Early Mobilization and Physical Activity Improve Stroke Recovery: A Cohort Study of Stroke Inpatients in Kisumu County Referral Hospitals, Kenya

Maurice Mike Ogolla^{1, 2}, Damian Otieno Opemo³ and Collins Otieno Asweto^4,

¹Faculty of Health Sciences, Great Lakes University of Kisumu, Kisumu, Kenya

²Department of Physiotherapy, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya

³Faculty of Health Science, Kibabii University, Bungoma, Kenya

⁴School of Public Health, Capital Medical University, Beijing, PR China

Cite this paper

Maurice Mike Ogolla, Damian Otieno Opemo and Collins Otieno Asweto. Early Mobilization and Physical Activity Improve Stroke Recovery: A Cohort Study of Stroke Inpatients in Kisumu County Referral Hospitals, Kenya. American Journal of Public Health Research. 2016; 4(4):154-158. doi: 10.12691/AJPHR-4-4-6

Abstract

Early mobilization in acute stroke care is highly recommended in a range of developed countries policy; however, in developing countries like Kenya, lack of evidence seems to hinder formulation and implementation of policy guideline on early mobilization in acute stroke care. Therefore, to estimate the safe optimal time for early mobilization of stroke patients in Kenya, we conducted a prospective cohort study in two purposively selected health facilities in Kisumu County, Kenya. About 100 stroke patients admitted in medical wards (mean age 59.1±2.3 years, females 61%) were recruited. Barthel Index’ tool was used to assess recovery and physical activity levels. It comprised of scoring scale ranging from 0-100. The participants were categorized as follows: Patients who score between 0 – 30 were considered as mildly recovered, 31 - 60 as moderately recovered and patients who score from 61 – 100 were regarded as fully recovered. Multiple logistic regression model was used to compute adjusted ORs (AOR) of early mobilization and Barthel Index variable, adjusting for age, gender and type of stroke. Early mobilization improves patient recovery. Participants in early mobilization group were more like to independently feed, groom, dress, use toilet, use wheel chair and climb stairs with help compared to late mobilization (p <0.05). Most (76%) participants who were exposed to high physical activity had full recovery than the (5%) bones in low physical activity (p< 0.001). This study provides evidence that early mobilization and high physical activity improves stroke patient recovery.

Keywords

stroke, early mobilization, Barthel Index score, physiotherapy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	WHO . The Atlas of Heart Disease and Stroke. WHO, Geneva, 2004. http://www.who.int/cardiovascular_diseases/resources/atlas/en/.
[2]	Mukherjee D, Patil CG. Epidemiology and the Global Burden of Stroke. World Neurosurg, 2011;76(6):85-90.
[3]	Kim AS, Johnston SC. (2011). Global Variation in the Relative Burden of Stroke and Ischaemic Heart Disease. Circulation, 2011;124:314-323.
[4]	Connor MD, Walker R, Modi G, Warlow CP. Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurology, 2007; 6: 269-278.
[5]	O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin S, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet, 2010; 376: 112-123.
[6]	Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Circulation, 2008;117(4):25-146.
[7]	Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev, 2007; 4: CD000197.
[8]	Indredavik B, Bakke F, Slørdahl SA, Rokseth R, Hamheim LL. Treatment in a combined acute and rehabilitation stroke unit: Which aspects are most important? Stroke, 1999;30:917-923.
[9]	Langhorne P, Pollock A, Stroke Unit Trialists’ Collaboration. What are the components of effective stroke unit care? Age Ageing, 2002;31:365-371.
[10]	Mutin-Carnino M, Carnino A, Rofino S, Chopard A. Effects of Muscle Unloading, Reloading and Exercises on Inflammation During a Head Down Bed Rest. Int J Sports Med, 2013;35:28-34.
[11]	Bamford J, Dennis M, Sandercock P, Burn J,Warlow CP. The Frequency, Causes and Timing of Death within 30 days of a First Stroke; The Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatry, 1990;35:824-829.
[12]	Langhorne P, Stott DJ, Robertson LS, Macdonald J, Jones LR. Medical Complications after Stroke: A Multicentre Study. Stroke, 2000;31:1223-1229.
[13]	Benhardt J, Dewey HM, Thrift AG, Donnan GA. Inactive and Alone:Physical Activity within the First 14 Days of Acute Stroke Unit Care. Stroke, 2004;35:1005-1009.
[14]	West T, Bernhardt J. Physical Activities in Hospitalized Stroke Patients. Stroke Res Treat, 2011; http://www.hindawi.com/journals/srt/2012/813765/.
[15]	Murphy TH, Corbett D. Plasticity During Stroke Recovery; From Synapse to Behaviour. Nat Rev Neurosci, 2009;10:861-872.
[16]	Johansson B. Brain Spasticity and Stroke Rehabilitation: The Willis Lecture. Stroke , 2000; 31(1):223-230.
[17]	Krakauer JW, Carmichael ST, Corbett D, Wittenberg G. Getting Neurorehabilitation Right: What can be Learned from Animal Model? Neurorehabil Neural Repair, 2012;26:923-931.
[18]	Pekna M, Pekny M, Nilsson M. Modulation of Neural Plasticity as a Basis for Stroke Rehabilitation. Stroke, 2012;4:2819-2828.
[19]	Bernhardt J, Dewey H, Thift A, Collier J, Donna G. A Very Early Rehabilitation Trial for Stroke (AVERT): Phase II Safety and Feasibility. Stroke, 2008;39(2):390-396.
[20]	Langhorne P, Stott D, Knight A, Bernhardt J, Barer D, Watkins C. Very early rehabilitation or intensive telemetry after stroke: A pilot randomized trial. Cerebrovasc Dis, 2010;29(4):352-360.
[21]	Craig LE, Bernhardt J, Langhorne P, et al. Early mobilization after stroke: An example of an individual patient data meta-analysis of a complex intervention. Stroke, 2010;41:2632-2636.
[22]	Arias M & Smith L. Early mobilization of acute stroke patients. Journal of Clinical Nursing, 2007; 16: 282-288
[23]	Maulden SA, Gassaway J, Horn SD, et al., Timing of initiation of rehabilitation after stroke, Arch Phys Med Rehabi, 2005; 86(12): 34-40.
[24]	Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Med Journal 1965;14:56-61.
[25]	Tomoko O, Tatsuro I, Takahiro H, Kentaro K, Rika I, Kosuke N, Surya S, Takeo N. Reliability and validity tests of an evaluation tool based on the modified Barthel Index International. Journal of Therapy & Rehabilitation, 2011;18(8):422.
[26]	Bernhardt J, Thuy MNT, Collier JM, Legg LA. Very early versus delayed mobilisation after stroke (Review). The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 2009.
[27]	Intercollegiate Stroke Working Party. National Clinical Guidelines for Stroke. London: Royal College of Physicians, 2008.
[28]	National Stroke Foundation. Clinical Guideliens for Stroke Management. Melbourne, Australia:2010.
[29]	Scottish Intercollegiate Guidelines Network. Management of Patients with stroke: Rehabilitation, Prevetion and Management of Complications and Discharge Planning. A National Clinical Guideline. Edinburgh, Scortland: 2010.