Occupational Therapy Utilization and Self-Perceived Occupational Functioning among Community-dwelling Stroke Survivors in Southwest Nigeria: A Cross-Sectional Study Using the Model of Human Occupation
Abstract:
Stroke is a leading cause of long-term disability that leave survivors with persistent impairments in occupational functioning (OCF). Local evidence on occupational therapy's (OT) association with self-perceived OCF among community-dwelling stroke survivors (SSVs) in Southwest Nigeria remains limited. This study examined OT utilization and OCF among SSVs in Southwest Nigeria, guided by the Model of Human Occupation (MOHO). Using a cross-sectional survey, 74 community-dwelling SSVs: 37 who had utilized OT and 37 age- and sex-matched non-users who received other rehabilitation that were purposively selected from four public tertiary health facilities in Southwest Nigeria participated in this study. OCF was assessed using the 1999 Assessment of Occupational Functioning (AOF), evaluating MOHO's volition (values, personal causation, interests), habituation (roles, habits), and performance skills subsystems. Independent t-tests compared groups; Pearson's correlation examined associations between OT utilization (frequency, dosage) and functioning among OT users. Groups were comparable on most sociodemographic and clinical characteristics (p>0.05), though post-stroke duration and hand dominance differed significantly. Overall OCF was significantly higher among OT users than non-users (55.81±11.61 vs. 37.41±4.43; t=9.01, p<0.001). OT users scored significantly higher across five of six MOHO subsystems; values, personal causation, interests, roles, and habits (p=0.001) with interests showing the strongest effect (t=9.41). No significant group difference emerged in performance skills. Both frequency and cumulative dosage of OT utilization correlated significantly with all occupational functioning domains (p=0.001). OT utilization was associated with significantly higher OCF among Nigerian SSVs, with a clear dose-response relationship, supporting expanded OT access within community stroke rehabilitation pathways.References:
[1].
Feigin VL, Volovici V, Brainin M, Norrving
B, Martins SO, Roth GA. The latest Global Stroke Fact Sheet 1990-2023: Global
Burden of Disease study. Neuroepidemiology. 2026 May 7.
[2].
Sacco RL, Kasner SE, Broderick JP, Caplan
LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st
century: A statement for healthcare professionals from the American Heart
Association/American Stroke Association. Stroke. 2013;44(7):2064-89.
[3].
GBD 2019 Stroke Collaborators. Stroke
incidence, mortality, and disability-adjusted life-years in 204 countries and
territories, 1990-2019: A systematic analysis for the Global Burden of Disease
Study. Lancet Neurol. 2021;20(9):715-31.
[4].
Prust ML, Forman R, Ovbiagele B.
Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol.
2024;20:207-21. Available from: doi:10.1038/s41582-023-00921-z
[5].
Ojagbemi A, Bello T, Owolabi M, Baiyewu O.
Prestroke cognitive decline in Africans: Prevalence, predictors and association
with poststroke dementia. J Neurol Sci. 2021 Oct 15;429:117619.
[6].
Ekerikevwe KI. Survival analysis of the
clinical episodes of stroke using data from Western Delta Region of Nigeria.
Britain Int Exact Sci (BIoEx) J. 2020;2(1):1-10.
[7].
Ackah M, Ameyaw L, Appiah R, Owiredu D,
Boakye H, Donaldy W, et al. Correction: 30-day in-hospital stroke case fatality
and significant risk factors in sub-Saharan Africa: A systematic review and
meta-analysis. PLOS Glob Public Health. 2026;6(3):e0006115.
[8].
Kayola G, Mataa MM,
Asukile M, Chishimba L, Chomba M, Mortel D, et al. Stroke
rehabilitation in low- and middle-income countries: Challenges and
opportunities. Am J Phys Med Rehabil. 2023;102(2 Suppl):S24-32.
[9].
Feigin VL, Owolabi MO, Abd-Allah F,
Akinyemi RO, Bhattacharjee NV, Brainin M, et al. Pragmatic solutions to reduce
the global burden of stroke: A World Stroke Organization-Lancet Neurology
Commission. Lancet Neurol. 2023;22(12):1160-206.
[10]. Hmaied
Assadi S, Barel H, Dudkiewicz I, Gross-Nevo RF, Rand D. Less-affected hand
function is associated with independence in daily living: A longitudinal study
poststroke. Stroke. 2022;53(3):939-46.
[11]. Li S,
Francisco GE, Zhou P. Post-stroke hemiplegic gait: New perspective and
insights. Front Physiol. 2018;9:1021.
[12]. Lo SH,
Chau JP. Experiences of participating in group-based rehabilitation programmes:
A qualitative study of community-dwelling adults with post-stroke aphasia. Int
J Lang Commun Disord. 2023;58(4):1082-97.
[13]. Harcourt
B, Brown RJ, Bowen A. Psychological aspects of caregiving after stroke: A
systematic scoping review and thematic synthesis of theories. Neuropsychol
Rehabil. 2025;35(10):2022-54. Available from: doi:10.1080/09602011.2025.2469652
[14]. Olaleye
O, Popoola OS, Akosile C, Adegoke BO. Relationship between post-stroke
spasticity and functional ambulation among Nigerian stroke survivors. J Nigeria
Soc Physiother. 2021;20(1):16-20. Available from: doi:10.5897/jnsp2021.0011
[15]. Ekechukwu
N, Olaleye O, Hamzat T. Clinical and psychosocial predictors of community
reintegration of stroke survivors three months post in-hospital discharge.
Ethiop J Health Sci. 2017;27(1):27-34.
[16]. World
Health Organization. International Classification of Functioning, Disability
and Health (ICF). Geneva: World Health Organization; 2001.
[17]. Leonardi
M, Lee H, Kostanjsek N, Fornari A, Raggi A, Martinuzzi A, et al. 20 years of
ICF—International Classification of Functioning, Disability and Health: Uses
and applications around the world. Int J Environ Res Public Health.
2022;19(18):11321. Available from: doi:10.3390/ijerph191811321
[18]. Vásquez-Carrasco
E, Jamett-Oliva P, Hernandez-Martinez J, Riquelme-Hernández C, Villagrán-Silva
F, Branco BH, et al. Effectiveness of occupational therapy interventions on
activities of daily living, cognitive function, and physical function in
middle-aged and older people with chronic stroke: A systematic review with
meta-analysis. J Clin Med. 2025;14(7):2197.
[19]. Raber
C, Watts J. The Assessment of Occupational Functioning–Collaborative Version.
In: Assessments in Occupational Therapy Mental Health. Routledge; 2024. p.
307-19.
[20]. Forsyth
K, Kielhofner G. Model of human occupation. In: Perspectives in Human
Occupation: Participation in Life. 2003. p. 45-86.
[21]. Winstein
CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for
adult stroke rehabilitation and recovery: A guideline for healthcare
professionals from the American Heart Association/American Stroke Association.
Stroke. 2016;47(6):e98-169.
[22]. Olaoye
OA, Soeker SM, Anthea R. Predictors of return to work among stroke survivors in
South-West Nigeria. Hong Kong J Occup Ther. 2021;34(1):13-22.
[23]. Ogunlana
MO, Oyewole OO, Fafolahan A, Govender P. Exploring community reintegration
among Nigerian stroke survivors. S Afr J Physiother. 2023;79(1):1857.
[24]. Mlambo
T, Pfavai Y, Chimusoro FR, Kaseke F. Stroke rehabilitation and occupational
therapy in low resource settings. In: Ambrosi PB, editor. Cerebrovascular
Diseases [Internet]. London: IntechOpen; 2021. Available from:
doi:10.5772/intechopen.101212
[25]. Napoleon
T, Akinrinde D, Alabi GJ, Eze C, Duru CN, Bazuaye O, et al. The burden of
stroke among HIV population in Africa: A review. Discov Public Health.
2025;22(1):336.
[26]. Okekunle AP, Jones S, Adeniji O, Watkins C, Hackett M, Di Tanna GL, et al. Stroke
in Africa: A systematic review and meta-analysis of the incidence and
case-fatality rates. Int J Stroke. 2023;18(6):634-44.
[27]. Adeloye
D, Ezejimofor M, Auta A, Mpazanje RG, Ezeigwe N, Ngige EN, et al. Estimating
morbidity due to stroke in Nigeria: A systematic review and meta-analysis. J
Neurol Sci. 2019;402:136-44.
[28]. Fernández-Solano
A, Del Baño-Aledo ME, Rodríguez-Bailón M. Results of an occupational
self-analysis program in people with acquired brain injury. A pilot study.
Brain Inj. 2019;34:253-61. Available from: doi:10.1080/02699052.2019.1689576
[29]. Harel-Katz
H, Carmeli E. The association between volition and participation in adults with
acquired disabilities: A scoping review. Hong Kong J Occup Ther.
2019;32(2):84-96. Available from: doi:10.1177/1569186119870022
[30]. Taylor
RR, editor. Kielhofner's model of human occupation: Research and application.
6th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2023.
[31]. Toh LK,
Križaj T. Experiences of occupational engagement in young and middle-aged women
post-stroke: A qualitative systematic review. Disabil Rehabil.
2026;48(3):581-97. Available from: doi:10.1080/09638288.2025.2515448
[32]. Shinohara
K, Yamada T, Kobayashi N, Forsyth K. The Model of Human Occupation-based
intervention for patients with stroke: A randomised trial. Hong Kong J Occup
Ther. 2012;22(2):60-9. Available from: doi:10.1016/j.hkjot.2012.09.001
[33]. Huang
YH, Wu CY, Kawano L, Kwak J, Simon K, Thai T. Predictors of self-efficacy and
health-related outcomes in community-dwelling stroke survivors. Am J Occup
Ther. 2019;73(4 Suppl 1):7311510244p1-. Available from:
doi:10.5014/ajot.2019.73S1-PO1045
[34]. Engelbrecht M, Van der Walt J, Van Biljon HM, Soeker SM. Occupational
therapy treatment protocols for cerebrovascular accidents: A rapid review of
evidence. S Afr J Occup Ther. 2024;54(2):87-97.
[35]. Hildebrand
MW, Geller D, Proffitt R. Occupational therapy practice guidelines for adults
with stroke. Am J Occup Ther. 2023;77(5):7705397010.
[36]. Kang E,
Kim MY, Lipsey KL, Foster ER. Person-centered goal setting: A systematic review
of intervention components and level of active engagement in rehabilitation
goal-setting interventions. Arch Phys Med Rehabil. 2022;103(1):121-30.
Available from: doi:10.1016/j.apmr.2021.06.025
[37]. Royal
College of Occupational Therapists. Professional standards for occupational
therapy practice, conduct and ethics. 3rd ed. London: Royal College of
Occupational Therapists; 2024.
[38]. Soeker
MS, Olaoye OA. Exploring the experiences of rehabilitated stroke survivors and
stakeholders with regard to returning to work in South-West Nigeria. Work.
2017;57(4):595-609.
[39]. García-Pérez
P, Rodríguez-Martínez MC, Gallardo-Tur A, Blanco-Reina E, de la Cruz-Cosme C,
Lara JP. Early occupational therapy intervention post-stroke (EOTIPS): A
randomized controlled trial. PLoS One. 2024;19(8):e0308800. Available from:
doi:10.1371/journal.pone.0308800
[40]. Esniwati
E. Analysis of the effect of occupational therapy on post-stroke patient
recovery: Impacts on motor skills, cognitive function, and emotional
well-being. Int J Health Med Sci. 2024;2(3):91-101.
[41]. Baichinov
R, Kumarzhanova KS, Kokkozeva K. The use of elements of occupational therapy in
the rehabilitation of speech of persons in the post-stroke period. J Psychol
Sociol. 2021.
[42]. Hua S,
Qiu K, Zeng S, Wang H, Liu T. Occupational therapy improves functional recovery
and reduces delirium in critically ill adults with and without stroke: A
systematic review and meta-analysis. Front Med (Lausanne). 2026;12:1733103.
Available from: doi:10.3389/fmed.2025.1733103. PMID: 41800213; PMCID:
PMC12961616.
[43]. Teasell
R, Salbach NM, Foley N, Mountain A, Cameron JI, Jong AD, et al. Canadian stroke
best practice recommendations: Rehabilitation, recovery, and community
participation following stroke. Part one: Rehabilitation and recovery following
stroke; update 2019. Int J Stroke. 2020;15(7):763-88. Available from:
doi:10.1177/1747493019897843
[44]. Langhorne, Derinto N, Olatunji G, Kokori E, Agbo CE, Babalola AE, et al. A scoping review of stroke rehabilitation in Africa: Interventions, barriers, and research gaps. J Health Popul Nutr. 2025;44(1):245. Available from: doi:10.1186/s41043-025-01004-z
