Monitoring changes in locomotion-related daily life activities in post-stroke patients: the responsiveness of ABILOCO-Benin questionnaire.

MATERIALS AND METHODS: We conducted a longitudinal study involving 81 stroke patients (mean (SD) age: 54.6 (10.8) years; 58% male, mean (SD) time after stroke onset: 4.3 (2.5) weeks). Participants were assessed at baseline (T1), two-month later (T2), and on average of 1.5 (0.5) years after stroke (T3), with the ABILOCO-Benin questionnaire, functional ambulation classification (FAC), six-minute walking test, ACTIVLIM-Stroke questionnaire, modified Rankin Scale, and Stroke Impairment Assessment Scale. Global-, sub-group- (stable and improved based on FAC scores), and individual-based analysis of changes were performed. RESULTS: Participants showed significantly larger improvement for all outcomes during the acute phase (T1-T2). Changes in the ABILOCO-Benin measures were significantly correlated with changes in other outcome measures. ABILOCO-Benin questionnaire detected a significant improvement in both the stable and improved groups at both T2 and T3 in the sub-group approach. Individual-based analysis with ABILOCO-Benin measures showed a significantly higher proportion of stable patients (n = 55) and lower proportion of improved ones (n = 23) between T2 and T3 (LR(df) = 15.52(4), p = 0.004). CONCLUSIONS: ABILOCO-Benin is responsive to changes in adult stroke patients within both acute and chronic phases. Implications for rehabilitationABILOCO-Benin questionnaire is highly responsive to changes in locomotion abilities of stroke patients within both acute (<6 months) and chronic (≥6 months) phases.It can be used in clinical and research practice to track changes in stroke patients after interventions in African settings and beyond.

Association between post-stroke psychological disorders, activity limitations and health-related quality of life in chronic stroke survivors in Benin.

PURPOSE: To evaluate the association between depression/anxiety and activity limitations and health-related quality of life (HRQoL) in chronic stroke survivors in Benin. MATERIALS AND METHODS: One hundred and seventy-six chronic stroke survivors (113 males; mean age (±SD): 56.5 (±10.5) years old) were included. We used the Barthel index (BI) to assess activity limitations. Participants were screened for depression and anxiety symptoms using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). Euroqol-5 Dimensions-3 Levels (EQ-5D-3L) including a Visual Analog Scale (EQ-VAS) was used to assess HRQoL. Multivariate linear regressions were performed to determine the impact of psychological disorders on activity limitations and HRQoL. RESULTS: Depression (ß=-0.54; p < 0.0001) and anxiety (ß=-0.35; p < 0.0001) were negatively associated with activity limitations (R2=0.60). Similar patterns of association were observed with HRQoL (ß≤-0.28; p < 0.0001; R2 ≥0.40). Inversely, occupational status showed positive association with EQ-5D-3L summary index scores (ß = 0.21; p = 0.015). CONCLUSIONS: Depression and anxiety had a negative impact on activity limitations and HRQoL in Beninese chronic stroke survivors. This call for action to integrate psychological interventions as part of rehabilitation programs in low and middle-income countries.Implications for rehabilitationPost-stroke depression and anxiety are quite common among stroke survivors in sub-Saharan Africa.Post-stroke depression and anxiety negatively impact activities and health-related quality of life in chronic stroke survivors in sub-Saharan Africa.Managing these post-stroke psychological disorders is necessary to promote the functional recovery and social reintegration of stroke survivors in their communities.

Effectiveness of a self-rehabilitation program to improve upper-extremity function after stroke in developing countries: A randomized controlled trial.

BACKGROUND: About two-thirds of stroke patients present long-term upper-limb impairment and limitations of activity, which constitutes a challenge in rehabilitation. This situation is particularly true in developing countries, where there is a need for inexpensive rehabilitation solutions. OBJECTIVE: This study assessed the effectiveness of a self-rehabilitation program including uni- or bi-manual functional exercises for improving upper-limb function after stroke with respect to the context in Benin, West Africa. METHODS: In this single-blind randomized controlled trial, chronic stroke individuals (>6 months post-stroke) performed a supervised home-based self-rehabilitation program for 8 weeks (intervention group); the control group did not receive any treatment. Participants were assessed before treatment (T0), at the end of treatment (T1) and 8 weeks after the end of treatment (T2). The primary outcome was the manual ability of the upper limb, assessed with ABILHAND-Stroke Benin. Secondary outcomes were grip force, motor impairment (Fugl-Meyer Assessment - Upper Extremity), gross manual ability (Box and Block test, Wolf Motor Function test) and quality of life (WHOQOL-26). RESULTS: We included 28 individuals in the intervention group and 31 in the control group. Adherence to the program was 83%. After 8 weeks of self-rehabilitation, individuals in the intervention group showed significantly improved manual ability and grip force as compared with the control group (P<0.001), with effect size 0.75 and 0.24, respectively. In the intervention group, the difference in average scores was 10% between T0 and T1 and between T0 and T2. Subscores of physical and psychological quality of life were also significantly improved in the intervention group. The other variables remained unchanged. CONCLUSIONS: A self-rehabilitation program was effective in improving manual ability, grip force and quality of life in individuals with stroke in Benin. More studies are needed to confirm these results in different contexts.

Outcomes of lower limb amputees at Cotonou.

BACKGROUND: Limb amputations are responsible for disability. We studied the outcomes of lower limb amputees in our daily practice. METHODS: This prospective analytical study over 7 years (January 2009-December 2015) included 70 amputees of lower limb. They were mainly male (73%), aged on average of 42.4 ± 18.8 years. The mean time of follow- up was 3.2 ± 1.9 years. We assessed disability on balance, walking, disability in daily life for patients with prosthesis, and the socio-economic impact of the amputation. Statistical analysis was performed with Chi2 and Mann-Whitney tests; a p-value ≤ 0.05 was considered statistically significant. RESULTS: The average Timed Up and Go Test was 18.5 s. Class II of Pohjolainen subjects were the most recovered (37%). The mean Houghton score in the 17 fitted patients was 6.2 ± 2.0. Socially, 90% of the patients no longer practiced leisure activities, and 4/53 patients were no longer in a couple. At the economic level, 87% of patients had a decreased monthly income. Factors that bear direct correlation to functional outcome of patients were the level of amputation, and the prosthesis fitting. CONCLUSION: Lower limbs amputations entail adverse consequences at the functional and socio-economic level. Our country must review its policy on prosthetic fittings for amputees, and vote laws that involve private firms and government in socio-economic reintegration, and empowerment of these subjects.

Evaluation of manual ability in stroke patients in Benin: cultural adaptation and Rasch validation of the ABILHAND-Stroke questionnaire.

BACKGROUND: ABILHAND is a self-reported questionnaire assessing manual ability. It was validated and calibrated using the Rasch analysis for European stroke patients. After a stroke, performing upper limb activities of daily living is influenced by personal and environmental contextual factors. It is thus important to conduct a contextual validation to use this questionnaire outside of Europe. AIM: The aim of this study was to perform a cross cultural validation of the ABILHAND-Stroke questionnaire for post-stroke patients living in Benin, a West-African country. DESIGN: Observational cross-sectional study. SETTING: Outpatient rehabilitation centres. POPULATION: 223 Beninese chronic stroke patients. METHODS: The experimental questionnaire was made of 59 items evaluating manual activities. Patients had to estimate their difficulty of performing each activity according to four response categories: impossible, very difficult, difficult and easy. For construct validity analysis, patients were also evaluated with other assessment tools: Box and Block Test, the motor subscale of the Functional Independence Measure, the Stroke Impairment Assessment Set, and ACTIVLIM-Stroke. Data were analysed with the Rasch partial credit model. RESULTS: The response categories very difficult and difficult were merged and the number of response categories was reduced from 4 to 3 (impossible, difficult and easy). The Rasch analyses selected 16 bimanual activities that fit the Rasch model (chi square=42.35; P=0.10). The item location ranged from -1.10 to 2.24 logits. The standard error ranged from 0.15 to 0.22 logits. There is no differential item functioning between subgroups (age, sex, dexterity, affected side, time since stroke). The person separation index is 0.82. The questionnaire can measure 3 levels of manual ability, similarly to the occidental version. CONCLUSIONS: The ABILHAND-stroke is a Rasch validated, unidimensional and invariant questionnaire to assess manual ability among Beninese patients. The ordinal score can be transformed into linear score using a conversion table. CLINICAL REHABILITATION IMPACT: This assessment tool is clinically relevant in Benin, a developing country, since it requires no specific equipment or training. It should promote and standardize assessments for stroke patients in clinical practice and research in this African country.

La lombalgie chronique : effets d'une thérapeutique multidisciplinaire

Introduction : La lombalgie est un symptôme fonctionnel fréquent. Sa prévalence a augmenté de 9,7% de 1990 à 2010. La restauration fonctionnelle du rachis (RFR) a été développée et proposée aux patients ayant un syndrome de déconditionnement et encore en activité professionnelle. Nous rapportons ici l'expérience du Centre Hospitalier Nord Caraïbe site du carbet, Martinique, France.Méthodes : Etude rétrospective, descriptive et analytique portant sur tous patients recrutés dans le programme restauration fonctionnelle du rachis de janvier 2010 à décembre 2014.Résultats : 144 patients ont été isolus. L'âge moyen était 48,7±10,1 ans, sans prédominance de sexe. Ils étaient essentiellement des lombalgiques (84,7%) et lombo-sciatalgiques (15,3%) évoluant depuis 6,7 ans et en surpoids. L'évaluation à l'entrée retrouvait : une EVA moyenne à 5,6/10. La distance doigt-sol était à 13cm, angle poplité à 153,2°, les tests d'endurance d'Ito-Shirado à 70±72 et de Sorensen 58±46. La qualité de vie, les capacités fonctionnelles et les croyances de ces patients significativement améliorés (p=0,001). Seul la douleur était significativement plus améliorée chez les opérés du rachis (p=0,001) comparés aux non-opérés.Conclusion : Le protocole restauration fonctionnelle du rachis est proposé aux lombalgiques chroniques, avec des résultats très satisfaisants dans les domaines physiques et fonctionnels mais modestes sur la douleur.D'autres études sont nécessaires pour confirmer ces résultats

Feasibility of a self-rehabilitation program for the upper limb for stroke patients in Benin.

INTRODUCTION: Stroke is a major cause of disability and represents a very high cost in developing countries. Self-rehabilitation programs represent a new and original treatment for stroke patients, likely to reduce upper limb impairments and improve activity and participation. The goal of this study is to evaluate the feasibility of a self-rehabilitation protocol in Benin. METHODS: Twelve chronic stroke patients carried out the upper limb self-rehabilitation program (3 hours/day, 5 days/week for 2 weeks). The performance of these patients was evaluated before and after the self-rehabilitation program, by measuring the number of exercises that patients were able to achieve during a three-hour session, and by assessing their gross manual dexterity. RESULTS: Twelve patients were effectively able to complete the entire program. The number of unimanual exercises and self-mobilizations performed during a three-hour session as well as the score of the Box and Block test were improved by the self-rehabilitation program (P<0.05). DISCUSSION AND CONCLUSION: Self-rehabilitation programs are feasible and inexpensive as they do not involve a therapist. It is then a promising approach in stroke rehabilitation, particularly in developing countries, where rehabilitation costs are usually supported by patients.

Box and block test in Beninese adults.

OBJECTIVE: To determine the Box and Block Test norm in a sub-Saharan population and to compare these data with published norms for North American adults. METHODS: A total of 692 healthy Beninese people, age range 20-85 years, were recruited. These subjects were asked to perform the Box and Block Test with both hands. RESULTS: Box and Block Test scores (mean and standard deviation (SD)) for women and men were, respectively, 81.3 (15.4) and 79 (16.6) for the dominant hand and 73.2 (13.7) and 72 (14.8) for the non-dominant hand. Mean Box and Block Test scores ranged from 89.1 (12.7) for people under the age of 25 years to 55.23 (10.5) for people over the age of 74 years. DISCUSSION: Manual dexterity was better for women than men, for dominant hand than non-dominant hand, and for younger subjects. In comparison with published results for US subjects, Beninese subjects had better dexterity below the age of 50 years in both sexes for the right hand and worse dexterity over 64 years of age in both sexes for the right hand. CONCLUSION: Developing and validating outcome scales in Africa will help to improve functional assessment of African populations in clinical practice and research.