With over 1.5 million cases of stroke reported in the country each year, the incidence has increased by a staggering 17.5% during the last 15 year. Despite availability of excellent health care services, increased awareness regarding prevention and identification of stroke symptoms, stroke remains a leading cause of disability with urban India at one-and-a-half times at greater risk than rural India.

A Bangalore based study revealed that male versus female incidence is 2:1, i.e., men are at higher risk. Stroke is no more a disease of the elderly; it has now become more common in patients in their late 20’s and 30’s leading to premature loss of productive lives and adding on to the disease burden in the country.

There has been a lot of focus on preventing strokes and measures taken to manage the risk factors. However, there is limited evidence available regarding the patients journey during the time period after discharge from hospitals post stroke. Due to lack of awareness regarding availability of rehabilitation and less focus extended on the comprehensive approach to therapy, the burden of care falls on family members.

In the interest of bridging the gap in community re-integration of stroke patients, finding insights regarding current practices in stroke rehabilitation in the community and understanding patients’ behavior, Nightingales Home Healthcare Services took the lead to conduct a survey using a novel approach by incorporating clinicians’ perspective.

Highlights of the research conducted:

 Typically the researches done in India among stroke patients at home have revolved around the perception of the treating Physiotherapists and/or patient family members. In a first of its kind a quantitative survey was conducted among 31 Neurologists who treat stroke patients on a daily basis.

 Research was conducted across 3 cities: Bangalore, Mumbai and Hyderabad.

 Double blinded research: the participating doctors were not aware regarding the organization behind the study and vice versa thereby; achieving unbiased results.

 The research was conducted by a 3rd party via face to face interviews using a structured questionnaire leading to authentic and unbiased results.

Key findings:

 80% Neurologists perceive home rehab to be a feasible option for their stroke patients.

 Improved feasibility was due to factors like compliance to prescribed therapy (78%), cost effectiveness (61%) and improved access to quality comprehensive care (61%) as per the Neurologists.

 90% Neurologists perceive multi-disciplinary services/comprehensive rehabilitation as an ideal solution to managing disabilities due to stroke at home.

 Our findings are consistent with a population based stroke survey done in Mumbai in 2008 which suggests that patients with stroke are not accessing appropriate healthcare probably due to non-affordability and difficulty in conveyance. The availability of multi-disciplinary services is on the rise but the awareness around how that might help patients and their family members is still relatively low.

 Another interesting finding was that patients’ drop out of rehabilitation due to lack of motivation due to severity of disability (56%) and lengthy rehabilitation phase (29%) - a very important finding since effects of a stroke are very complex in nature and patients’ might be taking rehabilitation for years together which requires a lot of dedication by the patient and the therapist to see positive outcomes.

 Physiotherapy (77%) is by far the most often top-of-mind service offering that Neurologists recalled to be included in a home rehab programme also widely accepted by patients. This shows that other services which are equally vital in complete patient rehabilitation like speech and language therapy or occupational therapy are not very well accepted by patients either due to lack of awareness or lack of availability.

 77% Neurologists felt that family members learn the exercises and treat patients at home without any therapists’ supervision which adds on to their existing challenge and burden of accompanying patients’ for their appointments (65%).

Commenting on the report, Dr. Akshata Rao (PT), Product Lead – Stroke Rehabilitation at Nightingales Home Health Services said, “Home rehabilitation as a concept is considered a feasible option by majority of the Neurologists owing to the associated benefits/drivers such as compliance, access, cost effectiveness and multidisciplinary services among others. Early comprehensive rehabilitation post stroke and compliance to prescribed rehabilitation program increases patients’ changes for a better recovery and resume their daily activities with minimal support.