1
|
Akgül E, Çifçili S, Apaydın Kaya Ç. Developing a post-stroke home care checklist for primary care professionals in Turkey: a modified Delphi study. Prim Health Care Res Dev 2023; 24:e22. [PMID: 36971010 PMCID: PMC10061270 DOI: 10.1017/s146342362300004x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/31/2022] [Accepted: 11/19/2022] [Indexed: 03/29/2023] Open
Abstract
AIM The aim of this study is to develop a post-stroke home care checklist for the use of primary care professionals. BACKGROUND Home care is an integral part of primary health care. In the literature, several scales are available to help determine elderly individuals' need for home care services; however, there are no standard care criteria or guidelines for the home care of stroke survivors. Therefore, a standardized post-stroke home care tool specific for use by primary care professionals is needed to identify patients' needs and to detect intervention areas. METHODS This is a checklist development study carried out between December 2017 and September 2018 in Turkey. A modified Delphi technique was used. In the first stage of the study, a literature review was carried out, a workshop was conducted with healthcare specialists in the stroke area, and a 102-item draft checklist was created. In the second stage, two written Delphi rounds were carried out via email with 16 healthcare professionals providing post-stroke home care. In stage three, the agreed items were reviewed, and similar items were grouped together to create the final checklist. FINDINGS A consensus was achieved in 93 of the 102 items. The final checklist, consisting of four main themes and 15 headings, was created. The four main areas of assessment in post-stroke home care are 'assessment of current status', 'identification of risks', 'evaluation of the care environment and caregiver', and 'planning follow-up care'. The Cronbach alpha reliability coefficient of the checklist was found to be 0.93. In conclusion, the PSHCC-PCP is the first checklist created to be used by primary care professionals in post-stroke home care. However, it needs to be assessed in terms of effectiveness and usefulness with further studies.
Collapse
Affiliation(s)
- Esra Akgül
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Serap Çifçili
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
- Eastern Mediterranean University School of Medicine, Istanbul, Turkey
| | - Çiğdem Apaydın Kaya
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
- Eastern Mediterranean University School of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
Morone G, Baricich A, Paolucci S, Bentivoglio AR, De Blasiis P, Carlucci M, Violi F, Levato G, Pani M, Carpagnano LF, Spandonaro F, Picelli A, Smania N. Long-Term Spasticity Management in Post-Stroke Patients: Issues and Possible Actions-A Systematic Review with an Italian Expert Opinion. Healthcare (Basel) 2023; 11:healthcare11060783. [PMID: 36981442 PMCID: PMC10048278 DOI: 10.3390/healthcare11060783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
Spasticity is a well-known motor dysfunction occurring after a stroke. A group of Italian physicians' experts in treating post-stroke spasticity (PSS) reviewed the current scientific evidence concerning the state-of-the-art clinical management of PSS management and the appropriate use of botulinum toxin, aiming to identify issues, possible actions, and effective management of the patient affected by spasticity. The participants were clinicians specifically selected to cover the range of multidisciplinary clinical and research expertise needed to diagnose and manage PSS. When evidence was not available, the panel discussed and agreed on the best way to manage and treat PSS. To address the barriers identified, the panel provides a series of consensus recommendations. This systematic review provides a focused guide in the evaluation and management of patients with PSS and its complications. The recommendations reached by this panel of experts should be used by less-experienced doctors in real life and should be used as a guide on how to best use botulinum toxin injection in treating spasticity after a stroke.
Collapse
Affiliation(s)
- Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- San Raffaele Institute of Sulmona, 67039 Sulmona, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | | | - Anna Rita Bentivoglio
- Neuroscience Department, Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Roma, Italy
| | - Paolo De Blasiis
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | | | - Francesco Violi
- Internal Medicine Department, Sapienza Università di, 00185 Roma, Italy
| | | | - Marcello Pani
- Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Roma, Italy
| | | | - Federico Spandonaro
- C.R.E.A. Sanità, University San Raffaele, 00166 Rome, Italy
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), 00196 Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| |
Collapse
|
3
|
Amatya B, Elmalik A, Lee SY, Song K, Galea M, Khan F. A process evaluation of patient care needs using the Post- Stroke Checklist: a prospective study. J Rehabil Med 2022; 54:jrm00259. [PMID: 35001136 PMCID: PMC8892296 DOI: 10.2340/jrm.v53.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of patients with stroke (PwS) in an inpatient rehabilitation setting. Methods Prospective observational design with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. The post-stroke checklist was administered at hospital discharge (T1) and 3 months post-discharge (T2). Furthermore, validated questionnaires assessed function and participation, including the Clinical Functioning Information Tool (ClinFIT) on admission (T0), T1 and T2. Results Participants’ mean age was 67.7 years (standard deviation; SD) 14.6), 58% of participants were female, and the mean length of inpatient stay was 32.7 days (SD 22.4). At T1, 80% and at T2 only 60% of participants reported ≥1 strokerelated problem (mean 5.3 (SD 3.3) and 3.6 (SD 2.8), respectively). Half of participants were referred to physiotherapy/occupational therapy, and 36% to specialist clinics following discharge. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living, and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed improved function at T1 and T2 (Extension Index, ClinFIT set), from T0 to T1 and T0 to T2 (p<0.001, with large effect sizes). Conclusion The mPSC is feasible to implement in an inpatient rehabilitation setting and community. It can identify relevant stroke-related problems, and hence facilitate targeted intervention.
Collapse
Affiliation(s)
- Bhasker Amatya
- Department of Rehabilitation, Royal Melbourne Hospital, Parkville, Victoria.
| | | | | | | | | | | |
Collapse
|
4
|
Jia M, Lu H, Olutoye F, Li J, Huang S, Zhou H. Translation and Cross-Cultural Adaptation of Post-Stroke Checklist into Mandarin: A Cognitive Interview Study. Neuropsychiatr Dis Treat 2022; 18:87-95. [PMID: 35068932 PMCID: PMC8769054 DOI: 10.2147/ndt.s342464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to translate the Post-stroke Checklist into Mandarin, validate its content, and cross-culturally adapt the Mandarin version of the Post-stroke Checklist (M-PSC) in line with expert review and cognitive interviewing. PATIENTS AND METHODS After translating into Mandarin, the M-PSC was modified and content validated using expert review, which resulted in a pilot version for cognitive interviewing among stroke survivors inclusive of subjects from an outpatient unit (n = 7), a rehabilitation department using traditional Chinese medicine (n = 10), and a community (n = 10). The interviews were transcribed and analyzed according to the four-stage cognitive model. A set of nine practice rounds where the number of rounds of iteration was determined based on the saturation of information was conducted. Data analysis was performed concurrently with data collection. Recommendations for changes to the M-PSC were made based on the analyses in the iteration. RESULTS We successfully developed an initial M-PSC, back-translated it into English, reviewed the discrepancies and performed a three-step expert review to modify the M-PSC and validate its excellent content. Twenty-seven interviews were carried out, and a wide range of sources of error primarily related to the comprehension, retrieval of information, and judgment was reported, and each item of the M-PSC was rectified accordingly. CONCLUSION The Post-stroke Checklist was translated into Mandarin and cross-culturally adapted based on expert review and cognitive interviewing. Adaptations were made to support that the Mandarin version can be implemented in clinical practice for long-term post-stroke care.
Collapse
Affiliation(s)
- Miao Jia
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.,School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Huiqi Lu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.,School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Femi Olutoye
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.,School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Jinjun Li
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.,School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Simin Huang
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.,School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Hongzhen Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.,School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| |
Collapse
|
5
|
Lin BL, Mei YX, Wang WN, Wang SS, Li YS, Xu MY, Zhang ZX, Tong Y. Unmet care needs of community-dwelling stroke survivors: a systematic review of quantitative studies. BMJ Open 2021; 11:e045560. [PMID: 33879490 PMCID: PMC8061855 DOI: 10.1136/bmjopen-2020-045560] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Understanding the unmet needs of community-dwelling stroke survivors is essential for further intervention. This systematic review was performed to summarise their unmet needs from a quantitative viewpoint. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES A comprehensive search of six databases was conducted from inception to February 2020: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and CBM. The methodological quality of the studies was assessed. Unmet needs were categorised, and a pooled analysis of the main outcomes was conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included quantitative studies focused on the unmet needs of stroke survivors who live at homes rather than in any other institutionalised organisation. RESULTS In total, 32 of 2660 studies were included, and 1980 unmet needs were identified. The prevalence of patients with unmet needs ranged from 15.08% to 97.59%, with a median of 67.20%; the median number of unmet needs per patient ranged from 2 to 8 (0-31). The prevalence of unmet needs was high at 6 months post-stroke (62.14%) and 2 years post-stroke (81.37%). After categorisation, the main concerns among these patients were revealed to be information support, physical function and mental health; a few studies reported unmet needs related to leisure exercise, return to work and so on. Additionally, differences in the measurement tools used across studies affect what unmet needs participants report. CONCLUSIONS Sufficient, accurate, individualised and dynamic information support is a priority among community-dwelling stroke survivors. Physical function and mental health are also the most significant concerns for re-achieving social participation. It is essential to design and disseminate standard, effective and time-saving tools to assess unmet needs. TRIAL REGISTRATION NUMBER CRD42018112181.
Collapse
Affiliation(s)
- Bei-Lei Lin
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yong-Xia Mei
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
| | - Wen-Na Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
| | - Shan-Shan Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
- The Hong Kong Polytechnic University, Hong Kong, China
| | - Ying-Shuang Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng-Ya Xu
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen-Xiang Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
| | - Yao Tong
- School of Information Engineering, Zhengzhou University, Zhengzhou, China
| |
Collapse
|
6
|
Olver J, Yang S, Fedele B, Ni J, Frayne J, Shen G, McKenzie D. Post Stroke Outcome: Global Insight into Persisting Sequelae Using the Post Stroke Checklist. J Stroke Cerebrovasc Dis 2021; 30:105612. [PMID: 33493876 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/17/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Following stroke, individuals commonly experience persisting loss of function. Whilst long-term care should involve continued support for ongoing stroke sequelae, this is often not routinely practiced globally. The Post Stroke Checklist was designed to standardise the process of detecting persisting treatable problems following stroke. AIMS This cross-sectional study aimed to identify the long-term problems reported in Australian and Chinese participants at six months post stroke using the Post Stroke Checklist. It also aimed to provide global insight into poststroke sequelae by comparing the study results to previously published studies which administered the Post Stroke Checklist in other countries. METHODS Participants were recruited from two hospitals in Australia and one hospital in China. The Post Stroke Checklist consists of 11 problem areas commonly experienced after stroke. This study follows a sequence of studies which have applied the checklist to monitor long-term outcomes after stroke in Germany, Italy, Singapore, Sweden and the United Kingdom. RESULTS Comparisons between Australia (n = 112) and China (n = 97) demonstrated statistically significant differences on the Post Stroke Checklist items. Across all seven countries, collectively the most common persisting difficulties post-stroke related to: cognition, life after stroke, mood, mobility and activities of daily living. An analysis of means procedure compared individual countries for each checklist item against the overall group mean (all countries combined). CONCLUSIONS Globally, individuals report persisting functional difficulties following stroke. There appear to be differences in the proportions affected across the various countries, and healthcare systems may benefit from geographically tailoring post-stroke care.
Collapse
Affiliation(s)
- John Olver
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia; Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - Shanshan Yang
- Rehabilitation Department, Xuzhou Children's Hospital No.18, Jiangsu Province, China
| | - Bianca Fedele
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia; Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Jun Ni
- Rehabilitation Department, the first Affiliated Hospital of Fujian Medical University, Fujian Province, China; Rehabilitation Department, the Affiliated Hospital of Nantong Medical University, Jiangsu Province, China.
| | - Judith Frayne
- School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Neurosciences and Van Cleef Roet Centre for Nervous Disease, Monash University, Melbourne, Australia
| | - Guangyu Shen
- Rehabilitation Department, the Affiliated Hospital of Nantong Medical University, Jiangsu Province, China
| | - Dean McKenzie
- Research Development and Governance Unit, Epworth HealthCare, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
7
|
Ullberg T, Månsson K, Berhin I, Pessah-Rasmussen H. Comprehensive and Structured 3-month Stroke Follow-up Using the Post-stroke Checklist (The Struct-FU study): A Feasibility and Explorative Study. J Stroke Cerebrovasc Dis 2020; 30:105482. [PMID: 33253985 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105482] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is recent evidence supporting that a comprehensive post-stroke treatment program improves outcome. However, the prevalence of stroke-related health problems and the extent of needed interventions have not been well-delineated. The Struct-FU study aims to assess the feasibility of a comprehensive stroke follow-up model and to map stroke-related problems and subsequent multidisciplinary interventions using a modified Post-stroke Checklist (PSC). METHODS We consecutively screened all acute stroke patients at Skåne University Hospital, Sweden during an eight-month period in 2018-2019. Patients discharged to own home were eligible for inclusion. We defined a stroke-related health problem as a health- or social issue corresponding to one of the 14 items in the modified PSC, and with onset after the stroke event. Three-months post-stroke, a semi-structured interview using a 14-item modified PSC was completed to map the prevalence of stroke-related health problems, as well as any subsequent multidisciplinary stroke team interventions prompted by the visit. RESULTS The number of included patients was 200. Of these, 165 (82.9%) completed three-month follow-up, one died, and 34 were lost to follow-up. All patients completed the full PSC, and the majority (92.7%) reported stroke-related problems identified using the PSC, with the median number being three per patient, and half having four or more problems. Patients <=65 years (n=44) presented with more stroke-related problems than patients >65 years (n=121) (5 vs. 3, p=0.003). The median number of interventions was two per patient. Doctor's interventions (changes in medication, referrals or further work-up) were done in 53% of patients, 77% needed a nurse's or other stroke team professional's intervention (tailored advice, information, audits, rehabilitation assessments) and 15% needed no intervention. Only 3.6% of patients reported other stroke-related challenges (PSC item 14) than those specified in item 1-13. CONCLUSION We report a high burden of stroke-related health problems in community dwelling stroke patients with mild to moderate stroke. Multidisciplinary interventions were prompted in the vast majority (85%). Only 3.6% of patients reported challenges not captured with the Post-stroke Checklist, reflecting that the comprehensive approach captures the majority of stroke-related health problems, and gives a good estimate of the total stroke-related health burden for each individual.
Collapse
Affiliation(s)
- Teresa Ullberg
- Stroke policy and quality register research group, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Malmö, Sweden.
| | - Kristina Månsson
- Stroke policy and quality register research group, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Malmö, Sweden.
| | - Ida Berhin
- Stroke policy and quality register research group, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Malmö, Sweden.
| | - Hélène Pessah-Rasmussen
- Stroke policy and quality register research group, Lund University, Lund, Sweden; Department of Rehabilitation, Skåne University Hospital, Sweden.
| |
Collapse
|
8
|
Sensorized Assessment of Dynamic Locomotor Imagery in People with Stroke and Healthy Subjects. SENSORS 2020; 20:s20164545. [PMID: 32823786 PMCID: PMC7472606 DOI: 10.3390/s20164545] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/29/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
Dynamic motor imagery (dMI) is a motor imagery task associated with movements partially mimicking those mentally represented. As well as conventional motor imagery, dMI has been typically assessed by mental chronometry tasks. In this paper, an instrumented approach was proposed for quantifying the correspondence between upper and lower limb oscillatory movements performed on the spot during the dMI of walking vs. during actual walking. Magneto-inertial measurement units were used to measure limb swinging in three different groups: young adults, older adults and stroke patients. Participants were tested in four experimental conditions: (i) simple limb swinging; (ii) limb swinging while imagining to walk (dMI-task); (iii) mental chronometry task, without any movement (pure MI); (iv) actual level walking at comfortable speed. Limb swinging was characterized in terms of the angular velocity, frequency of oscillations and sinusoidal waveform. The dMI was effective at reproducing upper limb oscillations more similar to those occurring during walking for all the three groups, but some exceptions occurred for lower limbs. This finding could be related to the sensory feedback, stretch reflexes and ground reaction forces occurring for lower limbs and not for upper limbs during walking. In conclusion, the instrumented approach through wearable motion devices adds significant information to the current dMI approach, further supporting their applications in neurorehabilitation for monitoring imagery training protocols in patients with stroke.
Collapse
|
9
|
Ghanbari Ghoshchi S, De Angelis S, Morone G, Panigazzi M, Persechino B, Tramontano M, Capodaglio E, Zoccolotti P, Paolucci S, Iosa M. Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145233. [PMID: 32698430 PMCID: PMC7399919 DOI: 10.3390/ijerph17145233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022]
Abstract
Cerebrovascular diseases, including stroke, are historically considered diseases of old adults so only in a few studies has “return to work” (RTW) been considered as an index of rehabilitative outcome. At the moment, data on RTW in patients with stroke are highly variable: four different reviews reported the following ranges: 11–85%, 19–73%, 22–53%, and 40–45%. The absence of re-integration to work after a stroke is shown to be associated with an increase of cardiac disorders and depression, with a higher level of mortality, with social isolation and with insufficient adaptive skills. The aim of this study was to verify the effectiveness of technological treatment, performed with optic (SonicHand) and wearable (Riablo™) systems providing auditory and visual biofeedback, on RTW in patients with stroke. RTW was found to be associated with a higher independence in the activities of daily living (assessed by the Modified Barthel Index). No significant differences were found between technological versus conventional rehabilitation in terms of RTW, despite the former showing a higher odds ratio than the latter (OR = 9 vs. 6). Assistive devices were mainly used in patients who had not returned to work. Finally, quality of life was found higher in those patients who returned to work with the same conditions (work duties and time) as before stroke.
Collapse
Affiliation(s)
- Sheyda Ghanbari Ghoshchi
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Sara De Angelis
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Giovanni Morone
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27040 Montescano, Italy;
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27100 Pavia, Italy;
| | - Benedetta Persechino
- Italian Workers’ Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, 00078 Rome, Italy;
| | - Marco Tramontano
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, 00135 Rome, Italy
| | - Edda Capodaglio
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27100 Pavia, Italy;
| | - Pierluigi Zoccolotti
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Paolucci
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Marco Iosa
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Correspondence:
| |
Collapse
|
10
|
The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
Collapse
|
11
|
Lin B, Ding C, Mei Y, Wang P, Ma F, Zhang ZX. Unmet care needs of community-dwelling stroke survivors: a protocol for systematic review and theme analysis of quantitative and qualitative studies. BMJ Open 2019; 9:e029160. [PMID: 31230030 PMCID: PMC6596939 DOI: 10.1136/bmjopen-2019-029160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/30/2019] [Accepted: 05/28/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Stroke is a leading cause of disability worldwide. The average hospital length of stay ranges from 3 to 28 days, and after discharge home the stroke survivors will live with physical, cognitive, even psychological disorders for the rest of their lives. It is essential to review the unmet needs of stroke survivors. METHODS AND ANALYSIS A systematic review of previous quantitative and qualitative studies reporting the unmet needs of stroke survivors in their homes will be conducted. The following six databases will be searched from inception to December 2018 for relevant articles: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and China Biology Medicine. We will include studies limited to human and published in English or Chinese, and the patients with stroke should discharge home rather than any other professional organisations including nursing homes or community rehabilitation units and so on. Data of quantitative research will be standardised for comparison, thematic analysis will be used for qualitative data and a narrative synthesis and pooled analysis of the main outcomes will be reported. ETHICS AND DISSEMINATION This review will be submitted to an international professional journal, and the detailed search strategies and analysis flowchart will be openly included as supplements. This study does not require ethical approval as no patient's identifiable data will be used. Our findings will give a new look at the aspect of stroke survivors' unmet needs in their long-term recovery stage, especially the trajectories of unmet needs at different timepoints. What is more, this review will demonstrate the long-term unmet needs of stroke survivors from different countries, will compare any variations between high-income and low-income regions, and the geographical differences of needs will be mapped if necessary. We will endeavour to provide as much information as possible to healthcare professionals and public health policy makers in order to promote further medical reform. TRIAL REGISTRATION NUMBER CRD42018112181.
Collapse
Affiliation(s)
- Beilei Lin
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Chunge Ding
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongxia Mei
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Panpan Wang
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Fayang Ma
- China-US (Henan) Hormel Cancer Institute, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen-Xiang Zhang
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
12
|
Kjörk EK, Carlsson G, Sunnerhagen KS, Lundgren-Nilsson Å. Experiences using the poststroke checklist in Sweden with a focus on feasibility and relevance: a mixed-method design. BMJ Open 2019; 9:e028218. [PMID: 31072862 PMCID: PMC6528008 DOI: 10.1136/bmjopen-2018-028218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The wide range of outcomes after stroke emphasises the need for comprehensive long-term follow-up. The aim was to evaluate how people with stroke and health professionals (HPs) perceive the use of the poststroke checklist (PSC), with a focus on feasibility and relevance. DESIGN An exploratory design with a mix of qualitative and quantitative methods. SETTING Outpatient care at a university hospital and primary care centres in western Sweden. PARTICIPANTS Forty-six consecutive patients (median age, 70; range, 41-85; 13 women) and 10 health professionals (median age 46; range, 35-63; 7 women). RESULTS Most patients (87%) had one or more problems identified by the PSC. The most common problem areas were life after stroke (61%), cognition (56%), mood (41%) and activities of daily living (39%). Three organisational themes emerged from the focus group discussions. The perception of the content and relevance of the PSC was that common poststroke problems were covered but that unmet needs still could be missed. Identifying needs was facilitated when using the PSC as a tool for dialogue. The dialogue between the patient and HP as well as HPs stroke expertise was perceived as important. The PSC was seen as a systematic routine and a base for egalitarian follow-up, but participants stressed consideration given to each individual. Addressing identified needs and meeting patient expectations were described as challenging given available healthcare services. CONCLUSIONS The PSC is a feasible and relevant tool to support egalitarian follow-up and identify patients who could benefit from targeted poststroke interventions. Stroke expertise, room for dialogue and caring for identified needs emerged as important issues to consider when using the PSC. Nutrition, sexuality and fatigue were areas mentioned that might need to be addressed within the discussions. The PSC can facilitate patients in expressing their needs, enhancing their ability to participate in decision-making.
Collapse
Affiliation(s)
- Emma K Kjörk
- Department of Clinical Neuroscience, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg
| | - Gunnel Carlsson
- Department of Clinical Neuroscience, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg
| | - Åsa Lundgren-Nilsson
- Department of Clinical Neuroscience, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg
| |
Collapse
|
13
|
Turner GM, Mullis R, Lim L, Kreit L, Mant J. Using a checklist to facilitate management of long-term care needs after stroke: insights from focus groups and a feasibility study. BMC FAMILY PRACTICE 2019; 20:2. [PMID: 30609920 PMCID: PMC6318919 DOI: 10.1186/s12875-018-0894-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/20/2018] [Indexed: 12/02/2022]
Abstract
Background Long-term needs of stroke survivors are often not adequately addressed and many patients are dissatisfied with care post-discharge from hospital. Primary care could play an important role in identifying need in people with stroke. Aim We aimed to explore, refine and test the feasibility and acceptability of a post-stroke checklist for stroke reviews in primary care. Design and setting Focus groups (using a generic qualitative approach) and a single-centre feasibility study. Method Five focus groups were conducted; three with healthcare providers and two with stroke survivors/carers. The focus groups discussed acceptability of a checklist approach and the content of an existing checklist. The checklist was then modified and piloted in one general practice surgery in the East of England. Results The qualitative data found the concept of a checklist was considered valuable to standardise stroke reviews and prevent post-stroke problems being missed. Items were identified that were missing from the original checklist: return to work, fatigue, intimate relationships and social activities. Time constraints was the main concern from healthcare professionals and pre-completion of the checklist was suggested to address this. Thirteen stroke survivors were recruited to the feasibility study. The modified checklist was found to be feasible and acceptable to patients and primary care clinicians and resulted in agreed action plans. Conclusion The modified post-stroke checklist is a pragmatic and feasible approach to identify problems post-stroke and facilitate referral to appropriate support services. The checklist is a potentially valuable tool to structure stroke reviews using a patient-centred approach. Electronic supplementary material The online version of this article (10.1186/s12875-018-0894-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Grace M Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, Edgbaston, B15 2TT, UK.
| | - Ricky Mullis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Lisa Lim
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Lizzie Kreit
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, CB1 8RN, UK
| |
Collapse
|
14
|
Sandrini G, Baricich A, Cisari C, Paolucci S, Smania N, Picelli A. Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey. FUNCTIONAL NEUROLOGY 2019; 33:37-43. [PMID: 29633695 DOI: 10.11138/fneur/2018.33.1.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present paper provides practical guidance on the management of adult spasticity with OnabotulinumtoxinA. Advisory Board members reviewed the available evidence and discussed their personal experiences in order to address the unmet needs in the management of spasticity with botulinum toxin type A identified by the recent Italian Real-Life Post-Stroke Spasticity Survey. Stroke patients should be referred to spasticity services that have adequate facilities and multidisciplinary teams with the necessary training, competence and expertise. The current literature shows a strong correlation between the development of post-stroke spasticity and the degree of central sensorimotor system destruction/disorganization. Use of tools such as the Poststroke Checklist may help clinicians in the long-term follow-up of stroke patients. The maximum dose of onabotulinumtoxinA - according to the current literature this ranges from 300U to 400U for upper limb and from 500U to 600U for lower limb aggregate postures - should be re-considered. In addition, there is a need for future consensus (also based on pharmacoeconomic considerations) on consistent clinical care models for the management of patients with post-stroke spasticity.
Collapse
|