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Akobundu UN, Onwudinjo O, Obiekwe SJ, Akosile CO, Nwankwo MJ, Daniel JA. Physiotherapists' attitudes, practice and barriers to sexual issues among stroke survivors in South-East Nigeria. Top Stroke Rehabil 2024:1-12. [PMID: 39244751 DOI: 10.1080/10749357.2024.2392438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/10/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Sexual issues post-stroke are common and can include difficulties related to arousal, orgasm, and decreased sexual desire, and satisfaction. AIM To determine the attitudes, practices, and barriers experienced by physiotherapists in addressing sexual issues among stroke survivors. METHODS This cross-sectional survey involved 72 practicing physiotherapists purposively recruited from selected tertiary hospitals in southeast Nigeria. Modified Physiotherapists' Attitudes on sexual issues, Physiotherapists' Performance Questionnaire in dealing with sexual issues, and Barriers to Discussing Sexual Issues Questionnaires were used to collect data that were analyzed using Statistical Package for Social Science (SPSS). RESULTS The results showed a significant association (p < 0.05) between the attitude and practice of physiotherapists in dealing with sexual issues of stroke survivors. Although most of the physiotherapists expressed confidence in their understanding of the need to address sexual issues of stroke survivors, only a quarter of them often or always assessed the patients' sexual function as well as included therapy for erectile dysfunction in their plan of care for stroke survivors. Patients' discomfort (88.9%) and insufficient knowledge and training (70.8%) were the most reported barriers. The majority (95.8%) indicated the need for a training program on the sexual issues, despite their area of specialization. CONCLUSION Although the studied physiotherapists understand the need to address these issues, the practical application remains limited due to varying barriers. There is a need for structured training programs focused on sexual health to bridge the gap between knowledge and practice, thereby enhancing the overall care and quality of life for stroke survivors.
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Affiliation(s)
| | - Oluchukwu Onwudinjo
- Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Sochima Johnmark Obiekwe
- Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Public Health, Lomo University of Research, Kinshasa, Congo DR
- Department of Research, Medical Research Circle, Bukavu, Congo DR
| | | | | | - Jovita Ada Daniel
- Department Prosthetics and Orthotics, Federal University Owerri, Owerri, Nigeria
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van den Broek B, Verrijt L, Rijnen S, van Heugten C, Bus B. Factors Related to the Quality and Stability of Partner Relationships After Stroke: A Systematic Literature Review. Arch Phys Med Rehabil 2024:S0003-9993(24)01005-0. [PMID: 38777292 DOI: 10.1016/j.apmr.2024.05.016] [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: 10/12/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To provide an overview of the current state of knowledge on factors related to relationship quality and relationship stability after stroke. DATA SOURCES Cumulative Index to Nursing and Allied Health (CINAHL), Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on November 15, 2022, for literature on factors associated with (1) relation quality and (2) relation stability after stroke. STUDY SELECTION English quantitative and qualitative studies investigating factors associated with relation quality and/or stability after stroke were included. Three reviewers independently assessed eligibility. Consensus meetings were held in case of divergent opinions. A total of 44 studies were included. DATA EXTRACTION Information regarding study objectives and characteristics, participant demographics, independent and dependent variables, and main findings was extracted. Study quality was rated using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and/or the Critical Appraisal Skills Programme Checklist for Qualitative Research. Both were administered by the lead reviewer and checked by the second reviewer. Identified factors are described and presented according to the domains of the International Classification of Functioning, Disability, and Health model. DATA SYNTHESIS Thirty-seven factors related to relationship quality after stroke were identified, covering the domains of body functions and structures (eg, cognitive problems), activities (eg, decrease in physical intimacy), participation (eg, being socially active), environment (eg, medication side effects), and personal factors (eg, hypervigilance). Eight factors related to relationship stability were identified, covering the domains of participation (agreement on reciprocal roles) and personal factors (eg, quality of prestroke relation). CONCLUSIONS Relationship quality and stability after stroke are related to a multitude of factors. Future research should confirm the relevance of factors found in a few studies of suboptimal quality; explore possible associations between relationship stability and factors falling in the domains of body functions and structure, activity, and environmental factors; and explicitly explore potential positive effects of stroke on relationships.
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Affiliation(s)
- Brenda van den Broek
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel; School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht; Limburg Brain Injury Centre, Maastricht.
| | - Laura Verrijt
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel
| | - Sophie Rijnen
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel; Limburg Brain Injury Centre, Maastricht
| | - Caroline van Heugten
- Limburg Brain Injury Centre, Maastricht; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Boudewijn Bus
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel; Limburg Brain Injury Centre, Maastricht
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Chaouche N, Delpierre Y, Chinier E, Soler JM, Hadiji N. Sexual disorders post-stroke: Description of a cohort of patients followed in rehabilitation. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102568. [PMID: 38350285 DOI: 10.1016/j.fjurol.2024.102568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/17/2023] [Accepted: 12/03/2023] [Indexed: 02/15/2024]
Abstract
INTRODUCTION The impairments resulting from a stroke can be multiple, including urinary and/or sexual dysfunctions. This acquired brain injury disrupts neurological control of sexual responses. MAIN OBJECTIVE to describe sexual disorders, after a first episode of stroke, in a population followed in a physical medicine and rehabilitation (PMR) center. SECONDARY OBJECTIVES to gather patients' expectations and PMR physicians' opinions on this subject. METHOD Observational, retrospective study in two PRM centers. Post-stroke sexuality was assessed using two validated questionnaires [for men: International Index of Erectile Function 15 (IIEF15) and for women: Female Sexual function Index (FSFI)]. Patients were asked 3 questions to approximate their expectations, and PRM physicians were asked 2 questions for their opinions. RESULTS Twenty-four subjects included (17 men/7 women). Thirteen had no post-stroke sexuality. Erectile function was analysable in 4 subjects, 3 of whom had moderate to severe erectile dysfunction. In women, female sexual dysfunction concerned 6/7 women, including lubrication. Ninety-six percent of subjects had never discussed sexuality with their PRM physician. Only 33% would have liked information on this subject. Our PRM physicians rarely discuss post-stroke sexual disability. CONCLUSION Post-stroke sexual disorders occur in both sexes. All areas of sexuality may be affected. A large-scale, prospective, controlled, multicenter study is needed to establish stroke as the direct neurological cause of sexual impairment.
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Affiliation(s)
- N Chaouche
- Service des lésions cérébrales, Centre de rééducation fonctionnelle des Capucins, CHU d'Angers, 49000 Angers, France; Services des lésions cérébrales-neuro-uro-sexologie, Centre de rééducation fonctionnelle de l'Arche, 72650 Saint-Saturnin-Le Mans, France
| | - Y Delpierre
- Unité d'analyse du mouvement, Centre de rééducation fonctionnelle de l'Arche, 72650 Saint-Saturnin-Le Mans, France
| | - E Chinier
- Service des lésions cérébrales, Centre de rééducation fonctionnelle des Capucins, CHU d'Angers, 49000 Angers, France
| | - J M Soler
- Laboratoire de neuro-urologie et de sexologie, Centre Bouffard-Vercelli, 66000 Perpignan, France
| | - N Hadiji
- Services des lésions cérébrales-neuro-uro-sexologie, Centre de rééducation fonctionnelle de l'Arche, 72650 Saint-Saturnin-Le Mans, France.
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Auger LP, Filiatrault J, Allegue DR, Vachon B, Thomas A, Morales E, Rochette A. Sexual Rehabilitation After a Stroke: A Multi-site Qualitative Study About Influencing Factors and Strategies to Improve Services. SEXUALITY AND DISABILITY 2023; 41:1-27. [PMID: 37362801 PMCID: PMC10206562 DOI: 10.1007/s11195-023-09795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 06/28/2023]
Abstract
This study aimed to better understand the factors influencing the provision of sexuality-related post-stroke rehabilitation services by clinicians on different sites and to explore strategies to improve post-stroke rehabilitation services with stakeholders. A qualitative study with co-design methods was conducted with 20 clinicians from five post-stroke rehabilitation centers in Canada, 1 manager and 1 patient-partner. Participants either took part in a focus group or in sessions of an adapted version of the LEGO Serious Play method to explore influencing factors and strategies of improvement in relation to post-stroke sexual rehabilitation services. Thematic analysis was conducted semi-deductively using the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation and Behaviour (COM-B) system and the Behaviour Change Wheel (BCW). A total of twenty factors pertaining either to the categories of Capability (n = 8; e.g., Sexual rehabilitation procedural knowledge), Motivation (n = 4; e.g., Professional boundaries) or Opportunity (n = 8; e.g., Workload) were perceived as influencing provision of sexual rehabilitation services by participants. A theoretical model was conceptualized. Strategies (n = 10) were categorized in concordance with the BCW as Training (n = 1), Enablement (n = 5) or Environmental restructuring (n = 4). This study showed that factors influencing provision of post-stroke rehabilitation services were numerous and interrelated, and that various strategies aiming either clinicians or the rehabilitation environment would be relevant to improve services. This study will help guide the design and implementation of future interventions studies aiming at improving post-stroke sexual rehabilitation services.
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Affiliation(s)
- Louis-Pierre Auger
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, QC Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363 Chem. Hudson, Montreal, QC H3S 1M9 Canada
| | - Johanne Filiatrault
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, QC Canada
- Montreal Geriatric University Institute Research Center, Montreal, QC Canada
| | - Dorra Rakia Allegue
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363 Chem. Hudson, Montreal, QC H3S 1M9 Canada
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC Canada
| | - Brigitte Vachon
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, QC Canada
- Montreal University Institute of Mental Health, Montreal, QC Canada
| | - Aliki Thomas
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363 Chem. Hudson, Montreal, QC H3S 1M9 Canada
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC Canada
| | - Ernesto Morales
- Department of Rehabilitation, Université Laval, Quebec City, QC Canada
- Interdisciplinary Research Centre in Rehabilitation and Social Inclusion (CIRRIS), Quebec City, QC Canada
| | - Annie Rochette
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, QC Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363 Chem. Hudson, Montreal, QC H3S 1M9 Canada
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Ek AS, Holmström C, Elmerstig E. Unmet Need for Sexual Rehabilitation after Acquired Brain Injury (ABI): A Cross-Sectional Study Concerning Sexual Activity, Sexual Relationships, and Sexual Rehabilitation after ABI. SEXUALITY AND DISABILITY 2023. [DOI: 10.1007/s11195-023-09788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
AbstractIn relation to brain injury rehabilitation, research has stressed the importance of including sexuality issues due to increased risk for sexual dysfunctions after Acquired Brain Injury (ABI). This study aims to explore experiences after non-stroke ABI concerning individual and relational aspects of sexuality, received information about sexuality at rehabilitation, and gender differences. A postal nationwide survey was conducted in Sweden, 2018–2019. The sample included individuals who had participated in brain injury rehabilitation 2014–2016, response rate 40% (250/624). Among all participants 78% had resumed sexual activity, and there was a significant difference between males (84%, 118/140) and females (69%, 76/110, p = 0.004). Among all participants, 95% reported physical intimacy as important, 80% considered sex as important on an individual level, and 91% stated sexuality as important for the relationship (no gender differences). Significantly more females (52%) than males (22%) reported that they had tried sexual aids (p = 0.000), and more males (29%) than females (16%) reported that professionals addressed sexuality issues during brain injury rehabilitation (p = 0.024). However, only a few participants were offered specific sexual counseling during brain injury rehabilitation, such as individual counseling (3%), couples counseling (2%), and group counseling (3%). To conclude, the vast majority valued both individual and relational aspects of sex and sexuality highly, and more males than females had resumed sexual activity. Few had received information about sexuality after ABI, and even fewer females compared to males reported that the issue was raised during rehabilitation. Clinical implications are discussed in relation to sexual rehabilitation.
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Ek AS, Holmström C, Elmerstig E. Sexuality >1 year after brain injury rehabilitation: A cross-sectional study in Sweden. Brain Inj 2023; 37:34-46. [PMID: 36408962 DOI: 10.1080/02699052.2022.2145358] [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: 11/23/2022]
Abstract
PURPOSE This study investigates whether Acquired Brain Injury (ABI) is associated with changes in sexual function and satisfaction and how such changes are experienced, focusing on invisible impairments after ABI. MATERIALS AND METHODS A study-specific questionnaire was distributed in 2018-2019. The sample included individuals aged 20-90 years diagnosed with ABI due to subarachnoid hemorrhage (SAH), trauma, infection, or anoxia (ischemic stroke and intracerebral hemorrhage excluded), who participated in brain injury rehabilitation in Sweden, 2014-2016. Chi-square and Logistic regression analyses were used. RESULTS The study consists of 250 participants (response rate was 40%). Among participants 78% (194/250) had resumed sexual life. Participants reporting sexual changes also experienced more consequences related to ABI. Those with decreased sexual desire (63%, 148/234) reported more ABI consequences, including decreased memory (86% vs 65%, p = 0.000), decreased concentration ability (82% vs 65%, p = 0.003), and increased tiredness (91% vs 70%, p = 0.000) compared to those with intact desire. Such consequences can be invisible to others. CONCLUSION Visible impairments are known to impact sexual functions and satisfaction after ABI. Our results show how invisible impairments also have a great impact. From a biopsychosocial perspective, these results imply that individuals should receive sexual rehabilitation, irrespective of ABI impairment.
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Affiliation(s)
- Ann-Sofie Ek
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics, Skåne University Hospital, Malmö-Lund, Sweden
| | - Charlotta Holmström
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Hwang JHA, Fraser EE, Downing MG, Ponsford JL. A qualitative study on the attitudes and approaches of Australian clinicians in addressing sexuality after acquired brain injury. Disabil Rehabil 2022; 44:8294-8302. [PMID: 34951561 DOI: 10.1080/09638288.2021.2012605] [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: 01/19/2023]
Abstract
PURPOSE Studies indicate that up to 50% of survivors of acquired brain injury (ABI) experience persistent changes in sexuality. However, research on clinicians' perspectives in addressing sexuality issues post-ABI is limited. This study explored the attitudes and approaches, barriers and facilitators, and training preferences of Australian clinicians in addressing sexuality in individuals post-ABI. METHOD Purposive sampling was used to recruit 20 Australian multi-disciplinary clinicians from a related survey study. Semi-structured interviews were conducted and qualitatively analysed using thematic analysis. RESULTS Three broad themes were identified: ABI results in multi-faceted changes in sexuality; there is a fundamental discomfort in talking about sexuality; and, strategies proposed by clinicians may help to improve sexuality support. Participants also provided suggestions for sexuality training, which they believed should start at university. CONCLUSION Most clinicians are aware of sexuality issues post-ABI but fail to adequately address sexuality in individuals post-ABI due to personal levels of discomfort, perpetuated by institutional factors. Therefore, participants believe that changes made at individual and institutional levels may increase sexuality support for individuals with ABI. However, further research on the causes and treatment of sexual problems and patient perspectives is required to provide the evidence-based guidelines and training programs that clinicians require.Implications for rehabilitationUp to half of individuals experience changes in sexuality after ABI that restrict quality of life and relationships.The consequences of ABI and their impacts on sexuality are understood by Australian clinicians but remain largely unaddressed due to individual discomfort, perpetuated by institutional factors.This study suggests that professional training targeted towards understanding, assessing and treating sexuality issues post-ABI may help to reduce the discomfort.Adjustments should also be made at individual, policy and procedural levels to ensure that sexuality is addressed within rehabilitation post-ABI.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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Patients with chronic diseases: is sexual health brought up by general practitioners during appointments? A web-based study. Maturitas 2022; 160:16-22. [DOI: 10.1016/j.maturitas.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 11/15/2022]
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El-Marbouhe-El-Faqyr K, Jiménez-Lasserrotte MDM, Fernández-Medina IM, Fernández-Sola C, Hernández-Padilla JM, Antequera-Raynal LH. Experience of Primary Care Nurses of Sexuality Care for Persons with Disabilities: A Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9121711. [PMID: 34946436 PMCID: PMC8700835 DOI: 10.3390/healthcare9121711] [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] [Received: 11/22/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Disability is a dynamic interaction between a person's health conditions and personal and environmental factors. Disability is an evolving concept, which can be improved by intervening in the barriers that prevent disabled people from functioning in their daily life and enjoying a satisfactory sexual life. Sexuality is an important dimension of life that affects people's well-being. The aim was to describe and understand the experiences of primary care nurses regarding care for the sexuality of persons with disabilities. (2) Methods: A descriptive qualitative study was designed. Twenty-one in-depth interviews were conducted with nurses. A thematic analysis was used to analyse the data. (3) Results: three main themes emerged: (1) Initial assessment of the patient: competencies for a nurse-patient therapeutic relationship; (2) A comprehensive approach to nursing care for persons with disabilities: the importance of sexuality; and (3) Sex counselling in nursing consultations. (4) Conclusions: Nurses have the skills to develop a good therapeutic relationship with patients. Planning of nursing interventions is required in order to promote individual coping, emotional support, and sex education. Sex counselling is essential to promote autonomy, with the figure of the sex therapist emerging for this purpose.
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Affiliation(s)
- Karim El-Marbouhe-El-Faqyr
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (K.E.-M.-E.-F.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.); (L.H.A.-R.)
| | - María del Mar Jiménez-Lasserrotte
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (K.E.-M.-E.-F.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.); (L.H.A.-R.)
- Correspondence: ; Tel.: +34-950214589
| | - Isabel María Fernández-Medina
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (K.E.-M.-E.-F.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.); (L.H.A.-R.)
| | - Cayetano Fernández-Sola
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (K.E.-M.-E.-F.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.); (L.H.A.-R.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Terrunco 4780000, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (K.E.-M.-E.-F.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.); (L.H.A.-R.)
- Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University, London NW4 4BT, UK
| | - Laura Helena Antequera-Raynal
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (K.E.-M.-E.-F.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.); (L.H.A.-R.)
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Vikan JK, Snekkevik H, Nilsson MI, Stanghelle JK, Geirdal AØ, Fugl-Meyer KS. Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation. Sex Med 2021; 9:100424. [PMID: 34474266 PMCID: PMC8498952 DOI: 10.1016/j.esxm.2021.100424] [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: 05/28/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The consequences of stroke on sexual life in stroke patients in need of specialized cognitive rehabilitation have been limited explored. A biopsychosocial perspective in post-stroke sexuality studies is warranted to capture the complex picture of stroke consequences and sexual life after stroke and sexual satisfaction is an important outcome measure when exploring such multifactorial associations. Aim To explore sexual satisfaction and associated biopsychosocial factors in stroke patients admitted to specialized cognitive rehabilitation. Methods A cross-sectional study was performed including 91 consecutive stroke patients admitted to specialized cognitive rehabilitation. Data were collected from medical records and by face-to-face interviews using a structured interview guide and questionnaires. Descriptive and inferential statistics were applied. Main outcome measures A wide range of biopsychosocial variables including medical and sociodemographic characteristics, social support, sexual complaints, aspects of sexual life, psychological distress and life satisfaction were analyzed in relation to the main outcome “Satisfaction with sexual life.” Results Only 33 % were satisfied with sexual life. Prevalence of sexual complaints was high, more frequent in women (84%) than in men (64%). Three-quarters were less sexually active than before stroke. Multivariable analyses showed that anxiety, sleep problems, manifested sexual complaint, decrease in sexual activity and fear of partner rejection were significantly associated with low odds of sexual satisfaction, while affectionate support and partnership satisfaction were significant for sexual satisfaction. When combined in a biopsychosocial multivariable model only fear of partner rejection (OR 0.07; 95 % CI: 0.01–0.42) and decrease in sexual activity (OR 0.11; 95 % CI: 0.02–0.58) showed significant contribution to sexual satisfaction. Conclusion The variety of predictors for sexual satisfaction indicates that therapeutic actions need to be individualized and points towards a broad assessment and interventional approach to meet the sexual rehabilitation needs of stroke patients with cognitive impairments in need of specialized rehabilitation. Vikan JK, Snekkevik H, Nilsson MI, et al. Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation. Sex Med 2021;9:100424.
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Affiliation(s)
- Jannike K Vikan
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden; Sunnaas Rehabilitation Hospital, Nesodden, Norway.
| | | | - Marie I Nilsson
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden; Function Area Social Work in Health, Karolinska University Hospital, Stockholm, Sweden
| | - Johan K Stanghelle
- Sunnaas Rehabilitation Hospital, Nesodden, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Amy Østertun Geirdal
- Faculty of Social Sciences, Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Kerstin S Fugl-Meyer
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden; Sunnaas Rehabilitation Hospital, Nesodden, Norway
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The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.
Method:
Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.
Results:
While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.
Conclusions:
Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.
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Heron J, Owen-Booth B. An exploration of the role of occupational therapists in addressing sexuality with service users post stroke. Br J Occup Ther 2021. [DOI: 10.1177/0308022621993026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Research suggests stroke negatively affects sexuality yet is rarely addressed by healthcare professionals. This study aims to explore occupational therapists’ perceptions of addressing sexuality post stroke with service users and whether they perceive it to fit into their scope of practice. Method A qualitative study was undertaken following an inductive reasoning approach. Three occupational therapists working within stroke rehabilitation were purposively recruited. Data were gathered through semi-structured interviews and analysed using inductive thematic analysis to generate four significant themes. Findings Findings generated the following themes: (1) Acknowledging the impact stroke has on sexuality. (2) Consideration of the appropriate stage of the stroke journey to address sexuality; identifying home/community environments to be more appropriate, utilising a multi-disciplinary approach to facilitate this. (3) Barriers to addressing sexuality, including staff’s personal feelings, inexperience, limited resources and ageism. (4) Facilitators to addressing sexuality, including approaching the topic appropriately and utilising the role of occupational therapy and resources. Conclusion This study highlights the gap in the stroke journey where sexuality lies and the role occupational therapists can play in closing this gap. Utilising facilitators such as resources and a multi-disciplinary approach can overcome barriers to practice including embarrassment, prejudice and inexperience.
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Affiliation(s)
- Jessica Heron
- Occupational Therapy, Glyndwr University, Wrexham, UK
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Auger LP, Aubertin M, Grondin M, Auger C, Filiatrault J, Rochette A. Assessment methods in sexual rehabilitation after stroke: a scoping review for rehabilitation professionals. Disabil Rehabil 2021; 44:4126-4148. [PMID: 33689511 DOI: 10.1080/09638288.2021.1889047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim was to identify and describe the assessment methods used by rehabilitation professionals to evaluate sexuality for individuals post-stroke, as well as the domains of sexuality addressed. METHODS Seven databases were selected for this scoping review. Articles needed to meet these inclusion criteria: published studies with a sample of ≥ 50% stroke clients and describing a quantitative or qualitative assessment method that could be used by rehabilitation professionals. This study was conducted following the PRISMA guidelines and domains of sexuality were categorized using the ICF core set for stroke. RESULTS Of the 2447 articles reviewed, the 96 that met the selection criteria identified a total of 116 assessment methods classified as standardized assessment tools (n = 62), original questionnaires (n = 28), semi-structured interviews (n = 16) or structured interviews (n = 10). Sexual functions were predominantly assessed using standardized tools, while intimate relationships and partner's perspective were generally addressed more by original questionnaires and qualitative methods. A stepwise approach combining relevant assessment methods is presented. CONCLUSIONS Individually, these diverse assessment methods addressed a limited scope of relevant domains. Future research should combine quantitative and qualitative methods to encompass most domains of sexuality of concern to post-stroke individuals.IMPLICATIONS FOR REHABILITATIONMost of the studies reviewed here used quantitative methods to assess sexuality, rather than qualitative methods, and mostly used standardized assessment tools.Few assessment methods covered all domains related to sexuality.Qualitative methods and standardized assessment tools were shown to be complementary, therefore emphasizing the added value of mixed methods in assessing sexuality after a stroke.Among the methods that were reviewed, certain would be more suitable for the identification of the need to address sexuality (e.g., Life Satisfaction Checklist-11) and others to assess more thoroughly sexuality (e.g., Change in Sexual Functioning Questionnaire (CSFQ-14)).
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Affiliation(s)
- Louis-Pierre Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Mélanie Aubertin
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
| | - Myrian Grondin
- Marguerite-d'Youville Library, Université de Montréal, Montreal, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Johanne Filiatrault
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Montreal Geriatric University Institute Research Center, Montreal, Canada
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
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14
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Johnsen NV, Cohn E, Johnson T, Vavilala MS, Rivara FP, Moore M. Sexual dysfunction following traumatic pelvic fracture. J Trauma Acute Care Surg 2021; 90:550-556. [PMID: 33093291 DOI: 10.1097/ta.0000000000003001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND While sexual dysfunction (SD) in men following traumatic pelvic fracture is common, little is known of how men experience changes in their sexual health after injury. The aims of the present study were to explore the personal and interpersonal impacts of SD in men after pelvic injury and to understood how interactions with the health care system can be optimized to improve patient-centered trauma survivorship care. METHODS Fifteen semistructured interviews were conducted with men who had a history of traumatic pelvic fracture and self-reported SD. Interviews were audio recorded, transcribed, and uploaded to a web-based qualitative analysis platform. A codebook was developed, and intercoder reliability was verified. Inductive thematic analysis was performed to identify notable themes related to patient postinjury sexual health experiences. RESULTS Median age of interviewees was 46 years (interquartile range, 44-54 years), with a median time since injury of 41 months (interquartile range, 22-55 months). Five primary themes were identified from the analysis: (1) effects on self-image and romantic relationships, (2) unknown care pathways and lack of communication, (3) inconsistencies with health care provider priorities, (4) provision of sexual health information and resources, and (5) the importance of setting expectations. Interviewees suggested that improved communication, provision of information related to possible adverse effects of their injuries, and expectation setting would improve posttrauma experiences. CONCLUSION Men's experiences with SD after pelvic trauma can be heavily influenced by their interactions with health care providers and the value that is placed on sexual health as a component of survivorship. Incorporating these findings into a patient-centered trauma survivorship program may improve patient experiences. LEVEL OF EVIDENCE Therapeutic, level V.
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Affiliation(s)
- Niels V Johnsen
- From the Department of Urology (N.V.J.), Vanderbilt University Medical Center, Nashville, Tennessee; Harborview Injury Prevention and Research Center (N.V.J., E.C., T.J., M.S.V., F.P.R., M.M.), Department of Anesthesiology and Pain Medicine (M.S.V.), Department of Pediatrics (F.P.R.), and School of Social Work (M.M.), University of Washington, Seattle, Washington
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15
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Freak‐Poli R. It's not age that prevents sexual activity later in life. Australas J Ageing 2020; 39 Suppl 1:22-29. [PMID: 32567179 PMCID: PMC7317726 DOI: 10.1111/ajag.12774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe key factors that facilitate sexual behaviour in later life. METHODS Re-analysis of data from a study of 2,374 Dutch older adults. RESULTS Partner availability, gender and health are likely to be more important factors influencing sexual behaviour engagement than the factor of age in later life. Lack of partner availability, traditional gender roles and poor health are associated with older age. However, current generations of older adults will be more capable, less ashamed of their sexual desires and engage in more sexual behaviour than prior generations. CONCLUSION This analysis observed that sexual activity is associated with partner availability and better health, rather than age, countering stereotypes of decline in sexual behaviour and normalising sexual activity and desire in later life.
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Affiliation(s)
- Rosanne Freak‐Poli
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVicAustralia
- Department of EpidemiologyErasmus Medical CentreRotterdamThe Netherlands
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16
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The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
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17
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McGrath M, Lever S, McCluskey A, Power E. How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies. Clin Rehabil 2018; 33:293-303. [DOI: 10.1177/0269215518793483] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors. Methods: MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team. Results: The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss. Conclusion: Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality.
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Affiliation(s)
- Margaret McGrath
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Sandra Lever
- Ryde Sexuality and Intimacy Clinic, Graythwaite Rehabilitation Centre, Ryde Hospital, NSW, Australia
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, M02- Sydney Nursing School, The University of Sydney, NSW, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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18
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Nasimbera A, Rosales J, Silva B, Alonso R, Bohorquez N, Lepera S, Garretto N, Arakaki T, Garcea O, Rey R, Quarracino C, Rodriguez GE. Everything you always wanted to know about sex and Neurology: neurological disability and sexuality. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:430-435. [DOI: 10.1590/0004-282x20180061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Chronic neurological disorders generate disabilities affecting multiple aspects of life, including sexuality. Objective To describe the presence of sexual dysfunction and comorbidities in a population with chronic neurological disorders. To analyze the relationship between disability and sexual dysfunction. Methods A cross-sectional case-control study was carried out. Patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease (PD), and stroke of at least one year since the onset of symptoms were included, and compared with controls with no neurological disease, matched by age and sex. Results We included 71 participants: 29 controls, with a mean age of 49.4 years, and 42 patients with a mean age of 53.8 years. Sexual dysfunction was present in 22.5% of the controls and 77.5% of the patients. A statistically significant relationship between sexual dysfunction and disability was found in the logistic regression analysis (OR = 20.38, 95%CI: 2.5 –165.86). Conclusions Disability proved to be the main variable related to the presence of sexual dysfunction. Patients with ALS had the worst rates of sexual dysfunction. Patients with MS were similar to the control group. As for the PD group, no patient had normal sexuality. Finally, in stroke patients, the presence of comorbidities and their treatment may have negatively influenced sexuality. These findings showed that patients with chronic neurological diseases have sexual dysfunction and underscore the need for neurologists to know and address this problem.
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Affiliation(s)
| | | | | | | | - Natalia Bohorquez
- Hospital JM Ramos Mejia, Argentina; Hospital JM Ramos Mejia, Argentina
| | | | | | | | | | - Raul Rey
- Hospital JM Ramos Mejia, Argentina
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