An evaluation of the structure and process of stroke rehabilitation in primary, secondary and tertiary hospitals in Ghana.

Background: Evidence shows that quality indicators such as the structure and process of stroke rehabilitation can influence patient outcomes. However, not much attention has been paid to the study of these issues in low- and middle-income countries such as Ghana. Objectives: Our study evaluated the structure and process of stroke rehabilitation in primary, secondary and tertiary hospitals in the Greater Accra Region of Ghana. Method: A cross-sectional survey was conducted involving 111 healthcare professionals. The World Health Organization (WHO) situational analysis and Measure of Processes of Care for Service Providers for Adults (MPOC-SP[A]) questionnaires were administered to gather information on the structure and process of stroke rehabilitation. Descriptive statistics were used to summarise data, and chi-square and Kruskal-Wallis tests were used to establish associations and comparisons, respectively. Results: A stroke unit was only available in the tertiary hospital. Although all three hospitals had a multidisciplinary team approach to care, the constituents differed. Length of hospital-stay, duration of treatment and basis for discharge from acute care were not associated with the hospitals. Therapy sessions, access to computed tomography (CT) and magnetic resonance imaging (MRI) scanning were dependent on the hospitals. Conclusion: The structure and process of stroke rehabilitation across the three hospitals were similar in some constructs and different in others. Clinical implications: Data gathered will help to provide information on the available structure and processes of stroke rehabilitation, which could help assess the quality of care provided.