scores of the PHCG (8.6±5.0) and HG (7.1±5.6) at pre-intervention to12.3±3.2 and 12.3±3.3 at week 10 respectively. The HRQLISP scores significantly increased from 70.4±4.9 pre-intervention to 75.2±5.4 in the PHCG and from 69.7+51 to 74.845.9 in the

HG. Similarly, walking speed significantly increased from 0.30±0.20 m/s pre-intervention to 0.60±0.40 m/s at week 10 in the PHCG and from 0.30±0.40 m/s to 0.50±0.40 m/s in the HG. The groups were comparable in each of the MM AS, RNLI, SFPASS, walking speed and overall HRQLISP scores pre-intervention and at week 10. However, the PHCG had a significantly higher spiritual interaction score (77.6±9.3) on the HRQLISP measure than the HG (14.2±8.3 ). The primary health care-based physiotherapy protocol improved motor function ability, walking speed, postural balance and quality of life among post-stroke patients. This protocol can be used for stroke rehabilitation at home and primary health centres which are closer to the community. Keywords: Stroke rehabilitation; Primary health care, Physiotherapy protocol word Count: 472