Stroke Rehabilitation in the Philippines: An Audit Study

Purpose: Although cerebrovascular accident is a leading cause of mortality in the Philippines, there has never been a national survey of stroke client descriptors and rehabilitation practices. This paper reports on data from the audit of stroke care for inpatients in hospitals serviced by physiatrists. Method: Audit was done of the medical records of stroke clients admitted to hospitals with rehabilitation units. Performance indicators for timely referral to rehabilitation were applied. Results: A total of 1683 records were audited. The majority of clients had cerebral infarct followed by cerebral haemorrhage. The median length of stay was 7 days; stay was lengthier for haemorrhagic strokes. Only 54.1% of the clients were referred to rehabilitation, with a median delay of 3 days between admission and referral to rehabilitation. 25.4% of the clients had early referral to rehabilitation. 39.2% of the 1397 clients were referred to rehabilitation earlier than 2 days before discharge. Conclusion: This Filipino study provides valuable information on stroke types and prevalence, demographics and rehabilitation practices. Despite the prevalence of post-stroke rehabilitation, it has been underutilised in the management of stroke. Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms. Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.