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Helbach J, Hoffmann F, Hecht N, Heesen C, Thomalla G, Wilfling D, Rahn AC. Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review. Eur Stroke J 2024:23969873241272744. [PMID: 39188106 DOI: 10.1177/23969873241272744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024] Open
Abstract
PURPOSE We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention. METHODS In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews. FINDINGS We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early. CONCLUSION PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.
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Affiliation(s)
- Jasmin Helbach
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Nina Hecht
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Wilfling
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
| | - Anne Christin Rahn
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
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Wang PY, Chen YW, Lin MH. Translation and validation of the Chinese version of the stroke knowledge test for the hypertension patient. Sci Rep 2023; 13:17446. [PMID: 37838764 PMCID: PMC10576787 DOI: 10.1038/s41598-023-44682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
The measurement of hypertensive patients' stroke knowledge is an important stroke prevention indicator of health care service quality. The aim of this study was to develop a Chinese version of the Stroke Knowledge Test and examine its psychometric properties, reliability, and validity for hypertensive patients. A sample of 200 hypertensive patients completed the Chinese version of the Stroke Knowledge Test, and 30 of the participants were retested after 2 weeks. The final Chinese version of the Stroke Knowledge Test included 20 items with acceptable content validity (I-CVI = 0.88 ~ 1.00, S-CVI/Ave = 0.97). These items showed satisfactory internal reliability consistency (Kuder Richardson-20 = 0.62) and test-retest reliability was 0.77. The 40% of the difficulty index was in the acceptable range, and 25% was in the difficult range, as well as the 90% items overall values for discrimination were ranged from 0.2 to > 0.4. Known-group validity testing was performed based on the education level, and the result exhibited significant difference (F = 21.21, p < 0.001). The Chinese version of the Stroke Knowledge Test demonstrated acceptable psychometric properties, thus providing a new tool for the future care of hypertensive patients in Taiwan. It also could be as a reference for healthcare providers to educate hypertensive patients on stroke prevention.
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Affiliation(s)
- Pao-Yu Wang
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan, ROC
| | - Yu-Wei Chen
- Department of Neurology, Neuroscience Center, Landseed International Hospital, Taoyuan, Taiwan, ROC
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Mei-Hsiang Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd. Beitou Dist, Taipei, Taiwan, ROC.
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Reistetter T, Hreha K, Dean JM, Pappadis MR, Deer RR, Li CY, Hong I, Na A, Nowakowski S, Shaltoni HM, Bhavnani SK. The Pre-Adaptation of a Stroke-Specific Self-Management Program Among Older Adults. J Aging Health 2023; 35:632-642. [PMID: 36719035 PMCID: PMC10387498 DOI: 10.1177/08982643231152520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objectives: Managing multimorbidity as aging stroke patients is complex; standard self-management programs necessitate adaptations. We used visual analytics to examine complex relationships among aging stroke survivors' comorbidities. These findings informed pre-adaptation of a component of the Chronic Disease Self-Management Program. Methods: Secondary analysis of 2013-2014 Medicare claims with stroke as an index condition, hospital readmission within 90 days (n = 42,938), and 72 comorbidities. Visual analytics identified patient subgroups and co-occurring comorbidities. Guided by the framework for reporting adaptations and modifications to evidence-based interventions, an interdisciplinary team developed vignettes that highlighted multimorbidity to customize the self-management program. Results: There were five significant subgroups (z = 6.19, p < .001) of comorbidities such as obesity and cancer. We constructed 6 vignettes based on the 5 subgroups. Discussion: Aging stroke patients often face substantial disease-management hurdles. We used visual analytics to inform pre-adaptation of a self-management program to fit the needs of older adult stroke survivors.
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Affiliation(s)
- Timothy Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900
| | - Kimberly Hreha
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC 27710
| | - Julianna M. Dean
- Department of Clinical, Health, and Applied Sciences, College of Human Sciences and Humanities, University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX 77058
| | - Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Rachel R. Deer
- Department of Nutrition, Metabolism and Rehabilitation Sciences, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, 135 Backun Hall, Yonsei Univroad 1, Wonju, Gangwon-do, Republic of Korea, 26493
| | - Annalisa Na
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102
| | - Sara Nowakowski
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Hashem M. Shaltoni
- Department of Neurology, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Suresh K. Bhavnani
- Department of Population Health and Health Disparities, School of Public and Population Health, 300 University Blvd, Galveston, TX 77555
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Lemoine ME, O'Connell SBL, Grunberg PH, Gagné K, Ells C, Zelkowitz P. Information needs of people seeking fertility services in Canada: a mixed methods analysis. Health Psychol Behav Med 2021; 9:104-127. [PMID: 34104552 PMCID: PMC8158234 DOI: 10.1080/21642850.2021.1879650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/18/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Infertility is a challenging experience associated with high levels of psychological distress. Many people seeking fertility services use the internet to obtain information about their conditions and treatments. OBJECTIVES This mixed-methods study aimed to describe the information-seeking experience of people seeking fertility services with respect to the fulfillment of their individually defined information needs and explore relationships between the fulfillment of information needs and psychological outcomes. METHODS One hundred and four participants completed a survey with close-ended and open-ended questions about their experience using an informational web-based application (app) called 'Infotility' and about their mental well-being before and after using the app. The questionnaires administered were the The Mobile Application Rating Scale (uMARS), the Fertility Quality of Life questionnaire (FertiQol), the Patient Empowerment Questionnaire (PEQ) and the General Anxiety Disorder 7-item Scale (GAD-7). Eleven participants completed in-depth qualitative interviews about their experience using the app. A thematic analysis was used to interpret qualitative results and quantitization was used to dichotomize participants into those with met information needs versus those with unmet information needs. Google Analytics was used to compare participants' reported experience with their actual use of the app. RESULTS The results of this study show that there is variability in the amount of information that people seeking fertility services wish to receive. Participants whose information needs were met reported improved psychological outcomes after using the app, while those with unmet needs showed no change in their psychological outcomes. CONCLUSIONS Our results suggest that fulfilling information needs was associated with improved psychological outcomes in people seeking fertility services. Our results also suggest that individual differences in information needs should be considered when developing health educational materials.
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Affiliation(s)
- Marie-Eve Lemoine
- Lady Davis Institute for Medical Research, Montreal, Canada
- University of Montreal, School of Public Health, Montreal, Canada
| | | | | | - Karolanne Gagné
- Jewish General Hospital Psychiatry Research Division, Montreal, Canada
| | - Carolyn Ells
- McGill University, Biomedical Ethics Unit, Montreal, Canada
| | - Phyllis Zelkowitz
- Jewish General Hospital Institute of Community and Family Psychiatry, Psychiatry, Montreal, Canada
- McGill University, Montreal, Canada
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Chu YM, Choi KS. Effectiveness of patient education in acute stroke: a comparison between a customised computer system and a pictorial information booklet. BMJ Health Care Inform 2020; 27:bmjhci-2020-100144. [PMID: 32816839 PMCID: PMC7430415 DOI: 10.1136/bmjhci-2020-100144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/03/2022] Open
Abstract
BackgroundPatients who develop acute stroke are at high risk for deterioration in the first 48–72 hours after admission. An effective educational intervention is needed.ObjectiveThis study aimed to examine the applicability of the customised interactive computer education system (CICS) in patients who had a stroke in the early acute phase in order to determine the efficacy of the education system in (1) information satisfaction and (2) physiological related management compliance.MethodsThe prospective non-blinded randomised controlled study was conducted in an acute stroke unit of a local hospital in Hong Kong from March to August 2019. Chinese participants were selected if they were at least 18 years of age, experienced a minor stroke within 3 days. The exclusion criteria were communication problem and comorbidity with another acute disease. On the first day of admission, participants were allocated to the CICS and booklet groups, with each group comprising 50 participants. On the third day, the primary outcome, Modified Information Satisfaction Questionnaire for Acute Stroke (MISQ-S), was assessed.ResultsThere was a significant difference in ‘the need to improve information measures’ of the MISQ-S (p=0.04) between the CICS and booklet groups. The management compliance of these two groups did not have difference, but the CICS group had better clinical outcome, though not significant (p=0.387).ConclusionPatient education was needed and feasible in the early acute phase, and the CICS was more efficacious than the booklet. The positive results provided insights into and give a direction to the use of information technology in patient education.
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Affiliation(s)
- Yin Man Chu
- Department of Medicine, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Kup Sze Choi
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
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Manola M, Petropoulou K, Calogero F. Gap in stroke patients' and carers' education. J Frailty Sarcopenia Falls 2020; 4:26-28. [PMID: 32300713 PMCID: PMC7155370 DOI: 10.22540/jfsf-04-026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 11/03/2022] Open
Abstract
Stroke is a multidimensional illness as it affects various aspects in a person's quality of life. The rehabilitation team focuses mainly on complications but there seems to be a gap in the education of the patients and their carers in skills relevant to the competencies required for community, aged care, health, housing and disability support services. Stroke patients' and carers' education-training, as well as their satisfaction has not been studied adequately. The current article presents important studies in the field about the association of patients' and carers' satisfaction and based on authors' opinion suggests appropriate interventions in order to improve the health of the patients.
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Affiliation(s)
- Margialena Manola
- 2 Rehabilitation Department, National Rehabilitation Center, Athens, Greece
| | | | - Foti Calogero
- Physical and Rehabilitation Medicine Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
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7
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Del Mar C. Priority setting for Cochrane Review Groups. J Clin Epidemiol 2019; 110:99-101. [DOI: 10.1016/j.jclinepi.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/04/2019] [Indexed: 11/24/2022]
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Abstract
OBJECTIVES To synthesise evidence on longer term unmet needs perceived by stroke survivors, and psychometric properties of the tools used to evaluate unmet care needs after stroke. DESIGN Systematic review. SETTING Community or patients' home. PARTICIPANTS Stroke survivors. METHODS We searched PubMed, PsycINFO, CINAHL, EMBASE from inception to 31 March 2018 to identify survey studies that evaluated unmet needs perceived by stroke survivors after hospital discharge. Reported unmet needs were categorised under three domains: body functioning, activity/participation and environmental factors. Ranges of prevalence rates of unmet needs reported in studies were presented. RESULTS We included 19 eligible studies, with considerable heterogeneity in patients, survey methods and results. Psychometric properties of two stroke-specific tools were formally evaluated, indicating their moderate reliability and content/concurrent validity. The median number of reported unmet needs per stroke survivor was from two to five, and the proportion of stroke survivors with at least one unmet needs was on average 73.8% (range 19.8%- 91.7%). Unmet needs perceived by stroke survivors included 55 records of unmet body functioning needs, 47 records of unmet activities/participatory needs and 101 records of unmet environmental needs. Common unmet service needs were unmet information needs (3.1%- 65.0%), transport (5.4%-53.0%), home help/personal care (4.7%-39.3%) and therapy (2.0%-35.7%). CONCLUSIONS The prevalence of unmet long-term needs is high among stroke survivors, and there is considerable heterogeneity in type and frequency of specific unmet needs. More research is required to link regular assessment of long-term unmet needs of stroke survivors with the provision of cost-effective patient-centred health and social care services.
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Affiliation(s)
- Ting Chen
- School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Bo Zhang
- School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Yan Deng
- School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Jing-Chun Fan
- School of Public Health, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Liansheng Zhang
- School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Fujian Song
- Department of Public Health and Epidemiology, Norwich Medical School, University of East Anglia, Norwich, UK
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Tooth L, Hoffmann T. Patient Perceptions of the Quality of Information Provided in a Hospital Stroke Rehabilitation Unit. Br J Occup Ther 2016. [DOI: 10.1177/030802260406700303] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explored the extent, source and format of the information received by stroke rehabilitation patients and their perceptions of the quality of that information. Additionally, the readability levels of the written materials received were assessed. Fifteen patients were interviewed approximately 1.8 months post-inpatient rehabilitation. Occupational therapists were the principal sources of information about returning home, equipment/ assistive devices, activities/exercise after stroke and the physical effects of stroke. The patients wanted additional information on the following topics that occupational therapists can address: treatments after stroke, the causes of stroke, risk factors/future prevention, stroke support groups, what to expect in rehabilitation and emotional problems/ difficulties during recovery. Most information was verbal. Although 70% of the patients felt that they had not received enough information and 87% identified gaps in what they had received, the information was considered relevant to their needs, easy to read/understand and helpful in coping with lifestyle changes. Two-thirds had received written information, written at an average grade 12 equivalent; this was a level too high for educating lay people about health. The implications for occupational therapists are that general information may be being provided at the expense of the information of most importance to the patients. Occupational therapists should assess and address patients' informational needs and identify the patients' preferred formats for receiving the information. The assessment of readability is also useful.
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Smith J, Forster A, Young J. A randomized trial to evaluate an education programme for patients and carers after stroke. Clin Rehabil 2016; 18:726-36. [PMID: 15573828 DOI: 10.1191/0269215504cr790oa] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: To evaluate the effectiveness of an education programme for patients and carers recovering from stroke. Design: Randomized controlled trial. Subjects and setting: One hundred and seventy patients admitted to a stroke rehabilitation unit and 97 carers of these patients. Interventions: The intervention group received a specifically designed stroke information manual and were invited to attend education meetings every two weeks with members of their multidisciplinary team. The control group received usual practice. Measures: Primary outcome was knowledge of stroke and stroke services. Secondary outcomes were handicap (London Handicap Scale), physical function (Barthel Index), social function (Frenchay Activities Index), mood (Hospital Anxiety and Depression Scale) and satisfaction (Pound Scale). Carer mood was measured by the General Health Questionnaire-28. Results: There was no statistical evidence for a treatment effect on knowledge but there were trends that favoured the intervention. The education programme was associated with a significantly greater reduction in patient anxiety score at both three months (p=0.034) and six months (p=0.021) and consequently fewer ‘cases’ (Hospital Anxiety and Depression Scale anxiety subscale score ≥ 11). There were no other significant statistical differences between the patient or carer groups for other outcomes, although there were trends in favour of the education programme. Conclusion: An education programme delivered within a stroke unit did not result in improved knowledge about stroke and stroke services but there was a significant reduction in patient anxiety at six months post stroke onset.
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Affiliation(s)
- Jane Smith
- Bradford Elderly Care and Rehabilitation Research Department, St Luke's Hospital, Bradford, UK.
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1557] [Impact Index Per Article: 194.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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A Telehealth Approach to Caregiver Self-Management Following Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:180-90. [DOI: 10.1097/htr.0000000000000167] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Korner-Bitensky N, Tarasuk J, Nelles J, Bouchard JM. The Impact of Interventions with Families Poststroke: A Review. Top Stroke Rehabil 2015; 5:69-85. [PMID: 26368586 DOI: 10.1310/7j8g-u4gl-3fxq-72pp] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Denby F, Harvey RL. An Educational Intervention for Stroke Rehabilitation Patients and Their Families: Healthy Living After Stroke. Top Stroke Rehabil 2015; 9:34-45. [PMID: 14523698 DOI: 10.1310/wpf9-k8jv-1bmy-vavd] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The education of stroke patients and their families on prevention of recurrent stroke is a rehabilitation challenge. The principal objective of this article is to share a process for creating a stroke education program that improves patient and caregiver knowledge of secondary prevention, stroke signs and symptoms, modifiable risk factors, and maintenance of functional independence. During stroke recovery, patient education is a continuous journey. The education program needs to take into consideration the individual's readiness to learn, unique learning styles, and timing of sessions. In our educational program, Healthy Living After Stroke, we used the stroke team to develop different venues of learning.
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Steiner V, Pierce LL. Building a Web of Support for Caregivers of Persons with Stroke. Top Stroke Rehabil 2015; 9:102-11. [PMID: 14523712 DOI: 10.1310/b9fe-qwev-rm1f-fja6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke is the leading cause of disability in the United States, with a cost of 30 billion US dollars annually. Most persons with stroke return home after initial treatment and are cared for by family members. Few researchers, however, have focused on Web-based interventions to strengthen caregivers'efforts. This article describes the development of Caring~Web, an online, in-home intervention of support for caregivers of persons with stroke. Through specifically designed Web pages, caregivers are able to ask questions of a nurse specialist and rehabilitation team, discuss issues with other caregivers and the nurse via email, and obtain educational information on stroke.
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Abstract
PURPOSE The purpose of this study was to develop a measure of stroke knowledge (the Stroke Knowledge Test [SKT]) using a systematic test construction process and to investigate the psychometric properties of this test. There are relatively few published measures of stroke knowledge, and, of those that exist, relatively little is documented about test construction or psychometric properties. Such tests are important for evaluation of stroke education programs. METHOD Test construction involved systematic generation of pilot test items, expert review of pilot items, and calculation of pilot item properties. After final item selection, two experiments were conducted to determine if the SKT was sensitive to varying levels of stroke knowledge and to estimate the reliability of the test. RESULTS The final version of the test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Results from psychometric investigations suggest that SKT has relatively good reliability (internal consistency and test-retest reliability) and construct validity (i.e., SKT scores significantly increased after stroke education [cf. nonstroke education], and community-dwelling older adults who had a relative with stroke [and more prior exposure to stroke information] scored higher on the SKT than those without a stroke relative). CONCLUSION Findings provide preliminary support for the SKT as a valid and reliable tool for assessing stroke knowledge. The SKT may be used to identify individual information needs of stroke survivors and their caregivers or as a tool to evaluate group- or community-based stroke education programs.
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Affiliation(s)
- Karen Sullivan
- School of Psychology & Counselling, Queensland University of Technology, Queensland, Australia
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Griffin E, McKenna K, Worrall L. Stroke Education Materials on the World Wide Web: An Evaluation of Their Quality and Suitability. Top Stroke Rehabil 2015; 11:29-40. [PMID: 15480952 DOI: 10.1310/jkjk-n2mp-9lq1-ff2n] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Web-based information is a valuable resource for people affected by stroke, however its accuracy and quality have been questioned. In this study, 30 stroke education websites were reviewed using accountability, readability, and reliability measures. Fifteen consumers and 11 health professionals evaluated six sites in terms of their design, content, and ease of use. The websites mostly met accountability criteria, but their reliability scores were low and their readability was high. Consumers' opinions were consistently higher than health professionals', but scores indicated their preferences for particular websites, especially in terms of design. The importance of considering consumers' preferences when designing and recommending websites is highlighted.
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Affiliation(s)
- Erin Griffin
- Royal Brisbane Hospital, Herston, Brisbane, Australia
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18
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Chenoweth L, Gietzelt D, Jeon YH. Perceived Needs of Stroke Survivors from Non-English-Speaking Backgrounds and Their Family Carers. Top Stroke Rehabil 2015; 9:67-79. [PMID: 14523723 DOI: 10.1310/d392-nul6-2j35-5egm] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this article is to discuss current findings in the research literature on the experiences and needs of stroke survivors and their family carers and to provide suggestions for future research. Based on this critical review, knowledge gaps and issues in stroke management in the community indicate that the needs of people surviving a stroke, particularly people from non-English speaking backgrounds, are not being adequately met by community-based health services. There is a critical need for changes in practices to meet the needs of this specific population.
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Affiliation(s)
- Lynn Chenoweth
- Health & Ageing Research Unit, South Eastern Sydney Area Health Service, Sydney, Australia
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Fukuoka Y, Hosomi N, Hyakuta T, Omori T, Ito Y, Uemura J, Kimura K, Matsumoto M, Moriyama M. Baseline feature of a randomized trial assessing the effects of disease management programs for the prevention of recurrent ischemic stroke. J Stroke Cerebrovasc Dis 2015; 24:610-7. [PMID: 25576351 DOI: 10.1016/j.jstrokecerebrovasdis.2014.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Comprehensive and long-term patient education programs designed to improve self-management can help patients better manage their medical condition. Using disease management programs (DMPs) that were created for each of the risk factor according to clinical practice guidelines, we evaluate their influence on the prevention of stroke recurrence. METHODS This is a randomized study conducted with ischemic stroke patients within 1 year from their onset. Subjects in the intervention group received a 6-month DMPs that included self-management education provided by a nurse along with support in collaboration with the primary care physician. Those in the usual care group received ordinary outpatient care. The primary end point is a difference of the Framingham risk score-general cardiovascular disease 10-year risk [corrected]. Patients were enrolled for 2 years with plans for a 2-year follow-up after the 6-month education period (total of 30 months). RESULTS A total of 321 eligible subjects (average age, 67.3 years; females, 96 [29.9%]), including 21 subjects (6.5%) with transient ischemic attack, were enrolled in this study. Regarding risk factors for stroke, 260 subjects (81.0%) had hypertension, 249 subjects (77.6%) had dyslipidemia, 102 subjects (31.8%) had diabetes mellitus, 47 subjects (14.6%) had atrial fibrillation, and 98 subjects (30.5%) had chronic kidney disease. There were no significant differences between the 2 groups with respect to subject characteristics. CONCLUSIONS This article describes the rationale, design, and baseline features of a randomized controlled trial that aimed to assess the effects of DMPs for the secondary prevention of stroke. Subject follow-up is in progress and will end in 2015.
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Affiliation(s)
- Yasuko Fukuoka
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Hyakuta
- Faculty of Nursing, Japanese Red Cross Hiroshima College of Nursing, Hiroshima, Japan
| | - Toyonori Omori
- National Institute of Health and Nutrition, Tokyo, Japan
| | - Yasuhiro Ito
- Department of Neurology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Jyunichi Uemura
- Department of Stroke Medicine, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michiko Moriyama
- Division of Nursing Science, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Newell JM, Lyons R, Martin-Misener R, Shearer CL. Creating a Supportive Environment for Living with Stroke in Rural Areas: Two Low-Cost Community-Based Interventions. Top Stroke Rehabil 2015; 16:147-56. [DOI: 10.1310/tsr1602-147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Eames S, Hoffmann T, Worrall L, Read S. Stroke Patients’ and Carers’ Perception of Barriers to Accessing Stroke Information. Top Stroke Rehabil 2015; 17:69-78. [DOI: 10.1310/tsr1702-69] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rose T, Worrall L, Hickson L, Hoffmann T. Do People With Aphasia Want Written Stroke and Aphasia Information? A Verbal Survey Exploring Preferences for When and How to Provide Stroke and Aphasia Information. Top Stroke Rehabil 2015; 17:79-98. [DOI: 10.1310/tsr1702-79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Eames S, Hoffmann T, McKenna K, Worrall L. Community-Based Stroke Information for Clients with Stroke and Their Carers: Is There Congruency Between Actual and Recommended Practice? Top Stroke Rehabil 2015; 15:295-306. [DOI: 10.1310/tsr1504-295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hoffmann T, McKenna K, Herd C, Wearing S. Written Education Materials for Stroke Patients and Their Carers: Perspectives and Practices of Health Professionals. Top Stroke Rehabil 2014; 14:88-97. [PMID: 17311795 DOI: 10.1310/tsr1401-88] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inadequacies in the provision of written education materials to stroke patients and their carers have been reported. In this study, 20 stroke team health professionals were surveyed regarding their use of and perspectives on written education materials. Seventy percent of participants provided materials to 25% or fewer stroke patients and 90% believed that patients and carers are only occasionally or rarely provided with sufficient written information. Health professionals were uncertain which team members provided written information and identified the need to improve the quality of materials used. Stroke teams should implement a system that facilitates the routine provision of quality written materials to patients and carers, communication among team members, and documentation and verbal reinforcement of the information provided.
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Affiliation(s)
- Tammy Hoffmann
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Koh WLE, Barr CJ, George S. Factors influencing post-stroke rehabilitation participation after discharge from hospital. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.6.260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wei Ling E Koh
- Senior Occupational Therapist at Changi General Hospital, Singapore and a Postgraduate in clinical rehabilitation at Flinders University, Australia
| | | | - Stacey George
- Senior Lecturer and Course Coordinator of postgraduate programmes in clinical rehabilitation, Flinders University, Australia
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Hayashi Y, Hai HH, Tai NA. Assessment of the needs of caregivers of stroke patients at state-owned acute-care hospitals in southern Vietnam, 2011. Prev Chronic Dis 2013; 10:E139. [PMID: 23968582 PMCID: PMC3754881 DOI: 10.5888/pcd10.130023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Care for stroke patients has improved steadily in southern Vietnam. Medical treatments such as thrombolytic therapy have been implemented at several hospitals, and stroke-care units composed of a team of various health professionals have been created. However, little attention has been focused on providing support to caregivers of stroke patients. This study aimed to characterize the caregivers of stroke patients who were treated in state-owned acute-care hospitals and to learn about their needs when patients are discharged. Such information can be used to enhance the caregiver's support system. METHODS We used questionnaires to conduct a descriptive study in 2011 at a state-owned acute-care hospital in southern Vietnam. We recruited study participants from among caregivers of stroke patients who had been informed of their hospital discharge date. We assessed 8 caregiver characteristics, and caregiver participants selected their needs from the survey's list of 15 possible needs. We analyzed the data by using the independent sample t test and logistic regression. RESULTS Of the 93 caregivers who consented to participate, 86 (92.5%) completed the survey and indicated their concerns at discharge. The most frequently cited need was information on how to prevent stroke recurrence (72, 83.7%), followed by which drugs are most effective in preventing a relapse (62, 72.1%), how long recovery would take (61, 70.9%), and availability of hospitals in the patient's hometown (60, 69.8%). A little over half of caregivers indicated financial concerns. A caregiver's need for information on diet for a stroke survivor increased with the caregiver's education level. CONCLUSIONS This study revealed several needs among caregivers of stroke survivors in southern Vietnam that are similar to those found by studies of caregivers of stroke survivors in high-income countries. Our findings suggest that comprehensive stroke care that includes caregiver education about healthful diets and prevention of stroke recurrence is needed at state-owned acute-care hospitals in southern Vietnam.
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Affiliation(s)
- Yumiko Hayashi
- Rehabilitation Department, Becamex International Hospital, Becamex Tower, 230 Binh Duong Avenue, Phu Hoa Ward, Thu Dau Mot City, Binh Duong Province, Vietnam.
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Mahrous MS. Patient perceptions regarding information given on hospital discharge in Almadinah Almunawwarah, Kingdom of Saudi Arabia. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Godwin KM, Swank PR, Vaeth P, Ostwald SK. The longitudinal and dyadic effects of mutuality on perceived stress for stroke survivors and their spousal caregivers. Aging Ment Health 2013; 17:423-31. [PMID: 23323629 PMCID: PMC3646563 DOI: 10.1080/13607863.2012.756457] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Functional impairment resulting from a stroke frequently requires the care of a family caregiver, often the spouse. This change in the relationship can be stressful for the couple. Thus, this study examined the longitudinal, dyadic relationship between caregivers' and stroke survivors' mutuality and caregivers' and stroke survivors' perceived stress. METHOD This secondary data analysis of 159 stroke survivors and their spousal caregivers utilized a cross-lagged, mixed models analysis with the actor-partner interdependence model to examine the dyadic relationship between mutuality and perceived stress over the first year post-discharge from inpatient rehabilitation. RESULTS Caregivers' mutuality showed an actor effect (β = -3.82, p < 0.0001) but not a partner effect. Thus, caregivers' mutuality influenced one's own perceived stress but not the stroke survivors' perceived stress. Stroke survivors' perceived stress showed a partner effect and affected caregivers' perceived stress (β = 0.13, p = 0.047). Caregivers' perceived stress did not show a partner effect and did not significantly affect stroke survivors' perceived stress. CONCLUSION These findings highlight the interpersonal nature of stress in the context of caregiving for a spouse. Caregivers are especially influenced by perceived stress in the spousal relationship. Couples should be encouraged to focus on positive aspects of the caregiving relationship to mitigate stress.
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Affiliation(s)
- Kyler M. Godwin
- Baylor College of Medicine, Department of Family and Community Health
| | - Paul R. Swank
- The University of Texas Health Science Center at Houston, Medical School
| | - Patrice Vaeth
- The University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus
| | - Sharon K. Ostwald
- The University of Texas Health Science Center at Houston, School of Nursing, Center on Aging
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Surman R, Bath PA. An assessment of the quality of information on stroke and speech and language difficulty web sites. J Inf Sci 2013. [DOI: 10.1177/0165551512469775] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Online healthcare information is used by patients, their carers and families (PCF) experiencing speech and language difficulties (SLD) after a stroke. This information may be of variable quality. Tools have been designed to assess the risk of poor information quality, evaluating both generic and specific concepts, yet none focuses on stroke. The readability of information is also an issue when communication disorders are under consideration. The study investigated the quality and readability of information on 51 web sites pertaining to SLD following a stroke. These were assessed using two generic evaluation tools (DISCERN and the HON Code), readability tests (Flesch Reading Ease and Flesch-Kincaid Grade Level) and a specifically designed Stroke Tool based on the reported information needs of stroke PCF experiencing SLD. The tools themselves were then evaluated for their feasibility, reliability and validity. In common with previous studies, the information quality of the selected web sites was found to be extremely variable with only 59% achieving a score of 50% or more using HON, only 37% using DISCERN, and 49% using the Stroke Tool. Readability is generally very poor with only 6% of web sites scoring below the recommended grade 7. The tools did not correlate well, suggesting that they measure different domains of quality. The Internet may be a valuable resource for stroke PCF; however, the variable quality of information means that cautious use is recommended. The readability of information is a more serious issue that needs addressing by web site developers.
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Affiliation(s)
- Ruth Surman
- Information School, University of Sheffield, UK
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Danzl MM, Hunter EG. Perceived value of stroke outcome measures across the post-acute care continuum: A qualitative case study. Physiother Theory Pract 2012; 29:202-10. [DOI: 10.3109/09593985.2012.727205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hamam N, McCluskey A, Cooper Robbins S. Sex after stroke: a content analysis of printable educational materials available online. Int J Stroke 2012; 8:518-28. [PMID: 22364586 DOI: 10.1111/j.1747-4949.2011.00758.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Providing written educational materials to stroke survivors is a key recommendation in many international stroke guidelines. Yet, sexual concerns are generally overlooked in current stroke rehabilitation and the content of educational materials on sexual concerns has not been analyzed nor evaluated in published stroke research. AIM The aim of this study was to identify, describe, and analyze printable educational materials on sexual concerns that are available online and easily shared with stroke survivors. METHOD Google search engine was used to locate printable educational materials from the Internet using a search term strategy of 35 phrases that were piloted for accuracy. The content of eligible materials was analyzed using NVivo software to produce both enumerative and thematic data. RESULTS Nine educational materials from reputable organizations were included with an average length of seven pages and 1445 words (total 61 pages, 13 000 words). The content of the materials was similar and covered three main content areas: problems experienced after stroke: 30% coverage suggested solutions: 32% coverage, and reassurance: 9% coverage. Content describing potential problems reflected published research, but solutions and reassurance were general, nonspecific, and often not supported by evidence. CONCLUSIONS Educational materials on sex after stroke may be helpful for health professionals, stroke survivors, and their partners, yet some messages appear to discourage recovery. Educators, health professionals, and organizations can use this analysis to evaluate their own educational resources and create resources that better address the sexual concerns of stroke survivors and their partners.
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Affiliation(s)
- Natalie Hamam
- Family Planning Victoria, Australia; Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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Hafsteinsdóttir TB, Vergunst M, Lindeman E, Schuurmans M. Educational needs of patients with a stroke and their caregivers: a systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2011; 85:14-25. [PMID: 20869189 DOI: 10.1016/j.pec.2010.07.046] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To systematically review the research on stroke patients' and caregivers' educational needs. METHODS A search of the literature prior to and including the year January 2009 was conducted using Medline, CINAHL, EMBASE, PsychINFO and the Cochrane Library, yielding 959 articles. Of these, 21 studies were included in the review. RESULTS Stroke patients and caregivers reported many and diverse educational needs, which often were not met. The educational needs of stroke patients and caregivers concerned knowledge about the clinical aspects of stroke, prevention, treatment and functional recovery. The most commonly reported needs of caregivers involved patients' moving and lifting, exercises, psychological changes and nutritional issues. Patients and caregivers wanted information that was tailored to their situation. CONCLUSION Patients and caregivers have many unmet educational needs. The findings call for improved education of patients and caregivers on various issues that are specific to the various recovery phases after stroke. PRACTICE IMPLICATIONS The findings of this review can be used to develop educational interventions for stroke patients and caregivers. Further research is needed to investigate the feasibility and effects of educational interventions and whether they meet the educational needs of patients and caregivers.
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Affiliation(s)
- Thóra B Hafsteinsdóttir
- Department of Rehabilitation, Nursing Science and Sport medicine, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands.
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Eames S, Hoffmann T, Worrall L, Read S. Delivery styles and formats for different stroke information topics: patient and carer preferences. PATIENT EDUCATION AND COUNSELING 2011; 84:e18-e23. [PMID: 20708899 DOI: 10.1016/j.pec.2010.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 06/22/2010] [Accepted: 07/03/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To identify the preferences of patients with stroke and their carers for format and delivery style, of different categories of stroke information, and whether these preferences changed over time. METHODS A semi-structured questionnaire, designed to explore preferences for four topic categories was administered to 34 acute stroke unit patients and 18 carers prior to discharge and again, 3 months after discharge to 27 of these patients and 16 of these carers. RESULTS Overall format preferences were a combination of face-to-face, written and telephone for both patients and carers prior to discharge. This combination continued for carers following discharge, while patients preferred face-to-face, written and alternative formats of online and audiovisual at this time. Patients and carers most frequently preferred delivery styles appeared to be a mix of active and passive delivery styles, across all topics. Access to a telephone hotline was a popular delivery style. CONCLUSION Patient and carer preferences varied, supporting the need to offer a variety of formats and delivery styles at each point of contact. PRACTICE IMPLICATIONS By focusing on specific formats and delivery styles for different topics, health professionals may maximise the access to, and relevance of, stroke information for patients and their carers.
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Affiliation(s)
- Sally Eames
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Cramm JM, Strating MMH, Nieboer AP. Validation of the caregivers' satisfaction with Stroke Care Questionnaire: C-SASC hospital scale. J Neurol 2011; 258:1008-12. [PMID: 21181184 PMCID: PMC3101354 DOI: 10.1007/s00415-010-5871-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 12/01/2010] [Accepted: 12/03/2010] [Indexed: 11/29/2022]
Abstract
To date, researchers have lacked a validated instrument to measure stroke caregivers' satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers' satisfaction with hospital care (C-SASC hospital scale) on caregivers of stroke patients admitted to nine stroke service facilities in the Netherlands. Stroke patients were identified through the stroke service facilities; caregivers were identified through the patients. We collected admission demographic data from the caregivers and gave them the C-SASC hospital scale. We tested the instrument by means of structural equation modeling and examined its validity and reliability. After the elimination of three items, the confirmatory factor analyses revealed good indices of fit with the resulting eight-item C-SASC hospital scale. Cronbach's α was high (0.85) and correlations with general satisfaction items with hospital care ranged from 0.594 to 0.594 (convergent validity). No significant relations were found with health and quality of life (divergent validity). Such results indicate strong construct validity. We conclude that the C-SASC hospital scale is a promising instrument for measuring stroke caregivers' satisfaction with hospital stroke care.
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Affiliation(s)
- Jane M. Cramm
- Institute of Health Policy and Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
| | - Mathilde M. H. Strating
- Institute of Health Policy and Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
| | - Anna P. Nieboer
- Institute of Health Policy and Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
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Gustafsson L, Hodge A, Robinson M, McKenna K, Bower K. Information provision to clients with stroke and their carers: self-reported practices of occupational therapists. Aust Occup Ther J 2011; 57:190-6. [PMID: 20854588 DOI: 10.1111/j.1440-1630.2008.00765.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The literature promotes the use of a wide range of educational materials for teaching and training clients with chronic conditions such as stroke. Client education is a valuable tool used by occupational therapists to facilitate client and carer ability to manage the stroke-affected upper limb. The aim of this study was to identify what information was provided to clients and carers, how this information was delivered, when the information was delivered and the client factors that influenced the method of information provision. METHODS Convenience and snowball sampling was used to recruit occupational therapists working in stroke. Twenty-eight participants completed the study questionnaire anonymously and their responses were summarised descriptively. RESULTS There was a clinically important trend for carers to receive less information than clients. Written and/or verbal information was the favoured method for delivering information related to handling (57%), soft-tissue injury minimisation (46.4%) and oedema management (50%). Information was delivered with decreasing frequency from admission (86%) to discharge (64%). More than 90% of participants indicated that the client's cognitive ability, visual ability, level of communication, primary language and perceptual ability were considered prior to the delivery of information. DISCUSSION Participants regularly conveyed information to clients and carers with respect to management of the stroke-affected upper limb. However, an increased emphasis on the development of practical self-management skills, awareness of the impact of personal factors and a timeline for information provision may prove useful.
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Affiliation(s)
- Louise Gustafsson
- Division of Occupational Therapy, University of Queensland, Brisbane, Queensland, Australia.
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Wallengren C, Segesten K, Friberg F. Relatives' information needs and the characteristics of their search for information--in the words of relatives of stroke survivors. J Clin Nurs 2010; 19:2888-96. [PMID: 20846233 DOI: 10.1111/j.1365-2702.2010.03259.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To explore relatives' information needs and the characteristics of their information-seeking process shortly after the stroke event and six months later. BACKGROUND Providing relatives of stroke survivors with information is important, as lack of information increases their uncertainty and risk becoming the 'second patient in the family' and early death. Therefore, it is essential to be aware of relatives' information needs and information-seeking process the first six months after stroke. DESIGN This qualitative study has a descriptive design. METHOD Open-ended interviews were conducted with sixteen relatives after stroke survivor's admission to stroke unit and six months later with nine of these relatives. Data were analysed by means of content analysis. RESULTS The identified information needs covered the spectrum from stroke survivor's medical condition because nurses' actions to relatives' changed health and life situation. Furthermore, relatives' information-seeking process was found to be related to their level of personal involvement, situational circumstances, different forms of knowledge and sources of information. CONCLUSIONS Relatives' search for information emerges when health and lifestyle changes occur in survivors or themselves. It is important that this information affect them personally. Also, they need to develop different forms of knowledge when they cannot trust their own competences. As a result, instead of following established curricula based on their beliefs of relatives' information needs, nurses need to practice on identifying relatives' information needs. RELEVANCE TO PRACTICE Different information needs and characteristics described in the study can serve as guidance in the development and implementation of pedagogical interventions to support relatives of stroke survivors. One pedagogical implication is to explore what a specific relative wants to know by how he/she talks or thinks about it. Thus, it must be taken into consideration that level of personal involvement, situational circumstances, sources of information and factual knowledge, understanding and skills are intertwined.
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Affiliation(s)
- Catarina Wallengren
- Department of Nursing Sciences, Faculty of Social and Life Science, School of Health Sciences, University College of Borås, Borås, Sweden.
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Ellis G, Mant J, Langhorne P, Dennis M, Winner S. Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis. Cochrane Database Syst Rev 2010; 2010:CD005066. [PMID: 20464736 PMCID: PMC6464840 DOI: 10.1002/14651858.cd005066.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing. OBJECTIVES To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators. SELECTION CRITERIA Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care. DATA COLLECTION AND ANALYSIS We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain. MAIN RESULTS We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P = 0.002). This risk difference equates to 11 fewer dead or dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. AUTHORS' CONCLUSIONS There is no evidence for the effectiveness of this multifaceted intervention in improving outcomes for all groups of patients or carers. Patients with mild to moderate disability benefit from a reduction in death and disability. Patients and carers do report improved satisfaction with some aspects of service provision.
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Affiliation(s)
- Graham Ellis
- Monklands HospitalMedicine for the ElderlyMonkscourt AvenueAirdrieUKML6 0JS
| | - Jonathan Mant
- University of CambridgeGeneral Practice & Primary Care Research Unit, Department of Public Health & Primary CareForvie SiteAddenbrookes HospitalCambridgeUKCB2 0SR
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric Medicine3rd Floor, Centre BlockRoyal InfirmaryGlasgowUKG4 0SF
| | - Martin Dennis
- University of EdinburghDivision of Clinical NeurosciencesWestern General HospitalCrewe RoadEdinburghUKEH4 2XU
| | - Simon Winner
- Radcliffe InfirmaryDepartment of Clinical GeratologyOxfordUKOX2 6HE
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Marsden D, Quinn R, Pond N, Golledge R, Neilson C, White J, McElduff P, Pollack M. A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: a pilot randomized controlled trial. Clin Rehabil 2010; 24:328-41. [PMID: 20176772 DOI: 10.1177/0269215509344268] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural settings; to measure the impact of the programme on health-related quality of life and functional performance; and to determine if any benefits gained are maintained. DESIGN Randomized, assessor blind, cross-over, controlled trial. SETTING Rural outpatient. SUBJECTS Twenty-five community-dwelling, chronic stroke survivors and 17 carers of participant stroke survivors. INTERVENTION The intervention group undertook a once-a-week, seven-week group programme combining physical activity, education, self-management principles and a 'healthy options' morning tea. At completion, the control group crossed over to receive the intervention. MAIN MEASURES Stroke Impact Scale (stroke survivors), Health Impact Scale (carers), Six Minute Walk Test, Timed Up and Go, Caregiver Strain Index. RESULTS There were insufficient participants for results to reach statistical significance. However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers. The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants. The programme was well attended. Of the seven sessions all participants attended four or more and 88% attended six or seven sessions. CONCLUSIONS This novel programme incorporating physical activity, education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian settings. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation.
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Affiliation(s)
- Dianne Marsden
- Hunter Stroke Service, Rankin Park Campus, New Lambton Heights, NSW, Australia.
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Torres-Arreola LDP, Doubova Dubova SV, Hernandez SF, Torres-Valdez LE, Constantino-Casas NP, Garcia-Contreras F, Torres-Castro S. Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico. J Clin Nurs 2009; 18:2993-3002. [PMID: 19821873 DOI: 10.1111/j.1365-2702.2009.02862.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Rehabilitation strategies have been developed to improve functional state in stroke patients. The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses, on the functional recovery of basic and social activities in stroke patients compared with conventional care. DESIGN A randomised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City between April 2003-May 2004. PARTICIPANTS Stroke patients. METHODS Two rehabilitation strategies provided by nurses for stroke patients were compared: physiotherapy plus caregiver education in rehabilitation (strategy 1, S1) vs. education alone (strategy 2, S2). The main outcome variables were the basic (Barthel index) and social (Frenchay activities index) activities of daily living, of each patient. Age, sex, morbidity, stroke symptoms, complications, neurological damage (Canadian Scale), cognitive state (mini-mental state examination questionnaire) and duration of hospitalisation were defined as the control variables. Patients were evaluated at baseline and months one, three and six thereafter. RESULTS One hundred and ten patients with ischaemic stroke were enrolled and randomised; 59 were assigned to S1 and 51 to S2. Comparison of the outcome variables showed that patients improved significantly over time, but no differences were observed between groups. We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living. RELEVANCE TO CLINICAL PRACTICE Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone. Those countries that do not have integral rehabilitation programmes for stroke patients should understand their importance and budget resources for them. Meanwhile, both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these patients.
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Affiliation(s)
- Laura del Pilar Torres-Arreola
- Coordination of High Specialty Medical Units, Clinical Excellence Department, Mexican Institute of Social Security, Mexico City, Mexico.
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Moreland JD, DePaul VG, DeHueck AL, Pagliuso SA, Yip DWC, Pollock BJ, Wilkins S. Needs assessment of individuals with stroke after discharge from hospital stratified by acute Functional Independence Measure score. Disabil Rehabil 2009; 31:2185-95. [DOI: 10.3109/09638280902951846] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hoffmann T, Cochrane T. What education do stroke patients receive in Australian hospitals? PATIENT EDUCATION AND COUNSELING 2009; 77:187-191. [PMID: 19356883 DOI: 10.1016/j.pec.2009.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 01/06/2009] [Accepted: 03/03/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study evaluated the educational practices of staff working in acute stroke wards in Australian hospitals, including the coordination and methods of patient education provision, post-discharge education and support services available, and the education and support services that health professionals would like to provide. METHODS Health professionals who worked in acute stroke wards in Australian hospitals were surveyed about the stroke education practices of staff in their ward. Thirty-four hospitals returned a completed questionnaire via email or fax. RESULTS Verbal communication and written materials were the most frequently used methods of information provision. Twenty-three (67.6%) wards developed their own written education materials, five (14.7%) offered group education programs, and 19 (55.9%) offered education or support after discharge. Fourteen (41.2%) wards had a particular staff member responsible for coordinating the provision of education to patients and one (2.9%) ward had a written policy on stroke education. The majority (70.6%) of participants would like to be able to provide more education/support services. CONCLUSION The educational practices of the Australian hospitals surveyed were variable, with improvements needed in the coordination and documentation of patient education and the available follow-up services. PRACTICE IMPLICATIONS Health professionals need to be aware of the importance of education in the care of patients following stroke. Patients' informational needs, while in hospital and after discharge, may be better met if staff in acute stroke wards had improved communication and coordination practices and ensured that stroke education was appropriately documented and supported by policy.
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Affiliation(s)
- Tammy Hoffmann
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Occupational Therapy, Queensland, Australia.
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Daniëls R, Winding K, Borell L. Experiences of Occupational Therapists in Stroke Rehabilitation: Dilemmas of Some Occupational Therapists in Inpatient Stroke Rehabilitation. Scand J Occup Ther 2009. [DOI: 10.1080/11038120260501190] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sullivan KA, Katajamaki A. Stroke education: retention effects in those at low- and high-risk of stroke. PATIENT EDUCATION AND COUNSELING 2009; 74:205-212. [PMID: 18926660 DOI: 10.1016/j.pec.2008.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 07/29/2008] [Accepted: 08/31/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Relatively few studies have tracked retention effects of stroke education in low- and high-risk groups. Such information is important to improve the design of stroke prevention programs. METHODS The frequency of risk factors within the sample was defined as "high" if 30% or more of participants in that group had that risk. Only one stroke risk factor was present at this level in the low-risk group (n=29; all less than 50 years old). The high-risk group was 44 individuals aged 50 years or over, with four stroke risk factors present at this level. Stroke knowledge was tested on three occasions: baseline, post-education, and retention. Education consisted of reading a published stroke brochure. RESULTS Stroke knowledge improved over time, from baseline to post-education, but not from post-education to retention. The performance of both groups increased, but there was a differential learning effect: low-risk participants learned more than high-risk participants. Important information was learned and included details such when TIA symptoms dissipate. This particular issue was one about which both groups knew little at baseline (less than 15% of combined sample answered this item correctly), but post-education at least 75% of participants got this question correct. CONCLUSION Both low- and high-risk individuals can learn information about stroke and retain it over the short term. The "durable" effects in learning observed in this study are important because the benefit of brochure-only approaches to education have not yet been convincingly demonstrated. PRACTICE IMPLICATIONS Information about stroke from education brochures is retained by at-risk populations for at least 1 week.
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Affiliation(s)
- Karen A Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia.
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Maloney LR, Weiss ME. Patients' Perceptions of Hospital Discharge Informational Content. Clin Nurs Res 2008; 17:200-19. [DOI: 10.1177/1054773808320406] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ensuring that patients' informational needs have been met prior to hospital discharge sets the stage for successful self-management of recovery at home. This secondary analysis study aims to identify differences in the amount of discharge teaching content needed and received by adult medical-surgical patients on the basis of their sociodemographic characteristics and hospitalization-related factors. The Quality of Discharge Teaching Scale (QDTS) is used to measure patients' perceptions of the amount of discharge-related informational content they needed and received. Eighty-nine percent of patients receive more informational content than they perceived they needed. Nonwhite patients report more content needed than White patients. Patients with prior hospitalizations and cardiac patients report greater amounts of content received. The QDTS content subscales provide a mechanism for assessing patient perceptions of discharge informational needs and discharge content received that can be used for clinical practice and quality monitoring.
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Affiliation(s)
- Lynn R. Maloney
- Marquette University College of Nursing, Milwaukee,
Wisconsin,
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Huijbregts MPJ, Kay T, Klinck B. Theory-based programme development and evaluation in physiotherapy. Physiother Can 2008; 60:40-50. [PMID: 20145741 DOI: 10.3138/physio/60/1/40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Programme evaluation has been defined as "the systematic process of collecting credible information for timely decision making about a particular program." Where possible, findings are used to develop, revise, and improve programmes. Theory-based programme development and evaluation provides a comprehensive approach to programme evaluation. SUMMARY OF KEY POINTS In order to obtain meaningful information from evaluation activities, relevant programme components need to be understood. Theory-based programme development and evaluation starts with a comprehensive description of the programme. A useful tool to describe a programme is the Sidani and Braden Model of Program Theory, consisting of six programme components: problem definition, critical inputs, mediating factors, expected outcomes, extraneous factors, and implementation issues. Articulation of these key components may guide physiotherapy programme implementation and delivery and assist in the development of key evaluation questions and methodologies. Using this approach leads to a better understanding of client needs, programme processes, and programme outcomes and can help to identify barriers to and enablers of successful implementation. Two specific examples, representing public and private sectors, will illustrate the application of this approach to clinical practice. CONCLUSIONS Theory-based programme development helps clinicians, administrators, and researchers develop an understanding of who benefits the most from which types of programmes and facilitates the implementation of processes to improve programmes.
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Affiliation(s)
- Maria P J Huijbregts
- Maria P.J. Huijbregts , BScPT, PhD: Director of Clinical Evaluation, Baycrest, Toronto; Assistant Professor (status only), Department of Physical Therapy, University of Toronto, Toronto, Ontario; Adjunct Professor, Master of Public Health Department, Lakehead University, Thunder Bay, Ontario
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Hermens RPMG, Ouwens MMTJ, Vonk-Okhuijsen SY, van der Wel Y, Tjan-Heijnen VCG, van den Broek LD, Ho VKY, Janssen-Heijnen MLG, Groen HJM, Grol RPTM, Wollersheim HCH. Development of quality indicators for diagnosis and treatment of patients with non-small cell lung cancer: A first step toward implementing a multidisciplinary, evidence-based guideline. Lung Cancer 2006; 54:117-24. [PMID: 16920220 DOI: 10.1016/j.lungcan.2006.07.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2006] [Revised: 06/27/2006] [Accepted: 07/09/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND While developing and distributing clinical practice guidelines are important in optimising clinical healthcare, insight into actual care is necessary to achieve successful implementation. Developing quality indicators may be the first step to becoming aware of actual care. The Dutch national practice guideline Non-small cell lung cancer: staging and treatment is one of the first clinical, multidisciplinary guidelines for oncology in the Netherlands for which quality indicators were developed systematically. We describe indicator development based on this guideline as a practical experience. METHODS To develop a set of indicators for diagnosis and treatment of patients with non-small cell lung cancer, we systematically achieved consensus on the basis of a national, multidisciplinary, evidence-based guideline and the opinions of professionals and patients. After the researchers extracted the recommendations from the guideline, we carried out a so-called Rand-modified-Delphi procedure. This consisted of three rounds: a national panel of professionals and representatives of the national patient organization scored all recommendations, the professionals had a consensus meeting, and the final set of indicators was e-mailed for a last check. Subsequently, some clinimetric characteristics of this final set were assessed in a practice test. RESULTS Thirty-two of 83 recommendations were selected in the first round. After the consensus meeting, 8 recommendations met the final criteria and were incorporated into 15 indicators, which were tested in practice. The most successful indicators for quality improvement are indicators that are measurable, have potential for improvement, have a broad range between practices and are applicable to a large part of the population. CONCLUSIONS For successful implementation of evidence-based guidelines, each new guideline should be developed and tested with a set of indicators based on the guideline. The procedure we describe can serve as an example for other new guidelines.
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Affiliation(s)
- R P M G Hermens
- Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, 117 KWAZO, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Hoffmann T, McKenna K. Analysis of stroke patients' and carers' reading ability and the content and design of written materials: recommendations for improving written stroke information. PATIENT EDUCATION AND COUNSELING 2006; 60:286-93. [PMID: 16098708 DOI: 10.1016/j.pec.2005.06.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 06/10/2005] [Accepted: 06/27/2005] [Indexed: 05/04/2023]
Abstract
OBJECTIVE This study (a) evaluated the reading ability of patients following stroke and their carers and the reading level and content and design characteristics of the written information provided to them, (b) explored the influence of sociodemographic and clinical characteristics on patients' reading ability, and (c) described an education package that provides well-designed information tailored to patients' and carers' informational needs. METHODS Fifty-seven patients and 12 carers were interviewed about their informational needs in an acute stroke unit. Their reading ability was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The written information provided to them in the acute stroke unit was analysed using the SMOG readability formula and the Suitability Assessment of Materials (SAM). RESULTS Thirteen (22.8%) patients and 5 (41.7%) carers had received written stroke information. The mean reading level of materials analysed was 11th grade while patients read at a mean of 7-8th grade. Most materials (89%) scored as only adequate in content and design. Patients with combined aphasia read significantly lower (4-6th grade) than other patients (p=0.001). CONCLUSION Only a small proportion of patients and carers received written materials about stroke and the readability level and content and design characteristics of most materials required improvement. PRACTICE IMPLICATIONS When developing and distributing written materials about stroke, health professionals should consider the reading ability and informational needs of the recipients, and the reading level and content and design characteristics of the written materials. A computer system can be used to generate written materials tailored to the informational needs and literacy skills of patients and carers.
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Affiliation(s)
- Tammy Hoffmann
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia.
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Suhonen R, Nenonen H, Laukka A, Välimäki M. Patients' informational needs and information received do not correspond in hospital. J Clin Nurs 2006; 14:1167-76. [PMID: 16238762 DOI: 10.1111/j.1365-2702.2005.01233.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study describes and compares the information patients want with the information they receive and examines whether this varies between patients. BACKGROUND Patient information during hospitalization has received increasing attention. Previous studies, however, have identified problems of inadequate or insufficient information from a patient's point of view. DESIGN Descriptive, survey design with questionnaires. METHODS The categorical data were collected by specifically designed questionnaires from adult patients (n = 928) on discharge from one Finnish hospital. The data were analysed statistically using descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis, McNemar and Wilcoxon Signed Ranks tests). RESULTS Patients attached great importance to information on illness and treatment, and information in this area was provided quite satisfactorily. Less importance was attached to information regarding patient's daily management of illness, such as aftercare, prognosis and patients' rights and less information was reportedly provided. Female gender was systematically associated with attaching greater importance to information and to better evaluations of informational areas. CONCLUSIONS Patients informational needs and the information received from staff did not correspond. The findings confirm the importance of nurses' roles in assessing patients' informational needs to tailor and provide explicit and relevant information to satisfy patients' informational needs. RELEVANCE TO CLINICAL PRACTICE More emphasis should be put on developing methods to ascertain patients' informational needs, to evaluate the content of information and to develop tailored information packages for different patients. This can be done by empowering and helping patients to access and understand relevant and appropriate information, for example, by Web-based information systems.
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Jullamate P, de Azeredo Z, Pául C, Subgranon R. Thai Stroke Patient Caregivers: Who They Are and What They Need. Cerebrovasc Dis 2006; 21:128-33. [PMID: 16340188 DOI: 10.1159/000090211] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 09/07/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSES Primary informal caregivers play a significant role in providing care to stroke survivors after having been discharged from the hospital. Our aims were to describe the characteristics of Thai stroke caregivers and to explore their needs while providing care to their stroke relatives. METHODS Using open-ended questions, we individually interviewed 20 caregivers of stroke survivors to identify their characteristics and their own needs. Additional field notes were made during all interviews. RESULTS Our findings revealed that the majority of Thai informal stroke caregivers in this study were female, mostly daughters, with the exception of 2 Thai primary stroke caregivers found to be nieces. The majority of caregivers provided care to their stroke relatives 24 h per day. The four major categories of informal rehabilitation were: physical, psychological, social, and spiritual rehabilitation activities. Assistance, information and social support were the three main needs of the caregivers. CONCLUSION Based on these findings, appropriate nursing information and assistance focusing on rehabilitation and stroke caregivers' needs should be provided to Thai stroke caregivers performing informal care to ensure that both patients and caregivers have the best possible quality of life.
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Affiliation(s)
- Pornchai Jullamate
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Talvitie U, Pyöriä O. Discourse analytic study of counseling sessions in stroke physiotherapy. HEALTH COMMUNICATION 2006; 20:187-96. [PMID: 16965256 DOI: 10.1207/s15327027hc2002_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Studies on the interaction between physiotherapists and patients during treatment sessions have found low levels of communicative participation by patients and lack of direct influence by patients on the content of their treatment. This article reports the results of 7 counseling sessions in which physiotherapists and patients with stroke and their caregivers discussed the patients' postural control and balance, which had been tested and videotaped at different stages of the rehabilitation process. The physiotherapists' discourses relating to the videotaped test performances were either brief comments on the patient's performance or critical appraisals with references to difficulties encountered during performance. Performances of the easier tasks were treated by the physiotherapists with rhetorical questions. The second type of discourse consisted of the physiotherapists directing the patients' attention to their problems, and of the patients' and caregivers' initiatives leading to conversation about the patients' problems. The patients understood the significance of the test performance for their life at home in varying ways. The results of this study showed that successful counseling calls for physiotherapists to develop dialogic communication skills to help patients in coconstructing their home exercise together with their social network.
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Affiliation(s)
- Ulla Talvitie
- Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.
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