|Year : 2020 | Volume
| Issue : 3 | Page : 153-157
Relationship between sociodemographic characteristics of stroke survivors and poststroke motor performance
Adamu Ahmad Rufai1, Aisha Zannah Mustapha2, Adewale Luqman Oyeyemi3
1 Department of Physiotherapy, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
2 Department of Physiotherapy, Federal Teaching Hospital, Gombe, Nigeria
3 Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
|Date of Submission||10-Jan-2019|
|Date of Decision||25-Feb-2019|
|Date of Acceptance||23-Apr-2019|
|Date of Web Publication||7-Oct-2020|
Dr. Adamu Ahmad Rufai
Department of Physiotherapy, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri
Background: Motor impairment is a frequent presentation of stroke leading to partial or total loss of function of a body part usually limbs. Objective: This study investigated poststroke motor performance and its association with sociodemographic and clinical characteristics of stroke survivors. Materials and Methods: Ninety-four stroke survivors from two selected physiotherapy clinics in Maiduguri participated in this study. Data form was used to obtain information on sociodemographic and clinical characteristics of the participants while the Short-Form Fugl Meyer scale was used to obtain the information on motor performance of the participants. Descriptive statistics of mean, standard deviation, frequency, and percentage were used to summarize the data. Chi-square test of association was used to analyze motor performance and its association with sociodemographic and clinical characteristics of the participants. Results: The mean age and poststroke duration of the participants were 52.65 ± 12.70 years and 26.32 ± 32.70 months, respectively. Of the entire participants, 55 (58.5%) were male, 49 (52.1%) were employed, and 33 (35.1%) had Qur'anic education. Forty (42.6%) had a duration of stroke between 3 and 12 months. Gender (χ2 = 12.72, P = 0.002) and educational level (χ2 = 17.77, P = 0.023) were significantly associated with motor performance. Age, employment status, and duration of stroke showed no significant association with motor performance. Conclusion: The outcome of this study suggests that female gender and “no educational” attainment were associated with poor motor performance among stroke survivors in Maiduguri. Gender and educational level can influence motor impairment after stroke and should represent an essential part of assessment during stroke rehabilitation.
Keywords: Clinical characteristics, motor performance, sociodemographics, stroke
|How to cite this article:|
Rufai AA, Mustapha AZ, Oyeyemi AL. Relationship between sociodemographic characteristics of stroke survivors and poststroke motor performance. Sahel Med J 2020;23:153-7
|How to cite this URL:|
Rufai AA, Mustapha AZ, Oyeyemi AL. Relationship between sociodemographic characteristics of stroke survivors and poststroke motor performance. Sahel Med J [serial online] 2020 [cited 2021 Dec 1];23:153-7. Available from: https://www.smjonline.org/text.asp?2020/23/3/153/297450
| Introduction|| |
Stroke is a leading cause of death and permanent disability with increasing burden in many low- and middle-income countries. Globally, about 16 million stroke survivors were estimated with deaths from stroke accounting for 9.7% of all global deaths. In the absence of significant global public health response, these figures are expected to increase to over 23 million new stroke cases and 7.8 million stroke deaths by 2030.
Motor impairment is a frequent presentation after stroke, a partial or total loss of function of a body part, usually a limb or limbs. Motor impairment is a major cause of disability causing declined activities of daily living in stroke survivors. The ability of individuals to live independently after stroke, therefore, depends largely on the reduction of motor impairment and recovery of motor function. After stroke, 50% of survivors have some level of hemiparesis, 30% are unable to walk without some assistance, and 20% are dependent in activities of daily living due to motor impairment with resultant significant impact on the survivors' quality of life and productivity. According to Baker et al., poor upper-limb motor function is also a major contributor to reduced quality of life after stroke. Many rehabilitation strategies attempt to enhance motor recovery in stroke patients, and knowledge of factors that are associated with poststroke motor performance may impact on these rehabilitation strategies.
Considering the negative impact of stroke on motor performance, there is a need for more data on motor performance after stroke. Information on motor performance and its association with sociodemographic and clinical characteristics of stroke survivors would be particularly relevant as such information may provide insight into factors that can impact poststroke motor performance. The present study, therefore, aims to investigate poststroke motor performance and its association with sociodemographic and clinical characteristics of stroke survivors in Maiduguri.
| Materials and Methods|| |
The participants of this study were stroke survivors recruited from two physiotherapy clinics in Maiduguri. Those included were stroke survivors who understand and communicate in English, Hausa, or Kanuri language and receive physiotherapy treatment on outpatient basis. Stroke survivors who were unconscious and ones with comorbid conditions that may negatively affect motor performance such as osteoarthritis of the knee were excluded.
The study was a cross-sectional survey. The sample of convenience was used to recruit stroke survivors that were willing to participate in the study. The sample size of 101 participants considering 20% attrition was determined using the formula for a finite population: significance), and 1 = constant.
This study was conducted at the Physiotherapy Clinics of the University of Maiduguri Teaching Hospital (UMTH) and State Specialist Hospital Maiduguri.
Information on the sociodemographic and clinical attributes of stroke survivors that included age, gender, educational level, employment status, and duration of stroke was collected. The Short-Form Fugl Meyer (S-FM) scale was used to assess the motor performance of stroke survivors who participated in the study. It is an ordinal scale that assesses the level of motor performance on a 3-point scale and is clinician administered. A score of “0” is given for the item if the participant cannot carry out the task, score of “1” is given when the task is performed partially, while a score of “2” is given when the task is performed fully. The S-FM scale contains 12 items, 6 items for the upper limb and 6 items for the lower limb, which makes it a very efficient measure for assessing the motor function of stroke patients for both clinical and research. The S-FM scale has a total score of 24 with scores of 0–8 depicting severe impairment, 9–15 depicting moderate impairment, and 16–24 representing mild impairment as adopted from the study by Velozo and Woodbury. The psychometric properties of the tool have been found to be valid, reliable, and responsive.
Data collection procedure
The approval of the Research and Ethics Committee of the University of Maiduguri Teaching Hospital was obtained (January 31, 2017) before the commencement of the study. The permission of Heads of Departments of Physiotherapy, UMTH and State Specialist Hospital, was obtained. The participants were individually contacted during their clinic visit and briefed about the purpose and benefits of the study. They were also assured that all information obtained will only be used for research purpose and will be treated with anonymity and confidentiality. The study procedure was clearly described to the prospective participants, and signed informed consent was obtained from the participants who were convincingly ready to participate prior to data collection.
Descriptive statistics of mean and standard deviation, frequency, and percentage were used to summarize the sociodemographic and clinical characteristics of the participants. Chi-square test was used to assess poststroke motor performance and its association with sociodemographic and clinical characteristics of stroke survivors. The data analyses were performed utilizing the Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Inc, Chicago, IL). The level of statistical significance was set at alpha = 0.05.
| Results|| |
One hundred prospective participants were contacted for recruitment, but only 94 participates gave a response rate of 94%. Out of the six that did not participate, one declined participation and five did not meet the inclusion criteria. Fifty-five (58.5%) were male while 39 (41.5%) were female with a mean age of 52.65 ± 12.70 years. Forty-nine (52.1%) were employed and 33 (35.1%) had Qur'anic education. Stroke survivors with a duration of stroke >12 months were in the majority. The mean poststroke duration of the participants was 26.32 ± 32.70 months. [Table 1] shows the detail information on the sociodemographic and clinical characteristics of the participants.
|Table 1: Sociodemographic and clinical characteristics of the participants|
Click here to view
[Table 2] shows the detailed information on motor performance and its association with sociodemographic data. There was a significant association between gender and poststroke motor performance. Majority of the females (48.7%) had severe impairment while 49.1% of males had mild impairment (χ2 = 12.72, P = 0.002). Furthermore, there was a significant association between educational level and poststroke motor performance (χ2 = 17.7, P = 0.023). Severe impairment was greater among those with “no educational” attainment (55.0%) and lowest among those with a tertiary level of education (16%). Older adults have severe impairment with 48.0% while younger adults have moderate impairment with 40.0%, and 37.0% of the middle age group have mild impairment (χ2 = 4.07, P = 0.396). Participants in the retired group of employment had the majority (50%) of moderate impairment in motor performance while 38.8% of the employed had mild impairment (χ2 = 2.24, P = 0.692). Thirty-seven percent of the participants with left-sided hemiplegia reported moderate and 28.6% mild impairment whereas the study reported no significant difference (χ2 = 1.93, P = 0.381). Fifty percent of participants had severe impairment with poststroke duration <3 months, while 37.5% had moderate impairment with poststroke duration of 3–12 months and 42.9% had mild impairment with poststroke duration >12 months. However, there was no significant difference (χ2 = 3.40, P = 0.495).
|Table 2: Motor performance and its association with sociodemographic characteristics|
Click here to view
| Discussion|| |
This study was designed to determine the association between motor performance and sociodemographic and clinical characteristics of stroke survivors from the two selected physiotherapy clinics in Maiduguri.
In South Africa, a study carried out on motor and functional recovery after stroke showed no significant difference outcomes by age. This is similar to the findings of this study which shows no statistically significant association of age with motor performance. The findings from this study are also consistent with the findings of a study on gender differences in longitudinal patterns of functioning in Nigeria stroke survivors during the 1st year after stroke, which reported no significant difference in age of stroke survivors. Another study carried out in China showed that there is no significant association between age and motor function of stroke survivors. Despite the fact that this study observed no significant difference in age, stroke survivors within the age group of 60 years and above were observed to have the highest presence of severe and moderate motor impairment. This may be due to the fact that they are geriatrics and aging is associated with reduced motor performance due to dysfunction of the central and peripheral nervous system as well as the neuromuscular system.
Chen and Winstein ascertained that gender has no significant impact on motor recovery and learning similar to another study in Nigeria which reported that there was no significant difference in motor performance, activity, and participation between the male and female stroke survivors. Another study also reported no association between motor and functional recovery and gender. However, this study shows that there is a significant difference in motor performance and its association with gender where majority of the participants with severe impairment were reported to be females. The difference observed may be as a result of social isolation from their spouse which is more common among elderly women than in men. It may also be as a result of depression that is common in this population which also lowers quality of life and partially explains worse outcome after stroke. In addition, a number of studies have evaluated the sex difference in stroke severity and motor function and several have confirmed that women have increased severity of stroke compared to their male counterpart.,
It has been shown that education changes the pattern of brain potentials and events. The findings of this study reveal a significant association between motor performance and educational level of the participants. Previously, a study showed the effect of low school level to decreased visual and motor abilities, lower ability, and dexterity on motor tasks involving both the upper and lower limbs. Similarly, Mariana et al. reported that low educational level had an influence on motor performance. The present study found that participants with no education had a significant severe impairment of motor performance compared to those with education. This is in concordance with the findings reported from a study in India that showed higher education to be correlated with less motor disability. Well-educated patients may have fewer stigmas, be more conscious about outcomes of stroke and more likely to adhere to medications, and actively participate in physical rehabilitation which may reduce the risk of long-term motor impairment. In general, greater difficulty was observed for individuals with lower educational status to learn new movements.
The previous study examined different indicators of income on motor function after stroke, and it was reported that those with high income have better motor function compared to those with low income. Employment or socioeconomic status has been shown to be an important predictor of poor motor performance outcomes related to stroke. However, this is contrary to the findings of this study that observed no significant difference in motor performance and its association with employment status. Employment status, not level of income was assessed in the present study. On the contrary, in this society, stroke patients may not necessarily require a better income level to receive an intervention. Better still, their medical bills may be taken care of by their immediate or extended family.
Motor performance was not associated with duration of stroke in the current study which is contrary to the findings from a study conducted in Korea. In the Korean study, a significant improvement in motor impairment was observed 3–6 months after stroke. Similarly, result from a previous study showed that the rate of recovery of the lower limb was faster than that of the upper limb and that the more severe motor impairment the longer the period of recovery. The findings of no association in this study may be explained by the fact that stroke patients are not referred at the right time for intervention. Furthermore, it may be because the management does not give the desired attention to the precise aspects of motor performance during the rehabilitation.
This study is not without limitations that should be considered when interpreting the results. The convenience sampling used means that the participants may not be true representative of stroke survivors' population in Maiduguri. Furthermore, the cross-sectional design adopted makes the interpretation of the cause and effect for the association between gender and motor performance difficult. However, the sample size calculation adds to the strength of the study.
| Conclusion|| |
The study results show that female gender and “no educational” attainments were associated with poor motor performance among stroke survivors in Maiduguri. Gender and educational level can influence motor impairment after stroke and should represent an essential part of assessment during stroke rehabilitation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: A meta-analysis and systematic review. JAMA 2011;306:1241-9.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al.
Global and regional burden of stroke during 1990-2010: Findings from the global burden of disease study 2010. Lancet 2014;383:245-54.
Strong K, Mathers C, Bonita R. Preventing stroke: Saving lives around the world. Lancet Neurol 2007;6:182-7.
Stinear C. Prediction of recovery of motor function after stroke. Lancet Neurol 2010;9:1228-32.
Jaimie M, Henderson M. Motor impairment, Neuromodulation: Technology at the neural interface. Int Neuromodulat J 2012;10:1402-525.
Rosamond W, Flegal K, Furie K. Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee; 2008. Available from: http://cir.ahajournals.com
. [Last accessed on 2018 Dec 24].
Baker K, Barrett L, Playford ED, Aspden T, Riazi A, Hobart J, et al.
Measuring arm function early after stroke: Is the DASH good enough? J Neurol Neurosurg Psychiatry 2016;87:604-10.
Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet 2011;377:1693-702.
Yamane T. Statistics: An Introductory Analysis. 2nd
ed. New York: Harper and Row; 1997.
Hsieh YW, Hsueh IP, Chou YT, Sheu CF, Hsieh CL, Kwakkel G. Development and validation of a short form of the Fugl-Meyer motor scale in patients with stroke. Stroke 2007;38:3052-4.
Velozo CA, Woodbury ML. Translating measurement findings into rehabilitation practice: An example using Fugl-Meyer assessment-upper extremity with patients following stroke. J Rehabil Res Dev 2011;48:1211-22.
Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA. Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke 2009;40:1032-7.
Vincent-Onabajo GO, Hamzat TK, Owolabi MO. Are there gender differences in longitudinal patterns of functioning in Nigerian stroke survivors during the first year after stroke? NeuroRehabilitation 2014;34:297-304.
Rongrong W, Tong Z. The motor function improvement of the affected hand after stroke induced by music supported therapy: A randomized control clinical trial. Int J Neurorehabil 2015;2:177.
Seidler RD, Alberts JL, Stelmach GE. Changes in multi-joint performance with age. Motor Control 2002;6:19-31.
Chen SY, Winstein CJ. A systematic review of voluntary arm recovery in hemiparetic stroke: Critical predictors for meaningful outcomes using the international classification of functioning, disability, and health. J Neurol Phys Ther 2009;33:2-13.
Boden-Albala B, Litwak E, Elkind MS, Rundek T, Sacco RL. Social isolation and outcome post stroke. J Neurol 2005;64:1888-92.
Mendirratta P, Wasau M, Mendirratta MM. Implications of female: A population-based study of middle-aged Swedish men and women. Stroke 2015;39:2191-6.
Kevin M, Thomas G, Robert D, Micheal F, Bradford W, Scott S. Sex differences in stroke severity, symptoms and deficits after first ever ischemic stroke. J Stroke Cerebrovasc Dis 2007;12:199-206.
Wesley K, Jyoti C, McCullough LD. Emergency department arrival times, treatment and functional recovery in women with acute ischemic stroke. J Womens Health 2010;19:681-8.
Angel L, Fay S, Bouazzaoui B, Baudouin A, Isingrini M. Protective role of educational level on episodic memory aging: An event-related potential study. Brain Cogn 2010;74:312-23.
Machado MS, Voos MC, Teixeria PS, Piemonte ME, Ribero DO, Valle LE. The impact of educational status on dual task performance. Braz J Mot Behav 2011;6:32-8.
Mariana CL, Leticia LM, Fatima AC, Sonia MD, Luiz ER. The influence of educational status on motor performance and learning: A literature review. Fisioter Pesqui 2014;21:297-304.
Ghosal MK, Burman P, Singh V, Das S, Paul N, Ray BK. Correlates of functional outcome among stroke survivors in a developing country – A prospective community-based study from India. J Stroke Cerebrovasc Dis 2014;23:2614-21.
Kuper H, Adami HO, Theorell T, Weiderpass E. The socioeconomic gradient in the incidence of stroke: A prospective study in middle-aged women in Sweden. Stroke 2007;38:27-33.
Nitrini R, Caramelli P, Herrera E Jr., Charchat-Fichman H, Porto CS. Performance in Luria's fist-edge-palm test according to educational level. Cogn Behav Neurol 2005;18:211-4.
Vestling M, Tufvesson B, Iwarsson S. Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction. J Rehabil Med 2003;35:127-31.
Li C, Hedblad B, Rosvall M, Buchwald F, Khan FA, Engström G. Stroke incidence, recurrence, and case-fatality in relation to socioeconomic position: A population-based study of middle-aged Swedish men and women. Stroke 2008;39:2191-6.
Lee KB, Lim SH, Kim KH, Kim KJ, Kim YR, Chang WN, et al.
Six-month functional recovery of stroke patients: A multi-time-point study. Int J Rehabil Res 2015;38:173-80.
Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: A systematic review of the literature. Arch Phys Med Rehabil 2002;83:1629-37.
[Table 1], [Table 2]