Clients with stroke and non-stroke and their guardians’ views on community reintegration status after inpatient rehabilitation|
Glickman, Leslie B. & Chimatiro, George
The aim of this study was to compare client community reintegration status following discharge from the Kachere Rehabilitation
Centre (KRC), Blantyre, Malawi, in 2 consecutive years with client versus guardian perspectives on reintegration status.
Using quantitative methods, 35 clients with stroke and non-stroke diagnoses (spinal cord dysfunction and neuropathic conditions)
and 32 client guardians (the family caregivers in Malawi) were separately interviewed using the WHO Disability Assessment Schedule
(DAS) 2.0 (a measure of disability due to reintegration problems back into the community). The results were analyzed using descriptive
statistics and the Wilcoxon Signed-Rank Test or the Mann-Whitney U Test, as appropriate, to test for significant differences between
groups. The clients’ home environments were categorized using an original checklist, the Home Observation Data Form (HOD).
Moderate to severe perceived levels of disability related to reintegration difficulties were noted by clients in years 1 and 2. For those
with non-stroke diagnoses, there was a significant change in year 2 results compared to year 1, but not for those with stroke diagnoses.
Guardians agreed with their client’s perceptions of difficulty in year 2. Major areas of concern were taking care of household
responsibilities, participating in day-to-day work or school routines, joining in community activities, and walking one kilometer per day.
Community reintegration challenges in suburban Blantyre, Malawi continued to plague individuals with stroke and non-stroke diagnoses
for 2 consecutive years after discharge from KRC. Based on the important role guardians play during their client’s rehabilitation phase
and when they return to the community, opportunities may exist to improve client perception of disability related to their reintegration
status. Future studies are important to replicate these results, investigate the idea of a more important role for guardians in patient-centered
care, and the relationship between motor and cognitive function and reintegration status.
stroke; spinal cord dysfunction; community reintegration; client and guardian views; Malawi