Stroke Rehabilitation in the Philippines: An Audit Study

Consuelo Belmonte Gonzalez-Suarez, Karen Grimmer, Isaias Alipio, Elda Grace Anota-Canencia, Maria Luisa Santos-Carpio, Janine Margarita Dizon, Lauren Liao, Jan Tyrone Cabrera, Romil Martinez, Eulalia Beredo, Carolina Valdecanas, Vania Yu

Abstract


Purpose: Although cerebrovascular accident is a leading cause of mortality in the Philippines, there has never been a national survey of stroke client descriptors and rehabilitation practices. This paper reports on data from the audit of stroke care for inpatients in hospitals serviced by physiatrists.

Method: Audit was done of the medical records of stroke clients admitted to hospitals with rehabilitation units. Performance indicators for timely referral to rehabilitation were applied.

Results: A total of 1683 records were audited. The majority of clients had cerebral infarct followed by cerebral haemorrhage. The median length of stay was 7 days; stay was lengthier for haemorrhagic strokes. Only 54.1% of the clients were referred to rehabilitation, with a median delay of 3 days between admission and referral to rehabilitation. 25.4% of the clients had early referral to rehabilitation. 39.2% of the 1397 clients were referred to rehabilitation earlier than 2 days before discharge.

Conclusion: This Filipino study provides valuable information on stroke types and prevalence, demographics and rehabilitation practices. Despite the prevalence of post-stroke rehabilitation, it has been underutilised in the management of stroke.

Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms.

Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.


Keywords


Stroke rehabilitation; audit study

Full Text:

PDF

References


Anderson B, Alcantara MO (2007). Technical assistance to the Republic of Philippines for the health sector development programme ADB TA 4647-PHI: final report. 2007. Available from: http://www2.adb.org/Documents/Reports/Consultant/39066-PHI/39066-PHI-TACR.pdf. [Accessed on 12 March 2015]

Anemaet WK (2002). Using standardised measures to meet the challenge of stroke assessment. Topics in Geriatric Rehabilitation; 18(2): 47-62. http://dx.doi.org/10.1097/00013614-200212000-00006

Australian Institute of Health and Welfare (2013). Stroke and its management in Australia: an update. Available from: http://apo.org.au/node/34784. [Accessed on 13 January 2015]

Bai Y, Hu Y, Wu Y, Zhu Y, He Q, Jiang C, Sun L, Fan W (2012). A prospective, randomised, single-blinded trial on the effect of early rehabilitation on daily activities and motor function of patients with haemorrhagic stroke. Journal of Clinical Neuroscience; 9: 1376–1379. http://dx.doi.org/10.1016/j.jocn.2011.10.021. PMid:22819061

Brainin M, Teuschl Y, Kalra L (2007). Acute treatment and long-term management of stroke in developing countries. Lancet Neurology; 6: 553–61. http://dx.doi.org/10.1016/S1474-4422(07)70005-4

Chlegel DJ, Tanne D, Demchuk AM, Levine SR, Kasner SE (2004). Prediction of hospital disposition after thrombolysis for acute ischaemic stroke using the National Institutes of Health Stroke Scale. Archives of Neurology; 29(6): 1258-1259.

Dans AL, Morales DD, Velandria FV, Abola T, Roxas A, Punzalan F, Sy RA, Paz-Pachecho E, Amarillo L, Villaruz MV (2005). National nutrition and health survey [NNHeS]: atherosclerosis-related diseases and risk factors. Philippine Journal of Internal Medicine; 43: 103–15.

Dewey HM, Bernhardt J (2007). Acute stroke patients–early hospital management. Australian Family Physician; 36: 904–12. PMid:18043775

Dixon N, Pearce M (2010). Clinical Audit Manual. Romsey: Healthcare Quality Quest Ltd.

Dizon JMR, Grimmer-Somers K, Kumar K (2012a). A pilot study of the evidence-based practice training programme for Filipino physiotherapists: emerging evidence on outcomes and acceptability (2012a). Internet Journal of Allied Health Science and Practice; 10(2): 1-12. Available from: http://ijahsp.nova.edu/articles/Vol10Num2/pdf/Dizon.pdf. [Accessed on 20 December 2014]

Dizon JMR, Grimmer-Somers K, Kumar K (2012b). Study Protocol effectiveness of the tailored EBP training program for Filipino physiotherapists: a randomised controlled trial. BMC Medical Education; 11: 14. Available from: http://www.biomedcentral.com/1472-6920/11/14. [Accessed on 14 November 2014]. http://dx.doi.org/10.1186/1472-6920-11-14. PMid:21489229 PMCid:PMC3100239

Gonzalez-Suarez CB, Grimmer-Somers K, Dizon JM, King E, Lorenzo S , Valdecaňas C, Gambito E, Fidel B (2012). Contextualising Western guidelines for stroke and low back pain to a developing country [Philippines]: An innovative approach to putting evidence into practice efficiently. Journal of Healthcare Leadership; 4: 141–156. Available from: http://www.dovepress.com/contextualizing-western-guidelines-for-stroke-and-low-back-pain-to-a-d-peer-reviewed-article-JHL [Accessed on 14 January 2015]. http://dx.doi.org/10.2147/JHL.S35370

Gonzalez-Suarez CB, Dizon MR, Grimmer K, Estrada M, Liao L, Malleta ARD, Tan ME, Marfil V, Versales CS, Suarez JL, So KC, Uyehara ED (2015). Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients. Journal of Multidisciplinary Healthcare; 2(8): 127-38.

Gregory B, Van Horn C, Kaprielan V (2008). Eight steps for a chart audit for quality care. Family Practice Management; 15(7): A3- A8. PMid:18763679

Hall MJ, Levant S, DeFrances CJ (2012). Hospitalisation for Stroke in U.S. Hospitals, 1989–2009. NCHS data brief, No. 95.

Inouye M, Kishi K, Ikeda Y, Takada M, Katoh J, Iwahashi M, Hayakawa M, Ishihara K, Sawamura S, Kazumi T (2000). Prediction of functional outcome after stroke rehabilitation. American Journal of Physical Medicine and Rehabilitation; 79: 513–518. http://dx.doi.org/10.1097/00002060-200011000-00007

PMid:11083301

Jamie L, Banks A, Charles A, Marotta CA (2007). Outcomes validity and reliability of the modified Rankin scale: Implications for stroke clinical trials: A literature review and synthesis. Stroke; 38: 1091-1096. http://dx.doi.org/10.1161/01.STR.0000258355.23810.c6 PMid:17272767

Kulshreshtha A, Anderson LM, Goyal A, Keenan NL (2012). Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010. Neuroepidemiology; 38:123–12. http://dx.doi.org/10.1159/000336230. PMid:22433930

Liu N, Cadilhac D, Andrew N, Zeng L, Li Z, Li J, Li Y, Yu X, Mi B, Li Z, Xu H, Chen Y, Wang J, Yao W, Li K, Yan F, Wang J (2014). Randomised controlled trial of early rehabilitation after intracerebral haemorrhage stroke: difference in outcomes within 6 months of stroke. Stroke; 45(3): 502-3507.

Navarro JC (2005). Prevalence of stroke: community survey. Philippine Journal of Neurology; 9: 11–5.

Navarro J, Baroque A, Lokin J, Venketasubramanian N (2014). The real stroke burden in the Philippines. International Journal of Stroke; 9: 640–641. http://dx.doi.org/10.1111/ijs.12287. PMid:24844610

Philippine Island: Geography of the Philippines; and National Capital Region (internet) Available from: http://www.philippineislands.ph/en/geography_of_the_philippines.html; http://www.philippine-islands.ph/en/national_capital_region-philippines.html [Accessed on 4 January 2015]

Skarin M, Bernhardt J, Sjӧholm A, Nilsson M, Linden T (2011). 'Better wear out sheets than shoes': a survey of 202 stroke professionals' early mobilisation practices and concerns. International Journal of Stroke; 6: 10–15. http://dx.doi.org/10.1111/j.1747-4949.2010.00534.x. PMid:21205235

Sulter G, Steen C, De Keyser J (1999). Use of Barthel Index and Modified Rankin Scale in acute stroke trials. Stroke; 8: 1538-1541. http://dx.doi.org/10.1161/01.STR.30.8.1538

Suputtitada A, Aksaranugraha C, Granger CV, Sankaew M (2003). Results of stroke rehabilitation in Thailand. Disability and Rehabilitation; 25: 1140–45. http://dx.doi.org/10.1080/0963828031000152039 PMid:12944154

Suzuki I, Asano R (1993). Epidemiology of stroke in Japan (in Japanese). Nihon Rinsho; 51: 20 – 29. PMid:8283666

Tu F, Tokunaga S, Deng ZL, Nobutomo K (2002). Analysis of hospital charges for cerebral infarction stroke inpatients in Beijing, People's Republic of China. Health Policy; 59: 243–56. http://dx.doi.org/10.1016/S0168-8510(01)00182-8

World Health Organisation Updates: Philippines profile. Available from: http://www.who.int/countries/phl/en/. [Accessed on 12 January 2015]




DOI: http://dx.doi.org/10.5463/dcid.v26i3.446

Refbacks

  • There are currently no refbacks.




Copyright (c) 2015 Consuelo Belmonte Gonzalez-Suarez, Karen Grimmer, Isaias Alipio, Elda Grace Anota-Canencia, Maria Luisa Santos-Carpio, Janine Margarita Dizon, Lauren Liao, Jan Tyrone Cabrera, Romil Martinez, Eulalia Beredo, Carolina Valdecanas, Vania Yu

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Supported by:

netherlandsleprosyrelief_logo_rgb_-_new_logo_2014_120CBMlightfortheworld_logo_rgb_-_new_logo_2014_120     

© Disability, CBR & Inclusive Development