title: Provision of inpatient rehabilitation and challenges experienced with participation post discharge: quantitative and qualitative inquiry of African stroke patients.
abstract: BACKGROUND
  The provision of rehabilitation differs between developed and developing countries, this could impact on the outcomes of post stroke rehabilitation. The aim of this paper is to present provision of in-patient stroke rehabilitation. In addition the challenges experienced by the individuals with participation post discharge are also presented.
  
  
  METHODS
  Qualitative and quantitative research methods were used to collect data. The quantitative data was collected using a retrospective survey of stroke patients admitted to hospitals over a three- to five-year period. Quantitative data was captured on a validated data capture sheet and analysed descriptively. The qualitative data was collected using interviews from a purposively and conveniently selected sample, audio-taped and analysed thematically. The qualitative data was presented within the participation model.
  
  
  RESULTS
  A total of 168 medical folders were reviewed for a South African sample, 139 for a Rwandan sample and 145 for a Tanzanian sample. The mean age ranged from 62.6 (13.78) years in the South African sample to 56.0 (17.4) in the Rwandan sample. While a total of 98 % of South African stroke patients received physiotherapy, only 39.4 % of Rwandan patients received physiotherapy. From the qualitative interviews, it became clear that the stroke patients had participation restrictions. When conceptualised within the Participation Model participation restrictions experienced by the stroke patients were a lack of accomplishment, inability to engage in previous roles and a perception of having health problems.
  
  
  CONCLUSIONS
  With the exception of Rwanda, stroke patients in the countries studied are admitted to settings early post stroke allowing for implementation of effective acute interventions. The participants were experiencing challenges which included a lack of transport and the physical geographic surroundings in the rural settings not being conducive to wheelchair use.
  
  
  CONCLUSIONS
  Stroke patients admitted to hospitals in certain African countries could receive limited in-patient therapeutic interventions. With the exception of barriers in the physical environment, stroke patients in developing countries where resources are limited experience the same participation restrictions as their counterparts in developed countries where resources are more freely available. Rehabilitation interventions in these developing countries should therefore be community-based focussing on intervening in the physical environment.
authors.affiliation: Faculty of Community and Health Sciences, University of the Western Cape Private Bag X17, 7535, Bellville, Western Cape, South Africa. arhoda@uwc.ac.za.
authors.forename: Anthea
authors.initials: A
authors.lastname: Rhoda
authors.affiliation: Faculty of Community and Health Sciences, University of the Western Cape Private Bag X17, 7535, Bellville, Western Cape, South Africa. natalielingham@yahoo.com.
authors.forename: Natalie
authors.initials: N
authors.lastname: Cunningham
authors.affiliation: Faculty of Community and Health Sciences, University of the Western Cape Private Bag X17, 7535, Bellville, Western Cape, South Africa. simonazaria@yahoo.com.
authors.forename: Simon
authors.initials: S
authors.lastname: Azaria
authors.affiliation: Faculty of Community and Health Sciences, University of the Western Cape Private Bag X17, 7535, Bellville, Western Cape, South Africa. ugerard@khi.ac.rw.|College of Medicine and Health Sciences, University of Rwanda, P.O Box 3286, Kigali, Rwanda. ugerard@khi.ac.rw.
authors.forename: Gerard
authors.initials: G
authors.lastname: Urimubenshi
mesh_terms: D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D004779:Environment Design; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010351:Patient Discharge / Q000191:economics*; D026741:Physical Therapy Modalities / Q000458:organization & administration*; D036301:Qualitative Research; D012107:Research Design; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D020521:Stroke / Q000191:economics; D000071939:Stroke Rehabilitation