Objectives Home-based physiotherapy interventions to improve post-stroke mobility are successful in high-income countries. These programs require less resources compared to center-based programs. However, feasibility of such an intervention in a low and middle-income setting remains unknown. Therefore, the SunRISe (Stroke Rehabilitation In Suriname) study aimed to assess feasibility and preliminary effectiveness of a home-based semi-supervised physiotherapy intervention to promote post-stroke mobility in a low resource setting. Design Prospective randomized controlled trial. Methods Chronic stroke patients were recruited and randomized into either an intervention group (IG (N = 20)) or a control group (CG (N = 10)). The IG received a 3-days-a-week home-based physiotherapy program that was supervised in the first 4 weeks and tele-supervised during the second 4 weeks. The physiotherapy program consisted of walking as well as functional and mobilization exercises. The CG received usual care. Feasibility outcome measures included adherence, patient satisfaction and safety. Efficacy measures included functional exercise tolerance (six-minute walking test (6MWT), functional balance (Berg Balance Score (BBS), upper extremity (UE) function (Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire), and UE strength ((non-)paretic handgrip (HG) strength). Two-way analysis of variance was used for data analysis. Results Thirty participants (61.8 ± 9.2 years old, 13 men) were enrolled in the study. The intervention was completed by 14 participants (70%). Adherence was affected by rainy season associated infrastructural problems (n = 2), the medical status of participants (n = 3) and insufficient motivation to continue the program without direct supervision (n = 1). No adverse events were noted and participants were satisfied with the program. Functional exercise tolerance (57.2 ± 67.3m, p = 0.02) and UE function (-9.8 ± 15.2, p = 0.04) improved in the IG compared to no change in the CG. HG strength was unaltered and a ceiling effect occurred for BBS. Conclusion Our home-based semi-supervised physiotherapy intervention seems safe, associated with moderate to high levels of engagement and patient satisfaction and results in functional improvements.@en

Background: Suriname is a middle-income country with a multi-ethnic population. Urbanization and ethnicity may be associated with incidence of cerebrovascular disease, but so far this has not been documented for Suriname. The objective of this study was to examine the prevalence of stroke in the capital of Suriname, and its association with ethnicity. Methods: Using the self-reported data from the ‘Healthy life in Suriname’ (HeliSur) study, we determined the prevalence of stroke in 1,478 subjects. The odds for having suffered from stroke in Javanese, Maroons and Creoles were separately compared to the odds in Hindustani. Odds ratios were adjusted for traditional risk factors including age, sex, diabetes, hypertension, dyslipidemia, and smoking, by use of multiple logistic regression analysis. Results:The overall prevalence of stroke in urban Surinameis 3.2% (95% CI 2.3 to 4.0%). Hindustani reported the highest prevalence of stroke (4.1%, 95% CI 2.4 to 5.8%) compared to the Javanese (2.0%, 95% CI 0 to 4.0%), Creoles (3.6%, 95% CI 2.7 to 4.5%) and Maroons (1.8%, 95% CI 0.5 to 3.1%). Adjusted odds ratios showed no significant association between ethnic background and stroke. Conclusions: Stroke prevalence is high in urban Suriname, and there seems to be ethnic difference in its prevalence. However, with and without adjustments for traditional risk factors, no significant association between stroke and ethnicity could be shown.@en