The influence of demographic, environmental and physical factors on functional independence post stroke

M.V Mamabolo,N.P Mbambo,A.S Stewart,S Olorunju,W Mudzi

doi:10.4102/sajp.v64i3.110

Abstract

Purpose: The magnitude of disability observed in strokesurvivors is believed to be dependent in part, on the severity of neurological deficits incurred. A s important but less well understood, is thecontribution of demographic, physical and environmental factors. The objective of this study was to establish what demographic, environmentaland physical factors influence functional independence post stroke. Method: Convenience sampling was used in the selection of subjects from four stroke outpatient public health facilities in the Gauteng Province of South Africa. The data were collected using a structured questionnaire. The analytical tools used included descriptive statistics to measure percentages and cross tabulations to measure the level of associations between functional independence and some of the demographic factors. The Barthel Index was computed to establish the degree of functional independence. Finally the influence of factors on functional independence was investigated using bivariate logistic regressions.Results: The results showed that younger patients (18 - 34 yrs) may have a higher likelihood of functional independence compared to older patients at the time of discharge from hospital (18 - 34 years: Odds Ratio = 1). Patients without helpers were more likely to be functionally independent than those with a helper (p = 0.03). Involvement in household activities (p = 0.01), participation in community activities (p = 0.02) and bowel and bladder continence (p = 0.003 and p = 0.04) improved the likelihood of functional independence.Conclusion and im plications: Factors that influence functional independence post stroke are: age, bowel and bladder continence, the presence of a caregiver, participation in household and community activities. It is also of value to encourage patients to participate in household and community activities post stroke as well as being less dependent on helpers in an effort to attain functional independence post stroke.

Highlights

There has been an improvement in health delivery since the 1950’s but despite these improvements, stroke remains a major source of functional disabilities (Ashburn 1999)
It is of value to encourage patients to participate in household and community activities post stroke as well as being less dependent on helpers in an effort to attain functional independence post stroke
The following patients were excluded from the study: patients who were dependent in activities of daily living (ADL) before the stroke and those who had more than one stroke as well as institutionalised or hospitalised patients

Summary

Introduction

There has been an improvement in health delivery since the 1950’s but despite these improvements, stroke remains a major source of functional disabilities (Ashburn 1999). About 50% of all patients who have had a stroke have some residual physical disability (Ashburn 1999) and about 66% of stroke survivors in South Africa require help with at least one activity of daily living (Connor et al 2004). Many factors influence the degree of functional independence. Presence of co-morbid diseases, continence (Barer 1989) and socio-demographic factors have been found to have an influence on the process of disability (Kelly-Hayes et al 2003). More women than men experience stroke and are more disabled at six months post stroke (Kelly-Hayes et al 2003)

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Conclusion