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Impact of Community Physiotherapy Services on Functional Mobility among Stroke Survivors in Nigeria

Abstract

Stroke is a major cause of long-term disability and functional limitations among adults in Nigeria. Stroke survivors may experience muscle weakness, impaired balance, reduced coordination, abnormal gait patterns, spasticity, and difficulties performing activities of daily living, which may limit independence and participation in family and community life. Physiotherapy plays an important role in improving movement, balance, strength, coordination, and functional independence following stroke. However, limited access to rehabilitation facilities, financial constraints, transportation difficulties, shortage of rehabilitation professionals, and long distances to healthcare facilities may restrict continued participation in conventional facility-based physiotherapy. Community physiotherapy services provide an opportunity to deliver rehabilitation closer to where stroke survivors live and may improve continuity and accessibility of post-stroke rehabilitation. Against this background, this study investigates the impact of community physiotherapy services on functional mobility among stroke survivors in Nigeria. The study will be anchored on the International Classification of Functioning, Disability and Health (ICF) Framework, Social Ecological Model, and Self-Efficacy Theory. The ICF Framework provides a comprehensive approach to understanding how stroke affects body functions, activities, participation, and environmental factors and emphasizes rehabilitation aimed at improving functional ability. The Social Ecological Model explains how individual, family, community, healthcare, and environmental factors influence access to and participation in community rehabilitation services. Self-Efficacy Theory emphasizes stroke survivors' confidence in their ability to perform prescribed exercises, mobility activities, and rehabilitation tasks consistently. Collectively, these theoretical perspectives provide a suitable framework for explaining how community physiotherapy services may influence functional mobility among stroke survivors in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adult stroke survivors receiving care in selected communities, primary healthcare facilities, rehabilitation centres, and hospitals across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, healthcare facilities, and eligible stroke survivors. Community physiotherapy services will be assessed using indicators such as frequency of physiotherapy sessions, duration of rehabilitation, accessibility of services, home-based physiotherapy visits, exercise prescription, balance training, gait training, strengthening exercises, mobility training, use of assistive devices, caregiver involvement, patient education, and follow-up arrangements. Functional mobility will be assessed using standardized measures such as the Timed Up and Go Test, 10-Metre Walk Test, Berg Balance Scale, Functional Ambulation Category, or other validated mobility assessment tools appropriate to the study population. Additional indicators may include walking ability, transfer ability, balance, lower-limb strength, use of mobility aids, and independence in mobility-related activities. Data will be collected using structured questionnaires, physiotherapy assessment forms, validated functional mobility instruments, rehabilitation records, attendance registers, and direct physical assessments. Descriptive statistics will be used to summarize participants' characteristics, exposure to community physiotherapy services, and functional mobility status. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of community physiotherapy services on functional mobility. Where a quasi-experimental design is adopted, functional mobility scores before and after participation in community physiotherapy services may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community physiotherapy services have a significant positive impact on functional mobility among stroke survivors in Nigeria. Stroke survivors who participate regularly in community physiotherapy are expected to demonstrate improvements in walking ability, balance, transfers, lower-limb strength, and overall functional mobility compared with survivors who have limited access to rehabilitation services. Home-based exercises, gait training, balance activities, strengthening exercises, and individualized rehabilitation plans may improve survivors' ability to perform mobility-related activities and increase functional independence. Delivering physiotherapy within communities may also reduce transportation and geographical barriers, encourage caregiver participation, and improve continuity of rehabilitation. However, severity of stroke-related disability, financial constraints, inadequate rehabilitation equipment, shortage of physiotherapists, transportation challenges, poor adherence to prescribed exercises, and limited availability of community rehabilitation programmes may affect outcomes. The study therefore expects accessible, continuous, individualized, and community-based physiotherapy services to contribute significantly to improved functional mobility among stroke survivors in Nigeria. The study is expected to contribute to the literature on community physiotherapy, stroke rehabilitation, functional mobility, disability management, rehabilitation services, community-based rehabilitation, post-stroke care, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, physiotherapy departments, rehabilitation centres, physiotherapists, occupational therapists, nurses, caregivers, disability organizations, development partners, and policymakers regarding strategies for improving post-stroke rehabilitation. The study will also provide evidence-based recommendations for expanding community-based physiotherapy services, integrating rehabilitation into primary healthcare, strengthening home-based rehabilitation programmes, improving access to physiotherapy professionals and equipment, training caregivers to support prescribed rehabilitation activities, and establishing effective referral and follow-up systems for stroke survivors across Nigeria.

Keywords: Community physiotherapy services, functional mobility, stroke survivors, stroke rehabilitation, community-based rehabilitation, physiotherapy, disability management, mobility, post-stroke care, Nigeria, public health.