Feasibility of a Nurse-Trained, Family Member-Delivered Rehabilitation Model for Disabled Stroke Patients in Rural Chongqing, China

Telerehabilitation for Neurological Motor Impairment: A Systematic Review and Meta-Analysis on Quality of Life, Satisfaction, and Acceptance in Stroke, Multiple Sclerosis, and Parkinson's Disease

Telerehabilitation (TR) seems to be a viable and feasible solution to face the rehabilitative challenges posed by neurological impairments and to improve patients' quality of life (QoL). This review aims to synthesize and analyze the evidence on the impact of physiotherapy intervention through TR on QoL in patients with stroke, Parkinson's disease (PD), and multiple sclerosis (MS), together with an evaluation of their satisfaction and technology acceptance levels. Through a systematic search of the literature and a screening process, treatment effects were assessed with meta-analyses using the standardized mean difference, setting the confidence interval at 95%. We included 28 studies in the review, which were analyzed for methodological quality, whereas 16 studies were included in the meta-analyses. The results suggest a significant improvement in QoL in patients who underwent TR. We were unable to perform analyses for satisfaction and technology acceptance outcomes due to insufficient data. Overall, motor TR has a positive impact on the QoL of patients with neurological diseases, especially in stroke patients; although caution is needed in the interpretation of the results due to the high heterogeneity found. For PD and MS, TR seems to yield comparable results to in-person treatment.

Effectiveness of interventions by non-professional community-level workers or family caregivers to improve outcomes for physical impairments or disabilities in low resource settings: systematic review of task-sharing strategies

BACKGROUND

In low-resource settings, access to basic rehabilitation could be supplemented by community-level interventions provided by community health workers, health volunteers, or family caregivers. Yet, it is unclear whether basic physical rehabilitation interventions delivered to adults by non-professional alternative resources in the community, under task-shifting or task-sharing approaches, are effective as those delivered by skilled rehabilitation professionals. We aim to synthesize evidence on the effectiveness of community-level rehabilitation interventions delivered by non-professional community-level workers or informal caregivers to improve health outcomes for persons with physical impairments or disabilities.

METHODS

We performed a systematic review with a PROSPERO registration. Eight databases were searched for (PubMed, CINAHL, Global Health, PDQ Evidence, Scopus, ProQuest, CENTRAL, and Web of Science), supplemented by snowballing and key-informant recommendations, with no time restrictions, applied. Controlled and non-controlled experiments were included if reporting the effects of interventions on mobility, activities of daily living (ADLs), quality of life, or social participation outcomes. Two independent investigators performed the eligibility decisions, data extraction, risk of bias, and assessed the quality of the evidence using the GRADE approach.

RESULTS

Ten studies (five randomized controlled trials [RCTs]) involving 2149 participants were included. Most common targeted stroke survivors (n = 8); family caregivers were most frequently used to deliver the intervention (n = 4); and the intervention was usually provided in homes (n = 7), with training initiated in the hospital (n = 4). Of the four RCTs delivered by family caregivers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; confidence interval [CI] 121.81-122.19; [p = 0.04]) and another one in ADLs (effect size: 0.4; CI 25.92-35.08; [p = 0.03]). Of the five non-RCT studies by community health workers or volunteers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; CI 10.143-16.857; [p < 0.05]), while two demonstrated improved statistically significant improvement in ADLs (effect size: 0.2; CI 180.202-184.789 [p = 0.001]; 0.4; CI - 7.643-18.643; [p = 0.026]). However, the quality of evidence, based on GRADE criteria, was rated as low to very low.

CONCLUSIONS

While task-sharing is a possible strategy to meet basic rehabilitation needs in low-resource settings, the current evidence on the effectiveness of delivering rehabilitation interventions by non-professional community-level workers and informal caregivers is inconclusive. We can use the data and experiences from existing studies to better design studies and improve the implementation of interventions. Trial registration PROSPERO registration number: CRD42022319130.

Interventions within the Scope of Occupational Therapy in the Hospital Discharge Process Post-Stroke: A Systematic Review

Stroke is one of the main causes of disability in adulthood. Its rehabilitation is a complex process that requires a multidisciplinary team of specialised professionals. The main goal of this review was to determine the impact of occupational therapy intervention post-stroke on the home discharge process. A systematic search was carried out of the following databases: Pubmed, Web of Science, PsycINFO, Scopus, Otseeker, and Dialnet. A screening was performed taking into account the type of article, including exclusively RCT, and type of intervention, only including interventions within the scope of occupational therapy that take place during the process of hospital discharge post-stroke. A total of 2285 citations were identified in the search from which 13 articles met the inclusion criteria. Comparisons of the groups indicated that early occupational therapy intervention during the process of hospital discharge can be effective in terms of functional recovery and can lead to the caregiver seeing improvements in self-efficacy and fatigue. In addition, the inclusion of a caregiver in the intervention influences the patient’s adherence to treatment, leading to a reduction in the cost of treatment and rehabilitation.

Effectiveness of caregiver-mediated exercise interventions on activities of daily living, anxiety and depression post-stroke rehabilitation: A systematic review and meta-analysis

AIMS

This review aims to examine updated evidence to evaluate the effectiveness of caregiver-mediated exercise interventions on basic and extended activities of daily living (ADL), anxiety and depression of post-stroke rehabilitation individuals.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

Six electronic databases, including CINAHL, CENTRAL, Embase, PubMed, PsycINFO and Scopus, grey literature and trial registry were searched from inception until February 2021.

METHODS

Only randomized controlled trials written in English were included. Meta-analyses were conducted for basic and extended ADL, anxiety and depression outcomes using RevMan software. Overall quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation framework.

RESULTS

A total of 11 randomized controlled trials comprising 2120 participants were identified, with 10 trials meta-analysed. Meta-analyses indicated statistically significant effects favouring caregiver-mediated exercise interventions for basic ADL. Subgroup analyses revealed significant effects for exercise-only interventions mediated by caregivers for basic ADL. No significant effects were found for extended ADL, anxiety and depression for stroke survivors.

CONCLUSION

Caregiver-mediated exercise interventions appear to have beneficial impacts on basic ADL for stroke survivors, suggesting caregiver-mediated exercise interventions as a potentially feasible way to improve functional independence.

IMPACT

Caregiver-mediated intervention with exercises as a major component could be a promising approach to augment stroke rehabilitation. Future research should include high-quality studies with focus on specific intervention components or to explore caregiver outcomes.

Early Occupational Therapy Intervention in the Hospital Discharge after Stroke

Stroke is the leading cause of acquired disability in adults which is a cerebrovascular disease of great impact in health and social terms, not only due to its prevalence and incidence but also because of its significant consequences in terms of patient dependence and its consequent impact on the patient and family lives. The general objective of this study is to determine whether an early occupational therapy intervention at hospital discharge after suffering a stroke has a positive effect on the functional independence of the patient three months after discharge—the patient’s level of independence being the main focus of this research. Data will be collected on readmissions to hospitals, mortality, returns to work and returns to driving, as well as an economic health analysis. This is a prospective, randomized, controlled clinical trial. The sample size will be made up of 60 patients who suffered a stroke and were discharged from the neurology unit of a second-level hospital in west Malaga (Spain), who were then referred to the rehabilitation service by the joint decision of the neurology and rehabilitation department. The patients and caregivers assigned to the experimental group were included in an early occupational therapy intervention program and compared with a control group that receives usual care.

Predictors of death within 6 months of stroke onset: A model with Barthel index, platelet/lymphocyte ratio and serum albumin

AIMS

To develop and internally validate a nomogram to predict the risk of death within 6 months of onset of stroke in Chinese. Identifying risk factors with potentially direct effects on the nomogram will improve the quality of risk assessment and help nurses implement preventive measures based on patient-specific risk factors.

DESIGN

A retrospective study.

METHODS

We performed a least absolute shrinkage and selection operator (LASSO) regression modelling and multivariate logistic regression analysis to establish a prediction model of death risk in stroke patients within 6 months of onset. LASSO and time-dependent Cox regression models were further used to analyse the 6-month survival of stroke patients. Data were collected from 21 October 2013-6 May 2019.

RESULTS

The independent predictors of the nomogram were Barthel index (odds ratio (OR) = 0.980, 95% confidence interval (CI) = 0.961-0.998, p = .03), platelet/lymphocyte ratio (OR = 1.005, 95% CI = 1.000-1.010, p = .04) and serum albumin (OR = 0.854, 95% CI = 0.774-0.931, p < .01). This model showed good discrimination and consistency, and its discrimination evaluation C-statistic was 0.879 in the training set and 0.891 in the internal validation set. The DCA indicated that the nomogram had a higher overall net benefit over most of the threshold probability range. The time-dependent Cox regression model established the impact of the time effect of the age variable on survival time.

CONCLUSIONS

Our results identified three predictors of death within 6 months of stroke in Chinese. These predictors can be used as risk assessment indicators to help caregivers performing clinical nursing work, and in clinical practice, it is suggested that nurses should evaluate the self-care ability of stroke patients in detail. The constructed nomogram can help identify patients at high risk of death within 6 months, so that intervention can be performed as early as possible.

Adjusted Indirect and Mixed Comparisons of Interventions for the Patient-Reported Outcomes Measures (PROMs) of Disabled Adults: A Systematic Review and Network Meta-Analysis

This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines and used the method of network meta-analysis to compare the effects of different types of interventions from different perspectives which were abilities of daily life activity, psychological health, social functioning, and overall life quality. The eligibility criteria were: (1) Participants were adults above 18 years old with disabilities; (2) Interventions could be classified into active exercise, passive therapy, psychological education, psychosocial support program, multi-disciplinary program, and usual care; (3) Outcomes should be the patient-reported outcome measures (PROMs) that could be classified into abilities of daily life activity, psychological health, social functioning, and overall life quality; (4) Randomized designed and published in English. The keywords and their search field were: (1) “people with disabilities/disability”, “disabled”, “handicapped”, or “disable people” in titles or abstracts; (2) AND “randomized” or “randomised” in titles or abstracts; (3) NOT “design”, “protocol”, or “review” in titles. After searching in databases of Medline (EBSCO), PubMed, CINAHL, and Ovid, 16 studies were included. As a result, active exercise and passive therapy are most likely to be the best interventions for overall life quality, psychological education and passive therapy are most likely to be the best interventions for abilities of daily life activity, and psychosocial support programs are most likely to be the best intervention for psychological health and social functioning.