Self-rehabilitation strategy for rural community-dwelling stroke survivors in a lower-middle income country: a modified Delphi study.

backgroundMore than half of stroke survivors in lower-middle income countries lack access to stroke rehabilitation services. The promotion of self-rehabilitation could be promising for addressing stroke rehabilitation inadequacies in lower-middle income countries. Self-rehabilitation interventions are more readily acceptable to community-dwelling stroke survivors, and therefore, have the potential to boost the successful realization of the Sustainable Development Goals and other WHO rehabilitation goals. We report a consensus-building process that sought to identify which task trainings are relevant to include in a task-specific self-rehabilitation strategy for rural community-dwelling stroke survivors.

methodsAn iterative two-stage mixed-method consensus-building approach was used: (1) focus group discussions (n =  5) with rural community-dwelling chronic stroke survivors were conducted to explore personal life experiences in performing daily activities, and the results were used to develop a list of candidate task trainings that could be included in a task-specific self-rehabilitation intervention model for improving functional ability of survivors; (2) a three-round Delphi exercise with a panel of stroke rehabilitation experts to establish consensus on the importance/relevance of the developed task trainings. Consensus was pre-defined to be the point where the proportion of items given a rating of 3 (quite relevant) or 4 (highly relevant) by expert panellists is ≥  0.8. Kendall's coefficient of concordance (W) was used to assess the level of agreement among the expert panellists.

resultsA list of 74 task trainings was generated from the results of the focus group discussions involving 29 chronic stroke survivors. The tasks were classified as follows: training for the upper extremity (37); lower extremity training (21); trunk training (7); and balance training (9). A panel of 13 stroke rehabilitation experts reviewed these task trainings using the Delphi method and consensus was reached on keeping 28 task trainings in the first round (Kendall's W =  0.252, p <  0.001) and an additional 7 in the second round (Kendall's W =  0.409, p <  0.001). In the study team's analysis of open text responses, several areas of debate were identified and some task trainings were modified. The exercise yielded 49 task trainings (66% of 74) on which there was consensus (the mean proportion of items given a rating of 3 or 4 by panellists was 0.93; Kendall's W =  0.291, p <  0.001) to keep 3 task training groups relating to: upper extremity (27), lower extremity/balance (8), trunk strength (4) as well as warm up exercises (10).

conclusionThe study provides a consensus-based view of the features of a task-specific self-rehabilitation training strategy to improve outcomes following a stroke. This self-rehabilitation training strategy can be used as an intervention approach to augment and promote stroke rehabilitation among rural community-dwelling stroke survivors, especially in sub-Saharan Africa.