FACTORS INFLUENCING ADHERENCE TO PHYSIOTHERAPY TREATMENT IN

STROKE PATIENTS ATTENDING KENYATTA NATIONAL HOSPITAL.

ROP JELIMO FAITH

D/PHYSIO/21020/084

DEPARTMENT OF PHYSIOTHERAPY

A RESEARCH PROJECT SUBMITTED TO KENYA MEDICAL TRAINING COLLAGE

IN PARTIAL FULFILMENTOF THE REQUIREMENTS FOR THE AWARD OF
DIPLOMA IN PHYSIOTHERAPY.

JUNE,2023
 Declaration.
This Research is my original work and has not been presented for a diploma in any other
institution.

Signature…………... Date…………………

ROP JELIMO FAITH

D/PHYSIO/21020/084

ii
 Supervisor’s Approval
This research has been submitted for review with our approval as college supervisors.

Signature……………. Date……………...

Name…………………………………...

Department……………………….

iii
 Dedication
I dedicate this work to all stroke patients and their families.

iv
 Acknowledgement.
I acknowledge and thank God for the gift of good health, I thank my supervisor, M.R Mburu for
making time and sharing knowledge to making this study a success. Special thanks to my family
for the financial support. I would also acknowledge all the participants who agreed to take part in
my study ,for their time, patience and information.

v
Table of Contents

Declaration......................................................................................................................................ii

Supervisor’s Approval....................................................................................................................iii

Dedication.......................................................................................................................................iv

Acknowledgement...........................................................................................................................v

Abbreviations................................................................................................................................vii

PWS- People with stroke...............................................................................................................vii

Definition of terms.......................................................................................................................viii

Abstract...........................................................................................................................................ix

CHAPTER ONE : INTRODUCTION.............................................................................................1

1.1 Background of information....................................................................................................1

1.2 problem statement..................................................................................................................2

1.3 Justification............................................................................................................................2

1.4 Objectives of the study...........................................................................................................2

1.4.1 Broad objective...................................................................................................................2

1.4.2 Specific objectives..............................................................................................................3

1.5 Research questions.................................................................................................................3

1.6 Significance of study..............................................................................................................3

1.7 Study limitation......................................................................................................................3

1.8 Scope of study........................................................................................................................3

CHAPTER TWO; LITERATURE REVIEW..................................................................................4

2.1 Economic burden...................................................................................................................4

2.2 Demographic factors..............................................................................................................5

2.3 Social-familial factors............................................................................................................6

vi
CHAPTER THREE: STUDY METHODOLOGY..........................................................................7

3.1 Study design...........................................................................................................................7

3.2 Study area...............................................................................................................................7

3.3 Study population....................................................................................................................7

3.3.1 Inclusion criteria.................................................................................................................7

3.3.2 Exclusion criteria................................................................................................................7

3.4 Variables................................................................................................................................7

3.4.1 Dependent Variables...........................................................................................................7

3.4.2 Independent variables.........................................................................................................7

3.5 Sampling technique................................................................................................................7

3.6 Sample size determination.....................................................................................................7

3.7 Data collection tool................................................................................................................8

3.8 Data collection process..........................................................................................................8

3.9 Pre-testing / piloting...............................................................................................................8

3.10 Validity.................................................................................................................................8

3.11 Reliability.............................................................................................................................8

3.12 Data analysis........................................................................................................................8

3.13 Ethical consideration............................................................................................................9

CHAPTERFOUR: STUDY FINDINGS AND INTERPRETATION...........................................10

4.0 Introduction..........................................................................................................................10

4.1 Analysis of demographic factors influencing adherence to physiotherapy treatment.........10

4.2 Analysis of economic factors affecting adherence to physiotherapy...................................12

Table 3 Affordability.....................................................................................................................12

4.3Analysis of social familial factors.........................................................................................14

Table 11; Accompanied to the facility...........................................................................................15

vii
CHAPTER 5 DISCUSSION..........................................................................................................17

5.1 Economic factors..................................................................................................................17

5.2 Social and familial factors....................................................................................................17

5.3 Demographic characteristics................................................................................................18

CHAPTER 6: CONCLUSION AND RECOMMENDATION.....................................................19

6.1Conclusion............................................................................................................................19

6.2 Recommendation.................................................................................................................19

6.3 Further research....................................................................................................................19

Reference.......................................................................................................................................20

APPENDICES...............................................................................................................................21

Appendix 1: Consent form.........................................................................................................21

Appendix 2: Research questions................................................................................................22

Appendix 3: work plan...............................................................................................................25

Appendix 4: budget....................................................................................................................26

viii
 Abbreviations
PWS- People with stroke

SSA- Sub-Saharan Africa

KNH-Kenyatta National Hospital

ix
 Definition of terms
Adherence-extent to which patient’s behavior are in accordance with the recommendation of
healthcare providers regarding individual behaviors, medication intake, diet observation or
lifestyle changes(WHO)

Stroke-temporary or permanent loss of function as a result of injury to cerebral tissue\

Physiotherapy-health providers that help to restore function when someone is affected by injury
or illness or disability.

x
 Abstract
Background; stroke is a major cause of disability in the world and its long term effects require
adherence to physiotherapy protocols for optimal rehabilitation. Poor attendance of
physiotherapy have negative effects on outcomes and healthcare costs. Objective of the study
was to determine the demographic factors , social-familial and economic factors that affect
adherence to physiotherapy in stroke patients. Methods that was used to collect data was self-
administered questionnaire containing: Economic, demographic and social familial factors,
randomly selected sample of 15 participants from a population of 60 who attended physiotherapy
outpatient in KNH. The major factor that affected adherence being finances. Health insurance
was highly recommended.

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 CHAPTER ONE : INTRODUCTION

1.1 Background of information

Stroke is a major cause of morbidity and mortality worldwide. Physiotherapy sessions are
intended To prevent deterioration of the condition, reduce further complications that may arise,
promote accession of activities of daily living, reduce pain and restore physical functioning.
Despite the documented benefits the proportion of patients with inconsistent uptake of these
interventions is a concern. (Mambo N.$ Hlongwana,2020)

The prevalence of stroke in India is estimated at 5590f 100000 persons per year. An estimated
20% of people with stroke in developing countries have had a prior stroke, reflecting insufficient
secondary prevention .International stroke guidelines strongly recommend therapeutic exercises
to optimize recovery of function and continuance of physical activity to prevent further stroke. In
India, stroke and rehabilitation units and rehabilitation facilities are virtually absent in the
government sector and those in the private sector are inaccessible for the semi-urban and rural
population. Therefore, home based rehabilitation is a feasible and economical alternative, which
has been shown to be equally effective as center based rehabilitation to promote function and
quality of life in stroke survivors.

In Africa, provision of stroke care in South Africa remains largely unmated and where available
is limited in quality and is difficult to access. Recourses for rehabilitation and social care for
people with stroke are also limited. In 2017 5 public hospitals in Cape Metro Health District
found majority of patients attend their first outpatient rehabilitation appointment, however,
subsequent low attendance rates were associated with lack of finances, patient’s migration to
other areas and long distance from the hospital PWS living in rural community had no access to
rehabilitation facility. Moreover, they did not get support from government or local authorities,
leaving responsibilities to some local nongovernmental organization and families that also had
limited resources to provide support.

Sub -Saharan Africa has the highest stroke burden globally with a steadily increasing estimated
at 316 cases per 100,000 persons. Stroke in SSA occurs in relatively young patients and tends to
be severe due to uncontrolled risk factors resulting in high personal and societal costs and
significant disability. While significant progress has been made in stroke care in high income

1
countries, stroke care in SSA is disjointed with glaring gaps in all areas of stroke care continuum.
This is due to poor health infrastructure, shortage of specialists, poor health financing models,
lack of and poor implementation of health policies and resources and poor leadership and
governance that characterize most health system in SSA. Consequently, specialized stroke care-
from pre hospital, hyper- acute and acute stroke care, to rehabilitation and secondary prevention
is markedly underdeveloped resulting in high morbidity and mortality

According to the latest WHO published 2020, stroke deaths in Kenya reached 15895 0r6.03% of
total deaths. The adjusted death rate is 92.66 per 100,000 of population ranks Kenya 81 in the
world. It is a neglected condition with a paucity of evidence despite its need for urgent care and
hefty economic burden. Most patients are managed in general wards by non-neurologists and
clinical officers with minimal training in stroke care. In addition, stroke patients are usually
refereed to private diagnostic facilities for neuroimaging due to breakdown or lack of scanners
which are only available in 13% of health facilities, adding to the financial burden of stroke.
These highlight far- reaching gaps in stroke care in Kenya; the extent to which is not well known

1.2 problem statement

Although stroke has shown to be the third major cause of death and disability, physiotherapy has
shown to reduce the risks of disability and death in stroke patients. Despite the documented
benefits of physiotherapy intervention, inconsistent uptake of these intervention is still a major
concern.

1.3 Justification
The study seeks to assess the barriers to physiotherapy services for stroke patients. It thus, seeks
to provide useful information to hospital management on how to tackle most of these barriers
and to enhance adherence to physiotherapy services to achieve better outcome for stroke patients
and ensure effective and efficient management of stroke

1.4 Objectives of the study

1.4.1 Broad objective

To determine challenges facing compliance to physiotherapy treatment in stroke patients
attending KNH

2
1.4.2 Specific objectives
1. To determine economic factors influencing adherence to physiotherapy treatment among
stroke patients attending KNH.
2. To establish the social-familial factors influencing adherence to physiotherapy treatment
among stroke patients attending KNH
3. To find out demographic factors influencing adherence to physiotherapy treatment in
stroke patients attending KNH

1.5 Research questions

1. What are the economic burden of stroke in patients attending KNH?

2. What are the social-familial challenges in stroke patients attending KNH?

3. What are the demographic characteristics of stroke patients attending KNH?

1.6 Significance of study

1.The study will be used as an education tool.

2.The study will be used to gather helpful and important information on the various factors
related to inconsistent uptake of physiotherapy services.

3. The study will be used for the award of certificate in diploma in physiotherapy.

1.7 Study limitation

The study will be carried out only at KNH outpatient department.

1.8 Scope of study

The scope of the study is to find out factors influencing adherence to physiotherapy treatment in
stroke patients attending KNH.

3
 CHAPTER TWO; LITERATURE REVIEW

2.1 Economic burden

Stroke is the leading cause of death and disability worldwide and the economic costs of post –
stroke care are enormous. As of now approximately 34% of the global total health care
expenditure is spent on stroke. The average health care cost of stroke per person including in-
patient care, rehabilitation and follow up is estimated at USD 140, 048 in the united states.
(Coulter, Parsons, Ashkham J, March 2015.)

In Sweden, economic burden of stroke was estimated from a societal perspective. In the cost
calculations both direct and indirect cost were estimated based on 12months after a first ever
stroke. For a population of 1.5million was 629million SEK. 50% of cost of stroke care fall on
acute care hospital, 40% on rehabilitation and long term care, informal care and productivity loss
explains 10% of total cost for the stroke disease. (Ghatnekar O, Persson U,2014)

In south Africa, most of the participants (74%) hired private transport to commute to the health
facility, costing an average amount R 300 for a round trip. This amount is said to be too much for
people who live below the poverty margin. Public transport was considered cheaper than hiring a
private car, however, key challenge with public transport was the pickups and drop offs points.
This points are often distant from patients houses. Link between finance and transport challenges
to non-adherence to treatment was established. (Naidoo & Ennion ,2019)

Despite the importance of rehabilitation to recovery from stroke, rehabilitation services in Iran
are provided with some limitations. For instance, only physiotherapy services are covered by
insurance provided that they are prescribed by neurologist or general surgeons, or physical
medical specialist. Moreover insurance organizations only cover 15 physiotherapy sessions per
month and do not cover home based physiotherapy. Therefore, rehabilitation in Iran is
considered costly. (Maryam Khoshbakht Pishkhani;2019)

4
2.2 Demographic factors
Inconsistent uptake of physiotherapy treatment among adults/survivors was found to be mostly
unintentional, as elderly patients rely on assistance from younger family members or healthcare
provider to follow their prescribed therapies. (Waari, Mutai&Gikunju,2018)

In study done in Iran, most patients with stroke age more than 45yrs were unable to move and go
to rehabilitation centers due to age and stroke related disabilities. Besides, they cannot
effectively participate in rehabilitation programs due to pain, fatigue, age related disability and
hence have limited adherence to medical orders and family members’ recommendation. Younger
patients who were willing to return to work show more adherence to rehabilitation programs
more than those who are not working. (Maryam Khoshbakht Pishkhani,2019)

Aging followed by reduction of the outcome becomes barrier to exercise in stroke patient. In
west European countries, half of the citizen perform minimum two hours and thirty minutes per
week. The number reduces with 10% after the age of 75 years old. similarly, the trend continues
to decline after the age of 80yrs old

Patients attending Ghana were predominantly males, between the ages 50-59 and mostly
married. In that, study, male patients were more affected than their female counterparts. This
may be related to the fact that males are more prone to risk factors associated with stroke,
especially those concerned with poor lifestyles such as smoking and drinking compared to
females. This can be compared with the study by Urimubenshi and Rhoda who found that more
than half of the respondents affected by stroke were males (Mercy Nketia-Kyere, July 2017)

90% of respondents in Tema Ghana had at least higher than the 50% reported by Urimubenshi ad
Rhoda. This can be explained partly by the fact that the setting for the study is made up of people
predominantly in the upper and middle class and are more likely to have had at least primary
education. Interestingly, stroke patients with tertiary education had high default rate. A gain, the
study showed that those with education had higher odds of defaulting than those with no
education. This could be attributed to the fact that this group of patients were more likely to be
financially sound and hence more likely to try other remedies. Additionally, this group may have

5
had knowledge of other alternative treatment available. It could also be explained by the fact that
those with tertiary education have high tendency of being employed in better jobs which are
likely to be time demanding thus limiting their time for physiotherapy sessions. Additionally, the
setting where the study took place had a number of alternative treatments available and patients
would be more likely to utilize these services for remedy, consequently, leading to their high
default to physiotherapy services at Tema Ghana. (Mercy Nketia-Kyere, July 2017)

2.3 Social-familial factors

Family responsibilities contributed towards low uptake to physiotherapy interventions as 66% of
participants were breadwinners for their households, 54% were married and they had
responsibilities of supporting their families through earning and income. Stroke survivors often
need the accompaniment of a family member or friend to appointments, given their limited
mobility. Majority of stroke survivors experience challenges at home with the families and these
challenges hinder them from attending all their scheduled physiotherapy appointments because
they still depend on them. (Kagee, le Roux & Dick)

On another study, reveals that family members have other responsibilities of their own and may
not always be readily available or even prepared to assist at a time when the patients’ needs
them. Perhaps, they themselves required emotional preparation and caregiving tips to provide
better care to stroke patients, over and above being physically available to provide care. (Naidoo
& Ennion 2019)

Research done in Tema Ghana. About 1/3 of the stroke patients reported having problem with
people seeing them in their conditions subsequently, this served tobe a barrier againt their
adherence to physiotherapy. this may be a suggestive of poor social attitude towards
stroke.Similarly, most were of belief that stroke has as spiritual cause and hence would require
other remedies other than physiotherapy. Accordingly,Payne suggested that cultural beliefs
should be considered in providing a care to people with stroke. (Mercy Nketia, July 2017)

6
 CHAPTER THREE: STUDY METHODOLOGY

3.1 Study design

A descriptive cross-sectional study design in which a questionnaire was used to determine
factors associated with adherence to physiotherapy treatment in stroke patients.

3.2 Study area

Kenyatta national hospital is the oldest hospital in Kenya. It is a public tertiary, referral hospital
for the ministry of health. It is the second largest in east Africa. It is located in Nairobi, Kenya in
the area to the immediate west of upper hill, Nairobi the capital and largest city of Kenya. It’s
about 3.5 km west of the city central business district. The hospital complex measures 45.7 acres.
It has a bed capacity of 1800. Offers general medical and surgical services. Opened in 1901.

3.3 Study population

3.3.1 Inclusion criteria

Stroke patients and care takers 18years and above, conscious and in good state of mind and
capable of giving voluntary consent. All stroke patients who were report and receive services at
the outpatient department and have defaulted for 2 or more sessions.

3.3.2 Exclusion criteria

Patient who were not be willing to give information. Patients below 18years, unconscious and
not in good state of mind.

3.4 Variables

3.4.1 Dependent Variables

Adherence to physiotherapy treatment in stroke patients.

3.4.2 Independent variables

Economic, social and demographic factors

3.5 Sampling technique

A random sampling technique was used to select stroke patients from the attending outpatient
department.

7
3.6 Sample size determination
The sample size was determined by systemic random sampling.

Formula of kth which kth =N/n; where n is the sample size and N is the population size.

Example given: N is the population size 250

Kth = sampling interval l = 5

That is 5 = 250/n

N =50 patients

3.7 Data collection tool

The study developed the use of questionnaire as a data collection tool covering information on
stroke patient’s demographic characteristics social- familial and economic barriers.

3.8 Data collection process

Unique code will be assigned to every questionnaire before administration to the patients for the
purpose of identification and confidentiality. Informed consent was required before participating
in the study.

3.9 Pre-testing / piloting

Pre-testing was be done using 10% of the sample size a week before the actual study at Homabay
County Teaching and Referral hospital. The questionnaire was modified in case of
inconveniences.

3.10 Validity
The participants of the study are the only one that decide if the results reflect the phenomena
being studied. It will thoroughly describe the context of the research to help the researcher in
being able to generalize the findings and apply them appropriately

3.11 Reliability
This is the measure of the degree to which the research instrument yields consistent result or data
after repeated trials. Reliability will be ensured by featuring similar questions in the
questionnaire using different language (Mugenda and Mugenda)

8
3.12 Data analysis
Data was analyzed to facilitate answering the research questions and objectives. Data was
represented in forms of tables, graphs, and charts. These was summarized and organize data and
to describe the characteristics of sample population

3.13 Ethical consideration

Permissionto conduct research was obtained and granted by KenyaMedical Training College,
Homabay through the head of department of physiotherapy. Permission to conduct the research
at KNH was obtained from the hospital administration. Participations wasissued with informed
consent before participation. Privacy and confidentiality of information was guaranteed during
the study and patients won’t be allowed to write their information on who they are on the
questionnaire.

9
 CHAPTERFOUR: STUDY FINDINGS AND INTERPRETATION

4.0 Introduction
This chapter presents the findings on factors influencing adherence to physiotherapy in stroke
patients Attending Kenyatta National Hospital –Nairobi. This study was conducted on 15
participants of which all the 15were given questionnaire to fill making a response rate of 100%.
The study findings are represented in tables and pie chart with appropriate explanation given
below.

4.1 Analysis of demographic factors influencing adherence to physiotherapy treatment.

Table 1. Demographic factors of the study population N=15

Variable Category Frequency Percentage

Sex Male 10 66.7%

Female 5 33.3%

Age 18-38 3 20%

39-59 4 26.7%

60-90 8 53.3%

81 and above 0 0%

Level of education Non-formal 5 33.3%

Primary 2 13.3%

Secondary 0 0%

Tertiary 8 53.3%

Marital status Married 15 100%

Physio schedule Once 4 26.7%

10
Twice 11 66.7%

Thrice 1 6.7%

11
In the table above, male respondents were 66.7% compared to female. 53.3% represented
respondents between 60-80 age bracket making them more participants. All respondents were
married and most of them 66.6% attended physiotherapy twice a week.

4.2 Analysis of economic factors affecting adherence to physiotherapy

Table 2 Medical cover

Variable Category Frequency Percentage

Medical cover Yes 7 46.7%

No 8 53.3%

Total 15 100%

The above table shows the percentage of respondent with medical cover representing 46.7%, 7
participants and 53.3% without representing 8 participants.

Table 3 Affordability

Variable Category Frequency Percentage

Affordability Yes 4 26.6%

No 11 73.3%

Total 15 100%

12
Figure 1; Transport

Transport

40% Public
Private

60%

The above pie chart represents respondents transportation. 60% public and 40% private.

Figure 2; Schedule interruption

Schedule interrruption
90%
80%
80%
70%
60%
Schedule interrruption
50%
40%
30%
20%
20%
10%
0%
yes No

The above bar graph represents schedule interruption. 3 respondents , 20% schedule was
interrupted while 80% had no interrupted schedule.

13
4.3Analysis of social familial factors
Table 4 Beliefs

Variable Category Frequency Percentage

Beliefs Medical condition 3 20%

Inheritance 12 80%

The above table shows belief of stroke. 80% believed it is a medical condition while 20%
believed it was a curse.

Figure 3 People seeing them in their condition

People seeing them in their con-

dition

20%

yes
No

80%

The above pie chart represents respondent’s opinion on people seeing them in their state. 80%
had a problem while 20% had no problem being seen.

Table 5, Who accompany them to the hospital

Variable Category Frequency Percentage

Who accompany Family 13 86.7%

them to the hospital

Friend 2 13.3%

14
Figure 4; Attitudes toward rehab services

Attitudes toward rehab services

90%
80%
80%
70%
60%
Attitudes toward rehab
50% services
40%
30%
20%
20%
10%
0%
Good Bad

The above bar graph represents the attitudes of respondents. 80% had good while 20%
represented bad attitude

Table 11; Accompanied to the facility

Variable Category Frequency Percentage

Accompanied to the Family 13 86.7%

facility

Friends 2 13.3%

Total 15 100%

The above table represent people who accompanied them to the facility. 86.7% were family
while 13.3 were accompanied by friends .

Figure 5: Rate of improvement

15
 Rate of improvement

20%

Improved
Constant

80%

The above pie chart represents rate of improvement. 80% reported of improvement while 20%
reported of being at a constant state.

16
 CHAPTER 5 DISCUSSION
This chapter presents discussion of findings of the study. Results were discussed in relation to
the literature review.

5.1 Economic factors

53.3% of the participants had no access to medical cover. This contributes to more than 50% of
total participants. This limit adherence as it was really expensive for them to afford every session
out of pocket, this supports research done by(Naidoo and ENNION 2019).The 46.6%who had
access to medical cover did not find much burden in terms of affordability to treatment.

60% of the participants used public transport to reach the hospital because of expensive private
transportation, this meant that they would take a longer time on the road and even making it
more difficult to move from one vehicle to the next, this affected their adherence negatively.

80% of the participants had no schedule interruption as most of them had no specific schedule to
attend to following the occurrence of their stroke

5.2 Social and familial factors

80% of the participants believed that stroke was a medical condition while the remaining 20%
thought it was a curse. This supports research done by (YA Payne ,2011) that states that a
smaller number of participants believed they were cursed because they were doing better in life
and certain group of people were jealous of their state.

80% of patients had problem seen by people in their state. This supports research done by (PA
Payne,2011) that says many stroke patients reported having problem with people seeing them in
their condition, this may be a suggestive of poor social attitude towards stroke.

86.6% of the participants were brought to the facility with a specific family member. When the
family members had other responsibilities this will force them to miss their physiotherapists
appointments. This supports research done by (Naidoo and Ennion,2019) which says family
members have their own responsibilities and may not always be readily available or even prepare
to assist at a time when the patients need them.

93.3% of the participants reported of improvement since attending physiotherapy. This supports
the study done by (Ntamo et al.2013) which state, physiotherapy is intended to prevent

17
deterioration of the condition, reduce further complications that may arise, promote accession of
activities of daily living, reduce pain and restore physical functioning.

5.3 Demographic characteristics

Majority of participants attending to physiotherapy were male compare to female, this supports
the study done by (Mercy Nketie Kyere, july2017) that says male patients were more affected
than female counterparts. This may be associated by the fact that males are more prone to risk
factors associated with stroke, especially poor lifestyles such as smoking and taking alcohol.

Although patients age 60 and above were more compared to those who were below. Most find it
difficult to adhere to physiotherapy. This supports the research done by (Maryam Khoshbakht
Pishkhani,2019) that says ,most aged participants were unable to go to rehabilitation center due
to pain ,fatigue, and age related disabilities and hence have limited adherence to medical orders.
Youngest patients were willing to return to work and show more adherence to rehabilitation
program.

All participants were married, most of the participants had a twice a week rehabilitation schedule
this is the fact that the facility had neuro –rehab specialist on those days.

18
 CHAPTER 6: CONCLUSION AND RECOMMENDATION

6.1Conclusion
From the study findings, the researcher made the following conclusion;

1.Economic factor remained to be a major factor that contributed to adherence with more than
half of the participants not accessing medical cover and having difficulty with transportation.

2.More than half 66.7% of he respondents were male and those between age 60-80.This ,ment
that male gender and old age were common risk factors to stroke

3.Most of the participants were brought to the facility by their family members .This ment that
family were at the forefront ensuring the patients adherence to rehabilitation.

6.2 Recommendation
1.As neurological rehabilitation takes much time , the public through the office of social work
should ensure to educate the public though the ministry of health on the importance of ensuring
their health

2.Through the office of chief physiotherapy, the facility can organice for fitness programmes to
discourage unhealthy behaviours and educate people on importance of physical fitness to reduce
stroke risks

3.Family being an important aspect of stroke rehabilitation, the physiotherapist should educate
family and patients on the condition ,prognosis and importance of consistency in achieving good
stroke rehabilitation outcome.

6.3 Further research

Research on ways to improve adherence for better outcome of stroke patients .

Tools for measuring and evaluate adherence to stroke rehabilitation

19
 Reference
1.A-eisha, 2010.Indicators to physiotherapy attendance among Saudi female patients with
mechanical low back pain; A clinical audit; BMC musculoskeletal disorders.

2.Basett S. F,2015, bridging the intentions behavior gap with behaviour change strategies for
physiotherapy rehabilitation non-adherence. Zealand journal of physiotherapy.

3. Ghatnekar O Persson U, Glader El, Terent A: cost of stroke in Sweden. Int J Tech Ass Health.
2014)

3.Waari G, Mutai. j&Gikunju J,2018, Medication adherence &factors associated with poor
adherence on follow up at KNH, Kenya. Pan African medical journal 29,1-15

4.Kagee A, le Roux M.& DickJ, 2017. Treatment adherence among primary care patients in a
historically disadvantage community in South Africa. A qualitative study. Journal of Health
psychology

5.Maryam Khoshbakht Pishkhani, December2019. Journal of vascular Nursing.

6.Mtaambo, &Hlongwana. K.,2020 factors associated with stroke survivor’s inconsistent uptake
physiotherapy intervention at Turton community Health centre. South African journal of
physiotherapy.

7.Naidoo U& ennion L,2019. Barriers and facilitators to utilization of rehabilitation services
amongst persons with stroke in rural communities in South Africa

8.Waari G, Mutai J.&Gikunju J,2018. Medication adherence & factors associated with poor
adherence on follow up at KNH, Kenya, Pan African medical journal 29, 1-15

9.YA Payne –journal of Black psychology ,2011- journals.

20
 APPENDICES

Appendix 1: Consent form

Dear participant,

I invite you to participate in research study titled factors that affect adherence to physiotherapy
treatment in stroke patients attending physiotherapy clinic at Kenyatta National Hospital. Iam a
physiotherapy student doing a research project with the purpose of finding out challenges that
affect adherence to physiotherapy treatment. The questionnaire has been designed to collect
information on economic, social, and demographic factors associated with adherence. Your
participation is voluntary. Your response will remain confidential and anonymous. Data from
this will be reported as a collectively combined total. If you agree to participate you will kindly
answer the questionnaire as best of your abilities. Should take approximately 30 minutes. Pease
submit back the questionnaire as soon as you done answering the questions.

21
Appendix 2: Research questions
The aim of the study is to establish factors affecting adherence to physiotherapy in stroke
patients at KNH

Instructions

a) All information will be held confidentially

b) Fill this questionnaire freely and honestly

c)Do not write your name or contact in this questionnaire

d)Tick in the choice you have made

Economic factors

1.Are you a beneficiary of any medical cover?

a) Yes

b) No

2.Is physiotherapy affordable

3.What is the mode of transport to the facility

a) Public

b) Private

4.Does coming to the facility interrupt your normal programs

a) Yes

b) No

5.How much time from home to the facility

a)1 hour or less

b)2Hours

c)3 Hours or more

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Social-familial factors

1.What do you believe is the cause of your disease

a) Curse

b) Medical condition

c)Inheritance

2. Are your comfortable people seeing you in your state

a) Yes

b) No

3. Who always ensure you come for your rehabilitation

a) Family member

b) Friend

c)other, specify

4.How do you rate your improvements

a) Improving

b) Constant

c)No improvements

5.What is your attitude towards rehabilitation services offered

a) Good

b) Bad

23
Demographic factors

1.What is your gender

a) Male

b) Female

2.which age bracket do you fall in

a)18-38

b)39-59

c)60-80

d)81 and above

3.What is your level of education

a) Primary

b) Secondary

c)Tertiary

d)Non formal

4.What is your marital status

a) Single

b) Married

5.How many times are you indicated for your rehabilitation per week

a) Once

b) Twice

c)Thrice

d)Other specify

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Appendix 3: work plan
Activity Oct Sept Nov Dec Jan Feb march Apr may June

Carried out

Topic
formulation

Research
writing

Data
collection

Report
writing and
data
analysis

Submission
of research
report

25
Appendix 4: budget

Items Quantity Unit Total

Research file 1 150 150

Foolscaps 100 10 1000

Research typing 200 10 2000

Printing 20 10 200

Binding 1 200 200

Pens 3 20 60

Ruler 1 60 60

Questionnaire 50 10 500

Internet 5GB 100 500

Miscellaneous 1 530 250

Total 5000

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