Open Access Open Badges Research article

Motor and functional recovery after stroke: a comparison between rehabilitation settings in a developed versus a developing country

Anthea Rhoda1*, Mario Smith1, Koen Putman2, Ratie Mpofu1, Willy DeWeerdt3 and Liesbet DeWit2

Author Affiliations

1 Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, 7535 Bellville, Western Cape, South Africa

2 Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussel, Laarbeeklaan 103, 1090 Jette, Belgium

3 Faculty of Kinesiology and Rehabilitation Sciences, Eekenhoornlaan 34, B-3210 Linden, Belgium

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BMC Health Services Research 2014, 14:82  doi:10.1186/1472-6963-14-82

Published: 22 February 2014



Recovery post stroke is well documented in the field of stroke rehabilitation. The structure and process of rehabilitation are different between developed and developing countries. The aim of the present study was to compare the motor and functional recovery of stroke patients in Germany versus stroke patients receiving rehabilitation in South Africa.


This study used secondary data analysis of patient protocols collected in two independent studies conducted in Germany and South Africa respectively. A total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recovery were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant differences in motor and functional recovery were found, using the Wilcoxon rank sum test on admission to the centre, and at two and six months after stroke. A generalized linear mixed-methods model (GLIMMIX) was used to compare the recovery patterns between the participants from the two settings over time.


The results of the GLIMMIX revealed a significant difference in favour of the German participants for gross motor (RMA-GF) and upper limb (RMA-A) recovery, while no significant difference was found for lower limb (RMA-LT) and functional (BI) recovery patterns between the participants of the two settings. No significant differences existed in RMA-A and BI-scores on admission to the CHC/SRU. At two and six months after stroke, both the RMA-A and BI-scores were significantly lower in the South African than the German sample.


The results of this study provide empirical evidence for differential recovery patterns for patients in developed and developing countries. A detailed exploration of the factors to which this difference in recovery patterns can be attributed was beyond the scope of the present study, and is recommended for future research.

Stroke; Recovery; Rehabilitation; Developing countries; Developed countries