|Year : 2017 | Volume
| Issue : 2 | Page : 109-112
A 24-hour assessment of lifestyle constraint in stroke survivors: A six patient case-based study
Muktar A Gadanya1, Rufai Y Ahmad2, Ibrahim Abdullahi2, Isa U Lawal2
1 Department of Community Medicine, Bayero University, Kano, Nigeria
2 Department of Physiotherapy, Bayero University, Kano, Nigeria
|Date of Web Publication||5-Oct-2017|
Rufai Y Ahmad
Department of Physiotherapy, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Background: Stroke often comes with a spectrum of constraints to lifestyle. This study investigated these constraints using a 24-hour lifestyle assessment among 6 stroke survivors. Objectives: The objective of this study was to provide an understanding of the ways in which stroke survivors are experiencing stroke, along with the opportunities and challenges of everyday life. Materials and Methods: Six stroke survivors were recruited to participate in this qualitative study. The study participants were 3 males and 3 females. Participants were engaged in in-depth interviews to generate information regarding the objective of this study. The interview was recorded on audiotape and transcribed. The generated data were analysed by thematic framework analysis. Results: Findings showed that 5 out of the 6 stroke survivors faced challenges in everyday life, in reconstructing their identity and depended on their family members to take care of them. All the stroke survivors reported some form of functional restrictions, with 4 out of the 6 responents indicating that their movement was restricted to their immediate compound and 5 out of the 6 respondents indicating that they were unable to do most of their house-hold chores; and one respondent said that he 'barely could do anything for self'. Conclusion and Recommendations: Among the 6 respondents, stroke has several manifestations on patients' mobility and indepdence. These have significant bearing on their wellbeing. Studies with larger sample sizes incorporating quantitative methods and longitudinal follow-up are recommended to shed more light on these findings.
Keywords: Lifestyle constraints, movement restriction, social support, stroke, survivors
|How to cite this article:|
Gadanya MA, Ahmad RY, Abdullahi I, Lawal IU. A 24-hour assessment of lifestyle constraint in stroke survivors: A six patient case-based study. Niger J Basic Clin Sci 2017;14:109-12
|How to cite this URL:|
Gadanya MA, Ahmad RY, Abdullahi I, Lawal IU. A 24-hour assessment of lifestyle constraint in stroke survivors: A six patient case-based study. Niger J Basic Clin Sci [serial online] 2017 [cited 2021 Dec 9];14:109-12. Available from: https://www.njbcs.net/text.asp?2017/14/2/109/216055
| Background|| |
Stroke 'is a rapidly developing loss of brain function (s) due to disturbance in the blood supply to the brain which could be due to ischemia (lack of blood flow), blockage (thrombosis, arterial embolism), or a haemorrhage (leakage of blood)'. Stroke incidence increases with age from as low as 2 in every 1000 person in the age group 55 to 64 years to 20 in every 1000 for those above 80 years. Hamzat and Olaleye  reported that the prevalence of stroke in African population ranged from 0.9% to 4%. This accounts for 6.5–41% of all admitted neurological conditions, and for an estimated 4–9% hospital mortalities in black Africans.
Stroke is a leading cause of long-term disability in adults and an important cause of increase in age-related disability. It is a disastrous event that affects all domains of a patient and their relatives compelling survivors to change their lifestyle and rebuild their personality.
Stroke survivors experience a myriad of physical, social and psychological difficulties that are intertwined and affect each other. Survivors may encounter challenges such as increased anxiety, apprehension of occurrence of another stroke, loss of self-esteem and depression. These constraint are often not apparent though constitute significant disabling factors that impede independent lifestyles and occupational rehabilitation.
Post stroke patients may also suffer from memory difficulties that may impede daily activities. Severe fatigue may be a consequence of stroke resulting in reduced motivation for rehabilitation and return to premorbid status. These consequences lead to reversal of roles among family members negatively impacting family and social relationships.
Stroke survivors usually set specific or general goals and develop strategies to overcome the consequences of stroke that affect family and social life. These strategies are usually aimed at achieving a specific goal that is essential for other goals. Survivors developed resourceful strategies to regain lost skills to help them reduce dependence on caregivers.
Stroke may affect different areas of the brain depending on the vessels affected; hence, resulting in different manifestations and peculiar implications to the lifestyle of every patient. In addition, environmental and social contexts may differ across different patients making it difficult to generalise the impact of stroke on all patients. Effective rehabilitation of people with stroke should be goal-oriented, especially with the advent of family-centred care where the opinion of the patients and their relatives on the impact of rehabilitation on their condition is given the utmost importance. Therefore, the constraints patients with stroke encounter should be considered from the perspective of the patient as they interact with the environment. There has not been a significant evidence or study that describes the 24-hour assessment of lifestyle constraints in stroke survivors; hence, this study aims at investigation of a 24-hour assessment of lifestyle constraints in stroke survivors.
| Materials and Methods|| |
The main aim of this study was to assess 24-hour lifestyle constraint among stroke survivors, using 6 patients in a case-based study; this is based on the findings of Krueger  and Morgan  that 6 interviews as focused group discussions or in-depth interviews are adequate to reach theoretical saturation, with each interview held once or multiple times. A qualitative research design was used in this study to observe the lifestyle constraint among stroke survivors. The study participants were stroke survivors attending the Physiotherapy Department in Aminu Kano Teaching Hospital. Participants were considered eligible if they were chronic stroke survivors (at least 1 year, ensuring that stroke survivors had sufficient time back in the community for possible re-integration into social roles). Participants were excluded if they had cognitive or affective impairment. Screening for cognitive impairment was conducted using the tool developed by Paddick et al., which has been validated for use in Nigeria. Screening for anxiety and depression was conducted using the using Hospital Anxiety and Depression Scale (HADS), which has been validated for use in Nigeria.
Data collection instruments
The following materials were used during the course of the study: audiotape recorder, interview guide and a checklist of point of discussion.
Data collection procedure
Ethical clearance was obtained from the Ethical Committee of Aminu Kano Teaching Hospital. Following ethical approval, the participants were screened to ensure they conformed to the study criteria. The procedure was explained to the participants, after which participants were asked to sign a written informed consent form. This included consent to audiotaping. The audiotape recorder was switched on, and interviews began by asking the patient to explain his/her lifestyle before the onset of the stroke and comparing that with lifestyle constraints after stroke.
The interview was operated as a guided conversation in which respondents were encouraged to talk about their 24-hour stroke experience as well as about the meaning it had for them in their lives. Interview was recorded in Hausa as a transcript and then translated back to English.
Data analysis procedure
The collected data was analysed thematically. This is appropriate for this study as it has pre-determined aims and objectives and will be used to improve patients' care. The steps for thematic analysis are:
- Familiarisation: This involved repetitively reading the transcripts, summarising the transcripts and identifying major themes and recurrent perspectives
- Identify a thematic framework: This is the procedure of creating a coding scheme for the transcripts
- Indexing: This involved creating lists of all the themes used in the analysis
- Charting: This involved cutting and pasting the transcripts and re-arranging them into appropriate thematic areas
- Mapping and interpretation: This involved analysing patterns across the charts and notes created during the development of the themes.
| Results|| |
Three patients stated that they could not visit the toilet. Patient 1 mentioned that 'I normally wake up early to visit the toilet but now that is impossible'; Patient 3 said that 'at the moment I cannot make it to the toilet on my own'; Patient 5 stated that 'I have to be assisted to the toilet'.
Two patients mentioned that they find themselves unable to move some of their limbs. Patient 1 mentioned 'I wake up to find myself unable to move any of my limbs'; Patient 5 said that 'Now I cannot do anything with my hands'.
Five patients stated that they had become challenged and dependent on their family members to get things done for them. Patient 1 said 'I was unable to do most of the house-hold chores I was used to doing, I only rely on some youths to get them accomplished'; patient 2 mentioned 'we have become challenged and dependent on our family members to get things done'; patient 3 stated that 'I barely could do anything for self, I have to be spoon fed and bathed by that girl always'; patient 4 reported that 'I only depend on good spirited individual for alms, and nephews and nieces who take good care of me even money for my hospital needs were provided by them; another challenge is how to make my hair, I need others to do it for me'; patient 5 also said 'but now I have to be assisted to do certain things. On source of income, it is my son that does everything for me'.
Five patients reported that thier movement was restricted to their immediate compound. Patient 1 stated that 'I cannot visit the market as usual; now my outing has been restricted to only once a week'; Patient 2 said that 'Now we have to rely on others to run our businesses and to maintain our families because our movements are restricted to our immediate compounds'; patient 3 commented 'I am cut-off from social visits except for visiting my younger sister while being pushed on this wheelchair'; patient 4 stated that 'I don't even visit anywhere except the hospital in a vehicle'; Patient 5 expressed 'my condition has hindered me from visiting my kinsmen although they constantly visit me'.
Three patients reported that 'it was after treatment at the hospital that am now able to slightly move the limbs'. Patient 1 stated that 'It was after some treatment at the hospital that I am now able to slightly move the limbs and say my prayers normally'; also patient 5 reported that 'as a result of my attending the clinic now I can move around the house freely'; patient 6 stated that 'it was as a result of my coming to the clinic now I can use my hand in bathing but I am having little problem with using my right hand though I am noticing tremendous improvement'.
Three patients reported that at the onset of the condition they could barely move their hands to eat. One of them (patient 1) said that 'at the onset of the condition, I barely could move my hand to eat'; patient 3 also commented that 'I barely could do anything for self, I have to be spoon fed'; patient 6 mentioned that 'my biggest challenge now is the use of my right hand to feed'.
Three of the patients reported that they could also dress by themselves. One of which (patient 1) expressed 'but glory be to God I can also dress myself which was a far cry some time ago'; patient 2 commented that 'I put a lot of efforts to get myself dressed-up even though slowly, because at the hospital we were advised to force our frail limbs to work, using the stronger limbs to assist the weaker ones in getting dressed'; patient 3 said that 'though I can dress myself anyway'.
Four patients expressed that they were unable to do most of their house-hold chores, out of which patient 1 stated that 'I was unable to do most of the house-hold chore, I was used to doing'; patient 3 said that 'I barely could do anything for self, I have a son who caters for all needs'; patient 4 mentioned that 'now I cannot do anything on my own, I am now out of business, whenever I attempt to read I find it nauseating'; patient 5 reported that 'now I cannot do anything with my hands, the only thing I can do now is to sit and look'.
Three patients reported that now they cannot lift things they could earlier lift easily nor could they trek to places in good time. Patient 2 stated that 'now one cannot lift things you could earlier lift easily nor could you trek to places in good time, we move at snail pace because you guys said exercise is good for recovery'; patient 6 expressed that 'but I am having little problem with using my right hand and I remain indoors mostly'.
Two patients reported that they are now out of business. For example, patient 4 reported that 'now I cannot do anything on my own, I am now out of business, I only depend on good spirited individual for alms, but nephews and nieces who take good care of me even money for my hospital needs were provided by them'; patient 5 stated that 'my business has stopped'.
Three patients reported that they used to observe their prayers while sitting down. Out of the patients, patient 1 stated that 'It was after some treatment at the hospital that I am now able to slightly move the limbs and say my prayers'; patient 4 also stated that 'In my present condition, I always wake-up every morning to crawl into the courtyard which is very close to my room to perform ablution and return indoors to say my prayers'; patient 5 mentioned that 'I used to observe my prayers while sitting down'.
Two patients reported that it was almost impossible to read. Patient 4 stated that 'whenever I attempt to read I find it nauseating'; patient 5 mentioned that 'It is almost impossible for me to recite the Qur'an but I honestly enjoy it being recited to me'.
Three patients mentioned that they could not bathe by themselves. Patient 1 mentioned that 'at the onset of the condition, I barely could move my hand to eat nor could I bathe myself'; patient 3 stated that 'I barely could do anything for self, I have to be spoon fed and bathed by that girl always'; patient 4 expressed that 'I depend on others to bathe me'. Patient 2 stated that 'someone has to carry my bucket to the bathroom for me to get bathed'; patient 6 reported that 'now I can't use my hand in bathing'.
| Discussion|| |
The results obtained for this study showed that 3 patients reported that they could not visit the toilet; 2 patients reported that they found themselves unable to move any of their limbs. Stroke survivors often respond actively to stroke by utilising social support, finding new ways of doing things, approaching tasks more slowly, initiating the process of relearning, exercising and covering up.
Furthermore, 5 patients revealed that they had become challenged and dependent on their family members to get things done. This is in line with the findings of Wade, Leigh-Smith, and Langton-Hewer, who described the impact of stroke survivors on their caregivers. This finding and the antecedent findings confirm the need of continuous support not only for stroke survivors but also for their caregivers.
This study showed that 5 patients found their movement restricted to their immediate compound. This finding has significant social and economic implications. Restriction of movement could hamper social interaction and earning of livelihood. This could make patients dependant on relatives and can further jeopardize medical care by reducing available resources. In an earlier study, Dowswell et al. reported that stroke survivors assessed their recovery relative to their pre-stroke lives and had to accept the fact that they may never be same again. Even among those with clinically adjudged mild stroke associated limitations, there was a significant perception of lifestyle worsening.
In this study, 3 patients also reported that at the onset of the condition they barely could move their hands to eat, which is half of the participants for this study. Three patients also reported that they could dress by themselves. Stroke survivors often developed innovative strategies of handling their lives by contriving new strategies to enable improve their independence.
Four patients out of the total participants reported that they are unable to do most of their house-hold chores. Two patients explained that they could not lift things they could earlier lift easily nor could they trek to places in good time. People who had stroke cannot walk to places by themselves in the right time, they find it difficult to walk very fast trying to attend an occasion or program in time.
In this study, two patients reported being out of business. People who had stroke and are out of business will be faced with economic difficulties, they may be forced to rely on other people, which can affect their esteem and medical management.
Three patients reported that they could not observe their prayers in the normal posture, as they have to observe it while sitting down. Two patients also had difficulty in reading. Three participants commented that they could not bathe by themselves.
This study showed that lifestyle constraints are pervasive among stroke survivors, manifesting as a spectrum of limitations. These have significant bearing on patients' well being and require better understanding to aid patient care.
| Conclusion|| |
This study assessed the 24-hour lifestyle constraints among stroke survivors using 6 patients in a case-based study. Study findings showed that stroke survivors could become dependent on relatives and may be grossly limited in performing daily routine activities. This study suggested that physical constraints could lead to economic, social and religious difficulties, with potential confounding effect on the management and general well-being of stroke survivors.
We thank all the stroke survivors who participated in the study and provided feedback on the analysis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sims NR, Muyderman H. Mitochondria, oxidative metabolism and cell death in stroke. Biochim Biophys Acta 2009;1802:80-91.
DOH. Our Healthier Nation, London: HMSO; 1999.
Hamzat TK, Olaleye OA. Stroke Rehabilitation: When should Ambulation commence. J Niger Med Rehabil Ther 2002;7:23-5.
Alaszewski A, Alaszewski H, Parker A. Empowerment and Protection: The development of policies and practices in risk assessment and management in services for adults with learning disabilities. Mental Health Foundation. London; 1999.
Ellis Hill C, Horn S. Change in identity and self-concept: A new theoretical approach to recovery following a stroke. Clin Rehabil 2000;14:279-88.
Burton CR. Re-thinking stroke rehabilitation: The Corbin and Strauss chronic illness trajectory framework. J Adv Nurs 2000;32:595-602.
Lawler J, Dowswell G, Hearn J, Forster A, Young J. Recovering from Stroke: A qualitative investigation of the role of goal setting in late stroke recovery. J Adv Nurs 1999;30:401-9.
Krueger RA. Focus groups: A practical guide for applied research. Thousand Oaks: Sage; 1988.
Morgan DL. Focus groups as qualitative research. 2nd
ed. Thousand Oaks, CA: Sage; 1997.
Paddick S, Gray WK, Ogunjimi L, lwezuala B, Olakehinde O, Kisoli A, et al
. Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania. BMC Geriatr 2015;15:53.
Abiodun OA. A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria. Br J Psychiatry 1994;165:669-72.
Pound P, Tilling K, Rudd A, Wolfe C. Does patient satisfaction reflect differences in care received after stroke? Stroke 1999;30:49-55.
Wade D, Leigh-Smith J, Langton-Hewer R. Effects of living with and looking after the survivors of stroke. BMJ 1986;293:418-20.
Dowswell G, Lawler J, Dowswell T, Young J, Forster A, Hearn J. Investigating recovery from stroke: A qualitative Study. J Clin Nurs 2000;9:507-15.