The achievement of community integration and productivity outcomes by CVA survivors in the Western Cape Metro Health District

Abstract

Introduction:  According to the South African National Rehabilitation policy, achieving advanced outcomes such as community integration and productive activity, should be the focus of the rehabilitation services.  However, according to the literature, rehabilitation does not often progress beyond basic outcomes such as mobility and self-care. 

The aim of this study was to describe the achievement of community integration and productive activity outcomes by a group of CVA survivors in the Western Cape Metro Health District. 

Methods: A descriptive study was carried out. Quantitative data were collected from 57 CVA survivors and caregivers. All these CVA survivors had received in-patient rehabilitation at the Western Cape Rehabilitation Centre (WCRC). Data were collected by means of a medical and demographic questionnaire, the Barthel Index and the Outcome Levels according to Landrum et al. 

Results:

On discharge from in-patient rehabilitation seven (12%) stroke survivors were at level II ie they had achieved only the basic rehabilitation outcomes necessary to preserve long term physiological health, whereas 37 (65%) stroke survivors were discharged at an outcome level III ie  ready for residential integration, and 12 (21%) were at level IV ie community integration, and one (2%) at level V (productive activity).  Assessment at the time of the study showed a general improvement post discharge, with 21 participants (37%) improving by one or two outcome to achieve community integration and five (9%) achieving the outcome level of productive activity through informal income generating activities.  

Conclusion:

Thirty three (58%) stroke survivors achieved community integration, while six (10%) progressed to employment.  One would like to see further progress to employment especially for those participants who were employed before the stroke.  Clinicians might be able to assist more stroke survivors to achieve this through using the outcome levels and incorporating the interventions to reach productive activity such as performing work and skills assessments, employer education and assistance with reasonable accommodations in rehabilitation goals.

Key words: Cerebro vascular accident, outcome levels, productive activity