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.

Comparison between self-reported and observed locomotion ability scores in patients with stroke: a cross-sectional study.

This study aimed to investigate (i) the validity of self-reported scores of locomotion ability in stroke survivors using the ABILOCO-Benin questionnaire, and (ii) the congruence between online Rasch analysis of the ABILOCO-Benin raw scores and a conversion table set along with the questionnaire development. Thirty-five adult poststroke patients [mean age: 52 (SD: 10) years, 60% men] recruited from the rehabilitation department of National University Hospital of Cotonou (Benin), self-reported their locomotion ability, filling out the ABILOCO-Benin questionnaire [self-reported scores (SRS)]. Afterwards, a physical therapist observed and rated the patients' locomotion ability, while they performed each of the 15 items of the questionnaire [performance-based scores (PBS)]. Both raw SRS and PBS were then converted to linear measures using (i) an online Rasch analysis method and (ii) an ordinal-to-interval transformation table. Analyses showed high correlation (intraclass correlation coefficient=0.74, P<0.001) and nonsignificant difference (P=0.778) between SRS and PBS. Linear measures from online Rasch and a conversion table also exhibited high correlation (intraclass correlation coefficient=0.92; P<0.001). However, the difference between online analysis and the conversion table was significant (P=0.022). In conclusion, self-report is a valid method to administer ABILOCO-Benin in stroke patients. The conversion table offers a valid opportunity for quick transfer of raw scores to linear measures. However, the accuracy of linear measures from the conversion table may be slightly affected by missing responses.