Hemiplegic stroke in rural western Kenya: Clinical profile, risk factors, rehabilitation strategies and functional outcomes between 2025 and 2026

Vollständiger Abstract

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Stroke is a leading cause of disability globally, with a disproportionate burden in low- and middle-income countries. Hemiplegia is among the most disabling consequences of stroke, yet there is limited evidence from rural Kenya regarding functional outcomes and rehabilitation needs. To examine the clinical profile, risk factors, rehabilitation strategies, and functional outcomes among stroke survivors in rural Western Kenya. Objective: To describe rehabilitation interventions and functional outcomes among stroke survivors and determine their implications for strengthening stroke care delivery in resource-limited African settings. A retrospective hospital-based descriptive cross-sectional study was conducted at Busia County Referral Hospital (BCRH), Kenya, between November 2025 and February 2026. Fifty-four adult patients with confirmed stroke-related hemiplegia who met the study inclusion criteria were included through consecutive sampling using medical record and patient biodata review. Data were collected through medical record review with a structured data extraction form, and clinical assessment findings documented in patient files. Functional status was assessed using the Modified Rankin Scale (mRS), while the International Classification of Functioning, Disability and Health framework (ICF) was used to categorize impairments, activity limitations, participation restrictions, and environmental factors. Data were analyzed using SPSS version 22 that adopted descriptive and inferential statistics for data analysis. Ethical approval was obtained from National Commission for Science, Technology and Innovation and Institutional Scientific Ethics and Review Committee, and informed consent was secured from participants and caregivers where applicable. Results: Haemorrhagic stroke accounted for 51.9% of cases, while ischemic stroke accounted for 48.1%. Hypertension was the predominant risk factor (92.6%), with poor medication adherence reported in 60% of patients. Retrospectively, severe neurological impairments were linked to altered consciousness (ICF-b110: 87%) and orientation deficits (ICF-b114: 87%). Motor impairment was substantial, with 53.7% observed partial movement and 22.2% showing no movement (ICF-b730). Dysphagia was linked to 38.9% of patients (ICF-b510). At discharge, 81.5% of patients were linked to severe disability, corresponding to a Modified Rankin Scale score of 4, despite low in-hospital mortality (3.7%). Participation restrictions were marked (ICF-d910: 72.2%), with high dependence on family caregivers (ICF-e310: 70%). Environmental barriers were linked to delayed referral and limited rehabilitation services (ICF-e355: 100%). Most patients (96.3%) were referred for physiotherapy management. Rehabilitation interventions were documented as early bed mobility and transfer training, trunk control and balance retraining, gait rehabilitation, progressive muscle strengthening, range-of-motion exercises, proprioceptive training, and repetitive task-specific exercises initiated within 24–72 hours after admission. Conclusion: Hemiplegic stroke at the hospital was noted to affect older women, with systemic hypertension identified as the major modifiable risk factor. Although in-hospital mortality was observed to be low, severe functional disability remained common among survivors. Recommendations: Strengthen preventive strategies targeting hypertension control, adherence to antihypertensive medication, and enhance community-based rehabilitation and interdisciplinary referral pathways for stroke survivors.