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Smith J, Forster A, Young J. Cochrane review: information provision for stroke patients and their caregivers. Clin Rehabil 2009; 23:195-206. [DOI: 10.1177/0269215508092820] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the effectiveness of information provision strategies in improving the outcome for stroke patients and/or their identified caregivers. Data sources: We searched: the Cochrane Stroke Group Trials Register; the Cochrane Central Register of Controlled Trials; electronic databases MEDLINE; EMBASE; CINAHL; PsycINFO; Science Citation Index and Social Science Citation Index; Assia; Index to UK theses; Dissertation Abstracts; ongoing trials and research registers; bibliographies of retrieved papers, relevant articles, and books; the Journal of Advanced Nursing. We also contacted researchers for additional information. Review methods: Two review authors independently assessed trial eligibility, extracted data and assessed methodological quality. Primary outcomes were knowledge about stroke and impact on mood. Meta-analyses were undertaken for the domains of knowledge, mood, satisfaction, and mortality. Results: Seventeen trials were identified and 11 contributed data to the meta-analyses. There were significant effects in favour of the intervention on patient knowledge (standardized mean difference (SMD) 0.29, 95% confidence interval (CI) 0.12 to 0.46), caregiver knowledge (SMD 0.74 95% CI 0.06 to 1.43), patient depression scores (weighted mean difference (WMD) -0.52, 95% CI -0.93 to -0.10), and one aspect of patient satisfaction (odds ratio (OR) 2.07, 95% CI 1.33 to 3.23). Post-hoc subgroup analyses showed that strategies which actively involved patient and caregivers had a significantly greater effect on patient anxiety (P<0.05) and depression (P<0.02) than passive strategies. Conclusion: There is some evidence to support the routine provision of information to stroke patients and their families. Although the best way to provide information is still not clear, the results of this review suggest that strategies which actively involve patients and caregivers should be used in routine practice.
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Affiliation(s)
- Jane Smith
- Academic Unit of Elderly Care and Rehabilitation, Institute of Health Sciences, University of Leeds, UK,
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Institute of Health Sciences, University of Leeds, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, Institute of Health Sciences, University of Leeds, UK
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McManus JA, Craig A, McAlpine C, Langhorne P, Ellis G. Does behaviour modification affect post-stroke risk factor control? Three-year follow-up of a randomized controlled trial. Clin Rehabil 2009; 23:99-105. [PMID: 19129262 DOI: 10.1177/0269215508095874] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Little is known about the long-term effectiveness after stroke of interventions for behaviour modification and ensuring concordance with therapies. We describe a follow-up study of a previous randomized controlled trial of a brief period of behaviour modification. The aim of this study was to determine outcomes three years after the initial intervention. DESIGN Survivors of the original cohort were contacted and asked to attend for follow-up interview, within a geriatric day hospital. This study was carried out in the Geriatric Day Hospital at Stobhill Hospital, Balornock Road, Glasgow. INTERVENTIONS Details of risk factor control, including blood pressure, cholesterol levels and diabetic control, were assessed. Questionnaires used in the initial study were repeated including the Geriatric Depression Scale score, Euroqol Perceived Health Status and Stroke Services Satisfaction Questionnaire. MAIN MEASURES Primary outcome was collective risk factor control. Clinical outcomes including recurrent cerebrovascular events, medication persistence and perceived health status were also recorded. RESULTS Mean length of follow-up was 3.6 years (SD 0.43). Of the 205 patients enrolled in the initial study, 102 patients attended for repeat interview(49 intervention/53 control). There were no significant differences in the percentage of controlled risk factors between groups (intervention 51.7% versus control 55.9%, P = 0.53). Similarities were observed in the number of recurrent clinical events and medication persistence between groups. No overall difference was observed in perceived health status, satisfaction with care or depression scores. CONCLUSIONS Brief intervention with respect to behaviour modification and risk factor control does not appear to have any long-term benefit. These results must be cautiously interpreted in light of the small study number and further research is required.
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Affiliation(s)
- Julie Ann McManus
- Department of Geriatric Medicine, Gartnavel General Hospital, Glasgow.
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Mangset M, Tor Erling Dahl, Førde R, Wyller TB. 'We're just sick people, nothing else': ... factors contributing to elderly stroke patients' satisfaction with rehabilitation. Clin Rehabil 2008; 22:825-35. [DOI: 10.1177/0269215508091872] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To identify factors contributing to elderly stroke patients' satisfaction with rehabilitation following stroke. Design: Qualitative study using semi-structured interviews. Setting: Interviews conducted in two phases, once in a stroke rehabilitation unit and once after hospital discharge. Subjects: Twelve elderly stroke patients (seven women and five men, aged 60—87 years). Results: One main category: 'To be treated with respect and dignity' was identified as a core factor contributing to patients' satisfaction with the rehabilitation services. This main factor was divided into five subcategories: (1) Being treated with humanity, (2) Being acknowledged as individuals, (3) Having their autonomy respected, (4) Having confidence and trust in professionals, (5) Dialogue and exchange of information. The statements covered a continuum from satisfaction via indifference to dissatisfaction. Expressions of satisfaction emerged mainly as general statements while expressions of dissatisfaction described situations in greater detail. Satisfaction was merely connected to daily care experiences and fulfilment of basic needs. Trust in providers and being dignified seemed more closely associated with satisfaction than being involved in treatment decisions. The findings demonstrate how the quality of patient—professional interaction influences patients' satisfaction with stroke rehabilitation. Conclusion: To be treated with respect and dignity seems to be a core element influencing vulnerable elderly stroke patients' satisfaction with rehabilitation. A merely functional definition of the success of rehabilitation should be expanded into an approach encompassing patients' perceptions and personal preferences. The meaning of dignity for elderly stroke patients in the rehabilitation setting should be further clarified and given practical substance.
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Affiliation(s)
- Margrete Mangset
- University of Oslo, Faculty of Medicine and Department of Geriatric Medicine, Ullevaal University Hospital,
| | - Tor Erling Dahl
- Department of Geriatric Medicine, Ullevaal University Hospital
| | | | - Torgeir Bruun Wyller
- University of Oslo, Faculty of Medicine and Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway
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Wain HR, Kneebone II, Billings J. Patient Experience of Neurologic Rehabilitation: A Qualitative Investigation. Arch Phys Med Rehabil 2008; 89:1366-71. [DOI: 10.1016/j.apmr.2007.11.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 11/03/2007] [Accepted: 11/12/2007] [Indexed: 10/21/2022]
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Smith J, Forster A, House A, Knapp P, Wright J, Young J. Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev 2008:CD001919. [PMID: 18425877 DOI: 10.1002/14651858.cd001919.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES To assess the effectiveness of information provision strategies in improving the outcome for stroke patients and/or their identified caregivers. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched May 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007), CINAHL (1982 to March 2007), PsycINFO (1974 to March 2007), Science Citation Index and Social Science Citation Index (1981 to March 2007), Assia (1987 to March 2007), Index to UK theses (1970 to March 2007), Dissertation Abstracts (1961 to March 2007), ongoing trials and research registers, bibliographies of retrieved papers, relevant articles and books, and the Journal of Advanced Nursing. We also contacted researchers for additional information. SELECTION CRITERIA Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood. MAIN RESULTS Seventeen trials involving 1773 patient and 1058 carer participants were included. Eight evaluated a passive and nine an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient and carer knowledge, one aspect of patient satisfaction, and patient depression scores. There was no significant effect on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes. AUTHORS' CONCLUSIONS There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and probably clinically insignificant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow up for clarification and reinforcement have a greater effect on patient mood.
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Affiliation(s)
- J Smith
- University of Leeds, Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK, BD9 6RJ.
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Lynch E, Harling R, English C, Stiller K. Patient satisfaction with circuit class therapy and individual physiotherapy. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.4.29035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this observational study was to determine patients' levels of satisfaction with circuit class therapy and individual physiotherapy sessions on a stroke rehabilitation unit. Forty-nine persons participated in both circuit class therapy and individual physiotherapy sessions as part of standard inpatient rehabilitation following stroke. A purpose-designed questionnaire was administered to investigate patient satisfaction. High degrees of satisfaction were reported with both methods of physiotherapy service delivery. Individual sessions were perceived as being more tailored to participants' goals, whereas participants reported that circuit classes offered a more supportive environment than the individual therapy sessions. Participants were satisfied with the amount of supervision and assistance provided in both forms of physiotherapy service delivery. No distinct advantage was seen for one form of therapy over the other in terms of patient satisfaction.
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How has the impact of ‘care pathway technologies’ on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? INT J EVID-BASED HEA 2008. [DOI: 10.1097/01258363-200803000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allen D, Rixson L. How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? ACTA ACUST UNITED AC 2008; 6:583-632. [PMID: 27819972 DOI: 10.11124/01938924-200806150-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Across the developed world, we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision. Integrated care pathways (ICPs) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration. ICPs map out a patient's journey, providing coordination of services for users. They aim to have: 'the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome'. The value for ICPs in supporting the delivery of care across organisational boundaries, providing greater consistency in practice, improving service continuity and increasing collaboration has been advocated by many. However, there is little evidence to support their use, and the need for systematic evaluations in order to measure their effectiveness has been widely identified. A recent Cochrane review assessed the effects of ICPs on functional outcome, process of care, quality of life and hospitalisation costs of inpatients with acute stroke, but did not specifically focus on service integration or its derivatives. To the best of our knowledge, no such systematic review of the literature exists. OBJECTIVES INCLUSION CRITERIA: Types of participants The review focused on the care of adult patients who had suffered a stroke. It included the full spectrum of services - acute care, rehabilitation and long-term support - in hospital and community settings.Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest, defined for the purpose of this review as 'a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and standardise the outcome orientated care'. Here 'multidisciplinary' is taken to refer to the involvement of two or more disciplines.Types of outcomes Service integration' was the outcome of interest however, this was defined and measured in the selected studies.Types of studies This review was concerned with how 'service integration' was defined in evaluations of ICPs; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on 'service integration'. Studies that made an explicit link between ICPs and service integration were included in the review. Evidence generated from randomised controlled trials, quasi-experimental, qualitative and health economics research was sought. The search was limited to publications after 1980, coinciding with the emergence of ICPs in the healthcare context. Assessment for inclusion of foreign papers was based on the English-language abstract, where available. These were included only if an English translation was available. EXCLUSION CRITERIA This review excluded studies that: SEARCH STRATEGY: In order to avoid replication, the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Database and the Cochrane Library were searched to establish that no systematic reviews existed and none were in progress. A three-stage search strategy was then used to identify both published and unpublished studies (see ). DATA COLLECTION Our search strategy located 2123 papers, of which 39 were retrieved for further evaluation. We critically appraised seven papers, representing five studies. These were all evaluation studies and, as is typical in this field, comprised a range of study designs and data collection methods. Owing to the diversity of the study types included in the review, we developed a single-appraisal checklist and data-extractiontool which could be applied to all research designs. The tool drew on the Joanna Briggs Institute (JBI) appraisal checklists for experimental studies and interpretive and critical research, and also incorporated specific information and issues which were relevant for our purposes (see ). This extends the thinking outlined in Lyne et al. in which, drawing on Campbell and Stanley's classic paper, the case is made for developing an appraisal tool which is applicable to all types of evaluation, irrespective of study design.In assessing the quality of the papers, we were sympathetic to the methodological challenges of evaluating complex interventions such as ICPs. We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare contexts. In accordance with the aims of this particular review, we have included studies, which are methodologically weaker than is typical of many systematic reviews because, in our view, in the absence of stronger evidence, they yield useful information. DATA SYNTHESIS Given the heterogeneity of the included studies, meta-analysis and/or qualitative synthesis was not possible. A narrative summary of the study findings is presented. RESULTS Therefore, we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits. CONCLUSIONS Implications for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care. This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of resources around the patient without incurring additional increases in length of stay. ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable. Their value in the context of rehabilitation settings in which recovery pathways are more variable is less clear. There is some evidence that ICPs may be effective in bringing about behavioural changes in contexts where deficiencies in service provision have been identified. Their value in contexts where inter-professional working is well established is less clear. While earlier before and after studies show a reduction in length of stay in ICP-managed care, this may reflect wider healthcare trends, and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced. There is some evidence to suggest that ICPs bring about improvements in documentation, but we do not know how far documented practice reflects actual practice. It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use. As none of the studies reviewed included an economic evaluation, moreover, it remains unclear whether the benefits of ICPs justify the costs of their implementation.
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Affiliation(s)
- Davina Allen
- 1. Wales Centre for Evidence Based Care: A Collaborating Centre of the Joanna Briggs Institute, Nursing, Health and Social Care Research Centre, Cardiff School of Nursing and Midwifery Studies, Cardiff University, Cardiff, UK 2. Originally published in the International Journal of Evidence-based Healthcare in 2008
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Young J, Green J, Forster A, Small N, Lowson K, Bogle S, George J, Heseltine D, Jayasuriya T, Rowe J. Postacute care for older people in community hospitals: a multicenter randomized, controlled trial. J Am Geriatr Soc 2007; 55:1995-2002. [PMID: 17979957 DOI: 10.1111/j.1532-5415.2007.01456.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care. DESIGN Randomized, controlled trial. SETTING Seven community hospitals and five general hospitals in the midlands and north of England. PARTICIPANTS Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness. INTERVENTION Multidisciplinary team care for older people in community hospitals. MEASUREMENTS The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services. RESULTS Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26-6.28; P=.03). The results for the secondary outcome measures were similar for the two groups. CONCLUSION Postacute community hospital rehabilitation care for older people is associated with greater independence.
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Affiliation(s)
- John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford, West Yorkshire, United Kingdom.
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61
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English CK, Hillier SL, Stiller KR, Warden-Flood A. Circuit Class Therapy Versus Individual Physiotherapy Sessions During Inpatient Stroke Rehabilitation: A Controlled Trial. Arch Phys Med Rehabil 2007; 88:955-63. [PMID: 17678655 DOI: 10.1016/j.apmr.2007.04.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the effectiveness of circuit class therapy and individual physiotherapy (PT) sessions in improving walking ability and functional balance for people recovering from stroke. DESIGN Nonrandomized, single-blind controlled trial. SETTING Medical rehabilitation ward of a rehabilitation hospital. PARTICIPANTS Sixty-eight persons receiving inpatient rehabilitation after a stroke. INTERVENTIONS Subjects received group circuit class therapy or individual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay. MAIN OUTCOME MEASURES Five-meter walk test (5MWT), two-minute walk test (2MWT), and the Berg Balance Scale (BBS) measured 4 weeks after admission. Secondary outcome measures included the Iowa Level of Assistance Scale, Motor Assessment Scale upper-limb items, and patient satisfaction. Measures were taken on admission and 4 weeks later. RESULTS Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures. There were no significant between group differences in the primary outcome measures at week 4 (5MWT mean difference, .07m/s; 2MWT mean difference, 1.8m; BBS mean difference, 3.9 points). A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge (P=.01) and were satisfied with the amount of therapy received (P=.007). CONCLUSIONS Circuit class therapy appeared as effective as individual PT sessions for this sample of subjects receiving inpatient rehabilitation poststroke. Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation.
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Affiliation(s)
- Coralie K English
- School of Health Sciences, University of South Australia, Adelaide, South Australia.
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Small N, Green J, Spink J, Forster A, Lowson K, Young J. The patient experience of community hospital--the process of care as a determinant of satisfaction. J Eval Clin Pract 2007; 13:95-101. [PMID: 17286730 DOI: 10.1111/j.1365-2753.2006.00653.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored. DESIGN A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice. RESULTS Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home-based atmosphere. The formal, or 'hard', process of rehabilitation was not well understood by patients. They were primarily concerned with 'soft' or process issues--where and how care was delivered. CONCLUSIONS We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.
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Affiliation(s)
- Neil Small
- School of Health Studies, University of Bradford, and Department of Health Care for the Elderly, St Luke's Hospital, Bradford, UK.
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Abstract
An illness event like stroke is generally believed to produce a biographical disruption in the individual, resulting in a reconstruction of one's self identity. One method of narrative reconstruction is the use of personal metaphor. Although previous research has illustrated a variety of illness metaphors, including that of war, there has been little research conducted on how these metaphors shift throughout a person's recovery period. The authors present data that indicate an intricate connection exists among changes in individuals' physical functioning, self-reported depression level, self-identity, and the metaphors they use to describe the stroke and stroke recovery experience. As the metaphor one uses to describe one's stroke experience shifts, so does one's sense of self. As one's self-identity changes, one's level of self-reported depression may also increase.
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Affiliation(s)
- Craig Boylstein
- Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Administration Center, Gainesville, FL 32608, USA.
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Boter H. Multicenter randomized controlled trial of an outreach nursing support program for recently discharged stroke patients. Stroke 2004; 35:2867-72. [PMID: 15514186 DOI: 10.1161/01.str.0000147717.57531.e5] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Many stroke patients and informal carers experience a decreased quality of life after discharge home and are dissatisfied with the care received. We assessed the effectiveness of an outreach nursing care program. METHODS In a multicenter trial, 536 stroke patients were randomized at discharge to standard care (n=273) or standard care plus outreach care (n=263). The outreach care consisted of 3 telephone calls and 1 home visit within 5 months after discharge by 1 of 13 stroke nurses. Patients were masked for the trial objectives. Six months after discharge, they assessed the 2 primary outcomes: quality of life (Short Form 36 [SF-36]) and dissatisfaction with care. Secondary measures of outcome were disability, handicap, depression, anxiety, and use of health care services and secondary prevention drugs. Informal carers assessed strain, and social support. Analysis was by intention to treat. RESULTS Twelve patients died before follow-up, 38 declined outcome assessment, and 486 completed the primary outcome assessments. Outreach care patients had better scores on the SF-36 domain "Role Emotional" than controls (mean difference 7.9 [95% confidence limit, 0.1 to 15.7]). No statistically significant differences were found on the other primary outcome measures. For secondary outcomes, no statistically significant differences were found, except that intervention patients used fewer rehabilitation services (relative risk, 0.66 [0.44 to 1.00]) and had lower anxiety scores (median difference 1 [0.19 to 2.79]). CONCLUSIONS This outreach nursing stroke care was not effective in improving quality of life and dissatisfaction with care of recently discharged patients.
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Affiliation(s)
- Han Boter
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands.
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Boter H, Rinkel GJE, de Haan RJ. Outreach nurse support after stroke: a descriptive study on patients' and carers' needs, and applied nursing interventions. Clin Rehabil 2004; 18:156-63. [PMID: 15053124 DOI: 10.1191/0269215504cr713oa] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe the number and types of problems mentioned by successfully contacted home-dwelling stroke patients and their carers, and nursing interventions applied. DESIGN In this multicentre quantitative study in the Netherlands, stroke patients and carers received outreach nurse support consisting of three telephone contacts and one home visit within six months after discharge. Standardized checklists describing a wide range of potential problems were used to record problems and interventions. SUBJECTS A sample of 173 patients admitted for a stroke and discharged home, and 148 carers. RESULTS Of 173 patients, 166 (96%) were contacted and 162 mentioned in total 1419 problems. Physical problems were mentioned most frequently (92%; 153/166), followed by emotional problems (60%; 99/166). The proportion of patients with problems decreased from 94% (142/151) at the first contact to 74% (108/145) at the last contact. Of 148 carers, 118 (80%) were contacted and 84 mentioned 266 problems. 'Psychosocial burden' was mentioned most frequently (45%; 53/118). Proportions of carers with problems were 56% (54/96) at the first contact and 37% (26/70) at the last contact. Of 864 interventions to patients, stroke nurses most frequently applied 'supportive listening' (55%; 471/864) and 'reassuring or encouraging' (12%; 107/864), and of 258 interventions to carers 45% (115/258) were 'supportive listening' and 17% (43/258) 'informing'. CONCLUSIONS Almost all patients and most carers were contacted. Though the number of needs decreased during the consecutive contacts, many patients and carers still raised problems during the last contact. Nurses most frequently applied the intervention 'supportive listening'.
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Affiliation(s)
- Han Boter
- Rudolf Magnus Institute of Neuroscience, Department of Neurology, University Medical Centre, Utrecht, The Netherlands.
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Marquardt BD, Burroughs EI. Using the Delphi technique to select items for use in assessing patients' satisfaction with dysphagia services. Percept Mot Skills 2004; 97:709-15. [PMID: 14738330 DOI: 10.2466/pms.2003.97.3.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Items for potential use in a survey for the assessment of patients' satisfaction with dysphagia services was developed using the Delphi technique. A panel of speech-language pathologists was provided with 105 potential survey items. They were asked to rate the items with respect to perceived importance in assessing patients' satisfaction. 45 items were rated as "very important." Items concerning the issues of information giving and the conduct and characteristics of the clinician were most common among the selected items. No items focusing on accessibility of services or quality of the treatment environment were in the "very important" group.
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Donnelly M, Power M, Russell M, Fullerton K. Randomized controlled trial of an early discharge rehabilitation service: the Belfast Community Stroke Trial. Stroke 2003; 35:127-33. [PMID: 14671238 DOI: 10.1161/01.str.0000106911.96026.8f] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To compare a community-based multidisciplinary stroke team (CST) approach with hospital-based rehabilitation in terms of hospital stay, functioning, quality of life, and service use and costs. METHODS Stroke patients who met pre-agreed criteria were allocated randomly to the CST service (n=59) or to usual inpatient rehabilitation and follow-up care (n=54). Assessments were completed at randomization and 12 months later. Caregiver strain and satisfaction (n=55) were also assessed. Cost data were collected for a subsample of 38 patients. RESULTS Almost 80% of surviving patients (n=691) were discharged home and a small number (n=55) were readmitted. Approximately 17% (113/649) were randomized. There were no statistically significant differences in hospital duration, costs, or outcome measures at baseline and 12 months except for higher satisfaction reported by CST patients. Overall, both groups recorded improvement in most domains over time. Carers reported a high level of satisfaction although the level of strain among carers is cause for concern. The community group (n=18) cost less than the hospital group (n=20). CONCLUSIONS A mixed model of hospital-based and community-based rehabilitation services is likely to lead to increased patient choice and satisfaction and a potential reduction in bed pressures for less severe stroke patients.
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Affiliation(s)
- Michael Donnelly
- Department of Epidemiology and Public Health, Queen's University Belfast, Belfast, UK.
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Mancuso M, Smith P, Illig S, Granger CV, Gonzales VA, Linn RT, Ottenbacher KJ. Satisfaction with medical rehabilitation in patients with orthopedic impairment. Arch Phys Med Rehabil 2003; 84:1343-9. [PMID: 13680572 DOI: 10.1016/s0003-9993(03)00144-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine patient satisfaction after orthopedic impairment at 80 to 180 days after inpatient rehabilitation. DESIGN Retrospective design examining records from facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSmr). SETTING Information submitted to UDSmr from 1997 to 1998 by 177 hospital and rehabilitation facilities from 40 states. PARTICIPANTS The sample (N=7781) was 72.63% female and 88.60% non-Hispanic white, with a mean age +/- standard deviation of 73.07+/-11.81 years, and average length of stay (LOS) of 13.84+/-10.48 days. INTERVENTION Usual rehabilitation care. Main outcome measures Level of satisfaction 80 to 180 days after discharge as well as motor, cognitive, and subscale ratings for the FIM trade mark instrument. Predictor variables included gender, age, English language, marital status, discharge setting, LOS, rehospitalization, FIM gain, and primary payer. RESULTS A logistic regression model was used to predict patient satisfaction at follow-up. Five statistically significant (P<.05) variables were found and correctly classified 94.9% of the patients. Discharge motor FIM rating, rehospitalization, age, patient's primary language, and discharge setting were associated with increased satisfaction. Discharge motor FIM ratings were significantly associated with increased satisfaction in patients with joint replacements and lower-extremity fractures. CONCLUSION unctional and demographic variables were identified as predictors of satisfaction in patients with orthopedic impairments.
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Affiliation(s)
- Melodee Mancuso
- Division of Rehabilitation Sciences, University of Texas medical Branch, Galveston, TX 77555-1028, USA
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69
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Swaine BR, Dutil E, Demers L, Gervais M. Evaluating clients' perceptions of the quality of head injury rehabilitation services: development and validation of a questionnaire. Brain Inj 2003; 17:575-87. [PMID: 12775270 DOI: 10.1080/0269905031000088568] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this research was to develop a tool to assess clients' perception of the quality of head injury rehabilitation services. METHODS AND RESULTS A questionnaire PQRS-Montreal 1.0 was developed in Montreal, Quebec using a standardized methodology that incorporated a new technique to reach consensus regarding the tool's contents. Five dimensions of care (i.e. ecological approach, client-centred approach, accessibility, quality of the service providers and continuity) and their corresponding standards were identified as pertinent to include in the tool and were subsequently validated by experts. A phase of item generation followed that led to the development of an 87-item prototype of the questionnaire. The questionnaire is to be administered during an interview and employs a 5-point rating scale. DISCUSSION AND CONCLUSION The implications for the use of PQRS-Montreal 1.0 in the accreditation process of head injury rehabilitation services are discussed, as well as plans for future quantitative research in the development of the tool.
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Affiliation(s)
- Bonnie R Swaine
- Ecole de réadaptation, Université de Montreal, Quebec, Canada.
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Sulch D, Melbourn A, Perez I, Kalra L. Integrated care pathways and quality of life on a stroke rehabilitation unit. Stroke 2002; 33:1600-4. [PMID: 12052998 DOI: 10.1161/01.str.0000017144.04043.87] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Integrated care pathways (ICP) may not reduce disability, institutionalization, or duration of hospitalization compared with conventional multidisciplinary team (MDT) care in organized stroke rehabilitation. Their potential to improve patient heath status or satisfaction with care is not known. METHODS A comparison of quality of life, caregiver strain, and patient/caregiver satisfaction at 6 months after stroke was undertaken in 152 stroke patients randomized to receive ICP or MDT care. Differences in processes of care were recorded with the use of a predefined schedule. Multivariate analyses were undertaken to identify the effect of age, sex, stroke severity, functional status, mood, and use of care pathway on quality of life score. RESULTS The 2 groups were comparable for baseline characteristics of age, sex, stroke severity, and initial disability. MDT care was characterized by greater emphasis on return of higher function and caregiver needs compared with ICP. EuroQol Visual Analogue Scale (EQ-VAS) scores were higher in the MDT group (median, 72 versus 63; P<0.005), who also had higher scores for EuroQol dimension of social functioning (P=0.014). Higher EQ-VAS scores were independently related to MDT care (P=0.04), Rankin score (P=0.01), and psychological function (P<0.0001) but not to age, sex, or stroke severity. There were no significant differences in patient or caregiver satisfaction between the 2 settings. CONCLUSIONS Better quality of life in patients receiving conventional MDT care may be attributable to improved social functioning and greater attention to higher function and caregiver needs during rehabilitation.
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Affiliation(s)
- David Sulch
- Guy's, King's, and St Thomas' School of Medicine, King's College, and Department of Adult Medicine, Queen Elizabeth Hospital, London, UK
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71
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Ottenbacher KJ, Gonzales VA, Smith PM, Illig SB, Fiedler RC, Granger CV. Satisfaction with medical rehabilitation in patients with cerebrovascular impairment. Am J Phys Med Rehabil 2001; 80:876-84. [PMID: 11821665 DOI: 10.1097/00002060-200112000-00002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Overall satisfaction has important social and economic implications for patients who have received inpatient medical rehabilitation. We conducted this study to examine the overall satisfaction level at 3- to 6-mo follow-up for inpatients with cerebrovascular impairments discharged from medical rehabilitation. DESIGN The study was retrospective using information from a national database representative of medical rehabilitation patients across the United States. Information submitted in 1997 and 1998 to the Uniform Data System for Medical Rehabilitation by 177 hospital and rehabilitation facilities from 40 states was examined. The final sample included 8,900 patient records. The main outcome measure was the level of satisfaction with medical rehabilitation at 80-180 days postdischarge follow-up. RESULTS A logistic regression model including ten independent variables was used to predict satisfied vs. dissatisfied at follow-up. Three statistically significant variables were included in the final model and correctly classified 95.1% of the patients. Higher FIM instrument discharge scores were associated with increased satisfaction. Further analysis of the FIM instrument subscales indicated that higher ratings in transfers, social cognition, and locomotion were significantly associated with increased satisfaction. CONCLUSION We identified several functional variables associated with increased satisfaction after medical rehabilitation in persons with stroke. The ability to objectively assess patient satisfaction is important as consumer-based outcome measures are integrated in accreditation and healthcare evaluation.
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Affiliation(s)
- K J Ottenbacher
- University of Texas Medical Branch, Galveston, Texas 77555-1028, USA
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72
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Ayana M, Pound P, Lampe F, Ebrahim S. Improving stroke patients' care: a patient held record is not enough. BMC Health Serv Res 2001; 1:1. [PMID: 11257719 PMCID: PMC32174 DOI: 10.1186/1472-6963-1-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2001] [Accepted: 03/06/2001] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stroke patients' care in hospital tends to be poorly organised, with poor communication and a lack of information being frequent sources of complaint. The purpose of this study was to evaluate whether a patient-held record (PHR) would result in greater patient satisfaction and better care planning for stroke patients. METHODS A time series control (6 months) - intervention (8 months) - control (6 months) was used among London teaching hospital general medical and geriatric medicine inpatient wards. All stroke patients admitted to the wards during the intervention phase received a PHR and were instructed in its use. Demographic, stroke severity, social factors and outcomes were collected from all stroke patients during all phases of the study. RESULTS Of 252 stroke patients aged 46 to 98 years entered into the study, by six months after admission 118 (46.8%) had died. PHR and control group patients were well matched in terms of socio-demographic characteristics and pre-stroke ability. At six months after admission, 119 (97%) patients responded to the questionnaire. Just over half (56%, 13) of intervention group patients recalled receiving a PHR. Of those patients, 59% reported reading the PHR, 27% had lost their PHR, and two-thirds said they had difficulties encouraging staff to write in the PHR. Half felt that possession of the PHR was more trouble than it was worth. PHR group patients were more satisfied with the recovery they had made (79% vs. 59%, p=0.04), but felt less able to talk to staff about their problems (61% vs. 82%, p=0.02). PHR group patients reported receiving fewer explanations about their condition (18% vs. 33%, p=0.12) and treatment (26% vs. 45%, p=0.07), and were more afraid of asking doctors questions (21% vs. 4%, p=0.01) than controls. PHR group patients were no better prepared for hospital discharge than control group patients, and both groups were ill-informed about services and benefits that might have helped after discharge from hospital. CONCLUSIONS Stroke patients received poor information and explanations regardless of whether they received a PHR. A PHR did not appear to improve patient satisfaction or discharge planning, and may have reduced opportunities for communication and explanation.
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Affiliation(s)
- Mulunish Ayana
- Department of Primary Care & population Sciences, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF
| | - Pandora Pound
- Department of Public Health Sciences, Guy's King's & St Thomas' School of Medicine
| | - Fiona Lampe
- Department of Primary Care & population Sciences, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF
| | - Shah Ebrahim
- Department of Social Medicine, Univeristy of Bristol
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Barrett JA, Watkins C, Plant R, Dickinson H, Clayton L, Sharma AK, Reston A, Gratton J, Fall S, Flynn A, Smith T, Leathley M, Smith S, Barer DH. The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation. Collaborative Stroke Audit and Research. Clin Rehabil 2001; 15:32-41. [PMID: 11237159 DOI: 10.1191/026921501672264719] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation. DESIGN A two-centre pilot study to assess the feasibility of performing a multicentre randomized controlled trial on this subject. SETTING Clatterbridge and Aintree Stroke Rehabilitation Units, Merseyside, UK. SUBJECTS Forty early stroke patients (mean age 67 years) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied. INTERVENTION A central randomization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient. They were allocated to either an 'encouraged to self-propel' or a 'discouraged from self-propulsion group'. OUTCOME MEASURES USED: Independent outcome assessment was performed by postal questionnaire and telephone interview using the Barthel ADL Scale, Nottingham Extended ADL Scales and the shortened General Health Questionnaire (GHQ-12) at 3 and 12 months. Patient's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital. RESULTS After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres. No major differences were found between the pilot groups for any of the outcome measures. CONCLUSIONS A multicentre randomized controlled trial to assess this question is feasible but further work is being conducted before proceeding, to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures.
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Affiliation(s)
- J A Barrett
- COSTAR wheelchair study group, Clatterbridge Hospital, Wirral, UK.
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74
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Forster A, Smith J, Young J, Knapp P, House A, Wright J. Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev 2001:CD001919. [PMID: 11687003 DOI: 10.1002/14651858.cd001919] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The provision of information has been recommended as a key component of service provision after stroke. However, research suggests that patients' understanding of stroke and associated issues remains poor. We determined to undertake a systematic review of information provision strategies for patients and their carers after stroke. OBJECTIVES To examine the effectiveness of an information and/or education strategy to improve the outcome of stroke patients and/or their identified caregivers. SEARCH STRATEGY Relevant trials were identified in the Cochrane Stroke Group Specialised Trials Register (last searched: June 2000). Additional intervention-based search strategies were developed for: The Cochrane Controlled Trials Register (CENTRAL/CCTR) Medline; Embase; CINAHL; ISI citation index; Science and Social Science Citation Indexes; ISI Web of Science Service; Aslib Index to UK theses; Dissertation Abstracts International, ASSIA and Psychlit/PsycINFO. We also searched the Journal of Advanced Nursing, bibliographies of retrieved papers, relevant articles and books. SELECTION CRITERIA Two or three investigators independently assessed trials and abstracts identified for eligibility, methodological quality and other participant characteristics. DATA COLLECTION AND ANALYSIS Data were extracted independently using piloted data extraction forms. The primary outcomes were knowledge about stroke and stroke services, and impact on health, specifically mood. MAIN RESULTS We identified 152 abstracts, of which 36 studies were potentially relevant to this review. The current analysis includes nine completed trials, a further eight studies are ongoing. Of the nine trials, three evaluated a programme of lectures and the remaining trials evaluated the provision of information. There is some evidence that information combined with educational sessions improved knowledge and was more effective than providing information only. Information provision only had no effect on mood, perceived health status or quality of life for patients or carers. Two trials used an objective measure of satisfaction and no significant differences were found between groups. One trial reported that information and education sessions for carers improved 'family functioning'. REVIEWER'S CONCLUSIONS The results of the review are limited by the variable quality of the trials and the wide range of outcome measures used. The general effectiveness of information provision has not been conclusively demonstrated. Future work should address the expressed needs of patients and carers and seek to identify appropriate teaching strategies which can be successfully implemented within clinical practice.
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Affiliation(s)
- A Forster
- Department of Health Care for the Elderly, St Luke's Hospital, Bradford, West Yorkshire, UK, BD5 ONA.
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Abstract
BACKGROUND Attention is currently focused on family care of stroke survivors, but the effectiveness of support services is unclear. We did a single-blind, randomised, controlled trial to assess the impact of family support on stroke patients and their carers. METHODS Patients with acute stroke admitted to hospitals in Oxford, UK, were assigned family support or normal care within 6 weeks of stroke. After 6 months, we assessed, for carers, knowledge about stroke, Frenchay activities index, general health questionnaire-28 scores, caregiver strain index, Dartmouth co-op charts, short form 36 (SF-36), and satisfaction scores, and, for patients, knowledge about stroke and use of services, Barthel index, Rivermead mobility index, Frenchay activities index, London handicap scale, hospital anxiety and depression scales, Dartmouth co-op charts, and satisfaction. FINDINGS 323 patients and 267 carers were followed up. Carers in the intervention group had significantly better Frenchay activities indices (p=0.03), SF-36 scores (energy p=0.02, mental health p=0.004, pain p=0.03, physical function p=0.025, and general health perception p=0.02), quality of life on the Dartmouth co-op chart (p=0.01), and satisfaction with understanding of stroke (82 vs 71%, p=0.04) than those in the control group. Patients' knowledge about stroke, disability, handicap, quality of life, and satisfaction with services and understanding of stroke did not differ between groups. Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge (44 vs 56%, p=0.04), but use of other services was similar. INTERPRETATION Family support significantly increased social activities and improved quality of life for carers, with no significant effects on patients.
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Affiliation(s)
- J Mant
- Department of Primary Care and General Practice, Medical School, University of Birmingham, Edgbaston, UK.
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76
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Abstract
OBJECTIVE To assess the quality of the process of discharge from hospital and follow-up services for people with stroke. DESIGN A criterion-based process audit and basic outcome measures, combined with surveys of patients' satisfaction and staff opinion of the service. SETTING All units treating stroke patients in a health care district including an acute and a community NHS trust, and 23 participating GP practices. SUBJECTS Process audit: documented notes of 98 stroke patients admitted and discharged over a four-month period. Patient satisfaction survey: 93 surviving stroke patients. Staff opinion survey: general practitioners, hospital doctors, therapists and nurses treating stroke patients throughout the district. RESULTS A poor level of service was found. The main shortcomings were poor communication and liaison and a narrow focus of rehabilitation which concentrated on the assessment and provision of basic home care and activities of daily living (ADL) required to obtain discharge. There was a paucity of provision beyond this most basic level and little follow-up after discharge. Pass rates against agreed criteria were: communication between staff and patients/carers 47%, liaison between staff 44%, assessment of home-based needs 48%, assessment of domestic skills 15.5%. Fifty-one per cent of patients were referred for follow-up therapy and of these 72% started follow-up therapy within six weeks of discharge, only 27% had any follow-up assessment of activity levels and well-being. Patients were dissatisfied with the information, support services and therapy they received. The main reasons for the shortcomings were lack of awareness of the services provided, professionals' low expectations of patients' abilities, and limitations of community-based therapy services. CONCLUSIONS Evidence from other publications suggests that these results do not indicate a service that is any worse than other districts, rather it represents the poor deal offered to stroke patients. By comprehensively assessing several aspects of the service together this methodology has been able to reveal these inadequacies and the reasons for them.
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Affiliation(s)
- S Tyson
- Centre for Research in Rehabilitation, Department of Health Studies, Brunel University, Isleworth, Middlesex, UK.
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77
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Morrison V, Johnston M, Walter RM. Predictors of distress following an acute stroke: Disability, control cognitions, and satisfaction with care. Psychol Health 2000. [DOI: 10.1080/08870440008402001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rodgers H, Atkinson C, Bond S, Suddes M, Dobson R, Curless R. Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. Stroke 1999; 30:2585-91. [PMID: 10582982 DOI: 10.1161/01.str.30.12.2585] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient- and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. RESULTS Only 51 of 108 (47%) surviving patients randomized to the SEP completed the program, as did 20 of 93 (22%) informal carers of surviving patients. Perceived health status (Short Form 36 [SF-36] health survey) scores were similar for SEP patients and controls. Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group (P=0.04). Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls (patients, P=0.02; carers, P=0. 01). Patients in the SEP group were more satisfied with the information that they had received about stroke (P=0.004). There were no differences in emotional or functional outcomes between groups. CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services, this was not associated with an improvement in their perceived health status. Indeed, the social functioning of informal carers randomized to the SEP was less than in the control group.
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Affiliation(s)
- H Rodgers
- School of Clinical Medical Science and the School of Health Sciences, University of Newcastle on Tyne, England
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79
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Abstract
OBJECTIVE To assess the process of hospital-based stroke rehabilitation. DESIGN A criterion-based process audit, combined with surveys of patient and staff opinions and basic outcome measures. SETTING All wards and units treating stroke patients in a health care district, including an acute and a community National Health Service (NHS) trust. SUBJECTS Process audit: documented notes of 115 stroke patients admitted over a four-month period. Patient satisfaction survey: 93 surviving stroke patients. Staff opinion survey: Hospital doctors, therapists and nurses treating stroke patients throughout the district. RESULTS A disappointingly poor level of service. The main shortcomings were poor assessment of impairment (pass rate, 46%), inadequate communication between staff and with patients and carers (pass rate, 43%), and an absence of rehabilitation beyond the basic of activities of daily living and indoor mobility (pass rate for assessment of disability and emotional need, 50%). Thirty-three per cent of patients were dissatisfied with the hospital-based service they received, particularly lack of therapy, information and recovery. The main reasons for these shortcomings were low priority given to stroke patients, lack of time, shortage of staff, and lack of knowledge and awareness of stroke amongst the staff. Rehabilitation units and elderly care tended to perform better than general medical units in areas of assessment of impairment, self-care skills and mobility, and wheelchair provision. CONCLUSIONS Evidence from previous publications suggests that this service was no worse than in other districts, but this audit methodology, by comprehensively examining many aspects of a service together, is better able to reveal inadequacies.
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Affiliation(s)
- S F Tyson
- Centre for Research in Rehabilitation, Department of Health Studies, Brunel University, Isleworth, Middlesex, UK.
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80
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Hart E. The use of pluralistic evaluation to explore people's experiences of stroke services in the community. HEALTH & SOCIAL CARE IN THE COMMUNITY 1999; 7:248-256. [PMID: 11560640 DOI: 10.1046/j.1365-2524.1999.00183.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of the present study was to explore the experience of stroke survivors and their informal carers of stroke services in the community, as part of a pluralistic evaluation of a Pilot Community Stroke Service (PCSS) in Nottingham, England. The research design involved qualitative in-depth interviews with four main stakeholder groups in the evaluation, in combination with analyses of varied data sources, including participant observational and documentary. In addition to interviews with 57 stroke survivors and their carers (as appropriate), interviews were conducted with the team of the PCSS, individually and as a group, and with a range of other workers. The pluralistic approach of the evaluation revealed that tensions and social conflicts at the interface between services, and particularly between health and social care services, had a negative impact on the quality of life of clients and carers alike, which were experienced as 'setbacks', and which could be shown to be system induced. Such 'System Induced Setbacks' also had negative consequences for the team of the PCSS, since rather than being a 'top up' service, in such cases it became a 'mop up' service, compensating for the shortfall in service provision. Thus its aims and objectives could not be fully realized. It was concluded that pluralistic evaluation had a number of strengths including that, because of its attention to process and social context, it revealed the existence of System Induced Setbacks and their negative and long-term impact on the daily lives of clients and carers, and on the team of the PCSS, in a way which would not have been possible had a quantitative approach been used.
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Affiliation(s)
- Elizabeth Hart
- School of Nursing, Postgraduate Division, Medical School (B50), Queen's Medical Centre, University of Nottingham, UK
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81
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Perry SI, Hsu RT, Brooks W, Cherry D. Perceptions of community services among Asian and white stroke survivors and their carers: an exploratory study. ETHNICITY & HEALTH 1999; 4:101-105. [PMID: 10887466 DOI: 10.1080/13557859998236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- S I Perry
- Department of Epidemiology and Public Health, University of Leicester
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82
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Pound P, Tilling K, Rudd AG, Wolfe CD. Does patient satisfaction reflect differences in care received after stroke? Stroke 1999; 30:49-55. [PMID: 9880387 DOI: 10.1161/01.str.30.1.49] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite the volume of research into patient satisfaction, it is not clear whether satisfaction ratings reflect differences in care received after stroke or the characteristics of patients. The aim of this study is to test the hypothesis that patient satisfaction is independently related to differences in care received after stroke. METHODS Stroke patients participating in a randomized controlled trial of early discharge to community therapy completed a satisfaction questionnaire and physical and psychological outcome measures at 4 and 12 months. Two hundred seventy-four patients (83%) were followed up at 4 months and 262 patients (79%) at 12 months. Use of therapy and community services was quantified. Logistic regression was used to investigate associations between satisfaction, patient characteristics, and service provision. RESULTS The more therapy, meals on wheels, and home help visits patients received, the more likely they were to be satisfied. Patients in the conventional arm of the trial were less likely to express satisfaction than those discharged early to community therapy. Women, older people, anxious people, and those more functionally independent were more likely to be satisfied, while those with depression, speech and swallowing deficit, motor deficit, and poor subjective health were less likely to be satisfied. CONCLUSIONS The finding that satisfaction assessments reflect real differences in the provision of care and occur independently of any associations with patient characteristics is new. Patient satisfaction should be taken seriously as an outcome.
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Affiliation(s)
- P Pound
- Department of Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, and Elderly Care Unit, St Thomas' Hospital, London,
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83
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Jones F. The accuracy of predicting functional recovery in patients following a stroke, by physiotherapists and patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 1998; 3:244-56. [PMID: 9859133 DOI: 10.1002/pri.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE The potential for post-stroke recovery and the range of predictive variables has been studied extensively. Knowledge of these variables alongside other factors, such as performance in therapy and professional experience, enable ongoing predictions to be made by members of the rehabilitation team. Patients' own predictions for their recovery has yet to receive much attention in this area of research. The aim of this study was to compare the predictive accuracy of the physiotherapist and the stroke patient with regard to functional change during a period 6-12 weeks post-stroke. METHOD The stroke sample (N = 29) came from two National Health Service Trusts as did the physiotherapists (N = 4). No comparisons were made between the hospitals and data was coded for anonymity. Estimations were made by both physiotherapists and patients regarding items on each of the three sections of The Rivermead Motor Assessment (RMA). Intra-class correlation coefficients (ICCs) were used to describe agreement of each set of predictions with the achieved RMA scores. The results reported here represent the main emphasis of the research; however, other areas were also screened (for example, change in cognition, language and quality of life) by use of basic standardized measures. Recovery was also compared to other known predictive variables, such as age, severity of stroke and urinary incontinence. RESULTS At follow-up assessment it was found that both physiotherapists' and patients' predictions demonstrated high and significant agreement with the achieved RMA scores at 12 weeks (ICCs ranging from 0.727 to 0.968). Physiotherapists' predictions demonstrated marginally higher levels of agreement than patients' predictions. CONCLUSIONS The degree of accuracy demonstrated by both physiotherapists and patients was considerable. The patient group was perhaps the more notable as no subject had had prior knowledge of a stroke. The implications in respect of lay persons' involvement in decision making and in the rehabilitative process, alongside the health professionals, are perhaps worthy of closer consideration.
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Affiliation(s)
- F Jones
- Department of Occupational Therapy and Physiotherapy, University of Brighton, UK
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84
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Mant J, Carter J, Wade DT, Winner S. The impact of an information pack on patients with stroke and their carers: a randomized controlled trial. Clin Rehabil 1998; 12:465-76. [PMID: 9869250 DOI: 10.1191/026921598668972226] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the impact of information packs on patients with stroke and their carers, and to pilot some of the methodology for a trial of a Family Support Organiser (FSO). SUBJECTS Seventy-one patients admitted to Oxford hospitals with acute stroke during February-July 1995, and 49 informal carers of these patients. DESIGN Randomized controlled trial. Intervention group received an Information pack containing various Stroke Association publications one month after their stroke, or at discharge from hospital, whichever was sooner. Control group received nothing. Follow-up was by interview at the place of residence of the patients six months after their stroke. MEASURES Outcome measures assessed knowledge about stroke; satisfaction with information received; patient behaviour in terms of access to community services and benefits; and health status and quality of life. RESULTS Patients and carers in the intervention group tended to know more about stroke, but these differences were not significant once adjusted for age. Patients in the intervention group (but not carers) tended to be more satisfied with the information that they had received, but the differences were not significant. There were no differences with regard to any aspects of quality of life in patients in the intervention group, though carers in the intervention group were found to have significantly better mental health (p = 0.04). CONCLUSIONS While the study was too small to generate firm conclusions, information leaflets may lead to improved knowledge about stroke several months after they have been distributed. This finding is worth following up with larger studies. The stroke knowledge questionnaire that was piloted in this trial seems to be able to detect differences between groups.
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Affiliation(s)
- J Mant
- Department of General Practice, Medical School, University of Birmingham, Edgbaston, UK
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85
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Ayana M, Pound P, Ebrahim S. The views of therapists on the use of a patient-held record in the care of stroke patients. Clin Rehabil 1998; 12:328-37. [PMID: 9744668 DOI: 10.1191/026921598670772117] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the views of therapists working with stroke patients on the use of a patient-held record (PHR) for stroke patients. A PHR was developed in the form of a pocket-sized booklet (21 cm x 14.5 cm) in which staff recorded information relating to the patient's management. The aim of the PHR was to facilitate communication and involve patients more directly in their care. METHODS Six semi-structured group interviews were conducted with therapists (25 in total) from one inner city hospital. RESULTS The following themes emerged from the content analysis: (1) Therapists were supportive of plans for a PHR, citing the benefits of greater patient involvement. (2) However, they questioned its feasibility, in particular the issue of patient responsibility and its use with the cognitively impaired. (3) They also questioned its ability to facilitate communication among health professionals because of existing differences in perspectives. (4) These therapists revealed concerns about the effect that information may have on patients. (5) They also raised practical issues about finding the time to make entries, wording and content of entries in the PHR. CONCLUSION Responsibility for the PHR may enhance patients' understanding and involvement in their care, yet ownership alone does not guarantee the confidence needed to encourage dialogue between patients and care providers. Furthermore, it is doubtful whether a PHR can hope to overcome the fundamental differences in the philosophies of care which the therapists reported.
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Affiliation(s)
- M Ayana
- Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK
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86
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O'Mahony PG, Rodgers H, Thomson RG, Dobson R, James OF. Satisfaction with information and advice received by stroke patients. Clin Rehabil 1997; 11:68-72. [PMID: 9065362 DOI: 10.1177/026921559701100110] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine levels of satisfaction with information and advice received about stroke disease and relevant issues by community-dwelling stroke survivors. DESIGN An interview questionnaire survey. SETTING A family health services authority area in northern England. SUBJECTS Stroke survivors identified by a valid screening questionnaire from a stratified random sample of 2000 subjects aged 45 years and over. MAIN OUTCOME MEASURE Proportion of subjects interviewed responding positively to the question 'Do you think you have received enough advice and information on ...?' eighteen topics considered relevant to stroke survivors. RESULTS The screening process identified 116 stroke survivors, of whom 76 agreed to be interviewed. The majority (> 80%) of patients were satisfied with information and advice received on lifestyle and health promotion issues, incontinence and their current treatment. However, satisfaction was poor for the areas of stroke disease in general, its effects, available services, and legal and financial affairs (range, 28-75% satisfied). CONCLUSIONS Deficits in the provision of adequate information and advice to stroke patients on relevant issues have beer identified in this study of a representative sample of community-dwelling stroke survivors. These deficits need to be addressed by those providing care for stroke patients in order to improve patients satisfaction.
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Affiliation(s)
- P G O'Mahony
- Department of Medicine (Geriatrics), University of Newcastle, Newcastle upon Tyne, UK
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87
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Scholte op Reimer WJ, de Haan RJ, Limburg M, van den Bos GA. Patients' satisfaction with care after stroke: relation with characteristics of patients and care. Qual Health Care 1996; 5:144-50. [PMID: 10161528 PMCID: PMC1055398 DOI: 10.1136/qshc.5.3.144] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate stroke patients' satisfaction with care received and to identify characteristics of patients and care which are associated with patients' dissatisfaction. DESIGN Cross sectional study. SETTING Sample of patients who participated in a multicentre study on quality of care in 23 hospitals in the Netherlands. PATIENTS 327 non-institutionalised patients who had been in hospital six months before because of stroke. MAIN MEASURES Data were collected on (a) characteristics of patients: socio-demographic status, cognitive function (mini mental state examination), disability (Barthel index), handicap (Rankin scale), emotional distress (emotional behavior subscale of the sickness impact profile) and health perception; (b) characteristics of care: use of various types of formal care after stroke, unmet care demands perceived by patients, unmet care demands confirmed by their general practitioners, continuity of care, and secondary prevention, and (c) patients' satisfaction with care received. RESULTS 40% of the study sample were dissatisfied with at least one type of care received. Multivariate analyses showed that unmet care demands perceived by patients (odds ratio (OR) 3.2, 95% confidence interval (95% CI) 1.8-5.7) and emotional distress (OR 1.8, 95% CI 1.1-3.0) were the main variable associated with dissatisfaction. CONCLUSIONS Patients' satisfaction was primarily associated with emotional distress and unmet care demands perceived by patients. No association was found between patients' satisfaction on the one hand and continuity of care or secondary prevention on the other; two care characteristics that are broadly accepted by professional care givers as important indicators of quality of long term care after stroke. IMPLICATIONS In view of these findings discussion should take place about the relative weight that should be given to patients' satisfaction as an indicator of quality of care, compared with other quality indicators such as continuity of care and technical competence. More research is needed to find which dimensions of quality care are considered the most important by stroke patients and professional care givers.
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88
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Bissett AF, Chesson R, Macduff C. Selection of the fittest in stroke research and audit. Lancet 1996; 347:1626-7. [PMID: 8667895 DOI: 10.1016/s0140-6736(96)91113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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89
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Pound P, Bury M, Gompertz P, Ebrahim S. Views of survivors of stroke on benefits of physiotherapy. Qual Health Care 1994; 3:69-74. [PMID: 10137587 PMCID: PMC1055199 DOI: 10.1136/qshc.3.2.69] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the components of physiotherapy valued by survivors of a stroke. DESIGN Qualitative study using in-depth interviews. SETTING Two adjacent districts in North East Thames Regional Health Authority. PATIENTS 82 survivors of stroke taken consecutively from a stroke register when they reached the tenth month after their stroke, 40 of whom agreed to be interviewed. MAIN MEASURES Content analysis of interviews. RESULTS Patients who agreed to the interview were significantly less likely to be disabled 12 months after stroke than those who did not. Twenty four patients had received physiotherapy, and these were more disabled than those who had not. Patients appreciated physiotherapy. It was believed to bring about functional improvement; the exercise component was valued because it was perceived to keep them active and busy and exercise programmes to follow at home were also valued for the structure they gave to each day; and therapists were considered a source of advice and information and a source of faith and hope. CONCLUSIONS Many of the positive aspects of caring which patients described in the context of physiotherapy could be incorporated into the mainstream of rehabilitation care and training. However, health professionals need to be careful not to promote false expectations about recovery. IMPLICATIONS The outcome of treatment is of critical importance to patients and should become a central dimension of patient satisfaction questionnaires. The impact of physiotherapy is not confined to reducing physical disability but may also affect wellbeing. The choice of outcome measures in rehabilitation research should reflect this situation.
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Affiliation(s)
- P Pound
- Royal Free Hospital School of Medicine, London
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