PIT FALLS IN STROKE REHABILITATION: A PAKISTANI PERSPECTIVE

Pit Falls in Stroke Rehabilitation

Abstract

Objectives: To identify short comings in the stroke rehabilitation referral and consultation in Pakistan.
Study Design: Observational study.
Place and duration of study: Stroke Clinic at Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi from March 2005 to September 2005.
Patients and Methods: 171 patients of stroke fulfilling the inclusion criteria were enrolled in the study. Detailed history was obtained and a thorough examination with emphasis on neurological and musculoskeletal system was performed. Medical records and radiological investigations were reviewed.
Results: There were 132 (77.2 %) males and 39 (22.8%) female patients. Radiological investigations were not available in some patients. In the remaining patients the frequency of Ischemic vs Hemorrhagic was 82% and 18% respectively .Involvement of right and left cerebral hemisphere was almost equal with 53% and 47% respectively. Majority, i.e 153 (89.5%) of the patients were referred as OPD cases while indoor rehabilitation consultation was made only for 18 (10.5%) patients. Only 04 (2.3%) patients were seen within 48 hours of stroke onset. In 39 (22.8%) cases consultation was made between one week to one month and for 116 (67.8%) between one to six months, while it was delayed beyond six months in 12 (7%) patients. Important shortcomings identified were non availability of physicians in rehabilitation medicine, late/ no referrals, inadequate referrals, long term placement of indwelling catheters and lack of patient and family education.
Conclusion: Stroke is an important cause of long-term disability. Timely and comprehensive stroke rehabilitation minimizes the impairments and leads to successful reintegration of individual into the society. It is a poorly understood concept in Pakistan. Physicians are either not aware of the concept and significance of stroke rehabilitation or often confuse it with physiotherapy alone. There is a need to improve the stroke rehabilitation services in the country.
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