Effectiveness of an integrated education for self-management in stroke rehabilitation in North-East Nigeria: a randomized controlled trial

Objective: To investigate the effectiveness of a modeled community-based education (CBE) for self-management towards reducing disability and improving lower extremity functions among stroke survivors.

Study type & settings: This single-blind randomized controlled trial (RCT) was conducted among stroke survivors attending outpatient Physiotherapy unit of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), in the North-Eastern part of Nigeria.

Methodology: Single-blind randomized controlled trial design was employed by grouping the participants into experimental and control groups. Participants were considered eligible if their stroke was due to cerebrovascular accident, able to walk 10 meters unsupported, at least 30 days’ post-stroke and possessed cognition score of >24 on Mini-Mental State Examination. Sixty participants were assigned to either the intervention (n=31) or control group (n=29) and received intervention for 6 weeks after the baseline assessments. Modified Rankin Scale, Six-Minute Walk Test and Ten-Meter Walk Test were used to measure the degree of disability, walking distance and gait speed respectively.

Results: Groups did not differ significantly in terms of stroke related disability, walking distance and gait speed at baseline. Post-intervention assessments showed time effect on participants’ walking distance across two test periods, indicating significant time effect (F =13.963, p =0.001) with an effect size of η2 =0.245. Disability was assessed using the modified ranking scale. The time effect of the participants’ performance on the scale across the two test periods indicated significant time effect; (F =8.563, p =0.005) with effect size of η2 =0.166. However, non-significant time effect was reported on gait speed of the participants in the study groups.

Conclusion: The community-based education (CBE) programmes for chronic diseases like stroke could be effective toward reducing the degree of disability and improving lower extremity function.