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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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O'Callaghan G, Fahy M, O'Meara S, Lindblom S, von Koch L, Langhorne P, Galvin R, Horgan F. Experiences and preferences of people with stroke and caregivers, around supports provided at the transition from hospital to home: a qualitative descriptive study. BMC Neurol 2024; 24:251. [PMID: 39039456 PMCID: PMC11265157 DOI: 10.1186/s12883-024-03767-0] [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] [Received: 02/14/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Transitioning home from the structured hospital setting poses challenges for people with stroke (PWS) and their caregivers (CGs), as they navigate through complex uncertainties. There are gaps in our understanding of appropriate support interventions for managing the transition home. In this qualitative study, we explored the perspectives of PWS and their CGs regarding their support experiences and preferences during this period. METHODS Between November 2022 and March 2023, and within six months of hospital discharge, audio-recorded, semi-structured interviews were conducted with PWS and CGs. All interviews were transcribed, imported into NVivo software, and analysed using reflexive thematic analysis. RESULTS Sixteen interviews were conducted, nine with PWS and seven with CGs. Four themes relevant to their collective experiences and preferences were identified: (i) Need for tailored information-sharing, at the right time, and in the right setting; (ii) The importance of emotional support; (iii) Left in limbo, (iv) Inequity of access. Experiences depict issues such as insufficient information-sharing, communication gaps, and fragmented and inequitable care; while a multi-faceted approach is desired to ease anxiety and uncertainty, minimise delays, and optimise recovery and participation during transition. CONCLUSIONS Our findings highlight that regardless of the discharge route, and even with formal support systems in place, PWS and families encounter challenges during the transition period. The experiences of support at this transition and the preferences of PWS and CGs during this important period highlights the need for better care co-ordination, early and ongoing emotional support, and equitable access to tailored services and support. Experiences are likely to be improved by implementing a partnership approach with improved collaboration, including joint goal-setting, between PWS, CGs, healthcare professionals and support organisations.
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Affiliation(s)
- Geraldine O'Callaghan
- iPASTAR Collaborative Doctoral Award Programme, School of Physiotherapy, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland.
- iPASTAR Collaborative Doctoral Award Programme, RCSI School of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland.
| | - Martin Fahy
- iPASTAR Collaborative Doctoral Award Programme, RCSI School of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Sigrid O'Meara
- iPASTAR Collaborative Doctoral Award Programme, RCSI School of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, Stockholm, Sweden
- Theme of Heart & Vascular and Neuro, Karolinska University Hospital, Stockholm, 14186, Sweden
| | - Peter Langhorne
- School of Cardiovascular and Metabolic Health (SCMH), University of Glasgow, 126 University Place, Glasgow, GT12 8TA, Scotland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Frances Horgan
- iPASTAR Collaborative Doctoral Award Programme, School of Physiotherapy, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
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Jaywant A, Keenan A. Pathophysiology, Assessment, and Management of Post-Stroke Cognitive Impairment, Depression, and Fatigue. Phys Med Rehabil Clin N Am 2024; 35:463-478. [PMID: 38514230 DOI: 10.1016/j.pmr.2023.06.028] [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] [Indexed: 03/23/2024]
Abstract
Post-stroke cognitive impairment, depression, and fatigue are common, persistent, and disabling. This review summarizes current knowledge on the pathophysiology, assessment, and management of these debilitating neuropsychiatric sequelae of stroke. We briefly review evolving knowledge on the neural mechanisms and risk factors for each condition. We describe patient-reported outcome measures and clinician rating techniques that can be used to assist in screening and comprehensive assessment. We then discuss behavioral and pharmacologic management strategies. Heterogeneity of stroke remains a challenge in management and new research is still needed to optimize and personalize treatments for stroke survivors.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA.
| | - Alexandra Keenan
- Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
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Heydari A, Manzari ZS, Mohammadpourhodki R. Peer-support interventions and related outcomes in patients with myocardial infarction: A systematic review. Heliyon 2024; 10:e25314. [PMID: 38327461 PMCID: PMC10847649 DOI: 10.1016/j.heliyon.2024.e25314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/19/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Objective Myocardial infarction (MI) is one of the main causes of disability and death worldwide. Peer-support can ameliorate the psychological and physical morbidities associated with heart diseases. The aim of this study was to determine whether peer-support interventions could improve the psychological and behavioral health outcomes commonly experienced by MI patients. Methods In this systematic review, international databases (PubMed, Web of Science, and Scopus) were searched to gather related publications up to March 2023. Eligible papers were those addressing the outcomes of peer-support interventions in individuals with a history of MI. Result Twelve clinical trials published in English with a Jadad score of 3 or 4 (out of 5) were included in the final review. These studies used four approaches to deliver peer-support interventions: face-to-face, telephone-based, educational videos, and group discussion. The results showed that peer-support could have a positive effect on depression, anxiety, quality of life, sexual performance, self-care, and medication adherence. Conclusion Considering the serious impacts of MI on life, these patients need empowerment training. Peer-support can be used as a complementary supportive method to reduce MI patients' psychological complications and improve their behavioral outcomes.
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Affiliation(s)
- Abbas Heydari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Mohammadpourhodki
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Wedege P, Mæland S, Abrahamsen FE, Divanoglou A. Structured, time-limited peer mentorship activity programmes for individuals with acquired brain or spinal cord injuries: a mixed methods systematic review of characteristics and outcomes. Disabil Rehabil 2024:1-16. [PMID: 38318804 DOI: 10.1080/09638288.2024.2310185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To determine the characteristics and outcomes of structured, time-limited peer mentorship activity programmes for individuals with acquired brain or spinal cord injury. MATERIALS AND METHODS A mixed methods systematic review with an advanced convergent qualitative meta-integration synthesis design was adopted. Seven databases were searched, with two reviewers independently screening, selecting, and extracting data and evaluating the methodological quality of the included studies. RESULTS The review included ten original studies: five qualitative, four quantitative, and one mixed methods. The peer mentorship programmes were conducted in Europe, Oceania, the United States, and Africa, lasting from two days to 2.5 weeks. The programmes had diverse focuses, but all addressed mentees' independence, health, or quality of life in some way. None was based on a theoretical framework. Programme participation positively impacted cognition, emotions, independence, and social life. The safe and supportive environments the mentees and peer mentors created facilitated the outcomes. The evidence of programme participation on life satisfaction and community participation was inconclusive. CONCLUSION Despite their short duration, structured, time-limited peer mentorship activity programmes can strengthen community rehabilitation of individuals with acquired brain or spinal cord injury. It is recommended that peer mentorship programmes are grounded on a theoretical framework.
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Affiliation(s)
- P Wedege
- Department of Sport and Social Sciences, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Follow-up Services after Spinal Cord Injury, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - S Mæland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - F E Abrahamsen
- Department of Sport and Social Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | - A Divanoglou
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Delvallée M, Marchal M, Termoz A, Habchi O, Derex L, Schott AM, Haesebaert J. Development of a patient-centered transition program for stroke survivors and their informal caregivers, combining case-management and access to an online information platform: A user-centered design approach. Digit Health 2024; 10:20552076241272628. [PMID: 39114116 PMCID: PMC11304490 DOI: 10.1177/20552076241272628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Background During the hospital-to-home transition, stroke survivors and their caregivers face a significant lack of support and information which impacts their psychosocial recovery. We aimed to co-design a program combining individual support by a trained case-manager (dedicated professional providing individual support) and an online information platform to address needs of stroke survivors and caregivers. Methods A two-step methodology was used. The first step followed a "user-centered design" approach during four workshops with stroke survivors, caregivers, and healthcare professionals to develop the platform and define the case-manager profile. The second step was a usability test of the platform following a Think Aloud method with patients and caregivers. The workshops and interviews were analyzed following a qualitative thematic analysis. The analysis of Think Aloud interviews was based on User Experience Honeycomb framework by Morville. Results Eight participants attended the workshops: two patients, two caregivers, three nurses, and a general practitioner. Activities, training, and skills of the case-manager were defined according to stroke survivors and caregivers needs. Name, graphics, navigation, and content of the platform were developed with the participants, a developer and a graphic designer. The usability of the platform was tested with 5 patients and 5 caregivers. The Think Aloud confirmed satisfaction with graphics and content but a need for improvement regarding the navigability. An update of the platform was conducted in order to answer the needs expressed by participants. Conclusion We developed, with a participatory approach, a patient-centered transition program, which will be evaluated in a randomized controlled trial.
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Affiliation(s)
- Marion Delvallée
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Mathilde Marchal
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Ouazna Habchi
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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7
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Delvallée M, Garreau R, Termoz A, Ploteau PM, Derex L, Schott AM, Haesebaert J. What are the available online resources targeting psychosocial burden among stroke survivors and their informal caregivers: A scoping review. Digit Health 2024; 10:20552076241240895. [PMID: 38515613 PMCID: PMC10956153 DOI: 10.1177/20552076241240895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Background After discharge home, stroke survivors and their informal caregivers face a significant lack of support and information which accentuates their psychosocial burden. Online resources might provide this support and address psychosocial needs, but existing online stroke programmes mainly target functional rehabilitation. We aimed to map the existing literature on online resources that have been evaluated in stroke rehabilitation and aimed at reducing psychosocial impact in stroke survivors and informal caregivers. Methods MEDLINE was searched (2010-2024) to identify studies investigating online resources targeting psychosocial health. Studies were selected and extracted independently by two reviewers. We described the content, use, and psychosocial impact of these interventions using a narrative approach. Results Eleven studies were included in the review, reporting 10 online resources (two studies relating to the same resource). Online resources were heterogeneous: eight information/resources websites, one mobile app, and one forum. Five online resources were dedicated to stroke survivors, four to stroke survivors and their informal caregivers, and one to informal caregivers. Two randomized controlled trials reported a significant decrease in depressive symptoms associated with the use of online resources. Stroke survivors and informal caregivers find online resources useful and acceptable to address their psychosocial needs. Conclusions Few online stroke resources have been designed and evaluated to support post-stroke psychosocial rehabilitation. Further larger-scale research needs to study the impact of these interventions on psychosocial recovery over time.
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Affiliation(s)
- Marion Delvallée
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Romain Garreau
- Pharmacy Department, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, UMR CNRS 5558, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Pierre-Marie Ploteau
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Dobe J, Gustafsson L, Walder K, Bower K, Lachman R. Co-creation of self-management support during inpatient stroke rehabilitation. PEC INNOVATION 2023; 3:100191. [PMID: 37521957 PMCID: PMC10371841 DOI: 10.1016/j.pecinn.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/04/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
Objective This study aimed to identify priority self-management skills and behaviours in partnership with stroke survivors, and to co-create approaches to support self-management during inpatient stroke rehabilitation. Methods Three stroke survivors and two communication partners participated in the three-stage Participatory Action Research project with embedded co-design processes after undertaking inpatient rehabilitation at a metropolitan tertiary hospital. Results Participants identified key factors influencing self-management during inpatient rehabilitation including motivation, emotional well-being, and fatigue. Three approaches to support people to self-manage post-stroke were co-created. (1) A health professional concierge and early family meeting. (2) A peer support person. (3) Adapting the hospital environment. Conclusion Findings suggest post-stroke self-management support should commence during inpatient rehabilitation to optimise its research-informed benefits. This support should focus on empowering stroke survivors and their key support people through active involvement in decision-making, and provision of multi-modal individualised education. The impact of hospital environments on emotional-wellbeing and self-management post-stroke also requires further investigation. Innovation The identification of a health professional concierge as a co-designed solution to the current challenges with self-management support is an innovative recommendation for practice. The findings support changes to the traditional processes of rehabilitation towards a consumer and family-led practices.
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Affiliation(s)
- Joshua Dobe
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Queensland, Australia
| | - Kim Walder
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Kylie Bower
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
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Middleton R, Metusela C, Marriott‐Statham K, Ferguson C, Davidson PM. The engagement of older people living with chronic lung disease in a peer support community-based exercise programme: A qualitative study. Health Expect 2023; 26:2409-2417. [PMID: 37571972 PMCID: PMC10632631 DOI: 10.1111/hex.13847] [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] [Received: 03/24/2023] [Revised: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Chronic lung disease is a common and complex condition. Pulmonary rehabilitation programmes-either hospital-based or in the community are recommended in evidence-based clinical practice guidelines. AIM To explore the experience of older people with chronic lung disease involved in a peer support community-based exercise maintenance programme. DESIGN AND METHOD Participants were a part of the Lungs in Action programme run in a local community leisure centre through Lung Foundation Australia. All the programme participants (n = 25) were invited by an independent person through email and/or letter to participate in the study and provided with a participant information and consent form. Participants who returned consent forms were scheduled for group interviews. Participants were recruited over a 2-week period between 30 August and 13 September 2022. We conducted qualitative group interviews using a semi-structured interview guide to explore the experiences of older people living with chronic lung disease. Data were analysed using reflexive thematic analysis. RESULTS A total of 14 participants (eight female and six male) aged between 64 and 86 years were interviewed. Three themes emerged from the data: motivation, authentic social engagement, and sustainable achievement. Motivation stemmed from the participants' perceived health benefits, and from the trainers' motivation and encouragement. Participants discussed how sharing experiences created an environment of trust and understanding, fun and friendship. Social engagement and creating authentic relationships were key aspects raised by participants. Feeling more confident in themselves and being able to accomplish physical tasks, making activities of daily living more manageable featured highly in participants' responses. DISCUSSION AND CONCLUSION Community-based peer support exercise groups enable environments for people with chronic lung disease to maintain physical fitness, and to connect with others to form friendships and have fun.
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Affiliation(s)
- Rebekkah Middleton
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Christine Metusela
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | | | - Caleb Ferguson
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
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Kusec A, Murphy FC, Peers PV, Bennett R, Carmona E, Korbacz A, Lawrence C, Cameron E, Bateman A, Watson P, Allanson J, duToit P, Manly T. Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): results from a randomised controlled pilot feasibility trial for low mood in acquired brain injury. BMC Med 2023; 21:445. [PMID: 37974189 PMCID: PMC10655452 DOI: 10.1186/s12916-023-03128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Acquired brain injury (ABI) is linked to increased depression risk. Existing therapies for depression in ABI (e.g., cognitive behavioural therapy) have mixed efficacy. Behavioural activation (BA), an intervention that encourages engaging in positively reinforcing activities, shows promise. The primary aims were to assess feasibility, acceptability, and potential efficacy of two 8-week BA groups. METHODS Adults (≥ 18 years) recruited from local ABI services, charities, and self-referral via social media were randomised to condition. The Activity Planning group (AP; "traditional" BA) trained participants to plan reinforcing activities over 8 weeks. The Activity Engagement group (AE; "experiential" BA) encouraged engagement in positive activities within session only. Both BA groups were compared to an 8-week Waitlist group (WL). The primary outcomes, feasibility and acceptability, were assessed via recruitment, retention, attendance, and qualitative feedback on groups. The secondary outcome, potential efficacy, was assessed via blinded assessments of self-reported activity levels, depression, and anxiety (at pre- and post-intervention and 1 month follow-up) and were compared across trial arms. Data were collected in-person and remotely due to COVID-19. RESULTS N = 60 participants were randomised to AP (randomised n = 22; total n = 29), AE (randomised n = 22; total n = 28), or re-randomised following WL (total n = 16). Whether in-person or remote, AP and AE were rated as similarly enjoyable and helpful. In exploring efficacy, 58.33% of AP members had clinically meaningful activity level improvements, relative to 50% AE and 38.5% WL. Both AP and AE groups had depression reductions relative to WL, but only AP participants demonstrated anxiety reductions relative to AE and WL. AP participants noted benefits of learning strategies to increase activities and learning from other group members. AE participants valued social discussion and choice in selecting in-session activities. CONCLUSIONS Both in-person and remote group BA were feasible and acceptable in ABI. Though both traditional and experiential BA may be effective, these may have different mechanisms. TRIAL REGISTRATION Clinicaltrials.gov, NCT03874650. Protocol version 2.3, May 26 2020.
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Affiliation(s)
- Andrea Kusec
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Fionnuala C Murphy
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Polly V Peers
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Ron Bennett
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Patient and Public Involvement Representative, University of Cambridge, Cambridge, UK
| | - Estela Carmona
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Aleksandra Korbacz
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Cara Lawrence
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Emma Cameron
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Judith Allanson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pieter duToit
- School of Health and Social Care, University of Essex, Colchester, UK
- The Disabilities Trust, Fen House, Ely, UK
| | - Tom Manly
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Farre A, Morris JH, Irvine L, Dombrowski SU, Breckenridge JP, Ozakinci G, Lebedis T, Jones C. Exploring the views and experiences of people recovering from a stroke about a new text message intervention to promote physical activity after rehabilitation-Keeping Active with Texting After Stroke: A qualitative study. Health Expect 2023; 26:2013-2022. [PMID: 37409460 PMCID: PMC10485328 DOI: 10.1111/hex.13809] [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] [Received: 02/20/2023] [Revised: 04/30/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Participating in exercise following a stroke is essential for recovery. When community-based rehabilitation services end, some people struggle to remain active. We codesigned Keeping Active with Texting After Stroke (KATS), a text message intervention to support home-based, self-directed plans to continue exercising. KATS delivers a series of automated text messages over a 12-week period from the point of discharge from National Health Service-funded therapy. The aim of this study was to explore the views and experiences of the first cohort of participants to complete the KATS intervention about the meaning, engagement, workability and worth of the intervention. METHODS We undertook a qualitative study, theoretically informed by Normalisation Process Theory. We conducted semi-structured telephone interviews with people with stroke from two Health Boards in Scotland. Data collection took place over two phases, with each participant being interviewed twice: first, halfway through intervention delivery (Week 6) and then again at the end of the intervention (Week 12). All interviews were audio-recorded, transcribed and analysed thematically. RESULTS A total of 24 interviews were conducted with 12 participants. Our findings were organised around four overarching analytical themes: (1) making sense of KATS: timing and complementarity in the rehabilitation journey; (2) engaging with KATS: connection and identification with others; (3) making KATS work: flexibility and tailorable guidance; (4) appraising the worth of KATS: encouragement and friendliness. Participants differentiated KATS from current rehabilitation practice, finding it relevant, fitting and worthwhile. Variations were reported in engagement with behaviour change techniques, but participants were able to tailor KATS use, making it work for them in different ways. CONCLUSIONS Perceived benefits went beyond promoting physical activity, including feeling supported and connected. Future research will test the effectiveness of KATS in promoting physical activity and explore any associations with relevant social and emotional secondary outcomes. PATIENT OR PUBLIC CONTRIBUTION A research funding proposal was developed in collaboration with five people with stroke and three spouses. After securing funding, six people with stroke were invited to join the project's Collaborative Working Group, alongside health professionals and stroke rehabilitation experts, to codevelop the intervention and support the feasibility study.
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Affiliation(s)
- Albert Farre
- School of Health SciencesUniversity of DundeeDundeeUK
| | | | - Linda Irvine
- School of Health SciencesUniversity of DundeeDundeeUK
| | | | | | - Gozde Ozakinci
- Division of Psychology, Faculty of Natural SciencesUniversity of StirlingStirlingUK
| | | | - Claire Jones
- Health Informatics CentreSchool of MedicineUniversity of DundeeDundeeUK
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12
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Lo SHS, Chau JPC, Choi KC, Wong RYM, Kwan JCY, Iu IHL. Health Professional- and Volunteer-partnered Self-management Support (COMBO-KEY) to Promote Self-efficacy and Self-management Behaviors in People with Stroke: A Randomized Controlled Trial. Ann Behav Med 2023; 57:866-876. [PMID: 37260291 PMCID: PMC10498819 DOI: 10.1093/abm/kaad028] [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: 06/02/2023] Open
Abstract
BACKGROUND Multiple systematic reviews have reported that self-management interventions are associated with positive impacts on self-efficacy and health-related quality of life (HRQoL) of people with stroke. PURPOSE This article reports the effects of an enhanced stroke self-management program. METHODS Eligible adults with stroke were recruited from community-based organizations and a support group for a two-arm, assessor-blinded randomized controlled trial. Participants in the control group received usual care, while those in the intervention group also received the 8-week self-management program, Coaching Ongoing Momentum Building On stroKe rEcovery journeY (COMBO-KEY), consisting of four individual home visits and five follow-up phone calls, delivered by healthcare professionals and trained volunteers. Assessments were conducted at baseline and after the intervention, for outcomes of self-efficacy, satisfaction with the performance of self-management behaviors, HRQoL, and community reintegration, which were analyzed using generalized estimating equations (GEEs). RESULTS 134 Participants were recruited [mean age = 64.1 years, standard deviation (SD) = 12.7]. Over 80% of the participants had a first-ever stroke [mean years after first stroke: 4.2 (SD = 5.1)]. The GEE analysis revealed that the intervention group participants showed significantly greater improvements in self-efficacy, satisfaction with their performance of self-management behaviors, HRQoL, and community reintegration at 8-week follow-up with respect to their baseline levels. CONCLUSIONS The COMBO-KEY program showed effective improvements in recovery outcomes of people with stroke. Future research should explore the inclusion of virtual/hybrid sessions, strategies to assess health conditions of people with stroke via online modes, and assessment of goal attainment and actual performance of self-management behaviors.
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Affiliation(s)
- Suzanne H S Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Janita P C Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Kai C Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Rebecca Y M Wong
- New Territories East Cluster, Hospital Authority, Hong Kong SAR (Former)
| | - Jackie C Y Kwan
- The Hong Kong Society for Rehabilitation, Hong Kong SAR (Former)
| | - Issac H L Iu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
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13
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Clayton-Jones D, Ong LZ, Bekhet AK, Jones W, Ontala E, Pena S, Griffin K, Griffin J, Peacock E, Haglund K. Sickle Cell Virtual Support Group Program for Adults: An Implementation Evaluation. Issues Ment Health Nurs 2023; 44:758-766. [PMID: 37549311 DOI: 10.1080/01612840.2023.2227266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Sickle cell disease (SCD) is associated with medical and psychosocial challenges. SCD in adulthood is characterized by increased morbidity and mortality, vulnerability, inadequate self-management preparation, and limited social support. This study evaluated the implementation of a virtual support group during the COVID-19 pandemic using an intervention parameters framework evaluation. Participants included six adults living with SCD. Content analysis was conducted for each of the six intervention parameters, and satisfaction scores were summarized. Participants positively evaluated all intervention parameters of the virtual support group. Findings confirmed that a community-engaged intervention supports self-management and establishes key social networks for adult participants.
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Affiliation(s)
| | - Lee Za Ong
- Department of Counselor Education and Counseling Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Abir K Bekhet
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | - Weneaka Jones
- Department of Counselor Education and Counseling Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | | | - Sylvia Pena
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | | | | | | | - Kristin Haglund
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
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14
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Zhang Q, Chen S, Zhang Y, Ni J, Huang J, Wu Y, Li M. Interventions targeting psychosocial adaptation in people with stroke: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 113:107751. [PMID: 37116222 DOI: 10.1016/j.pec.2023.107751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This scoping review aimed to describe and map interventions targeting psychosocial adaptation in people with stroke. METHODS A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. We included original studies with interventions targeting psychosocial adaptation (concept) on people with stroke (population) in any setting (context). We searched five online electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Cochrane Central Registry of Controlled Trials). We described interventions in terms of design characteristics, theoretical basis, details of interventions, and quantitative outcomes indicated in psychosocial adaptation. RESULTS Forty-three studies were identified. Five intervention categories were identified to describe the interventions targeting psychosocial adaptation. Quantitative outcomes indicated psychosocial adaptation in our review were grouped into four domains: global adaptation, psychological adaptation, social adaptation, and others. CONCLUSIONS The mapping and description brought to light the large heterogeneity of interventions targeting psychosocial adaptation in people with stroke. PRACTICE IMPLICATIONS Deepening understanding of psychosocial adaptation can help health professionals further develop effective interventions aiming at promoting psychosocial adaptation and reducing negative health sequelae, such as risk of reduced psychosomatic recovery post stroke.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Shanshan Chen
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Jieqing Ni
- School of Social Sciences in Applied Psychology, Lingnan University, Hong Kong, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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van Nimwegen D, Hjelle EG, Bragstad LK, Kirkevold M, Sveen U, Hafsteinsdóttir T, Schoonhoven L, Visser-Meily J, de Man-van Ginkel JM. Interventions for improving psychosocial well-being after stroke: A systematic review. Int J Nurs Stud 2023; 142:104492. [PMID: 37084476 DOI: 10.1016/j.ijnurstu.2023.104492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Up to one third of all stroke patients suffer from one or more psychosocial impairments. Recognition and treatment of these impairments are essential in improving psychosocial well-being after stroke. Although nurses are ideally positioned to address psychosocial well-being, they often feel insecure about providing the needed psychosocial care. Therefore, we expect that providing nurses with better knowledge to deliver this care could lead to an improvement in psychosocial well-being after stroke. Currently it is not known which interventions are effective and what aspects of these interventions are most effective to improve psychosocial well-being after stroke. OBJECTIVE To identify potentially effective interventions - and intervention components - which can be delivered by nurses to improve patients' psychosocial well-being after stroke. METHODS A systematic review and data synthesis of randomized controlled trials and quasi experimental studies was conducted. Papers were included according to the following criteria: 1) before-after design, 2) all types of stroke patients, 3) interventions that can be delivered by nurses, 4) the primary outcome(s) were psychosocial. PubMed, Embase, PsychInfo, CINAHL and Cochrane library were searched (August 2019-April 2022). Articles were selected based on title, abstract, full text and quality. Quality was assessed by using Joanna Briggs Institute checklists and a standardized data extraction form developed by Joanna Brigss Institute was used to extract the data. RESULTS In total 60 studies were included, of which 52 randomized controlled trials, three non-randomized controlled trials, four quasi-experimental studies, and one randomized cross-over study. Nineteen studies had a clear psychosocial content, twenty-nine a partly psychosocial content, and twelve no psychosocial content. Thirty-nine interventions that showed positive effects on psychosocial well-being after stroke were identified. Effective intervention topics were found to be mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management, and medication management. Active information and physical exercise were identified as effective methods of delivery. DISCUSSION The results suggest that interventions to improve psychosocial well-being should include the intervention topics and methods of delivery that were identified as effective. Since effectiveness of the intervention can depend on the interaction of intervention components, these interactions should be studied. Nurses and patients should be involved in the development of such interventions to ensure it can be used by nurses and will help improve patients' psychosocial well-being. FUNDING AND REGISTRATION This study was supported by the Taskforce for Applied Research SIA (RAAK.PUB04.010). This review was not registered.
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Affiliation(s)
- Dagmar van Nimwegen
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Ellen Gabrielsen Hjelle
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Line Kildal Bragstad
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Marit Kirkevold
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Unni Sveen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Thóra Hafsteinsdóttir
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Hall P, Lawrence M, Blake C, Lennon O. Interventions for Behaviour Change and Self-Management of Risk in Stroke Secondary Prevention: An Overview of Reviews. Cerebrovasc Dis 2023; 53:1-13. [PMID: 37231867 DOI: 10.1159/000531138] [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: 01/02/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Optimised secondary prevention strategies that include lifestyle change are recommended after stroke. While multiple systematic reviews (SRs) address behaviour change interventions, intervention definitions, and associated outcomes differ between reviews. This overview of reviews addresses the pressing need to synthesise high-level evidence for lifestyle-based behavioural and/or self-management interventions to reduce risk in stroke secondary prevention in a structured, consistent way. METHODS Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were applied to meta-analyses, demonstrating statistically significant effect sizes to establish the certainty of existing evidence. Electronic databases MEDLINE, Embase, Epistemonikos, and the Cochrane Library of Systematic Reviews were systematically searched, current to March 2023. RESULTS Fifteen SRs were identified following screening, with moderate overlap of primary studies demonstrated (5.84% degree of corrected covered area). Interventions identified could be broadly categorised as multimodal; behavioural change; self-management; psychological talk therapies, albeit with overlap between some theoretical domains. Seventy-two meta-analyses addressing twenty-one preventive outcomes of interest were reported. Best-evidence synthesis identifies that for primary outcomes of mortality and future cardiovascular events post-stroke, moderate certainty GRADE evidence supports multimodal interventions to reduce cardiac events, with no available evidence for outcomes of mortality (all-cause or cardiovascular) or recurrent stroke events. For secondary outcomes addressing risk-reducing behaviours, best-evidence synthesis identifies moderate certainty GRADE evidence for multimodal lifestyle-based interventions to increase physical activity participation, and low certainty GRADE evidence for behavioural change interventions to improve healthy eating post-stroke. Similarly, low certainty GRADE evidence supports self-management interventions to improve preventive medication adherence. For mood self-management post-stroke, moderate GRADE evidence supports psychological therapies for remission and/or reduction of depression and low/very low certainty GRADE evidence for reduction of psychological distress and anxiety. Best-evidence for outcomes addressing proxy physiological measures identified low GRADE evidence supporting multimodal interventions to improve blood pressure, waist circumference, and LDL cholesterol. CONCLUSION Effective strategies to redress risk-related health behaviours are required in stroke survivors to complement current pharmacological secondary prevention. Inclusion of multimodal interventions and psychological talk therapies in evidence-based stroke secondary prevention programmes is warranted given the moderate GRADE of evidence that supports their role in risk reduction. Given the overlap in primary studies across reviews, often with overlapping theoretical domains between broad intervention categories, further research is required to identify optimal intervention behavioural change theories and techniques employed in behavioural/self-management interventions.
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Affiliation(s)
- Patricia Hall
- iPASTAR CDA Programme, Division of Population Health Sciences, RCSI, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, UCD, Dublin, Ireland
| | - Maggie Lawrence
- Department of Nursing and Community Health, GCU, G4 0BA Glasgow, Glasgow, UK
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, UCD, Dublin, Ireland
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, UCD, Dublin, Ireland
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Mediating effect of post-stroke depression between activities of daily living and health-related quality of life: meta-analytic structural equation modeling. Qual Life Res 2023; 32:331-338. [PMID: 35972616 DOI: 10.1007/s11136-022-03225-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Stroke survivors face various problems that affect their health-related quality of life (HRQoL). Reduced activities of daily living (ADL) may contribute to post-stroke depression (PSD) and low HRQoL, and depression might be associated with low HRQoL. However, these relationships are not well known. This study aimed to analyze correlations among ADL, PSD, and HRQoL in stroke survivors and further explore the mediating role of PSD between ADL and HRQoL. METHODS This study utilized meta-analytic structural equation modeling (MASEM) on systematically searched articles from six electronic databases, namely PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (China), Wanfang database (China), and SinoMed (China), from inception up to July 31, 2021. Two researchers independently assessed study eligibility, and data from the eligible studies were encoded and assessed for quality. MASEM was utilized to examine correlations among ADL, PSD, and HRQoL, with an estimation of a pooled correlation matrix under a random-effects model. The matrix was directly fitted to a structural equation model using webMASEM. RESULTS In total, 8580 articles were screened, and data from 27 studies involving 33 effect sizes were used in the MASEM analysis. Correlations among the three variables were significant (both P < 0.01). Furthermore, PSD partially mediated the correlation between ADL and HRQoL (β = 0.24, 95% confidence interval 0.15-0.30). CONCLUSIONS The findings suggest that both decreased ADL and PSD may reduce HRQoL, while a decrease in ADL tends to cause depression after stroke. Therefore, ADL and PSD reductions should be improved to achieve better HRQoL of stroke survivors. Future studies should continue to discuss other factors affecting HRQoL to achieve optimal recovery in stroke survivors.
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Price A, de Bell S, Shaw N, Bethel A, Anderson R, Coon JT. What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1264. [PMID: 36909883 PMCID: PMC9316011 DOI: 10.1002/cl2.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Peer support interventions involve people drawing on shared personal experience to help one another improve their physical or mental health, or reduce social isolation. If effective, they may also lessen the demand on health and social care services, reducing costs. However, the design and delivery of peer support varies greatly, from the targeted problem or need, the setting and mode of delivery, to the number and content of sessions. Robust evidence is essential for policymakers commissioning peer support and practitioners delivering services in health care and community settings. This map draws together evidence on different types of peer support to support the design and delivery of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent, high quality evidence on the effectiveness and cost-effectiveness of the use of peer support in health and social care. Search Methods We searched MEDLINE, seven further bibliographic databases, and Epistemonikos for systematic reviews (in October 2020), randomised controlled trials (in March 2021) and economic evaluations (in May 2021) on the effectiveness of peer support interventions in health and social care. We also conducted searches of Google Scholar, two trial registers, PROSPERO, and completed citation chasing on included studies. Selection Criteria Systematic reviews, randomised controlled trials and economic evaluations were included in the map. Included studies focused on adult populations with a defined health or social care need, were conducted in high-income countries, and published since 2015. Any measure of effectiveness was included, as was any form of peer support providing the peer had shared experience with the participant and a formalised role. Data Collection and Analysis Data were extracted on the type of peer support intervention and outcomes assessed in included studies. Standardised tools were used to assess study quality for all studies: assessing the methodological quality of systematic reviews 2 for systematic reviews; Cochrane risk of bias tool for randomised controlled trials; and consensus health economic criteria list for economic evaluations. Main Results We included 91 studies: 32 systematic reviews; 52 randomised controlled trials; and 7 economic evaluations. Whilst most included systematic reviews and economic evaluations were assessed to be of low or medium quality, the majority of randomised controlled trials were of higher quality. There were concentrations of evidence relating to different types of peer support, including education, psychological support, self-care/self-management and social support. Populations with long-term health conditions were most commonly studied. The majority of studies measured health-related indicators as outcomes; few studies assessed cost-effectiveness. Studies were unevenly distributed geographically, with most being conducted in the USA. Several gaps were evident regarding the delivery of peer support, particularly the integration of peers and professionals in delivering support and interventions of longer duration. Authors' Conclusions Although there is evidence available to inform the commissioning and delivery of peer support in health and social care, there are also clear gaps that need to be addressed to further support provision, particularly regarding cost-effectiveness. The effectiveness of peer support in different countries, with varying health and social care systems, is a priority for future research, as is the integration of peers with professionals in delivering peer support.
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Affiliation(s)
- Anna Price
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Siân de Bell
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
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Wan X, Chau JPC, Wu Y, Xu L, Gong W. Effects of a nurse-led peer support intervention for stroke survivors: protocol for a randomised controlled trial. BMJ Open 2022; 12:e062531. [PMID: 35688588 PMCID: PMC9189841 DOI: 10.1136/bmjopen-2022-062531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Many stroke survivors have unmet psychosocial needs during the recovery phase following a stroke. There is emerging evidence that peer support interventions may play a valuable role in managing stroke. However, evidence regarding the effectiveness of peer support interventions on the psychosocial outcomes of stroke survivors is uncertain. This study aims to develop a nurse-led peer support intervention for stroke survivors based on the Person-Environment-Occupation-Performance Model and evaluate its effects on the psychosocial outcomes of stroke survivors. METHODS AND ANALYSIS This is an assessor-blinded two-arm randomised controlled trial. A convenience sample of 120 stroke survivors will be recruited from two community centres and one rehabilitation unit in Yangzhou, a medium-sized city in eastern China, with 60 participants each in the intervention and control groups. The participants allocated to the intervention group will receive the nurse-led peer support intervention, which includes 6 weekly peer support sessions facilitated by a nurse and at least one peer facilitator. Participants randomised to the control group will receive the same dose of interpersonal interaction as intervention participants, including weekly individual face-to-face session for 6 weeks. The primary outcomes are social participation and participation self-efficacy. The secondary outcomes are psychosocial distress, social support, stigma towards disease, self-efficacy in managing chronic conditions and quality of life. Data will be collected at baseline, immediately after the intervention and 3 months after the intervention. A process evaluation will be conducted qualitatively and quantitively to examine the mechanism by which the intervention impacts the psychosocial outcomes of stroke survivors. All outcomes will be analysed following the intention to treat principle. Generalised Estimation Equation models will be used to assess the intervention effect. ETHICS AND DISSEMINATION This protocol was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2021.196-T). All participants will be required to provide written informed consent. Results of the study will be disseminated through publication in peer-reviewed journals and presentation at local or international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100050853.
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Affiliation(s)
- Xiaojuan Wan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ying Wu
- Yangzhou Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Yangzhou, China
| | - Limei Xu
- Outpatient Pharmacy, Wenfeng Community Health Service Centre, Yangzhou, China
| | - Weijuan Gong
- Department of Medicine, Yangzhou University, Yangzhou, China
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Lo SHS, Chau JPC, Lam SKY, Saran R. Understanding the priorities in life beyond the first year after stroke: Qualitative findings and non-participant observations of stroke survivors and service providers. Neuropsychol Rehabil 2022; 33:794-820. [PMID: 35261329 DOI: 10.1080/09602011.2022.2049827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTLong-term unmet health needs are associated with a lower quality of life in stroke survivors. Survivors' priorities in living their lives and health professionals' recognition influence survivors' perceptions of their needs. From the perspectives of survivors and service providers, this study investigated survivors' long-term priorities for continuing their lives after stroke. A qualitative study was conducted with a convenience sample of 40 stroke survivors and a purposive sample of 11 providers who had worked with survivors for more than five years and were currently managers of community-based stroke care services or leaders of volunteer groups. Following the survivors' interviews, non-participant observations of a random day's activities were conducted. Data were transcribed verbatim. Survivors' and providers' data were analyzed separately and then together thematically. Five themes emerged: healing the mind in order to move forward, optimizing adaptations and maintaining physical function, living a safe and cost-effective life, returning to work, and giving back to society. Community-based services can be improved to offer more at-home, technology-supported psychological and self-management interventions, barrier-free and one-stop services, and opportunities for employment and volunteering. It would be worthwhile to invest in conducting public education to promote social inclusion and strengthening collaboration between academic and community organizations.
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Affiliation(s)
- Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Kwun Yu Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ravneet Saran
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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