Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay

Feasibility of Problem-Solving Training During Inpatient Rehabilitation in Patients With Stroke

IMPORTANCE

Stroke survivors report feeling unprepared to manage challenges that arise during the transition from hospital to home. Cultivating problem-solving skills before discharge may better prepare patients for the transition home.

OBJECTIVE

To determine the feasibility of a protocol to deliver Problem-Solving Training (PST) to stroke survivors during inpatient rehabilitation to increase goal achievement.

DESIGN

Single-group feasibility study.

SETTING

Academic and county hospital inpatient rehabilitation units.

PARTICIPANTS

Adult patients with stroke and planned discharge home.

INTERVENTION

Up to six PST sessions over 2 to 3 wk followed by 3 mo of mobile health boosters.

RESULTS

Of 17 eligible participants, 15 consented and 11 completed three or more PST sessions. Six participants used electronic boosters, achieving at least one goal postdischarge. Participants reported high satisfaction with PST (Client Satisfaction Questionnaire-8 M score = 29.3, SD = 4.4; range = 8-32), moderate depression at baseline (eight-item Patient Health Questionnaire [PHQ-8] score, M = 11.0, SD = 6.1; range = 0-27), mild depression at 3 mo postdischarge (PHQ-8 score, M = 8.3, SD = 5.5), moderately high self-efficacy at baseline (General Self-Efficacy Scale [GSE] score, M = 31.1, SD = 7.3; range = 10-40), and a self-efficacy increase at 3 mo postdischarge (GSE score, M = 34.1, SD = 4.2).

CONCLUSIONS AND RELEVANCE

PST among patients with stroke during inpatient rehabilitation was feasible, and participants demonstrated improvements in clinical outcomes and goal attainment. Barriers to participation and adherence should be addressed in future studies. What This Article Adds: Teaching patients problem-solving skills early after a stroke using a metacognitive strategy is feasible and may decrease depression and increase self-efficacy while fostering independent goal setting and problem solving.

Examining Care Partner Problems Using the International Classification of Functioning, Disability and Health

IMPORTANCE

Care partners report that they are unprepared to manage the care of their loved one during the predischarge rehabilitation process and at the time of transition from hospital to home.

OBJECTIVE

To link, classify, and describe care partner-reported problems using the International Classification of Functioning, Disability and Health (ICF) to explore care partner experiences during the predischarge rehabilitation process.

DESIGN

We linked meaningful concepts collected during problem-solving training implemented with care partners of patients with sudden-onset conditions to the ICF using a standardized linking technique.

SETTING

Health care institution.

RESULTS

Care partner-reported problems were linked to 13 of the 30 ICF chapters. Activities and participation was most frequently addressed, followed by body functions. Care partners most commonly reported problems in the areas of emotional function, major life areas, self-care, domestic life, interpersonal relationships, and sleep functions.

CONCLUSIONS AND RELEVANCE

The ICF can be used to examine and describe care partners' health-related experiences. Care partners experience myriad problems related to activities and participation, body functions, environmental factors, and personal health before the care recipient's initial discharge from the hospital. What this Article Adds: Care partners' problems early in the rehabilitation process are complex and interrelated. The ICF can serve as a framework for a systematic approach to identifying care partner needs, as it has for patients with a variety of diagnoses.

Identifying user-centered content, design, and features for mobile health apps to support long-term assessment, behavioral intervention, and transitions of care in neurological rehabilitation: An exploratory study

Introduction

The use of mobile health technology has the potential to increase healthcare accessibility, promote self-management, provide education materials, and support self-monitoring of biometrics. This may be of particular benefit to those living in the community with chronic neurological conditions. The purpose of this research was to characterize perspectives of individuals with brain injury or stroke, their care partners, and neuro-rehabilitation clinicians to inform the design of mobile health app-based interventions that address the need for ongoing community-based health-related professional support.

Methods

Individuals with stroke or traumatic brain injury, their care partners, and clinicians were recruited from a large university hospital with a specialized neuro-rehabilitation program. Data were collected via semi-structured focus groups and were examined using descriptive statistics and content analysis.

Results

Five consistent themes emerged: (a) all-in-one app with customized features; (b) communication with healthcare providers; (c) cognitive strategies; (d) app accessibility; and (e) user education. The clinician focus group reiterated these consumer focus group themes, with one additional theme: (f) logistics of clinician time and effort to provide effective app-based services to patients.

Conclusions

Results have directly informed the ongoing development of a community-based mobile health app intervention, and may also inform the content and design of future mHealth technological development in this population.