participation restrictions of stroke patients living in the community at selected community health

220 Pages·2015·15.45 MB·English

PARTICIPATION RESTRICTIONS OF STROKE PATIENTS LIVING IN THE
COMMUNITY AT SELECTED COMMUNITY HEALTH CENTRES IN THE
METROPOLE DISTRICTS IN THE WESTERN CAPE, SOUTH AFRICA

AYORINDE IBUKUN AROWOIYA
3302415

A thesis submitted in partial fulfilment of the requirements for a Masters degree in
Physiotherapy in the Department of Physiotherapy, University of the Western Cape
November 2014

SUPERVISOR
Dr Nondwe Mlenzana

CO - SUPERVISOR
Professor Anthea Rhoda
(University of the Western Cape)

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KEYWORDS

Stroke  

Disability

International Classification of Functioning, Disability and Health

Physiotherapy
Impairment
Activity Limitation
Participation Restrictions
Community Health Centers
Metropole District
South Africa

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ABSTRACT
Stroke is the second leading cause of death globally and the consequences on human and

economic health are of major concern. The aim of this study was to determine and explore

the participation restrictions experienced by stroke patients. The study populations were

stroke patients living within the community in Western Cape, South Africa. A mixed

methods approach was used to collect data in this study which consisted of two phases. For
the first phase, the descriptive, observational cross sectional design was used to determine the
participation restrictions of stroke patients living within the community and the factors
associated with community with respect to integration. In this phase, an interviewer-
administered questionnaire was used to collect data; the instrument for this study is the
standard World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) for disability
assessment which includes the International Classification of Functioning Health and
Disability (ICF) concept in disability assessment which has been tested and found to be
reliable and valid, to determine various participation restrictions among stroke patients living
in the society. While in the second phase of this study, two focus group discussions were
conducted at the selected community health centre, these participants were conveniently
selected from those who participated in the first phase of the study. This was conducted to
retrieve in-depth information on difficulties encountered in participating in daily life
situations. The Statistical Package for Social Sciences (SPSS) was used for descriptive and
inferential statistics. Chi square and Anova t-test was used to determine the association
between the demographics statistic and participation restrictions. Alpha level was set at 0.05.
For qualitative findings, audiotaped interviews and note taken were transcribed and translated
into English; the expressed ideas were coded and reduced into subthemes, themes and
categories. Ethical clearance and permission to conduct study was sought, consents from
participants were sought, clearly stating the right to participate and withdraw from the study
was respected and anonymity and confidentiality has been ensured.
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The result of the study showed that participants encountered difficulty with cognition, (23.3%
of participants reported severe difficulty in learning a new task; 20% reported severe

difficulty analyzing and finding solution to day to day activities), mobility (34%

acknowledged difficulty walking a long distance like one kilometre after stroke), self-care (

44% indicated difficulty staying alone for few days after stroke, while the majority, 61%

complaints of difficulty with getting dressed by self), getting along with people with the
majority of the difficulties (36%) are sexual activities, household activities with major
complaints (46.6% and 31.4%, for severity and exemption respectively) in getting needed
household work done, severe difficulty (51.7%) reported in relaxation and pleasure after
stroke, 50.8% been financially restrained after stroke, 40% with difficulty in joining in the
community activities, 39.2% severely affected by people perception towards them and 25.8%
of the participants indicated extreme time spent on health; all difficulties investigated within
the society 30 days after the incidence of stroke. However, the result of the qualitative phase
reported the participation restrictions experienced by the participants. Difficulty in cognition
was reported, which promotes indiscipline among family members. Limitation in activity
level such as in mobility (walking for a long distance, standing from a sitting position), in
self-care (washing the whole body, eating, staying alone after stroke), in getting along
(maintaining friendship, sexual activities), in household activities and work activities was
reported. Participants experienced difficulty in joining in community activities, emotional
fluctuations, poor perception of attitudes of others after stroke, excessive use of time on
health conditions, increased financial impact of health condition and burden impact on family
was reported. Environmental barriers such as transportation and toilet facilities were reported.
The current study findings suggest appropriate and specific programmes should be aimed at
improving participation among stroke survivors in the community.
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DECLARATION

I hereby declare that “Participation Restrict ions Of Stroke Patients Living In The

Community At Selected Community Health Centres In The Metropole Districts In The

Western Cape, South Africa” is my own work, that it has not been submitted for any degree
or examination in any other university, and that all the sources used or quoted have been
indicated and acknowledged by complete references.

Arowoiya, Ayorinde Ibukun

Signature………………………. November, 2014

Witness…………………………

Professor Anthea Rhoda

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DEDICATION

I dedicate this thesis to my family (dad, mom, brothers and sisters) who always believed in

me, provided me with the love and constant support that was needed to complete my work.
May God continue to bless you all.

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ACKNOWLEDGEMENTS

I would like to express my sincere gratitude an d appreciation to the following people and

institutions for their contributions:

Jesus Christ for granting me strength, understanding and courage in life, especially during my
times of studies.
My Supervisor, Doctor Nondwe Mlenzana and co-supervisor, Professor Anthea Rhoda for
their guidance, constructive feedback, commitment, love and support throughout this project.
I am forever grateful!
South African National Research Fund (NRF) through my wonderful Head of Department,
Professor Anthea Rhoda, for their financial support that without doubt assisted in completion
of this project.
My Husband (Doctor Anthony Kolawole Ojo) and special friends (Kenny, Biola and
Damilola, for your interest, support and prayers during the completion of this project.
To the Physiotherapy Department at the University of the Western Cape for the message of
encouragement and genuine interest. Special thanks to Ms Marla Warner and Ms Mandy
Coetzee for their administrative assistance.
To the research assistance, Tania Johannes, Xipu Felicity, Rehana Isaacs and Nomana
Twsina, without you this project would have been incomplete. May God bless you all.
And I extend special thanks to all who assisted me in one way or the other.
To all the Participants.

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TABLE OF CONTENTS
TITLE PAGE…………………………………………………………………………i

KEYWORDS…………………………………… ……………………………………ii

ABSTRACT……………………………………………………………………….....iii

DECLARATION……………………………………………………………………..vi
DEDICATION……………………………………………………………………….vii
ACKNOWLEDGEMENTS………………………………………………………….viii
TABLE OF CONTENTS…………………………………………………………….ix
LIST OF APPENDICES……………………………………………………………..xviii
LIST OF FIGURES…………………………………………………………………..xix
LIST OF TABLES……………………………………………………………………xxi
ABBREVIATIONS…………………………………………………………………..xxii

CHAPTER ONE: INTRODUCTION………………………………………………1
1. INTRODUCTION…………………………………………………………………1
1.2 BACKGROUND TO THE STUDY………………………………………………1
1.3 STATEMENT OF THE PROBLEM……………………………………………...5
1.4 RESEARCH QUESTION…………………………………………………………6
1.5 AIM OF THE STUDY…………………………………………………………….6
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1.6 OBJECTIVES OF THE STUDY………………………………………………….7
1.7 SIGNIFICANCE OF THE STUDY……………………………………………….7

1.8 DEFINITIONS OF TERM…………………… ……………………………………8

1.9 OUTLINE OF THE CHAPTERS OF THE STUDY………………………………10

CHAPTER TWO: LITERATURE REVIEW……………………………………….12
2. INTRODUCTION………………………………………………………………….12
2.1 TYPES AND CAUSES OF STROKE……………………………………………...12
2.1.1 Ischemic Stroke……………………………………………………………......13
2.1.2 Haemorrhagic Stroke………………………………………………………......13
2.1.3 Subarachnoid Haemorrhage…………………………………………………....14
2.2 EPIDEMIOLOGY OF STROKE…………………………………………………...14
2.3 THE PREVALENCES/BURDEN OF STROKE……………………………….......16
2.4 INTERNATIONAL CLASSIFICATION OF FUNCTIONING, HEALTH AND
DISABILITY……………………………………………………………………………19
2.5 IMPAIRMENTS AND ACTIVITY LIMITATIONS IN STROKE………………...22
2.5.1 Sensory Disturbances…………………………………………………………..22
2.5.2 Paralysis or weakness of Limbs………………………………………………..23
2.5.3 Incontinence…………………………………………………………………….23
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2.5.4 Perception………………………………………………………………………24
2.5.5 Cognitive Impairments…………………………………………………………25

2.6 THE PROBLEMS ENCOUNTERED WIT H PARTICIPATION RESTRICTIONS IN

STROKE…………………………………………………………………………………25

2.6.1 The Impact of Stroke on Participation………………………………………….27
2.6.1.1 Loss of Ability to Perform Meaningful Activities………………………29
2.6.1.2 Loss of Personal Characteristics, Role or Identity and change in Relationships
as a Result of Stroke ………………………………………………………….....30
2.6.1.3 Loss of Mobility Independence and Ability to Drive…………………..31
2.6.1.4 Social isolation………………………………………………………….33
2.6.1.5 Loss of Hope……………………………………………………………34
2.6.1.6 Return to Work and School (Education in General)……………………35
2.7 STROKE REHABILITATION……………………………………………………..36
2.7.1 Physiotherapy Role in Stroke Rehabilitation………………………………….38
2.7.2 Barriers to Stroke Rehabilitation in South Africa……………………………..40
2.8 SUMMARY OF THE CHAPTER………………………………………………….41

CHAPTER THREE: METHODOLOGY …………………………………………....42
3.0 INTRODUCTION TO CHAPTER……………………………………………….....42
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