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Luker JA, Bernhardsson S, Lynch E, Murray C, Hill OP, Bernhardt J. Carers' experiences, needs and preferences during inpatient stroke rehabilitation: a protocol for a systematic review of qualitative studies. Syst Rev 2015; 4:108. [PMID: 26260629 PMCID: PMC4532249 DOI: 10.1186/s13643-015-0097-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large numbers of people provide carer roles for survivors of stroke. Person-centred stroke rehabilitation must consider the perspectives of carers, as stroke affects not only the stroke survivor but also the quality of life and health of the carers. There is little collective knowledge about stroke carers' experiences, needs and preferences during the inpatient stroke rehabilitation process to then inform person-centred service improvements. Our objective is to report and synthesise experiences, needs and preferences of the carers of stroke survivors undergoing rehabilitation in inpatient settings. METHODS/DESIGN We will conduct a systematic review of qualitative studies using a thematic synthesis methodology. We will follow the Enhancing Transparency in Reporting the Synthesis of Qualitative Research Guidelines (ENTREQ) and search the following databases for relevant articles: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Embase, and Web of Science. No language or publication date constraints will be applied. Eligible studies will have to use qualitative methods of data collection and analysis and reported data from the carers of stroke survivors who underwent inpatient stroke rehabilitation. Studies will be eligible for inclusion if they report the experiences, needs and preferences of carers regarding inpatient rehabilitation environments, organisation, care systems, therapeutic interventions, information exchange, carer training, discharge and community service planning and other issues of relevance to their roles as carers. Study selection and assessment of quality will be performed independently by two reviewers. Any disagreement will be resolved by a third reviewer. Data will be extracted by one reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results, discussion and conclusion sections will be entered into the NVivo software for analysis. Extracted texts will be inductively coded independently by two reviewers and analysed in three phases using thematic synthesis. Descriptive and analytical themes will be developed. DISCUSSION This study is expected to provide new insights into the perspectives of stroke survivors' carers. Increased knowledge about carer perspectives and preferences will inform person-centred improvements in stroke rehabilitation. STUDY REGISTRATION PROSPERO registration number: CRD42015017315 .
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Affiliation(s)
- Julie A Luker
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia. .,Florey Institute of Neuroscience & Mental Health, University of Melbourne, Melbourne, Australia.
| | - Susanne Bernhardsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Strandvägen 35, 475 40, Hönö, Sweden.
| | - Elizabeth Lynch
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia.
| | - Carolyn Murray
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia.
| | - Olivia P Hill
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia.
| | - Julie Bernhardt
- Florey Institute of Neuroscience & Mental Health, University of Melbourne, Melbourne, Australia.
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Danzl MM, Harrison A, Hunter EG, Kuperstein J, Sylvia V, Maddy K, Campbell S. "A Lot of Things Passed Me by": Rural Stroke Survivors' and Caregivers' Experience of Receiving Education From Health Care Providers. J Rural Health 2015; 32:13-24. [PMID: 26100171 DOI: 10.1111/jrh.12124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to examine rural Appalachian Kentucky stroke survivors' and caregivers' experiences of receiving education from health care providers with the long-term goal of optimizing educational interactions and interventions for an underserved population. METHODS An interprofessional research team, representing nursing, occupational therapy, physical therapy, and speech language pathology, conducted a qualitative descriptive study involving semistructured interviews with 13 stroke survivors and 12 caregivers. Qualitative content analysis included predetermined and emerging coding. This article presents an in-depth analysis of a subset of data from the coding scheme of a larger study that examined the overall experience of stroke for participants. FINDINGS Findings are presented within a developing model of patient and caregiver education constructs including providers and receivers of education and the content, timing, and delivery of information. CONCLUSIONS Understanding the experience of receiving education for survivors and caregivers will help practitioners provide the right education, to the right people, at the right time, and in the right way to better support underserved groups. Improving patient and caregiver education is paramount to supporting health behavior change to optimize life poststroke and prevent future strokes. Our results suggest the need for improved access to educational providers, proactive identification of informational needs by providers, greater inclusion of caregivers in education, enhanced communication with information provision, and education from multiple providers using multiple delivery methods at multiple time points.
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Affiliation(s)
- Megan M Danzl
- Physical Therapy Program, Bellarmine University, Louisville, Kentucky
| | - Anne Harrison
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Elizabeth G Hunter
- Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky
| | - Janice Kuperstein
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Violet Sylvia
- Appalachian Regional Healthcare Inc, Lexington, Kentucky
| | - Katherine Maddy
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Sarah Campbell
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
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Evaluating Siebens Domain Management Model for inpatient rehabilitation to increase functional independence and discharge rate to home in geriatric patients. Arch Phys Med Rehabil 2015; 96:1310-8. [PMID: 25838019 DOI: 10.1016/j.apmr.2015.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/14/2015] [Accepted: 03/02/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home. DESIGN Before and after study. SETTING IR facility. PARTICIPANTS During 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups. INTERVENTION The SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home. MAIN OUTCOME MEASURES FIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). RESULTS Pre-/postintervention group admission FIM scores were similar (t=2.96, P<.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P<.0001). There were significantly more discharges to the community in the postintervention group (74.4%) than the preintervention group (58.5%, χ(2)=26.2, P<.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ(2)=30.47, P<.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=-5.5, P<.0001) and greater discharge to community (χ(2)=34, P<.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P<.0001). CONCLUSIONS Use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.
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Cameron JI, Naglie G, Green TL, Gignac MAM, Bayley M, Huijbregts M, Silver FL, Czerwonka A. A feasibility and pilot randomized controlled trial of the “Timing it Right Stroke Family Support Program”. Clin Rehabil 2014; 29:1129-40. [PMID: 25552525 DOI: 10.1177/0269215514564897] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/29/2014] [Indexed: 11/16/2022]
Abstract
Objective: Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. Design: Multi-site mixed method randomized controlled trial. Setting: Acute and community care in three Canadian cities. Subjects: Caregivers were family members or friends providing care to individuals who experienced their first stroke. Intervention: The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. Main measures: Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. Results: Thirty-one caregivers received standard care ( n=10), self-directed ( n=10), or stroke support person-directed ( n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records ( n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews ( n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. Conclusions: Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial.
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Affiliation(s)
- Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
- Department of Medicine, UHN-Toronto Rehabilitation Institute, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Theresa L Green
- Faculty of Nursing, University of Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Monique AM Gignac
- Institute for Work and Health; Toronto Western Research Institute; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Mark Bayley
- Department of Medicine, UHN-Toronto Rehabilitation Institute, Canada
| | - Maria Huijbregts
- Family Service Toronto, Department of Physical Therapy, University of Toronto, Canada
| | - Frank L Silver
- Department of Neurology, UHN-Toronto Western Hospital, Canada
| | - Anna Czerwonka
- Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
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O’Brien CL, Moore G, Rolley JX, Ski CF, Thompson DR, Lautenschlager NT, Gonzales G, Hsueh YS(A, Castle D. Exploring Health Care Providers’ Perceptions of the Needs of Stroke Carers: Informing Development of an Optimal Health Program. Top Stroke Rehabil 2014; 21:421-31. [DOI: 10.1310/tsr2105-421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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White CL, Brady TL, Saucedo LL, Motz D, Sharp J, Birnbaum LA. Towards a better understanding of readmissions after stroke: partnering with stroke survivors and caregivers. J Clin Nurs 2014; 24:1091-100. [PMID: 25441776 DOI: 10.1111/jocn.12739] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe the experience of readmission from the perspective of the stroke survivor and family caregiver. BACKGROUND Older stroke survivors are at an increased risk for readmission with approximately 40% being readmitted in the first year after stroke. Patients and their families are best positioned to provide information about factors associated with readmission, yet their perspectives have rarely been elicited. DESIGN Descriptive qualitative study. METHODS This study included older stroke survivors who were readmitted to acute care from home in the six months following stroke, and their family caregivers. Participants were interviewed by telephone at approximately two weeks after discharge and a sub-set was also interviewed in person during the readmission. Interviews were audio-taped and content analysis was used to identify themes. RESULTS From the 29 semi-structured interviews conducted with 20 stroke survivors and/or their caregivers, the following themes were identified: preparing to go home after the stroke, what to expect at home, complexity of medication management, support for self-care in the community and the influence of social factors. CONCLUSIONS This study provides the critical perspective of the stroke survivor and family caregiver into furthering our understanding of readmissions after stroke. Participants identified several areas for intervention including better discharge preparation and the need for support in the community for medication management and self-care. The findings suggest that interventions designed to reduce readmissions after stroke should be multifaceted in approach and extend across the continuum of care. RELEVANCE TO CLINICAL PRACTICE The hospital level has been the focus of interventions to reduce preventable readmissions, but the results of this study suggest the importance of community-level care. The individual nature of each situation must be taken into account, including the postdischarge environment and the availability of social support.
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Affiliation(s)
- Carole L White
- School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
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Bastawrous M, Gignac MA, Kapral MK, Cameron JI. Daughters providing poststroke care: perspectives on the parent-child relationship and well-being. QUALITATIVE HEALTH RESEARCH 2014; 24:1527-1539. [PMID: 25150222 DOI: 10.1177/1049732314548689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Stroke is a leading cause of disability and dependence on the family, specifically daughter caregivers. The quality of the parent-child relationship can influence the experiences and well-being of daughters. Little is known about this in the context of stroke caregiving. We aimed to explore daughters' perceptions of changes in the relationship with their parent and how these changes contribute to their well-being. We used a qualitative descriptive design. Twenty-three daughters completed one in-depth interview that was transcribed, reviewed, coded, and categorized to generate themes. The parent-child relationship was central to each of the three themes: It (a) led daughters to take on the caregiving role, (b) changed as a result of caregiving, and (c) contributed to daughters' physical and emotional health. Targeted counseling that addresses changes in the parent-child relationship can help mitigate losses in communication and intimacy between daughters and parents. Insight into temporal relationship changes is needed.
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Affiliation(s)
| | | | - Moira K Kapral
- Toronto General Research Institute, Toronto, Ontario, Canada
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Evaluating use of the Siebens Domain Management Model during inpatient rehabilitation to increase functional independence and discharge rate to home in stroke patients. PM R 2014; 7:354-64. [PMID: 25459653 DOI: 10.1016/j.pmrj.2014.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 10/15/2014] [Accepted: 10/19/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate use of the Siebens Domain Management Model (SDMM) during stroke inpatient rehabilitation (IR) to increase functional independence and rate of discharge to home. DESIGN Before and after study. SETTING IR facility. PARTICIPANTS Before the intervention: 154 patients with ischemic/hemorrhagic strokes who were admitted to an IR facility in 2010; on average, they were admitted 9.1 days after receiving acute care. After the intervention: 151 patients with ischemic/hemorrhagic strokes who were admitted to an IR facility in 2012; on average they were admitted 7.3 days after receiving acute care. The comorbidity tier severity and prestroke living setting and living support appeared to be similar in both the preintervention and postintervention groups. INTERVENTION Use of the SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home including medical/surgical issues, cognitive/emotional coping issues, physical function, and living environment/community re-entry needs. MAIN OUTCOME MEASURES Use of Functional Independence Measure (FIM) score change during IR length of stay (LOS; FIM-LOS efficiency) and rates of discharge to community/home, acute care, and long-term care (LTC) to compare 2010/preintervention data with postintervention data from 2012, along with comparison of facility data to national aggregate data from the Uniform Data System for Medical Rehabilitation (UDSMR) for both years. RESULTS Preintervention 2010 FIM-LOS efficiency was 1.44 compared with a 2012 postintervention FIM-LOS efficiency of 2.24, which was significant (t = 4.3; P < .0001). Comparison of the UDSMR 2012 national FIM-LOS efficiency score (1.72) to the 2012 postintervention score of 2.24 reached significance (t = 2.6; P < .01). In addition, a significant difference was found between groups for discharge location: In the preintervention group, 57.8% were discharged to home/community, 14.9% to LTC, and 27.3% back to acute care compared with the postintervention group, in which 81.2% were discharged to home/community, 9.4% to LTC, and 9.4% back to acute care (χ(2) = 8.98; P < .001). Also significant was comparison between the 2012 postintervention group and the 2012 national UDSMR data for the same 3 discharge locations (χ(2) = 3.94; P < .05). Comparison of 2010 to 2012 facility data then shows a 23.4% increase in discharge to the community compared with an increase of 5.8% for the UDSMR 2010 to 2012 data, representing a community discharge rate that is 4 times greater for the 2012 facility postintervention group (χ(2) = 83.596; P < .0001). CONCLUSIONS Use of the SDMM during stroke IR may convey improvement in functional independence and is associated with an increased discharge rate to home/community and a reduction in institutionalization and acute-care transfers.
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Bauler S, Jacquin-Courtois S, Haesebaert J, Luaute J, Coudeyre E, Feutrier C, Allenet B, Decullier E, Rode G, Janoly-Dumenil A. Barriers and facilitators for medication adherence in stroke patients: a qualitative study conducted in French neurological rehabilitation units. Eur Neurol 2014; 72:262-70. [PMID: 25277833 DOI: 10.1159/000362718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 04/06/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. METHOD A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. RESULTS Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of over medication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. CONCLUSION This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.
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Affiliation(s)
- Stephanie Bauler
- Pôle de Rééducation et de Réadaptation Fonctionnelles, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France
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110
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Barbic SP, Mayo NE, White CL, Bartlett SJ. Emotional vitality in family caregivers: content validation of a theoretical framework. Qual Life Res 2014; 23:2865-72. [PMID: 24853533 DOI: 10.1007/s11136-014-0718-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Emotional vitality may play an important role in determining whether informal caregivers are able to successfully adopt and persist in their roles. This study describes a content validation of a conceptual model of emotional vitality in informal caregivers. METHODS A secondary content analysis was performed on transcripts of 30 caregivers who were interviewed about their quality of life in relation to assuming the role of informal caregiver for a family member who had experienced a recent stroke. Caregivers discussed changes in their own health, relationships, roles, finances, participation, and mood after assuming the caregiving role. Using a thematic inductive approach, two raters independently coded the presence and frequency of physical, emotional, and social impacts associated with the caregiving role in order to further develop and validate a conceptual model of caregiver emotional vitality. RESULTS The interviews provided information that affirmed the relevance of four themes relevant to caregiver emotional vitality previously identified: physical health and well-being; mood regulation; sense of control/mastery of new skills; and participation in meaningful activity. An additional theme of support and recognition from others also emerged. CONCLUSIONS Adopting the informal caregiving role results in major impacts to the caregiver's physical, emotional, and social health. Five core domains appear to meaningfully contribute to emotional vitality of caregivers and may influence their ability to persist in this role over time. Many of the factors that influence emotional vitality in caregivers are potentially modifiable. This new model offers new opportunities for rehabilitation specialists and allied health professionals to develop skill-building interventions that may help caregivers successfully adapt and thrive in the caregiving role.
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Affiliation(s)
- Skye P Barbic
- Social Aetiology of Mental Illness Program, Centre for Addiction and Mental Health, 33 Russell, Suite 1111, Toronto, ON, M5S 2G8, Canada,
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111
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Saji N, Kimura K, Ohsaka G, Higashi Y, Teramoto Y, Usui M, Kita Y. Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study. Disabil Rehabil 2014; 37:331-7. [DOI: 10.3109/09638288.2014.918195] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naoki Saji
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan,
- Department of Neurology, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan,
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan,
| | - Goro Ohsaka
- Department of Rehabilitation Medicine, Hyogo Prefectural Rehabilitation Hospital, Tatsuno, Hyogo, Japan,
| | - Yasuto Higashi
- Department of Neurology, Himeji Central Hospital, Himeji, Hyogo, Japan,
| | - Yoichi Teramoto
- Department of Rehabilitation Medicine, Ishikawa Hospital, Himeji, Hyogo, Japan, and
| | - Masanobu Usui
- Department of Rehabilitation Medicine, Steel Memorial Hirohata Hospital, Himeji, Hyogo, Japan
| | - Yasushi Kita
- Department of Neurology, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan,
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Clarke DJ, Hawkins R, Sadler E, Harding G, McKevitt C, Godfrey M, Dickerson J, Farrin AJ, Kalra L, Smithard D, Forster A. Introducing structured caregiver training in stroke care: findings from the TRACS process evaluation study. BMJ Open 2014; 4:e004473. [PMID: 24736035 PMCID: PMC4010820 DOI: 10.1136/bmjopen-2013-004473] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/14/2014] [Accepted: 03/23/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate the process of implementation of the modified London Stroke Carers Training Course (LSCTC) in the Training Caregivers After Stroke (TRACS) cluster randomised trial and contribute to the interpretation of the TRACS trial results. The LSCTC was a structured competency-based training programme designed to help develop the knowledge and skills (eg, patient handling or transfer skills) essential for the day-to-day management of disabled survivors of stroke. The LSCTC comprised 14 components, 6 were mandatory (and delivered to all) and 8 non-mandatory, to be delivered based on individual assessment of caregiver need. DESIGN Process evaluation using non-participant observation, documentary analysis and semistructured interviews. PARTICIPANTS Patients with stroke (n=38), caregivers (n=38), stroke unit staff (n=53). SETTINGS 10 of the 36 stroke units participating in the TRACS trial in four English regions (Yorkshire, North West, South East and South West, Peninsula). RESULTS Preparatory cascade training on delivery of the LSCTC did not reach all staff and did not lead to multidisciplinary team (MDT) wide understanding of, engagement with or commitment to the LSCTC. Although senior therapists in most intervention units observed developed ownership of the LSCTC, MDT working led to separation rather than integration of delivery of LSCTC elements. Organisational features of stroke units and professionals' patient-focused practices limited the involvement of caregivers. Caregivers were often invited to observe therapy or care being provided by professionals but had few opportunities to make sense of, or to develop knowledge and stroke-specific skills provided by the LSCTC. Where provided, caregiver training came very late in the inpatient stay. Assessment and development of caregiver competence was not commonly observed. CONCLUSIONS Contextual factors including service improvement pressures and staff perceptions of the necessity for and work required in caregiver training impacted negatively on implementation of the caregiver training intervention. Structured caregiver training programmes such as the LSCTC are unlikely to be practical in settings with short inpatient stays. Stroke units where early supported discharge is in place potentially offer a more effective vehicle for introducing competency based caregiver training. LINKED TRACS CLUSTER RANDOMISED CONTROLLED TRIAL NUMBER ISRCTN49208824.
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Affiliation(s)
- David J Clarke
- Bradford Teaching Hospitals NHS Trust and University of Leeds, Bradford, UK
| | - R Hawkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - E Sadler
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - G Harding
- Peninsula College of Medicine and Dentistry, Exeter, Devon, UK
| | - C McKevitt
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - M Godfrey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - J Dickerson
- Bradford Teaching Hospitals NHS Trust and University of Leeds, Bradford, UK
| | - A J Farrin
- Clinical Trials Research Unit, Health Sciences Division, University of Leeds, Leeds, UK
| | - L Kalra
- Department of Stroke Medicine Guy's, King's & St Thomas’ School of Medicine, London, UK
| | - D Smithard
- Kent Community Health NHS Trust, Kent, UK
| | - A Forster
- Bradford Teaching Hospitals NHS Trust and University of Leeds, Bradford, UK
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, D'Amico F, Addante LM, Ferlisi G, Zullo V, Oliva D, Megna M. Technology to help persons with extensive neuro-motor impairment and lack of speech with their leisure occupation and communication. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:611-618. [PMID: 24472502 DOI: 10.1016/j.ridd.2014.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/02/2014] [Indexed: 06/03/2023]
Abstract
These two studies were aimed at extending the assessment of technology-aided programs to enhance leisure occupation or communication with persons with extensive neuro-motor impairment and lack of speech. Specifically, Study I implemented the program for leisure occupation with two post-stroke patients. Study II implemented the program for communication with two persons affected by amyotrophic lateral sclerosis (ALS). In Study I, a computer system presented the participants with a variety of stimuli. The participants could select/access those stimuli by microswitch activation or could bypass them by abstaining from microswitch responses. In Study II, the participants used a computer-aided telephone system that allowed them to choose via microswitch activation the persons to call. On the computer screen, they also had words and phrases that they could activate during the calls to influence the conversation with the persons called. Data from both studies were largely positive. The post-stroke patients showed high levels of stimulus selection (access) and extended engagement. The patients with ALS were able to make phone calls and to select the words/phrases to influence the conversations. The relevance of technology-aided programs for leisure occupation and communication of persons with extensive multiple disabilities was discussed.
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Affiliation(s)
| | - Nirbhay N Singh
- Medical College of Georgia, Georgia Regents University, Augusta, USA
| | | | | | - Fiora D'Amico
- S. Raffaele Medical Care Center, Alberobello and Modugno, Italy
| | - Luigi M Addante
- S. Raffaele Medical Care Center, Alberobello and Modugno, Italy
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Cameron JI, Naglie G, Gignac MAM, Bayley M, Warner G, Green T, Czerwonka A, Huijbregts M, Silver FL, Phillips SJ, Cheung AM. Randomized clinical trial of the Timing it Right Stroke Family Support Program: research protocol. BMC Health Serv Res 2014; 14:18. [PMID: 24433234 PMCID: PMC3898562 DOI: 10.1186/1472-6963-14-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 01/06/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. METHODS/DESIGN Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke, 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. DISCUSSION This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions. TRIAL REGISTRATION ClinicalTrials.gov: NCT00958607.
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Affiliation(s)
- Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario M5G 1V7, Canada
- UHN Toronto Rehabilitation Institute, Toronto, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, 3560 Bathurst Street, Toronto, Ontario M6A 2E1, Canada
- Research Department, UHN Toronto Rehabilitation Institute, Toronto, Canada
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Monique A M Gignac
- UHN Toronto Western Research Institute, 399 Bathurst Street, Main Pavilion, 10-328, Toronto, ON ON M5T 2S8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mark Bayley
- UHN Toronto Rehabilitation Institute, University Centre, University of Toronto, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
- Department of Medicine, University of Toronto, Toronto Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, 5689 University Ave, Halifax, Nova Scotia B3H 3J5, Canada
| | - Theresa Green
- Faculty of Nursing, University of Calgary, 2500 University Dr NW, Calgary AB T2N 1N4, Canada
| | - Anna Czerwonka
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario M5G 1V7, Canada
- UHN Toronto Rehabilitation Institute, Toronto, Canada
| | - Maria Huijbregts
- Family Service Toronto, 355 Church Street, Toronto, Ontario M5B 1Z8, Canada
- Department of Physical Therapy, University of Toronto, Baycrest Health Sciences, Toronto, Canada
| | - Frank L Silver
- UHN Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Steve J Phillips
- Department of Medicine, Division of Neurology, Dalhousie University/QEII Health Sciences Centre, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
| | - Angela M Cheung
- UHN Toronto General Hospital, 200 Elizabeth Street, 7 Eaton North - room 221, Toronto, Ontario M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Hallé MC, Le Dorze G. Understanding significant others’ experience of aphasia and rehabilitation following stroke. Disabil Rehabil 2013; 36:1774-82. [DOI: 10.3109/09638288.2013.870608] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Creasy KR, Lutz BJ, Young ME, Ford A, Martz C. The impact of interactions with providers on stroke caregivers' needs. Rehabil Nurs 2013; 38:88-98. [PMID: 23529947 DOI: 10.1002/rnj.69] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Preparation for caregiving is improved through engaged interactions between stroke family caregivers and healthcare providers throughout the care trajectory. We explored caregivers' perceptions about interactions with providers in rehabilitation, and how these experiences affected caregiver preparation. DESIGN Seventeen caregivers, included in this grounded theory study, were interviewed during a rehabilitation stay and postdischarge. Data were analyzed using dimensional and comparative analysis. FINDINGS Caregivers described interactions with providers on a continuum from collaborative to disconnected, and a range of strategies to enhance interactions. CONCLUSIONS Caregivers want to be actively engaged with providers during inpatient rehabilitation and collaborative interactions enhance preparedness and care satisfaction. RELEVANCE Family members should be assessed for caregiving capacity and interactions between providers and caregivers should be individualized to specific needs. Providers must also be aware that many caregivers are not active information seekers. They must engage caregivers who may not even know what questions to ask.
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Affiliation(s)
- Kerry Rae Creasy
- College of Nursing, University of Florida, Gainesville, FL, USA.
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McAdam JJ, Leathley MJ, Crichton MS, Dickens J, Jack CIA, Watkins CL. Evaluation of a rehabilitation support service after acute stroke: Feasibility and patient/carer benefit. Health (London) 2013. [DOI: 10.4236/health.2013.57152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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