51
|
Gallacher K, Morrison D, Jani B, Macdonald S, May CR, Montori VM, Erwin PJ, Batty GD, Eton DT, Langhorne P, Mair FS. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med 2013; 10:e1001473. [PMID: 23824703 PMCID: PMC3692487 DOI: 10.1371/journal.pmed.1001473] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. METHODS AND FINDINGS The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. CONCLUSIONS Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.
Collapse
Affiliation(s)
- Katie Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Bhautesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carl R. May
- Faculty of Health Sciences, University of Southampton, United Kingdom
| | - Victor M. Montori
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Patricia J. Erwin
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom
| | - David T. Eton
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
- * E-mail:
| |
Collapse
|
52
|
Kitzmüller G, Häggström T, Asplund K, Gilje FL. The Existential Meaning of Couples' Long-Term Experience of Living with Stroke. ACTA ACUST UNITED AC 2012. [DOI: 10.2190/il.20.4.c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study employs Heideggerian hermeneutic phenomenology to uncover the existential meaning of couples' long-term experiences of living with stroke. Transcripts of 23 interviews with stroke survivors and 17 interviews with spouses focusing on the couple perspective were analyzed. The five emerging themes and the constitutive pattern illuminate the existential meaning of stroke and include fear, hope, unfamiliarity, temporality, and reinterpretation of the life-world. The constitutive pattern indicates that life after stroke is characterized by the struggle to adapt to an abruptly twisted and unfamiliar being-in-the-world. Changes in couples' interpretations of their life-world seem to be connected with different interpretations of time and an increased view of life as limited. Health professionals with an empathic understanding of the existential meaning of stroke may better facilitate the reinterpretation of couples' actual life-world. Stroke couples' life-restricting fears of living, dying, and caregiving should be explored further.
Collapse
Affiliation(s)
| | | | - Kenneth Asplund
- University of Mid-Sweden, Sundsvall and University of Tromsø, Norway
| | | |
Collapse
|
53
|
Anderson S, Whitfield K. Social identity and stroke: ‘they don't make me feel like, there's something wrong with me’. Scand J Caring Sci 2012; 27:820-30. [DOI: 10.1111/j.1471-6712.2012.01086.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 07/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Sharon Anderson
- Social Support Research Program; Suite 700 University Terrace, University of Alberta; Edmonton AB Canada
| | - Kyle Whitfield
- Faculty of Extension, School of Public Health; University of Alberta; Edmonton AB Canada
| |
Collapse
|
54
|
Chang LH, Wang J. Institutional contexts contribute to the low priority given to developing self-care independence in a rehabilitation ward: a qualitative study. Clin Rehabil 2012; 27:538-45. [PMID: 23117348 DOI: 10.1177/0269215512461264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the institutional contexts that contribute to the low priority given to the development of self-care independence in a rehabilitation ward. DESIGN Research was guided by ethnographic principles of Martyn Hammersley and Paul Atkinson (2007). Individual in-depth interviews were completed. Participant observation was done daily during the rehabilitation stay of the patients. PATIENTS Six men and three women with neurological impairments and their caregivers. RESULTS Patients' daily routines on a rehabilitation ward in Taiwan are described. Four prominent themes emerged from the data: (1) the attitudes of patients, caregivers, and staff facilitated extended rehabilitation stays within the first year after disability, (2) attending therapy sessions was the most important activity, (3) pragmatic considerations, such as 'faster and easier', outweighed the value of developing self-care independence, and (4) strategic organization of daily routines to keep therapy the priority was critical for daily activity. CONCLUSION Multiple institutional factors jeopardize the development of self-care independence in a rehabilitation ward. The factors include the primacy of biomedical-oriented rehabilitation ideology, insurance reimbursement policies, and cultural values associated with family caregiving. They legitimize the low priority given to developing self-care independence. Therapists need to include a critical review of daily routines (what and how activities are carried out inside and outside of therapy clinics) as part of therapy regime to identify opportunities and institutional constraints to the development of self-care independence.
Collapse
Affiliation(s)
- Ling-Hui Chang
- Department of Occupational Therapy, National Cheng-Kung University, College of Medicine, Tainan, Taiwan
| | | |
Collapse
|
55
|
Abstract
BACKGROUND Fatigue affects 33-77% of stroke survivors. There is no consensus concerning risk factors for fatigue post-stroke, perhaps reflecting the multifaceted nature of fatigue. We characterized post-stroke fatigue using the Fatigue Impact Scale (FIS), a validated questionnaire capturing physical, cognitive, and psychosocial aspects of fatigue. METHODS The Stroke Outcomes Study (SOS) prospectively enrolled ischemic stroke patients from 2001-2002. Measures collected included basic demographics, pre-morbid function (Oxford Handicap Scale, OHS), stroke severity (Stroke Severity Scale, SSS), stroke subtype (Oxfordshire Community Stroke Project Classification, OCSP), and discharge function (OHS; Barthel Index, BI). An interview was performed at 12 months evaluating function (BI; Modified Rankin Score, mRS), quality of life (Reintegration into Normal living Scale, RNL), depression (Geriatric Depression Scale, GDS), and fatigue (FIS). RESULTS We enrolled 522 ischemic stroke patients and 228 (57.6%) survivors completed one-year follow-up. In total, 36.8% endorsed fatigue (59.5% rated one of worst post-stroke symptoms). Linear regression demonstrated younger age was associated with increased fatigue frequency (β=-0.20;p=0.01), duration (β=-0.22;p<0.01), and disability (β=-0.24;p<0.01). Younger patients were more likely to describe fatigue as one of the worst symptoms post-stroke (β=-0.24;p=0.001). Younger patients experienced greater impact on cognitive (β=-0.27;p<0.05) and psychosocial (β=-0.27;p<0.05) function due to fatigue. Fatigue was correlated with depressive symptoms and diminished quality of life. Fatigue occurred without depression as 49.0% of respondents with fatigue as one of their worst symptoms did not have an elevated GDS. CONCLUSIONS Age was the only consistent predictor of fatigue severity at one year. Younger participants experienced increased cognitive and psychosocial fatigue.
Collapse
|
56
|
Lamb M, Buchanan D, Godfrey CM, Harrison MB, Oakley P. The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review. INT J EVID-BASED HEA 2012; 6:173-205. [PMID: 21631820 DOI: 10.1111/j.1744-1609.2008.00079.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. Inclusion criteria This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. Search strategy The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Methodological quality Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data collection Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data synthesis Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. Results A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. Conclusion The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self.
Collapse
Affiliation(s)
- Marianne Lamb
- School of Nursing, Queen's University, Kingston, Ontario, Canada, K7L 3N6, Queen's Joanna Briggs Collaboration, Queen's University, Kingston, Ontario, Canada, K7L 3N6, National Research Council Information Centre Institute for Information Technology, Fredericton, New Brunswick, Canada, E3B 9W4
| | | | | | | | | |
Collapse
|
57
|
Eilertsen G, Ormstad H, Kirkevold M. Experiences of poststroke fatigue: qualitative meta-synthesis. J Adv Nurs 2012; 69:514-25. [DOI: 10.1111/jan.12002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Grethe Eilertsen
- Department of Health Sciences; Buskerud University College; Drammen Norway
| | - Heidi Ormstad
- Vestre Viken Hospital Trust/Buskerud University College; Drammen Norway
| | - Marit Kirkevold
- Department of Nursing Science; Institute of Health and Society; University of Oslo; Oslo Norway
| |
Collapse
|
58
|
Determining the needs, priorities, and desired rehabilitation outcomes of young adults who have had a stroke. Rehabil Res Pract 2012; 2012:963978. [PMID: 22852087 PMCID: PMC3407657 DOI: 10.1155/2012/963978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 05/21/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Guidelines state that young adults' (aged 18–55 years) rehabilitation needs and priorities following stroke are different from older adults'. However, there is a lack of evidence regarding young adults' perspectives of their needs and priorities.
Aim. To gain an understanding of young adults' experience of stroke and associated rehabilitation needs, priorities, and desired outcomes.
Methods. A qualitative approach was adopted, based on the phenomenology of Merleau-Ponty. Longitudinal data were gathered using unstructured interviews and analysed using phenomenological reduction.
Results. Ten young adults took part in up to four interviews over two years. An overarching theme, Embodied Disorientation, and three subthemes: Mortal Body, Situated Body, and Embodied Perception of Difference, described the young adults' experience. A subsequent iterative process enabled tabulation of patient-centred rehabilitation needs, priorities, and outcomes.
Conclusion. Rehabilitation professionals can use the evidence-based outcomes table to work with young adults to develop meaningful patient-centred goals and select appropriate interventions which align with identified needs and outcomes throughout the stroke recovery trajectory.
Collapse
|
59
|
Zedlitz AMEE, van Eijk M, Kessels RPC, Geurts ACH, Fasotti L. Poststroke Fatigue Is Still a Neglected Issue: Findings from an Internet-Based Study on the Need for Information and Treatment in The Netherlands. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/629589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. To evaluate the need for information and treatment of poststroke fatigue (PSF) in community-dwelling patients with stroke in The Netherlands. Methods. Data were obtained from a Dutch internet-based questionnaire. The amount of information received about PSF, self-management and other treatment options, and the perceived need for treatment were scored. PSF was assessed with two Visual Numerical Scales of fatigue severity (VNSF), the Fatigue Severity Scale (FSS7), and by scoring the nature (physical versus mental) and onset time of PSF. Results. Data were available of 538 stroke survivors (mean age 52 years, 45% men, and mean time since onset 2.7 years). Severe fatigue (both VNSF items ≥7; 48%) and severe fatigue impact (FSS7 > 5; 68%) were frequent. Most participants (57%) experienced both physical and mental fatigue. Only 17% of the respondents indicated to have had received sufficient information about PSF and 7% about treatment options, whereas 56% expressed a substantial need for treatment. The need for treatment was moderately associated with fatigue severity and fatigue impact, whereas information status was not related to any demographical, fatigue, or stroke characteristic. Conclusions. PSF is a significant symptom after stroke requiring medical attention and treatment. The results of this survey indicate that patients do not receive adequate information on PSF.
Collapse
Affiliation(s)
- Aglaia M. E. E. Zedlitz
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE Nijmegen, The Netherlands
- Department of Clinical Neuropsychology, Leiden University, 2300 RB Leiden, The Netherlands
| | | | - Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation Medicine, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE Nijmegen, The Netherlands
- Research, Development and Education, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands
| |
Collapse
|
60
|
Rejnö Å, Danielson E, von Post I. The unexpected force of acute stroke leading to patients’ sudden death as described by nurses. Scand J Caring Sci 2012; 27:123-30. [DOI: 10.1111/j.1471-6712.2012.01011.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
61
|
Andersen G, Christensen D, Kirkevold M, Johnsen SP. Post-stroke fatigue and return to work: a 2-year follow-up. Acta Neurol Scand 2012; 125:248-53. [PMID: 21692753 DOI: 10.1111/j.1600-0404.2011.01557.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Post-stroke fatigue may affect the ability to return to work but quantitative studies are lacking. METHOD We included 83 first-ever stroke patients <60 years and employed either full-time (n = 77) or part-time (n = 6) at baseline. The patients were recruited from stroke units at Aarhus University Hospital between 2003 and 2005 and were followed for 2 years. Fatigue was assessed by the Multidimensional Fatigue Inventory. Pathological fatigue was defined as a score ≥12 on the General Fatigue dimension. Return to paid work was defined as working at least 10 h per week. Data were analyzed using multivariable logistic regression. RESULTS A total of 58% of patients had returned to paid work after 2 years. The adjusted Odds Ratio (OR) for returning to paid work was 0.39 (95% confidence interval (CI) 0.16-1.08) for patients with a General Fatigue score ≥12 at baseline. Persisting pathological fatigue after 2 years of follow-up was associated with a lower chance of returning to paid work [adjusted OR 0.29 (95% CI 0.11-0.74)]. Higher scores of General Fatigue at follow-up also correlated negatively with the chance of returning to paid work when analyzing fatigue on a continuous scale (adjusted OR 0.87, 95% CI 0.80-0.94 for each point increase in General Fatigue). CONCLUSIONS Post-stroke fatigue appears to be an independent determinant of not being able to resume paid work following stroke.
Collapse
Affiliation(s)
- G Andersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | | | | | | |
Collapse
|
62
|
Sumathipala K, Radcliffe E, Sadler E, Wolfe CDA, McKevitt C. Identifying the long-term needs of stroke survivors using the International Classification of Functioning, Disability and Health. Chronic Illn 2012; 8:31-44. [PMID: 22025770 DOI: 10.1177/1742395311423848] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate how contextual factors, as described by the World Health Organisation's International Classification of Functioning, Disability and Health (ICF), impact on stroke survivors' functioning and how needs are perceived in the long term after stroke. METHODS Semi-structured interviews were conducted with 35 participants between 1 and 11 years after stroke. Data were analysed thematically using the ICF conceptual framework. RESULTS Long-term needs related to activities of daily living, social participation, mobility aids, home adaptations, housing, financial support, rehabilitation, information and transport. Participants identified a range of ICF environmental and personal factors including 'support and relationships,' 'products and technology,' 'services, systems and policies,' 'attitudes,' life experiences, social position and personal attitudes. Interactions between these contextual factors shaped functioning and how long-term needs were perceived. Social support from family and friends was a key facilitator of functioning for most participants, buffering the impact of disabilities and mediating perceived needs. Needs were not always stroke specific as many participants experienced other health problems. DISCUSSION The ICF framework was useful to investigate how contextual factors shaped functioning and mediated perceived long-term needs. Development of services to meet long-term needs among stroke survivors should consider the range of environmental and personal factors affecting how needs are perceived.
Collapse
|
63
|
Poor concurrence between disabilities as described by patients and established assessment tools three months after stroke: A mixed methods approach. J Neurol Sci 2012; 313:160-6. [DOI: 10.1016/j.jns.2011.08.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/24/2011] [Accepted: 08/26/2011] [Indexed: 11/30/2022]
|
64
|
Bontje P, Asaba E, Tamura Y, Josephsson S. Japanese older adults' perspectives on resuming daily life during hospitalization and after returning home. Occup Ther Int 2012; 19:98-107. [PMID: 22223443 DOI: 10.1002/oti.329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 11/05/2022] Open
Abstract
Throughout Japan, occupational therapy for older adults is available in an increasing array of institutional and community settings. However, there is a need for more knowledge of "how" older adults resume their daily lives particularly in the community. The aim of this qualitative research was to identify and describe how some older adults in Japan describe their experiences of resuming daily life during hospitalization and after returning home. Nine older adults with various physical impairments were interviewed. The open interviews were conducted 10 months to 5 years from the onset of their physical impairment. Data analysis on the basis of a constant comparative methodology resulted in three themes that characterize their experiences of resuming daily life: "doing the right thing", "reconciling to dependence" and "becoming invigorated". These themes may inform occupational therapists to take into consideration older clients' perspectives when assisting them to recapture the quality of their daily life according to their preferences. Adaptive change is promoted by assisting older clients to generate the energy they need by judiciously varying approaches appropriate to their goals and by helping older clients to make decisions that are "right" for them, which may fluctuate during processes of resuming daily life. Limitations of this study are found in the small sample size, and additional research may help to clarify how moral aspects, vigour (physical and mental energy/force) and other dimensions shape processes of resuming daily life as well as the influences of time.
Collapse
Affiliation(s)
- Peter Bontje
- Division of Occupational Therapy, Karolinska Institute, Fack 23 200, SE-141-23, Huddinge, Sweden.
| | | | | | | |
Collapse
|
65
|
Wottrich AW, Åström K, Löfgren M. On parallel tracks: newly home from hospital—people with stroke describe their expectations. Disabil Rehabil 2011; 34:1218-24. [DOI: 10.3109/09638288.2011.640381] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
66
|
Kirkevold M, Christensen D, Andersen G, Johansen SP, Harder I. Fatigue after stroke: manifestations and strategies. Disabil Rehabil 2011; 34:665-70. [PMID: 21995298 DOI: 10.3109/09638288.2011.615373] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe how fatigue is experienced by stroke survivors, how they understand and deal with fatigue and how fatigue impacts their daily life. METHOD A qualitative interview study was carried out as part of a larger longitudinal study investigating the prevalence, characteristics and contributing factors to post-stroke fatigue. Thirty-two participants (15 men and 17 women) were strategically sampled to explore the experiences of fatigue. Participants were interviewed at 6 months, 1 year and 2 years post-stroke. Data were analysed applying a Grounded theory approach. RESULTS Patients clearly described and differentiated their experience between: (1) tiredness as an ordinary life event and (2) fatigue as a post-stroke life condition. Three fatigue-transforming strategies were identified, being on a mission, settling for less and stalling. Stalling seemed to put the stroke survivors in a particularly vulnerable situation. Over time, some participants moved between these two tiredness/fatigue manifestations and their range of strategies. CONCLUSIONS Post-stroke fatigue is a new life experience different from ordinary tiredness and seems to be a significant problem in the stroke survivors' struggle to regain a new normalcy. Intervention studies are needed to reduce the impact of post-stroke fatigue on coping and recovery.
Collapse
Affiliation(s)
- Marit Kirkevold
- Department of Public Health, Aarhus University, Århus, Denmark.
| | | | | | | | | |
Collapse
|
67
|
Palmcrantz SM, Holmqvist LW, Sommerfeld DK. Development, validity and reliability of a postal questionnaire assessing health states relevant to young persons with stroke in Sweden. Disabil Rehabil 2011; 33:1179-85. [DOI: 10.3109/09638288.2010.524273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
68
|
Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011; 25:501-14. [DOI: 10.1177/0269215510394467] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To map out from the literature the nature, extent and effects of application of patient-centred goal setting in stroke rehabilitation practice. Design: Systematic review. Data sources: A search was conducted in the Cochrane (Wiley), AMED, Medline (EBSCO), Embase, Sports discuss, Medline (Ovid) and CINAHL databases. Secondary search based on references from the preliminary search was undertaken. Review methods: Quantitative and qualitative studies that included aspects of patient-centredness and goal setting in stroke patients from 1980 to June 2010 were collected. Studies were scrutinized for relevance and quality based on published methodology. The findings were synthesized by aggregating the themes from the qualitative studies and relating them to relevant findings from the quantitative studies. Results: Eighteen qualitative and eight quantitative and one mixed method study conducted in stroke rehabilitation services ranging from acute to community rehabilitation were included. Themes that emerged were related to perceptions of patients and professionals regarding patient-centredness, nominal adoption of this concept, consequences of discrepancies in the perceptions and practice, related ethical conflicts, challenges to application and strategies to improve its application. The effects of following patient-centred goal-setting practice have been studied mostly with weak methodologies and studies show some benefit with psychological outcomes. Conclusion: Patient-centred goal setting is minimally adopted in goal-setting practice due to various barriers. Since the effects of incorporating this concept have not been evaluated rigorously it is suggested that further research is essential to investigate its effect on patient outcomes.
Collapse
Affiliation(s)
- Sheeba Rosewilliam
- School of Health and Population Sciences-Nursing and Physiotherapy, University of Birmingham, UK
| | - Carolyn Anne Roskell
- School of Health and Population Sciences-Nursing and Physiotherapy, University of Birmingham, UK
| | - AD Pandyan
- School of Health and Rehabilitation, Keele University, UK
| |
Collapse
|
69
|
Morris R. The psychology of stroke in young adults: the roles of service provision and return to work. Stroke Res Treat 2011; 2011:534812. [PMID: 21423559 PMCID: PMC3056452 DOI: 10.4061/2011/534812] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 12/23/2010] [Accepted: 01/09/2011] [Indexed: 01/23/2023] Open
Abstract
Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. "Hidden" cognitive impairments, a disrupted sense of self, and the incongruity of suffering an "older person's" disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.
Collapse
Affiliation(s)
- Reg Morris
- School of Psychology, Cardiff University, and Cardiff and Vale University Local Health Board, Archway House, 77 TY Glas Avenue, Llanishen, Cardiff CF14 5DX, UK
| |
Collapse
|
70
|
Abstract
Approximately one-third of patients with stroke exhibit persistent disability after the initial cerebrovascular episode, with motor impairments accounting for most poststroke disability. Exercise and training have long been used to restore motor function after stroke. Better training strategies and therapies to enhance the effects of these rehabilitative protocols are currently being developed for poststroke disability. The advancement of our understanding of the neuroplastic changes associated with poststroke motor impairment and the innate mechanisms of repair is crucial to this endeavor. Pharmaceutical, biological and electrophysiological treatments that augment neuroplasticity are being explored to further extend the boundaries of poststroke rehabilitation. Potential motor rehabilitation therapies, such as stem cell therapy, exogenous tissue engineering and brain-computer interface technologies, could be integral in helping patients with stroke regain motor control. As the methods for providing motor rehabilitation change, the primary goals of poststroke rehabilitation will be driven by the activity and quality of life needs of individual patients. This Review aims to provide a focused overview of neuroplasticity associated with poststroke motor impairment, and the latest experimental interventions being developed to manipulate neuroplasticity to enhance motor rehabilitation.
Collapse
Affiliation(s)
- Michael A Dimyan
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1428, USA
| | | |
Collapse
|
71
|
Eilertsen G, Kirkevold M, Bjørk IT. Recovering from a stroke: a longitudinal, qualitative study of older Norwegian women. J Clin Nurs 2011; 19:2004-13. [PMID: 20920026 DOI: 10.1111/j.1365-2702.2009.03138.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To illuminate older women's experiences and the characteristics of the recovery process following a stroke. BACKGROUND Patients with stroke face serious challenges related to bodily changes, existential aspects and daily life after stroke. Few qualitative longitudinal studies have examined the recovery process from the perspective of the patient. Knowledge about older women's experiences in coping with life after a stroke is limited. DESIGN Prospective, longitudinal, case-study design. METHODS Six women aged 68-83 suffering from first-time stroke were recruited from two stroke units. Each participant was interviewed in-depth 12-14 times during the first two years post stroke. The interviews addressed how they experienced their body, their self-understanding, daily life and how this had changed over time. Most interviews took place in the participants' homes. Gadamer's philosophical hermeneutics informed the analyses. RESULTS Post stroke recovery was slow and complex and evolved through four distinct phases. In the first phase (0-2 months post stroke), the participants' main concerns were their bodily changes; in the second phase (2-6 months), activities of daily life; in the third phase (6-12 months), self-understanding and in the fourth phase (12-24 months), going on with life. The transition between phases was gradual. CONCLUSION Recovery from stroke evolves over time through four distinct phases, which differ depending on significant experiences and associated meanings. Psychological and social resources are equally critical in the women's process of recovery. RELEVANCE TO CLINICAL PRACTICE The four phases of rehabilitation suggest at what points various concerns require increased therapeutic attention. Psychological and social resources must be vitalised at an early phase similar to bodily resources. This knowledge may assist professionals in offering adequate help throughout the recovery process even beyond the established rehabilitation period.
Collapse
|
72
|
The Joanna Briggs Institute Best Practice Information Sheet: The psychosocial and spiritual experiences of elderly individuals recovering from a stroke. Nurs Health Sci 2010; 12:515-8. [DOI: 10.1111/j.1442-2018.2010.00555.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
73
|
Wood JP, Connelly DM, Maly MR. 'Getting back to real living': A qualitative study of the process of community reintegration after stroke. Clin Rehabil 2010; 24:1045-56. [PMID: 20713436 DOI: 10.1177/0269215510375901] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the process of community reintegration over the first year following stroke, from the patient's perspective. DESIGN Qualitative, longitudinal, grounded theory study involving ten participants. During the first year post discharge from inpatient rehabilitation, 46 one-on-one semi-structured interviews were conducted with ten participants. Interviews were completed with participants before discharge from inpatient stroke rehabilitation and in their homes at two weeks, three months, six months and one year post discharge. Analysis was guided by grounded theory methods described by Corbin and Strauss. SUBJECTS Four women and six men (mean age 59.6 ± 18.0, all with left hemiparesis and without aphasia) who had sustained their first hemispheric stroke and were returning to the community following inpatient rehabilitation. RESULTS The process of community reintegration after stroke involved transitioning through a series of goals: gaining physical function, establishing independence, adjusting expectations and getting back to real living. The ultimate challenge for stroke survivors during this process of community reintegration was to create a balance between their expectations of themselves and their physical capacity to engage in meaningful roles. CONCLUSIONS Over the first year after stroke, participants reported that the process of community reintegration was marked by ongoing changes in their goals. Formal and informal caregivers need to work with stroke survivors living in the community to facilitate realistic and achievable goal setting. Tools which identify meaningful activities should also be incorporated to provide stroke survivors with the opportunity to contribute and engage with others in the community.
Collapse
Affiliation(s)
- Jennifer P Wood
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | | |
Collapse
|
74
|
Almborg AH, Ulander K, Thulin A, Berg S. Discharged after stroke - important factors for health-related quality of life. J Clin Nurs 2010; 19:2196-206. [DOI: 10.1111/j.1365-2702.2010.03251.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
75
|
Lerdal A, Bakken LN, Rasmussen EF, Beiermann C, Ryen S, Pynten S, Drefvelin AS, Dahl AM, Rognstad G, Finset A, Lee KA, Kim HS. Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke. Disabil Rehabil 2010; 33:334-42. [PMID: 20521900 DOI: 10.3109/09638288.2010.490867] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to describe prevalence of fatigue and its relationship with demographic and clinical variables during the first 2 weeks (acute phase) following a stroke. METHOD Data were collected in a cross-sectional correlational study from face-to-face interviews using structured questionnaires and patient's medical records. The sample consists of 115 patients with first-ever stroke admitted to two hospitals in Norway in 2007 and 2008. Post-stroke fatigue was measured with the Fatigue Severity Scale (FSS). The FSS measure was applied in the analysis as a continuous variable, and also used to categorise patients into three groups of fatigue intensity: no fatigue (mean FSS-score <4), moderate fatigue (mean FSS-score = 4-4.9) and severe fatigue (mean FSS-score ≥5). Patients who reported fatigue lasting longer than 3 months before the stroke were defined as having prestroke fatigue. RESULTS Pre-stroke fatigue was reported by 34 patients (30%). After stroke, 24% had severe fatigue, and fatigue was more common for women (57%). Controlling for sex and prestroke fatigue, the multivariate analysis showed that prestroke fatigue, lower physical function and depressive symptoms were related to post-stroke fatigue. CONCLUSION Pre-stroke fatigue and fatigue during the acute phase needs to be assessed in relation to physical functioning and depression during recovery and the rehabilitation process.
Collapse
Affiliation(s)
- Anners Lerdal
- Department of Health Sciences, Buskerud University College, Drammen, Norway.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Lawrence M. Young adults' experience of stroke: a qualitative review of the literature. ACTA ACUST UNITED AC 2010; 19:241-8. [PMID: 20220675 DOI: 10.12968/bjon.2010.19.4.46787] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke is a life-threatening event that has a devastating impact on young adults and their families. The author conducted a systematic review of the qualitative literature to explore the experience of stroke from the perspective of young adults. Four primary research 'papers' were analyzed using the Qualitative Assessment and Review Instrument; 60 findings were extracted from the papers and merged into 13 categories, from which three synthesized findings were developed - disorientation, disrupted sense of self, and roles and relationships. Many of the effects of stroke are 'invisible' but have significant impact on social participation, including the ability to return to work and to enjoy an active social life. Young adults feel the same and yet different following stroke, which may have a profound effect on relationships. Effective communication between patients, families and health professionals is crucial to all aspects of recovery.
Collapse
Affiliation(s)
- Maggie Lawrence
- Buchanan House, School of Health, Glasgow Caledonian University, UK
| |
Collapse
|
77
|
Carlsson E, Ehnfors M, Ehrenberg A. Multidisciplinary recording and continuity of care for stroke patients with eating difficulties. J Interprof Care 2010; 24:298-310. [DOI: 10.3109/13561820903011976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
78
|
Rochette A, Korner-Bitensky N, Bishop D, Teasell R, White C, Bravo G, Côté R, Lachaine J, Green T, Lebrun LH, Lanthier S, Kapral M, Wood-Dauphinee S. Study protocol of the YOU CALL--WE CALL TRIAL: impact of a multimodal support intervention after a "mild" stroke. BMC Neurol 2010; 10:3. [PMID: 20053273 PMCID: PMC2818655 DOI: 10.1186/1471-2377-10-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/06/2010] [Indexed: 11/26/2022] Open
Abstract
Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable. Trial Registration ISRCTN95662526
Collapse
|
79
|
The role of nursing in the rehabilitation of stroke survivors: an extended theoretical account. ANS Adv Nurs Sci 2010; 33:E27-40. [PMID: 20154522 DOI: 10.1097/ans.0b013e3181cd837f] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article provides a critique and theoretical extension of a work that sought to describe the contribution of nurses to stroke rehabilitation. At the time, the role of nursing was considered important but therapeutically nonspecific. Stroke nursing research has increased significantly and so has research focusing on the patient experiences of the adjustment and rehabilitation processes following a stroke. These developments provide significant new insights that may refine and extend the original understanding of the role of nursing in stroke rehabilitation. This article proposes an extended theoretical framework of the role of nursing in stroke recovery and rehabilitation.
Collapse
|
80
|
Lerdal A, Bakken LN, Kouwenhoven SE, Pedersen G, Kirkevold M, Finset A, Kim HS. Poststroke fatigue--a review. J Pain Symptom Manage 2009; 38:928-49. [PMID: 19811888 DOI: 10.1016/j.jpainsymman.2009.04.028] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 04/07/2009] [Accepted: 04/09/2009] [Indexed: 12/26/2022]
Abstract
Although fatigue is a common complaint after stroke, relatively little is known about how poststroke fatigue is experienced and what its related factors are. An in-depth understanding is necessary to develop effective and patient-centered poststroke rehabilitation programs. This review was undertaken to provide a comprehensive synthesis of knowledge from the literature concerning the description, definition, and measurement of fatigue and its relationship to sociodemographic and clinical factors. A search in PubMed, CINAHL, EMBASE, and PsychInfo was performed using "stroke" or "cerebrovascular accident" as medical subject headings in combination with "fatigue" as a key word. Descriptions of fatigue revealed multiple dimensions of the phenomenon. Although no specific theoretical definition of fatigue as a poststroke condition was found, a case definition has recently been published to be used as a tool to determine the presence of fatigue in poststroke patients. Poststroke fatigue is most frequently measured by using the general fatigue scales such as the Fatigue Severity Scale and a Fatigue Visual Analogue Scale, as there is no scale developed to measure poststroke fatigue specifically. Age, sex, living conditions, and personality were associated with poststroke fatigue, albeit with some conflicting findings. Conflicting results also were found in the relationships between fatigue and stroke-related characteristics such as stroke location/type, the number of strokes, and neurological deficits. There is an indication that prestroke and poststroke fatigue are related. Possible antecedent components identified are personal factors, biomarkers, stroke characteristics, prestroke fatigue, and comorbidity. As knowledge regarding poststroke fatigue remains limited, there is a need to continue empirical research with various theoretical orientations.
Collapse
Affiliation(s)
- Anners Lerdal
- Department of Health Sciences, Buskerud University College, 3007 Drammen, Norway.
| | | | | | | | | | | | | |
Collapse
|
81
|
Finch LE, Higgins J, Wood-Dauphinee SL, Mayo NE. A Measure of Physical Functioning to Define Stroke Recovery at 3 Months: Preliminary Results. Arch Phys Med Rehabil 2009; 90:1584-95. [DOI: 10.1016/j.apmr.2009.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 02/16/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
|
82
|
Wolf TJ, Baum C, Conner LT. Changing face of stroke: implications for occupational therapy practice. Am J Occup Ther 2009; 63:621-5. [PMID: 19785261 PMCID: PMC2862359 DOI: 10.5014/ajot.63.5.621] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stroke is one of the most life-altering syndromes affecting the world population. Rehabilitation for people experiencing stroke is focused almost exclusively on self-care activities and being able to return home and has little to no focus on work rehabilitation or community reintegration. The Cognitive Rehabilitation Research Group (CRRG) at the Washington University School of Medicine in St. Louis was formed with the vision of improving everyday life for people after stroke by translating knowledge from neuroscience into treatment programs for productive living. Descriptive analysis of the intake assessment from the CRRG Clinical Core (N = 7,740) revealed three important findings: The age at stroke is decreasing, most strokes are neurologically mild to moderate in nature, and discharge placement decisions are being made largely on the basis of measures of impairment. The changes in the stroke population require occupational therapy to expand rehabilitation beyond the acute management of stroke to address full participation in work, family, and community life.
Collapse
Affiliation(s)
- Timothy J Wolf
- Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108, USA.
| | | | | |
Collapse
|
83
|
Carlsson GE, Möller A, Blomstrand C. Managing an everyday life of uncertainty – A qualitative study of coping in persons with mild stroke. Disabil Rehabil 2009; 31:773-82. [DOI: 10.1080/09638280802638857] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
84
|
Abstract
Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or "will" and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.
Collapse
Affiliation(s)
- Jennie Medin
- National Center of Work and Rehabilitation, Linköping University, Linköping, Sweden.
| | | | | |
Collapse
|
85
|
Daniel K, Wolfe CDA, Busch MA, McKevitt C. What are the social consequences of stroke for working-aged adults? A systematic review. Stroke 2009; 40:e431-40. [PMID: 19390074 DOI: 10.1161/strokeaha.108.534487] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Approximately one fourth of strokes occur in people aged <65 years. UK current policy calls for services that meet the specific needs of working-aged adults with stroke. We aimed to identify the social consequences of stroke in working-aged adults, which might subsequently inform the development and evaluation of services for this group. METHODS We reviewed quantitative and qualitative studies identifying social consequences for working-aged adults with stroke using multiple search strategies (electronic databases, bibliographic references, hand searches). Social consequences were defined as those pertaining to the World Health Organization International Classification of Functioning, Disability and Health domain "participation." Two authors reviewed articles using a standardized matrix for data extraction. RESULTS Seventy-eight studies were included: 66 were quantitative observational studies, 2 were quantitative interventional studies, 9 were qualitative studies, and one used mixed methods. Seventy studies reported data on return to work after stroke with proportions ranging from 0% to 100%. Other categories of social consequences included negative impact on family relationships (5% to 54%), deterioration in sexual life (5% to 76%), economic difficulties (24% to 33%), and deterioration in leisure activities (15% to 79%). CONCLUSIONS Methodological variations account for the wide range of rates of return to work after stroke. There is limited evidence of the negative impact of stroke on other aspects of social participation. Robust estimates of the prevalence of such outcomes are required to inform the development of appropriate interventions. We propose strategies by which methodology and reporting in this field might be improved.
Collapse
Affiliation(s)
- Katie Daniel
- King's College London, Division of Health and Social Care Research, 42 Weston Street, London SE1 3QD, UK.
| | | | | | | |
Collapse
|
86
|
|
87
|
Abstract
The main purpose of this study is to categorize and analyze the most stressful situations perceived by stroke patients during a period of 6 months after experiencing a stroke. The events that have an impact on the subjective well-being and the intensity of the stress are also investigated. A clinic-based sample of 82 hospitalized stroke patients were studied 4 times after the stroke incident. They were asked to describe and appraise the most stressful event or situation that had affected them during the last 3 days. The data analysis was conducted according to phenomenological and hermeneutical methods. The study was approved by the Regional Committee for Ethics in Medical Research. The reported difficulties after a stroke have been separated into 5 categories: 1) impairments and disabilities in bodily functions; 2) communication and memory problems; 3) negative thoughts, depression and loneliness; 4) anxiety, fear, and worries; and 5) anger. Stressful situations in the first category were the most frequently reported, while those in the fourth category increased during the first 2 weeks after discharge, but decreased again within 3 months after the stroke. Encounters in the second category were less reported over time while those in the third category tended to become a more stable emotional state. Some interviewees expressed anger (category five). Few described relief or no difficulties at all. In total, the intensity of the stressful events decreased strongly. The increased occurrence of anxiety, fear, and worries during the first weeks after discharge from hospital gives rise to concern. These strains coincide with the withdrawal of health services.
Collapse
|
88
|
Pringle J, Hendry C, McLafferty E. A review of the early discharge experiences of stroke survivors and their carers. J Clin Nurs 2008; 17:2384-97. [PMID: 18705718 DOI: 10.1111/j.1365-2702.2008.02372.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES Understanding the experiences of stroke patients and their carers during the early days following discharge from hospital is an important aspect of providing appropriate care during this crucial time. BACKGROUND Due to the diverse changes that can result from a stroke, adjustment to returning home may raise many issues for those involved. A review of research was undertaken with the aim of identifying what is already known about experiences at this time. DESIGN Systematic review. METHOD Search of electronic databases. RESULTS The review revealed that recognition of the impact of stroke on patients and carers is improving, with many studies focussing on the longer-term aspects of stroke recovery. Research into the early discharge experiences of stroke patients and/or their carers is often limited to retrospective, longitudinal studies. With the continuing shift towards care in the community, patients and carers can increasingly expect more recovery to be taking place at home at an even earlier stage. Earlier discharge may have important implications for those involved. The review also highlighted that patients with aphasia have frequently been excluded from stroke research and that social roles are important aspects in stroke recovery. CONCLUSIONS To prepare patients and carers better for the impact of returning home, further research is needed into their experiences at this significant time, particularly in the UK. There is also a need to facilitate the inclusion of those with aphasia in stroke research. RELEVANCE TO CLINICAL PRACTICE An improved understanding of the issues facing stroke patients and carers during their early days at home should facilitate the preparation for discharge in the hospital setting and allow more focussed follow-up services in the community.
Collapse
Affiliation(s)
- Jan Pringle
- Chest, Heart & Stroke Scotland/NHS Fife, Cameron Hospital, Windygates, Fife, UK.
| | | | | |
Collapse
|
89
|
Haslam C, Holme A, Haslam SA, Iyer A, Jetten J, Williams WH. Maintaining group memberships: Social identity continuity predicts well-being after stroke. Neuropsychol Rehabil 2008; 18:671-91. [DOI: 10.1080/09602010701643449] [Citation(s) in RCA: 266] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
90
|
Almborg AH, Ulander K, Thulin A, Berg S. Patients' perceptions of their participation in discharge planning after acute stroke. J Clin Nurs 2008; 18:199-209. [PMID: 18702620 DOI: 10.1111/j.1365-2702.2008.02321.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe stroke patients' perceptions of their participation in the discharge planning process and identify correlates of perceived participation. BACKGROUND Patients have the right to participate in discharge planning, but earlier research has shown that they are often dissatisfied with the information they receive and their involvement in goal-setting during discharge planning. DESIGN Cross-sectional study. METHODS The sample consisted of 188 persons (mean age 74 years, SD 11.2) with acute stroke who were admitted to a stroke unit at a hospital in southern Sweden during 2003-2005. Data was collected by face-to-face interviews 2-3 weeks after discharge using the 'Patients' Questionnaire on Participation in Discharge Planning'. This instrument measures perceived participation in discharge planning in three subscales: P-Information, P-Medical Treatment, P-Goals and Needs. RESULTS The percentage of patients who perceived that they had participated in discharge planning was as follows: 72-90% according to P-Information, 29-38% according to P-Medical Treatment and 15-47% according to P-Goals and NEEDS Age, education and performance of activities of daily living were significantly related to perceived participation as measured by different subscales. CONCLUSIONS Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal-setting. Professionals need to pay more attention to patients in different subgroups to facilitate their participation in discharge planning. Relevance to clinical practice. To facilitate and increase patients' participation in discharge planning, methods should be implemented for goal-setting and identifying patients' needs. Methods that foster patient participation may improve goal-orientated care, services and rehabilitation after discharge.
Collapse
Affiliation(s)
- Ann-Helene Almborg
- Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden.
| | | | | | | |
Collapse
|
91
|
Jones F, Mandy A, Partridge C. Reasons for recovery after stroke: a perspective based on personal experience. Disabil Rehabil 2008; 30:507-16. [PMID: 17852260 DOI: 10.1080/09638280701355561] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to learn more about individual beliefs and personal strategies used to support the period of recovery after stroke. It sought to identify the factors that were perceived to be enablers as well as challenges to recovery. Personal actions or experiences, which were perceived to be effective in influencing progress, would be identified. METHOD Qualitative in-depth interviews were carried out with 10 participants (mean age 61.8 years). Time following stroke onset ranged between 6 weeks and 13 months. All participants had some residual activity limitation and three participants had varying degrees of aphasia. The interviews were approximately 60 - 90 minutes and all data was subjected to content analysis. RESULTS Analyses of interview data identified two main themes which were perceived to have influenced progress after stroke. The first related to internal factors such as personal control over progress, optimism and fears of dependency and the second included more external factors, such as the influence of therapeutic interactions and success with a specified marker of independence such as dressing, washing and walking. CONCLUSION An important finding of this study was that individuals all identified a number of specific factors which had supported or hindered their own recovery. There were a diversity of both internal/personal and external factors which may not be surprising, given the complexity of stroke, but all participants stressed the importance of both factors. The findings from this study are preliminary and relate only to this particular group of participants, as such they cannot be generalizable to the stroke population as a whole. However, the interaction between the two themes identified requires further exploration, especially in relation to therapy which could have both a positive and negative influence on personal control. There is a clear need to understand how professionals can, in the first place, take time to identify each individual's preferences and personal goals and secondly, make sure that these are fully addressed in a planned treatment programme. This will ensure that progress in individuals after stroke is supported by professionals with a more eclectic, individualized approach.
Collapse
Affiliation(s)
- Fiona Jones
- St George's, University of London, London, UK.
| | | | | |
Collapse
|
92
|
|
93
|
Wallengren C, Friberg F, Segesten K. Like a shadow – on becoming a stroke victim's relative. Scand J Caring Sci 2008; 22:48-55. [DOI: 10.1111/j.1471-6712.2006.00494.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
94
|
|
95
|
Lamb M, Buchanan D, Godfrey CM, Harrison MB, Oakley P. The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review. ACTA ACUST UNITED AC 2008; 6:432-483. [PMID: 27820476 DOI: 10.11124/01938924-200806120-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. INCLUSION CRITERIA This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. SEARCH STRATEGY The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. METHODOLOGICAL QUALITY Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. DATA COLLECTION Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. DATA SYNTHESIS Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. RESULTS A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. CONCLUSION The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self.
Collapse
Affiliation(s)
- Marianne Lamb
- 1. School of Nursing, Queen's University, Kingston, Ontario, Canada, K7L 3N6 2. Queen's Joanna Briggs Collaboration, Queen's University, Kingston, Ontario, Canada, K7L 3N6 3. National Research Council Information Centre Institute for Information Technology, Fredericton, New Brunswick, Canada, E3B 9W4 4. Originally published in the International Journal of Evidence-based Healthcare in 2008
| | | | | | | | | |
Collapse
|
96
|
Wottrich AW, von Koch L, Tham K. The meaning of rehabilitation in the home environment after acute stroke from the perspective of a multiprofessional team. Phys Ther 2007; 87:778-88. [PMID: 17442837 DOI: 10.2522/ptj.20060152] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Intervention programs for home-based rehabilitation are not fully described in the literature, and rehabilitation team members' experiences and tacit understanding of working with patients after stroke in the home environment need to be further understood. The aim of this study was to identify the meaning of rehabilitation in the home environment after stroke from the perspective of members of a multiprofessional team. SUBJECTS Thirteen members of a multiprofessional outreach team (physical therapists, occupational therapists, speech and language therapists, and a social worker) working at a geriatric hospital in Stockholm, Sweden, participated in the study. METHODS A qualitative method (the Empirical Phenomenological Psychological method) was used, with data being obtained from retrospective interviews of the team members after completing home-based rehabilitation of patients after acute stroke. RESULTS One main theme ("supporting continuity") and 4 subthemes ("making a journey together from hospital to home," "enabling experiences of functioning," "refraining from interventions-encouraging patient problem-solving skills," and "looking for a new phase-uncertain endings") were revealed. DISCUSSION AND CONCLUSION The findings suggest that contextual factors, both environmental and personal, were considered to be of great importance by the members of the multiprofessional team and were accounted for when they were working in the home environment in the rehabilitation of patients after stroke. Contextual factors detected in the home environment gave valuable information to the team members, who used the information in their strategies to assist the patients in finding continuity in their daily life and to link the past to the present and the "new body" to the "old body."
Collapse
Affiliation(s)
- Annica Wohlin Wottrich
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23100, SE-141 83 Huddinge, Sweden.
| | | | | |
Collapse
|
97
|
Rochette A, Tribble DSC, Desrosiers J, Bravo G, Bourget A. Adaptation and coping following a first stroke: a qualitative analysis of a phenomenological orientation. Int J Rehabil Res 2007; 29:247-9. [PMID: 16900047 DOI: 10.1097/01.mrr.0000230051.24228.c8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Stroke can have consequences in all areas of a person's life. If not coped with optimally, this life event will have a deleterious effect on the quality of life. The aim of this study was to improve understanding of appraisal and coping, post-stroke. Ten individuals were purposely recruited upon admission for a first stroke to participate in this qualitative study. Participants were asked to share their personal experiences with regard to their efforts to deal with the consequences of the stroke. In-depth interviews were transcribed verbatim and the content was analyzed using a rigorous method, inspired by a phenomenological orientation. Seven themes related to appraisal (unpredictability, overwhelming, feeling out of control, threat, turning point, acceptance/resignation and future prospects) and five themes related to coping (active and passive compensation, escape, change how the situation is perceived and utilization of resources) emerged from the content analysis of the in-depth interviews. In conclusion, since returning to the previous life style and activities is rather improbable, changing how the situation is perceived appears to be the most effective way of coping, in order to reach a state of acceptance/resignation favourable to an optimal quality of life.
Collapse
Affiliation(s)
- Annie Rochette
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Canada.
| | | | | | | | | |
Collapse
|
98
|
Stone SD. Patient concerns posthaemorrhagic stroke: a study of the Internet narratives of patients with ruptured arteriovenous malformation. J Clin Nurs 2007; 16:289-97. [PMID: 17239064 DOI: 10.1111/j.1365-2702.2005.01490.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS To identify and describe the experiences and concerns of a sample of young haemorrhagic stroke patients who experienced a ruptured arteriovenous malformation and determine whether there are gender differences. BACKGROUND Patients with arteriovenous malformation haemorrhage tend to be young adults, but little is known about their experiences and concerns. Some research suggest that there is a need to take gender into account when investigating their experiences and concerns. DESIGN A content analysis of a sample of narratives posted by survivors of an arteriovenous malformation haemorrhage on an Internet site, to determine the extent to which writers discuss similar concerns and experiences. METHODS The sample consists of 83 narratives. The author and a research assistant carefully considered the content of each narrative, created categories based upon this reading and then coded men and women's narratives separately, according to the topic discussed. RESULTS Five main categories of topics were identified: 'symptoms', 'doctors and hospitals', 'rehabilitation and recovery', 'disabilities' and 'miscellaneous reflections'. The latter category contained the sub-categories 'arteriovenous malformation website', 'thanks', 'life now' and 'feelings'. Narratives varied greatly regarding how much each topic was addressed, but there were few gender differences. Overall, most attention was paid to discussing doctors and hospitals and most writers also paid significant attention to the importance of being able to share experiences with other survivors. CONCLUSIONS For these narrators, the experience of being evaluated and treated for arteriovenous malformation haemorrhage is traumatic, leaves a lasting impact and men and women share similar concerns and experiences. Narrators show a need to talk about their experiences, especially with others who may share similar experiences. RELEVANCE TO CLINICAL PRACTICE Knowing the concerns and perspectives of a sample of arteriovenous malformation patients may help nurses anticipate the concerns of their own haemorrhagic stroke patients and help improve patients' psychosocial well-being.
Collapse
Affiliation(s)
- Sharon Dale Stone
- Department of Sociology, Lakehead University, Thunder Bay, ON, Canada.
| |
Collapse
|
99
|
TAKAHASHI R, LIEHR P, NISHIMURA C, ITO M, SUMMERS LC. Meaning of health for Japanese elders who have had a stroke. Jpn J Nurs Sci 2005. [DOI: 10.1111/j.1742-7924.2005.00032.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|