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Young DL, Hannum SM, Engels R, Colantuoni E, Friedman LA, Hoyer EH. Dynamic Prediction of Post-Acute Care Needs for Hospitalized Medicine Patients. J Am Med Dir Assoc 2024; 25:104939. [PMID: 38387858 DOI: 10.1016/j.jamda.2024.01.008] [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: 05/10/2023] [Revised: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC) discharge. DESIGN Retrospective cohort analysis of electronic medical records. SETTING AND PARTICIPANTS Patients admitted to the two participating Hospitals from November 2016 through December 2019 with ≥72 hours in a general medicine service. METHODS Discharge location (PAC vs home) was the primary outcome, and 2 time-varying measures of patient mobility, Activity Measure for Post-Acute Care (AM-PAC) Mobility "6-clicks" and Johns Hopkins Highest Level of Mobility, were the primary predictors. Other predictors included demographic and clinical characteristics. For each day of hospitalization, we predicted discharge to PAC using the demographic and clinical characteristics and most recent mobility data within a random forest (RF) for survival, longitudinal, and multivariate (RF-SLAM) data. A regression tree for the daily predicted probabilities of discharge to PAC was constructed to represent a global summary of the RF. RESULTS There were 23,090 total patients and compared to PAC, those discharged home were younger (64 vs 71), had shorter length of stay (5 vs 8 days), higher AM-PAC at admission (43 vs 32), and average AM-PAC throughout hospitalization (45 vs 35). AM-PAC was the most important predictor, followed by age, and whether the patient lives alone. The area under the hospital day-specific receiver operating characteristic curve ranged from 0.76 to 0.79 during the first 5 days. The global summary tree explained 75% of the variation in predicted probabilities for PAC from the RF. Sensitivity (75%), specificity (70%), and accuracy (72%) were maximized at a PAC probability threshold of 40%. CONCLUSIONS AND IMPLICATIONS Daily assessment of patient mobility should be part of routine practice to help inform care planning by hospital teams. Our prediction model could be used as a valuable tool by multidisciplinary teams in the discharge planning process.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Engels
- Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Heim R, Satink T, van Nes F. "Standing alone": understanding the self-management of family caregivers of persons post-stroke at the time of acute care. Disabil Rehabil 2024; 46:2871-2879. [PMID: 37461245 DOI: 10.1080/09638288.2023.2236020] [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: 10/21/2021] [Accepted: 07/07/2023] [Indexed: 06/20/2024]
Abstract
PURPOSE To support family caregivers of persons post-stroke adequately from the start and to develop self-management interventions, we aim to gain a better understanding of family caregivers experiences at the time of acute care and therefore achieve a better understanding of how they manage their new situation. METHODS AND MATERIALS We chose a qualitative descriptive methodology using individual semi-structured interviews with eleven family caregivers of persons post-stroke. We conducted interviews retrospectively, between 2 and 10 months post-stroke, and analysed transcripts using thematic analysis. RESULTS The themes (1) being in survival mode, (2) feeling supported by family and friends, (3) feeling left alone by the treatment team and (4) insisting on information emerged from the data. CONCLUSION During acute care, many self-management skills are required from family caregivers but are just starting to be developed. This development can first be observed as co-management with the social network and is often combined with shared decision-making. Information-sharing, foundational for developing self-management, is essential for family caregivers and should be supported proactively by health professionals from the beginning. Further, from the start, health professionals should raise awareness about role changes and imbalances of activities among family caregivers to prevent negative influences on their health.
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Affiliation(s)
- Romana Heim
- Cantonal Hospital Winterthur, Institute of Therapy and Rehabilitation, Occupational Therapy, Winterthur, Switzerland
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ton Satink
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Researchgroup Neurorehabilitation - Self-regulation and Participation, HAN_University of Applied Sciences, Nijmegen, Netherlands
| | - Fenna van Nes
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Zhang L, Zhang C, Li K, Zhang Y. Longitudinal qualitative study on the psychological experiences of COVID-19 patients based on timing it right framework. Sci Rep 2024; 14:12409. [PMID: 38811669 PMCID: PMC11137053 DOI: 10.1038/s41598-024-63215-4] [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: 12/17/2023] [Accepted: 05/27/2024] [Indexed: 05/31/2024] Open
Abstract
Timing it right framework was used as a framework to explore the illness experiences of patients infected with COVID-19 and to analyze the patients' perceptions of the disease and their true inner feelings to provide a reference for the control of infectious diseases. This research adopted a phenomenological research approach to develop a longitudinal qualitative study. A purposive sampling method was used to select participants and 37 patients were recruited. Depending on the principle that participants should have maximum variation and sampling should cease when interviews content saturation is achieved, 16 COVID-19 patients in an isolation ward in Ningbo City, Zhejiang Province were finally included. Data were collected using semi-structured interviews, and the content of the interviews was analyzed by Colaizzi's 7-step method. The themes of COVID-19 patients' experiences at various phase were presented as follows: multiple emotions intertwined at the time of diagnosis (anxiety, stressful panic, facing the diagnosis calmly), multiple pressures during the hospitalization period (concerns about the disease, unable to adapt to the ward environment, worrying about future hardship), growth of positive illness experience during the isolation and observation period (sublimated outlook on life, affirmation of the government's anti-epidemic policy, more concerned about their own health), adjustment after returning to society (stigma, loss of previous living environment, problems caused by nucleic acid testing), and adaptation to social life (return to normal life, avoidance of illness experience, post-covid-19 syndrome). The illness experience of COVID-19 patients changed dynamically with time, but a sense of shame and uncertainty about recovery was present throughout the process. Interventions should be developed according to the needs of the patients at different times to inform subsequent optimization of care and management of infectious diseases.
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Affiliation(s)
- Liangyan Zhang
- Hemtology Department, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Chen Zhang
- Intensive Care Unit, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China.
| | - Kesang Li
- Hemtology Department, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Yan Zhang
- Infection Department, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
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Su X, Ma S, Yang X, Zhang C, Chen W. Health Literacy Needs of Acute Pancreatitis Patients During the Diagnosis and Treatment Process Under the Lens of the Timing It Right Theory: A Qualitative Study. Patient Prefer Adherence 2024; 18:507-517. [PMID: 38433996 PMCID: PMC10906671 DOI: 10.2147/ppa.s444955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Background The incidence and recurrence rate of acute pancreatitis (AP) continues to increase worldwide. The risk of AP attack and recurrence is closely related to the patient's health literacy. Previous studies have shown that AP patients had low levels of health literacy. Understanding patients' experience in AP's diagnosis and treatment process and their health literacy needs might significantly improve their health status. Objective This study aims to understand the experience of acute pancreatitis (AP) patients in the diagnostic and treatment process and explore their health literacy needs at various phases of this process. Methods This study utilized a qualitative approach based on Timing It Right theory. A purposive sampling strategy was employed to select 31 participants diagnosed with AP at various phases of the diagnosis and treatment process. These patients were selected from the Pancreatitis Treatment Centers of two tertiary hospitals in Eastern China. Subsequently, semi-structured in-depth interviews were conducted with the selected participants. The qualitative data was analyzed using the Colaizzi's method. Results The themes of AP patients' experiences and health literacy needs at various phases of the diagnosis and treatment process were presented as follows. 1. Diagnosis phase: inability to obtain disease information, psychological support seeking, and change unhealthy lifestyle; 2. Hospitalization phase: disease treatment information needs and medical professionals' healthcare. 3. Discharge Preparation phase: fear of recurrence, individualized healthy lifestyle instruction. 4. Home Recovery phase: self-management, continuous healthcare needs, and family support. Conclusion AP patients' HL needs and health-related problems vary during the diagnosis and treatment process. Medical professionals should comprehend AP patients' changing needs and individual differences, provide continuous healthcare, and involve families in patient management. These factors support patients' long-term self-management and preserve their overall health.
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Affiliation(s)
- Xia Su
- Hepatobiliary and Pancreatic Center, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- School of Nursing & Public Health, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Shuli Ma
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Xiaoxi Yang
- School of Health and Wellness, Panzhihua University, Panzhihua, Sichuan, People’s Republic of China
| | - Can Zhang
- Hepatobiliary and Pancreatic Center, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Weiwei Chen
- Medical College of Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
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Wu C, Xu R, Cao J, Wang S, Peng S, Wang C, Wang K. Barriers and Facilitators of Self-Management for Older Adults Living With Type 2 Diabetes Mellitus: A Qualitative Study in China. Sci Diabetes Self Manag Care 2024; 50:44-55. [PMID: 38240230 DOI: 10.1177/26350106231221454] [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: 02/08/2024]
Abstract
PURPOSE The purpose of the study was to explore the barriers to and facilitators of self-management among older adults with type 2 diabetes mellitus (T2DM). METHODS This study followed a qualitative descriptive methodology. Older adults with T2DM living in Jinan, Shandong Province, China were recruited using purposive sampling. Information saturation was used to gauge the sample size. Semistructured interviews were conducted with 23 participants. The data analysis was guided using a thematic approach. Themes were inducted from the interview data undergirded by the cumulative complexity model. RESULTS The key findings of this study are presented in terms of 2 themes: facilitators of T2DM self-management and barriers to T2DM self-management. Each theme has subthemes, including that having family members with diabetes, having family members who are health care professionals, and visual cues were factors for good self-management practices by older adults with T2DM. Conversely, poor health status (ie, multimorbidity and lower-limb dysfunction and pain) and intergenerational care responsibilities were identified as barriers to effective self-management. Moreover, the use of media resources, especially traditional media, was found to both assist and hinder participants in their self-management practices. CONCLUSION The findings from this study can inform new research to build on existing self-management promotion programs and restructure existing services to improve the self-management of older adults with T2DM. With the increase in the number and types of media outlets, our finding implies that researchers or clinical practitioners may develop strategies to leverage media resources to enhance the self-management of diabetes among older adults with T2DM.
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Affiliation(s)
- Chen Wu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ruiyang Xu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiepin Cao
- Department of Population Health, Grossman School of Medicine, New York University, New York
| | - Shan Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Sijing Peng
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chunyan Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kefang Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
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Fowler K, Mayock P, Byrne E, Bennett K, Sexton E. "Coming home was a disaster, I didn't know what was going to happen": a qualitative study of survivors' and family members' experiences of navigating care post-stroke. Disabil Rehabil 2024:1-13. [PMID: 38265039 DOI: 10.1080/09638288.2024.2303368] [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: 07/01/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Understanding navigational barriers and facilitators has the potential to advance equitable stroke care delivery. The aim of this study was to explore, using a qualitative study, the experiences of stroke survivors and their families as they journey through the stroke care system, both before and during the COVID-19 pandemic. METHODS In-depth semi-structured interviews were conducted with 18 stroke survivors and 12 family members during 2021 and 2022. Participants were recruited through voluntary organisations, social media, and stroke support groups. Data analysis followed a systematic process guided by the framework method with steps including familiarisation, coding, framework development, and charting and interpretation. RESULTS The experiences of navigating stroke care were particularly challenging following discharge from hospital into the community. Barriers to stroke care continuity included insufficient appropriate services and information, unsatisfactory relationships with healthcare professionals and distressed mental health. There were particular navigational challenges for survivors with aphasia. Facilitators to effective navigation included having prior knowledge of the health system, harnessing support for care co-ordination, and being persistent. CONCLUSION Greater support for patient navigation, and person-centred referral pathways, particularly during times of increased pressure on the system, have the potential to improve access to services and wellbeing among stroke survivors.
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Affiliation(s)
- Karen Fowler
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eithne Sexton
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Benmessaoud C, Pfisterer KJ, De Leon A, Saragadam A, El-Dassouki N, Young KGM, Lohani R, Xiong T, Pham Q. Design of a Dyadic Digital Health Module for Chronic Disease Shared Care: Development Study. JMIR Hum Factors 2023; 10:e45035. [PMID: 38145480 PMCID: PMC10775044 DOI: 10.2196/45035] [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: 12/19/2022] [Revised: 03/08/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care "Caretown for Medly," which empowers ICs to concurrently expand patients' self-care abilities while acknowledging ICs' eagerness to provide greater support. OBJECTIVE We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly. METHODS We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint's ability to quickly "solve big problems and test new ideas," which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the "KTA Sprint." RESULTS We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care's synergistic benefits. Features were designed for customizability to suit the patient's condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care. CONCLUSIONS These disease-invariant features were designed to address ICs' needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads.
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Affiliation(s)
- Camila Benmessaoud
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Kaylen J Pfisterer
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Anjelica De Leon
- Healthcare Human Factors, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Faculty of Media and Arts, Humber College, Toronto, ON, Canada
| | - Ashish Saragadam
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Noor El-Dassouki
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Karen G M Young
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Raima Lohani
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ting Xiong
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Quynh Pham
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
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Welsh A, Hanson S, Pfeiffer K, Khoury R, Clark A, Ashford PA, Hopewell S, Logan P, Crotty M, Costa M, Lamb S, Smith T, Hip Helper Study C. Perspectives of informal caregivers who support people following hip fracture surgery: a qualitative study embedded within the HIP HELPER feasibility trial. BMJ Open 2023; 13:e074095. [PMID: 37977867 PMCID: PMC10660837 DOI: 10.1136/bmjopen-2023-074095] [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: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to illuminate the perspectives of informal caregivers who support people following hip fracture surgery. DESIGN A qualitative study embedded within a now completed multicentre, feasibility randomised controlled trial (HIP HELPER). SETTING Five English National Health Service hospitals. PARTICIPANTS We interviewed 20 participants (10 informal caregivers and 10 people with hip fracture), following hip fracture surgery. This included one male and nine females who experienced a hip fracture; and seven male and three female informal caregivers. The median age was 72.5 years (range: 65-96 years), 71.0 years (range: 43-81 years) for people with hip fracture and informal caregivers, respectively. METHODS Semistructured, virtual interviews were undertaken between November 2021 and March 2022, with caregiver dyads (person with hip fracture and their informal caregiver). Data were analysed thematically. FINDINGS We identified two main themes: expectations of the informal caregiver role and reality of being an informal caregiver; and subthemes: expectations of care and services; responsibility and advocacy; profile of people with hip fracture; decision to be a caregiver; transition from hospital to home. CONCLUSION Findings suggest informal caregivers do not feel empowered to advocate for a person's recovery or navigate the care system, leading to increased and unnecessary stress, anxiety and frustration when supporting the person with hip fracture. We suggest that a tailored information giving on the recovery pathway, which is responsive to the caregiving population (ie, considering the needs of male, younger and more active informal caregivers and people with hip fracture) would smooth the transition from hospital to home. TRIAL REGISTRATION NUMBER ISRCTN13270387.Cite Now.
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Affiliation(s)
- Allie Welsh
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Reema Khoury
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sallie Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Toby Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- University of Warwick, Coventry, UK
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Shafer JS, Haley KL, Jacks A. Barriers to Informational Support for Care Partners of People With Aphasia After Stroke. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2211-2231. [PMID: 37566895 DOI: 10.1044/2023_ajslp-22-00391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Care partners of people with aphasia after stroke need various informational supports, such as aphasia education and resources for psychosocial support. However, informational support may vary across clinicians, and access to these supports remains a persistent unmet need. Using implementation science frameworks can help to assess the gap between what is known about an issue and what is occurring in practice. AIM The aim was to identify barriers to providing informational support for care partners of people with aphasia after stroke. METHOD AND PROCEDURE We performed a secondary analysis of qualitative data collected from two of our previous studies. New themes were identified by comparing feedback from both speech-language pathologists and care partners, and previously assigned codes were interpreted relative to the Knowledge to Action (KTA) framework. OUTCOMES AND RESULTS We identified four implementation themes that were specifically related to the action cycle of the KTA framework: (a) Aphasia rehabilitation tends to exclude care partners, (b) aphasia rehabilitation can be hard to understand, (c) structure is lacking for care partner check-ins, and (d) care partner informational support rarely extends beyond the acute phases of recovery. CONCLUSION The results suggest that changes are needed at both systemic and care provider levels to ensure that tailored information is provided to care partners of people with aphasia.
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Affiliation(s)
- Jennifer S Shafer
- Program on Integrative Medicine, The University of North Carolina at Chapel Hill
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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Hua W, Zhou J, Wang L, Li C, Zheng Q, Yuwen W, Jiang L. 'It turned my life upside down': Parents' emotional experience of the transition with their preterm infant from birth to discharge Home-A qualitative study. Aust Crit Care 2023; 36:679-686. [PMID: 36464525 DOI: 10.1016/j.aucc.2022.10.007] [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: 05/15/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis' Transition Theory, parents might experience emotional change initiated by critical events during this transition. OBJECTIVES The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better. METHODS This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis. RESULTS The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents' experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge. CONCLUSIONS Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents' critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.
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Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Jingxin Zhou
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, PR China
| | - Liying Wang
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Chenxing Li
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Qiaomu Zheng
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Weichao Yuwen
- School of Nursing and Healthcare Leadership, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, 200092, Shanghai, PR China.
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Han M, Fu Y, Ji Q, Deng X, Fang X. The effectiveness of theory-based smoking cessation interventions in patients with chronic obstructive pulmonary disease: a meta-analysis. BMC Public Health 2023; 23:1510. [PMID: 37559043 PMCID: PMC10410903 DOI: 10.1186/s12889-023-16441-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Smoking cessation can effectively reduce the risk of death, alleviate respiratory symptoms, and decrease the frequency of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Effective smoking cessation strategies are crucial for the prevention and treatment of COPD. Currently, clinical interventions based on theoretical frameworks are being increasingly used to help patients quit smoking and have shown promising results. However, theory-guided smoking cessation interventions have not been systematically evaluated or meta-analyzed for their effectiveness in COPD patients. To improve smoking cessation rates, this study sought to examine the effects of theory-based smoking cessation interventions on COPD patients. METHODS We adhered to the PRISMA guidelines for our systematic review and meta-analysis. The Cochrane Library, Web of Science, PubMed, Embase, Wanfang, CNKI, VIP Information Services Platform, and China Biomedical Literature Service System were searched from the establishment of the database to April 20, 2023. The study quality was assessed using the Cochrane Collaboration's risk assessment tool for bias. The revman5.4 software was used for meta-analysis. The I2 test was used for the heterogeneity test, the random effect model and fixed effect model were used for meta-analysis, and sensitivity analysis was performed by excluding individual studies. RESULTS A total of 11 RCTs involving 3,830 patients were included in the meta-analysis. Results showed that theory-based smoking cessation interventions improved smoking cessation rates, quality of life, and lung function in COPD patients compared to conventional nursing. However, these interventions did not significantly affect the level of nicotine dependence in patients. CONCLUSION Theory-based smoking cessation intervention as a non-pharmacologically assisted smoking cessation strategy has a positive impact on motivating COPD patients to quit smoking and improving their lung function and quality of life. TRIAL REGISTRATION PROSPERO registration Number: CRD42023434357.
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Affiliation(s)
- Mengjing Han
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People's Republic of China
| | - Yingping Fu
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People's Republic of China
| | - Quanyue Ji
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People's Republic of China
| | - Xiaoli Deng
- The First People's Hospital of Yunnan Province, Kunming, Yunnan, People's Republic of China.
| | - Xuewen Fang
- The First People's Hospital of Yunnan Province, Kunming, Yunnan, People's Republic of China
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Huang J, Lin X, Xiong D, Huang K, Luo X, Lin Q, Li M, Zhang P. Impact of the teach-back method on caregiver outcomes using the "Timing it Right" framework for hemodialysis patients. Front Public Health 2023; 11:1123006. [PMID: 37427278 PMCID: PMC10326316 DOI: 10.3389/fpubh.2023.1123006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Background The caregivers play vital roles in the health care of hemodialysis patients. Ineffective education strategy for the caregivers negatively affects the care ability of caregivers. This study aimed to evaluate the effectiveness of the teach-back method based on the "Timing it Right" framework on the caregivers' care ability, emotions and health-related quality of life for hemodialysis patients. Methods The study involved 78 caregivers of 78 hemodialysis patients. Participants in the control group received routine nursing care and traditional oral health education, while those in the intervention group received health education through the teach-back method based on the "Timing it Right" framework. All participants were followed for 6 months. The degree of anxiety and depression of caregivers was evaluated through the Self-rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), respectively. The care ability of caregivers was assessed by the Family Caregiver Task Inventory (FCTI). The health-related quality of life of hemodialysis patients was evaluated using the 36-item Short Form Health Survey (SF-36). Results Compared to baseline (T0), the SAS, SDS and FCTI scores of the intervention group were significantly reduced at the time of discharge (T1), three (T2) and 6 months (T3) (all p < 0.001). Besides, at T1, T2, and T3, the FCTI scores of the intervention group were significantly lower than that in control group (all p < 0.001). The SAS and SDS scores were also significantly lower in the intervention group at T1, T2, and T3 compared to the control group (all p < 0.001). For SF-36 scores, all domains of the intervention group were significantly higher than those of the control group at T1, T2 and T3, including physical functioning (p < 0.001), role physical (p = 0.007), bodily pain (p < 0.001), general health (p = 0.002), vitality (p = 0.043), social functioning (p = 0.016), role emotional (p = 0.002), and mental health(p = 0.025). Conclusion The application of teach-back method based on the "Timing it Right" framework could obviously alleviate the anxiety and depression of caregivers for hemodialysis patients. Furthermore, it could significantly improve the care ability of caregivers and the quality of life of patients.
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Affiliation(s)
- Jing Huang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiutian Lin
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dailan Xiong
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Kaiwei Huang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiaofei Luo
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qinwen Lin
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Min Li
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ping Zhang
- School of Nursing, Southern Medical University, Guangzhou, China
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Karlsen L, Mjølstad BP, Løfaldli BB, Helvik AS. Family caregiver involvement and role in hospital at home for adults: the patients' and family caregivers' perspective - a Norwegian qualitative study. BMC Health Serv Res 2023; 23:499. [PMID: 37198679 DOI: 10.1186/s12913-023-09531-3] [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: 02/06/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Hospital at home (HaH) provides acute healthcare services in patients' homes instead of traditional in-patient care. Research has reported positive outcomes for patients and reduced costs. Although HaH has developed into a global concept, we have little knowledge about the involvement and role of family caregivers (FCs) of adults. The aim of this study was to explore FC involvement and role during HaH treatment as perceived by patients and FCs in a Norwegian healthcare context. METHODS A qualitative study was carried out among seven patients and nine FCs in Mid-Norway. The data was obtained through fifteen semi-structured interviews; fourteen were performed individually and one as duad interview. The age of the participants varied between 31 and 73 years, and mean age of 57 years. A hermeneutic phenomenological approach was used, and the analysis was performed according to Kvale and Brinkmann's description of interpretation. RESULTS We identified three main categories and seven subcategories regarding FC involvement and role in HaH: (1) Preparing for something new and unfamiliar, including the subcategories `Lack of involvement in the decision process` and `Information overload affecting caregiver readiness`, (2) Adjusting to a new everyday life at home, including the subcategories `The critical first days at home`, `Coherent care and support in a novel situation`, and `Prior established family roles influencing the new everyday life at home`, (3) FCs` role gradually diminishes and looking back, including the subcategories `A smooth transition to life beyond hospital at home` and `Finding meaning and motivation in providing care`. CONCLUSIONS FCs played an important role in HaH, although their tasks, involvement and effort varied across different phases during HaH treatment. The study findings contribute to a greater understanding of the dynamic nature of the caregiver experiences during HaH treatment, which can guide healthcare professionals on how they can provide timely and appropriate support to FCs in HaH over time. Such knowledge is important to decrease the risk of caregiver distress during HaH treatment. Further work, such as longitudinal studies, should be done to examine the course of caregiving in HaH over time to correct or support the phases described in this study.
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Affiliation(s)
- Lillian Karlsen
- The Centre for Health Innovation, Øvre Enggate 8B, Kristiansund N, N-6509, Norway.
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, N-7491, Norway.
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, N-7491, Trondheim, Norway
| | - Bjarte Bye Løfaldli
- The Centre for Health Innovation, Øvre Enggate 8B, Kristiansund N, N-6509, Norway
| | - Anne-Sofie Helvik
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, N-7491, Norway
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Mou H, Lam SKK, Chien WT. The effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: A randomised controlled trial. Int J Nurs Stud 2023; 143:104504. [PMID: 37149953 DOI: 10.1016/j.ijnurstu.2023.104504] [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: 01/17/2023] [Revised: 04/08/2023] [Accepted: 04/08/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Stroke can cause a variety of physical and psychosocial disturbances for both survivors and their family caregivers (i.e., stroke dyads). Dyadic psychoeducation appears to be a promising approach for providing knowledge of stroke and self-care or caregiving skills to improve stroke dyads' health outcomes. Therefore, a family-focused psychoeducation intervention was designed and tested to improve the health outcomes of stroke dyads. OBJECTIVE To examine the effects of a family-focused dyadic psychoeducational intervention on the functional and psychosocial outcomes of stroke survivors and family caregivers. DESIGN A single-blinded, parallel-group randomised controlled trial with repeated-measures design. SETTINGS Two general hospitals and one rehabilitation facility in Jinan, China. PARTICIPANTS Stroke survivors and family caregivers (N = 162 dyads). METHODS The dyads were randomly allocated to either psychoeducation or control group with usual care only (N = 81 dyads per group). The intervention included three structured face-to-face education sessions (one hour per session) in hospital pre-discharge and four weekly telephone counselling calls post-discharge. Study outcomes included survivor functioning and caregiver burden (primary outcomes), and other secondary outcomes (i.e., caregiving competence, dyads' coping, depressive and anxiety symptoms, family functioning, and dyadic relationship, as well as survivor healthcare utilisation and caregiving-related injury). Data were collected at baseline (T0) and immediately (T1) and 3 months post-intervention (T2). The intervention effects were estimated using generalised estimating equation models. RESULTS Participants in the psychoeducation group revealed significantly greater reductions on caregiver burden than the control group at T1 (β = -6.01, p = 0.026) and T2 (β = -6.73, p = 0.039), but non-significant effects on survivor functioning, except in emotion domain at T1 (β = 7.22, p = 0.015). In addition, the intervention demonstrated significantly greater improvements on caregiving competence (β = 0.98, p = 0.013; β = 1.58, p < 0.001), survivors' depressive symptoms (β = -1.56, p = 0.007; β = -2.06, p = 0.005), and dyadic relationship (β = 0.26, p = 0.012; β = 0.27, p = 0.022) at T1 and T2, as well as on survivor coping at T2 (β = 6.73, p = 0.008). CONCLUSIONS Our study added values on the benefits of family-focused dyadic psychoeducation to routine stroke rehabilitation and family care. Future research can evaluate its long-term effects for families of stroke survivors with diverse socio-demographic and stroke-related characteristics. REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100042684). Recruitment: March to June 2021.
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Affiliation(s)
- Huanyu Mou
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Bin Suliman MA, Hanis TM, Kamdi MKA, Ibrahim MI, Musa KI. A Bibliometric Analysis of Stroke Caregiver Research from 1989 to 2022. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4642. [PMID: 36901652 PMCID: PMC10001807 DOI: 10.3390/ijerph20054642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Many stroke survivors suffer with varying degrees of disability and require assistance. Family members commonly act as informal caregivers, caring for these stroke survivors and ensuring care adherence. However, many caregivers reported a poor quality of life and physical and psychological distress. Due to these issues, multiple studies have been conducted to understand the experience of caregivers, the outcomes of caregiving, and interventional studies among caregivers. This study aims to explore the intellectual landscape of studies on stroke caregivers using bibliometric analysis. Studies with "stroke" and "caregiver" terms in the title were extracted from the Web of Sciences (WOS) database. The resulting publications were analysed using the 'bibliometrix' package in R. There were 678 publications analysed, dating from 1989 to 2022. The USA has the highest number of publications (28.6%), followed by China (12.1%) and Canada (6.1%). The most productive institution, journal and author were The University of Toronto (9.5%), 'Topics in Stroke Rehabilitation' journal (5.8%) and Tamilyn Bakas (3.1%), respectively. Co-occurrences keywords analysis revealed mainstream research on stroke survivors, burden, quality of life, depression, care, and rehabilitation, reflecting the timeless hotspot in the field. This bibliometric analysis helps us understand the current state of stroke caregiver research and its recent developments. This study can be used to evaluate research policies and promote international cooperation.
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16
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Zhang M, Zhang C, Chen C, Liu L, Liang Y, Hong Y, Chen Y, Shi Y. The experience of diabetic retinopathy patients during hospital-to-home full-cycle care: A qualitative study. BMC Nurs 2023; 22:58. [PMID: 36869346 PMCID: PMC9983167 DOI: 10.1186/s12912-023-01206-y] [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: 12/13/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the major blinding eye diseases worldwide. Psychological, emotional and social problems of DR patients are prominent. The aim of this study is to explore the experiences of patients with different phases of DR from hospital to home based on the "Timing It Right" framework, and to provide a reference for formulating corresponding intervention strategies. METHODS The phenomenological method and semi-structured interviews were used in this study. A total of 40 patients with DR in different phases were recruited from a tertiary eye hospital between April and August 2022. Colaizzi's analysis method was used to analyse the interview data. RESULTS Based on the "Timing It Right" framework, different experiences in five phases of DR before and after Pars Plana Vitrectomy (PPV) were extracted. The patients experienced complicated emotional reactions and inadequate coping skills during the pre-surgery phase, increased uncertainty during the post-surgery phase, insufficient confidence and the decision to change during the discharge preparation phase, eagerness for professional support and moving forward in exploration during the discharge adjustment phase, and courageous acceptance and positive integration during the discharge adaptation phase. CONCLUSION The experiences of DR patients with vitrectomy in different phases of disease are ever-changing, and medical staff should provide personalized support and guidance to help DR patients get through the hard times smoothly and enhance the quality of hospital-family holistic care.
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Affiliation(s)
- Mengyue Zhang
- grid.268099.c0000 0001 0348 3990School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - ChunHua Zhang
- grid.268099.c0000 0001 0348 3990School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Chen Chen
- grid.268099.c0000 0001 0348 3990School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Linjie Liu
- grid.414701.7The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Youping Liang
- grid.414701.7The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - YiRong Hong
- grid.414701.7The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Yanyan Chen
- The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Yinghui Shi
- The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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Lobo EH, Frølich A, Abdelrazek M, Rasmussen LJ, Grundy J, Livingston PM, Islam SMS, Kensing F. Information, involvement, self-care and support-The needs of caregivers of people with stroke: A grounded theory approach. PLoS One 2023; 18:e0281198. [PMID: 36719929 PMCID: PMC9888718 DOI: 10.1371/journal.pone.0281198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Globally, stroke is a leading cause of death and disability, with most care undertaken by caregivers who are generally family and friends without prior experience of care. The lack of experience or unpreparedness results in feelings of uncertainty, burnout, anxiety, burden, etc. Hence, it is necessary to identify the needs of caregivers to better support them in their caregiving journey and improve the quality of care delivered. METHODS The study employed a grounded theory methodology that utilizes information gathered from literature reviews and social media to represent the needs and create a storyline visually. The storyline is further refined and evaluated using an online survey of 72 participants recruited through online stroke caregiving communities. RESULTS The study identified four core categories of needs: (i) Information: sufficient information delivered in layman's terms based on the individual situation of the caregiver and survivor through oral and hands-on demonstrations, (ii) Involvement: inclusion in the decision-making processes at different stages of recovery through face-to-face communication at the hospital, (iii) Self-care: ability to engage in work and leisure activities, (iv) Support: receive support in the form of resources, services and finances from different other stakeholders. CONCLUSIONS There is a need to create a caregiver-centered approach in stroke recovery to ensure limited obstruction to care and reduced uncertainty in stroke recovery. Moreover, through the inclusion of caregivers in stroke recovery, it may be possible to reduce the burden of care to the caregiver and ensure the satisfaction of the healthcare system throughout stroke recovery.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | | | | | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Ritsma BR, Gariscsak PJ, Vyas A, Chan-Nguyen S, Appireddy R. The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning. Clin Rehabil 2022:2692155221146448. [PMID: 36575852 DOI: 10.1177/02692155221146448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the virtual family conference as an educational, preparatory, and transition planning intervention in stroke rehabilitation. DESIGN Observational-cross-sectional study. SETTING Inpatient stroke rehabilitation. SUBJECTS Eighty-seven carers, participating in 48 conferences, were evaluated. INTERVENTIONS The virtual family conference, involving the patient, carer(s), and interdisciplinary rehabilitation team, completed prior to community transition. The conference protocol and framework, consisting of nine primary themes and additional sub-themes, are outlined. Teleconferencing was the utilized virtual modality. MAIN MEASURES Carers were assessed via questionnaires regarding pre- and post-conference rated: (1) stroke-related knowledge, (2) satisfaction with information provision, and (3) confidence, preparedness, and stress associated with community transition; by use of the Stroke Knowledge and Community Transition Preparedness Questionnaire, Mant et al. Information Satisfaction Questionnaire, and Kingston Caregiver Stress Scale. RESULTS Significant improvement in post-conference carer-rating was noted for knowledge, pertaining to stroke nature/impairments, stroke management/prevention, functional status, and community services. Significant gains were demonstrated in post-conference satisfaction with information provided regarding stroke and discharge planning, across all assessed topics. There was also a significant increase in carer-reported confidence and preparedness for the community transition as well as a significant reduction in self-perceived stress for elements of the caregiving role. Organization of community follow-up care was consistently enabled within the proposed framework. CONCLUSIONS The virtual family conference intervention demonstrated efficacy in facilitating carer education and preparation, along with discharge planning prior to community transition from stroke rehabilitation. Thus, illustrating potential benefits of family conferences and feasibility of their virtual application in stroke rehabilitative care.
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Affiliation(s)
- Benjamin R Ritsma
- Department of Physical Medicine & Rehabilitation, 4257Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | | | - Aarti Vyas
- Department of Medicine-Division of Neurology, 4257Queen's University, Kingston, ON, Canada
| | - Sophy Chan-Nguyen
- Department of Medicine-Division of Neurology, 4257Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Department of Medicine-Division of Neurology, 4257Queen's University, Kingston, ON, Canada
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Calder A, Sole G, Mulligan H. Co-Design of an Educational Resource with Female Partners of Male Stroke Survivors to Support Physical Activity Participation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16856. [PMID: 36554747 PMCID: PMC9779113 DOI: 10.3390/ijerph192416856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Many male stroke survivors find it challenging to meet the recommended physical activity (PA) guidelines for health benefits. The spouse/partner is an important source of self-management for stroke survivor PA participation; however, they feel unsupported by health professionals. This study aimed to co-design an educational resource prototype to guide and empower female partners in supporting male stroke survivors' participation in PA. We used a participatory action research (PAR) methodology. Thirteen support persons of male stroke survivors from Canterbury, New Zealand participated in four PAR cycles. The data were collected using individual interviews and focus groups and analyzed inductively using the general inductive approach. Three themes were reflected in the data and informed the prototype content: (1) managing an unwanted and challenging new life, (2) inconsistent access to meaningful information, and (3) considerations for successful stroke survivor PA participation. If partners are to be an essential source in supporting stroke survivors' self-management of PA, they require resources that are meaningful and credible to enhance their confidence and self-efficacy. Further research is needed to explore the acceptability and usability of the educational resource with a wider audience and evaluate the co-design process. An inclusive and collaborative approach where support persons were valued for their expertise was essential in co-designing a meaningful resource intended to support stroke survivors and support persons' self-management of their PA.
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Abstract
OBJECTIVES To engage critical care end-users (survivors and caregivers) to describe their emotions and experiences across their recovery trajectory, and elicit their ideas and solutions for health service improvements to improve the ICU recovery experience. DESIGN End-user engagement as part of a qualitative design using the Framework Analysis method. SETTING The Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups). SUBJECTS Patients and caregivers following critical illness and identified through the collaboratives. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eighty-six interviews were conducted. The following themes were identified: 1) Emotions and experiences of patients-"Loss of former self; Experiences of disability and adaptation"; 2) Emotions and experiences of caregivers-"Emotional impacts, adopting new roles, and caregiver burden; Influence of gender roles; Adaptation, adjustment, recalibration"; and 3) Patient and caregiver-generated solutions to improve recovery across the arc of care-"Family-targeted education; Expectation management; Rehabilitation for patients and caregivers; Peer support groups; Reconnecting with ICU post-discharge; Access to community-based supports post-discharge; Psychological support; Education of issues of ICU survivorship for health professionals; Support across recovery trajectory." Themes were mapped to a previously published recovery framework (Timing It Right) that captures patient and caregiver experiences and their support needs across the phases of care from the event/diagnosis to adaptation post-discharge home. CONCLUSIONS Patients and caregivers reported a range of emotions and experiences across the recovery trajectory from ICU to home. Through end-user engagement strategies many potential solutions were identified that could be implemented by health services and tested to support the delivery of higher-quality care for ICU survivors and their caregivers that extend from tertiary to primary care settings.
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See Toh WXS, Lim WHJ, Yobas P, Lim S. The experiences of spousal and adult child caregivers of stroke survivors in transitional care: A qualitative systematic review. J Adv Nurs 2022; 78:3897-3929. [PMID: 35986588 DOI: 10.1111/jan.15420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/03/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
AIM To synthesize and present the currently available literature on the experiences of spousal and adult child caregivers of stroke patients in transitional care. DESIGN This is a qualitative systematic review. DATA SOURCES Eight electronic databases (PubMed, CINAHL, Cochrane, Embase, Web of Science, PsychINFO, ProQuest and Scopus) were searched from September 2020 to April 2022 for relevant literature and grey literature. Qualitative studies exploring the experiences of sspousal or adult child caregivers of stroke survivors up till 1 year after discharge were included. REVIEW METHODS The selection of articles was done by two independent reviewers who screened the titles and the abstracts of studies, and the full texts of selected articles. Quality appraisal and data extraction of selected articles were undertaken by two independent reviewers using Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis was conducted using a meta-aggregative approach recommended by JBI. RESULTS A total of 19 papers were included in this review. A total of three synthesized findings centred around caregivers' experience with healthcare professionals, changes in their life roles and needs, effects of caregiving and how they adapted to their changes were aggregated. CONCLUSION Spousal and adult child caregivers faced multiple barriers during transitional care, such as the lack of resources and an inability to cope with changes in their lives. Support and adequate preparation were key facilitators in easing stroke caregivers into their role. IMPACT The findings from this review can be used to guide future implementations of caregiver education programmes and comprehensive discharge planning for stroke survivors.
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Affiliation(s)
- Wen Xiu Samantha See Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiothoracic & Vascular Unit, National University Heart Centre, Singapore
| | - Wei Heong Joshua Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Acute Stroke Unit, Tan Tock Seng Hospital, Singapore
| | - Piyanee Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
| | - Siriwan Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
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23
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Chou A, Lutz BJ, Beach SR, Freburger JK. Informal caregiver training to address functional mobility limitations of stroke survivors: a scoping review. Top Stroke Rehabil 2022:1-14. [PMID: 36403145 DOI: 10.1080/10749357.2022.2145761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Informal caregivers of stroke survivors often report the need for training on how to care for a loved one with functional mobility limitations. Evidence on training interventions to help informal caregivers with issues related to mobility is varied. The objective of this scoping review was to examine the literature including skill-based training interventions that educate caregivers on functional mobility for stroke survivors. RESEARCH DESIGN AND METHODS We extracted studies from OVID Medline, Cochrane, ISI Web of Knowledge, and Embase published between 1990 and 2021. At every stage of assessment, data extraction forms were used to reach consensus among at least three out of four authors. We followed PRISMA-ScR guidelines and Arskey and O'Malley's framework to chart information into several tables based on research questions and summarized with descriptive statistics. RESULTS Most studies were conducted outside the US focused on training in mobility and activities of daily living. The stroke survivor, on average, was an older individual (mean age 64.8 [SD = 5.3] years). The informal caregiver was predominately a younger female spouse (mean age 54.2 [SD = 6.3]). More than a third of the studies reported improvement in the stroke survivors' physical function post-intervention, with a mean follow-up time of 4.4 months. Effective studies tended to include stroke survivors with less cognitive and functional mobility limitations at higher training dosages. DISCUSSION AND IMPLICATIONS Gaps in our understanding of informal caregiver training for those caring for stroke survivors are identified, and recommendations are provided for future research.
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Affiliation(s)
- Aileen Chou
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara J. Lutz
- School of Nursing, University of North Carolina-Wilmington, Wilmington, NC, USA
| | - Scott R. Beach
- University Center for Social and Urban Research, University of Pittsburgh, PA, USA
| | - Janet K. Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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24
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Aleshchenko E, Swart E, Spix C, Voigt M, Trocchi P, Langer T, Calaminus G, Baust K, Glogner J, Ihle P, Küpper-Nybelen J, Lüpkes C, Kloppe T, Horenkamp-Sonntag D, Meier I, Marschall U, Dröge P, Klein M, Weiss A, Apfelbacher C. Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence (VersKiK): study protocol of a large scale multi-methods non-interventional study. BMC Health Serv Res 2022; 22:1176. [PMID: 36127717 PMCID: PMC9487026 DOI: 10.1186/s12913-022-08549-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been shown previously that a relevant proportion of childhood cancer survivors suffers from late effects, which are often directly related to the cancer itself or its therapy, resulting in particular follow-up needs, additionally burdening healthcare systems. Being diagnosed with cancer at a vulnerable stage of development, this group of cancer survivors is at comparatively higher risk of relapse or subsequent cancer. Although national and international follow-up guidelines based on treatment modalities have been developed, their implementation seems to leave room for improvement. Additionally, they lack a sufficient consideration of the survivors' psychosocial needs, affecting their adherence to them. The aim of the VersKiK study is to provide representative information on late effects in childhood and adolescence cancer survivors in Germany. The main research objectives are: (1) to describe the state of follow-up care among survivors after a cancer diagnosis in childhood or adolescence; (2) to quantify the occurrence of late effects among this group of survivors; (3) to examine the adherence to selected audiological and cardiological follow-up guidelines and to identify factors affecting it; (4) to explore actual follow-up needs of paediatric cancer survivors; (5) to review selected follow-up guidelines with the aim to improve and expand them. METHODS VersKiK is designed as a mixed-methods non-interventional study. We will use claims data from statutory health insurance companies in combination with individually linked population-based registry data from the German Childhood Cancer Registry (GCCR). This data base will permit us to quantify diagnoses and procedures in comparison to the general population as well as the adherence to existing follow-up guidelines. Additional information will be obtained through interviews with childhood and adolescence cancer survivors and their informal caregivers, as well as in focus groups with healthcare professionals. DISCUSSION The present study aims to research the actual needs of individuals after cancer diagnosis and treatment in childhood or adolescence - physical, psychological and organisational - in order to improve existing follow-up guidelines. These improvements might further positively affect not only actual care provided to paediatric cancer survivors, but also benefit healthcare systems in general while decreasing consequent medical visits in this group of patients. TRIAL REGISTRATION Registered at German Clinical Trial Register (ID: DRKS00025960 and DRKS00026092).
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Affiliation(s)
- E Aleshchenko
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany.
| | - E Swart
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany
| | - C Spix
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Voigt
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - P Trocchi
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - G Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - K Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - J Glogner
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - P Ihle
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - J Küpper-Nybelen
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - C Lüpkes
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | - T Kloppe
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | | | - I Meier
- Techniker Krankenkasse (TK), Hamburg, Germany
| | | | - P Dröge
- AOK Research Institute (WIdO), Berlin, Germany
| | - M Klein
- DAK-Gesundheit, Hamburg, Germany
| | - A Weiss
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Bavarian Care and Nursing Authority, Amberg, Germany
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany
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25
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Care Dependency of Hospitalized Stroke Patients Based on Family Caregivers’ and Nurses’ Assessments: A Comparative Study. Healthcare (Basel) 2022; 10:healthcare10061007. [PMID: 35742058 PMCID: PMC9222839 DOI: 10.3390/healthcare10061007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023] Open
Abstract
Stroke impacts care dependency, and thus the patient needs home care after suffering a stroke. This study was carried out to investigate similarities and differences between the assessments made by family caregivers and nurses regarding the care dependency level of stroke patients in Indonesian hospitals. This study was a comparative study of the care dependency of stroke patients. Data were collected on the stroke wards on the day of admission using the Care Dependency Scale (CDS). The sample consisted of 118 family caregivers and 21 nurses. The Wilcoxon signed-rank test was performed to determine the mean differences between the paired data collected by family caregivers and nurses. The results of this study show that significant differences exist between the family caregivers’ and nurses’ assessments regarding the care dependency levels of stroke patients. Nurses assigned higher scores to all CDS items than family caregivers did. Significant differences between the family caregivers’ and nurses’ assessments were observed on numerous items of the Care Dependency Scale. This study contributes to efforts to raise awareness of potential differences in perceived care dependency levels of stroke patients. The findings can help nurses plan the patient’s discharge together with family caregivers.
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26
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Lutz BJ, Kucharska-Newton AM, Jones SB, Psioda MA, Gesell SB, Coleman SW, Johnson AM, Radman MD, Levy S, Bettger JP, Freburger JK, Chou A, Celestino J, Rosamond WD, Bushnell CD, Duncan PW. Familial caregiving following stroke: findings from the comprehensive post-acute stroke services (COMPASS) pragmatic cluster-randomized transitional care study. Top Stroke Rehabil 2022; 30:436-447. [PMID: 35603644 DOI: 10.1080/10749357.2022.2077520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke patients discharged home often require prolonged assistance from caregivers. Little is known about the real-world effectiveness of a comprehensive stroke transitional care intervention on relieving caregiver strain. OBJECTIVES To describe the effect of the COMPASS transitional care (COMPASS-TC) intervention on caregiver strain and characterize the types, duration, and intensity of caregiving. METHODS The cluster-randomized COMPASS pragmatic trial evaluated the effectiveness of COMPASS-TC versus usual care with patients with mild stroke and TIA at 40 hospitals in North Carolina, USA. Of 5882 patients enrolled, 4208 (71%) identified a familial caregiver. A follow-up Caregiver Questionnaire, including the Modified Caregiver Strain Index, was administered at approximately three months post-discharge. Demographics and frequency, duration, and intensity of caregiving were compared between groups. RESULTS 1228 caregivers (29%) completed the questionnaire. Completion was positively associated with older patient age, white race, and spousal relationship. One-third of the caregivers provided ≥30 hours of care per week and 889 (79%) provided care ≥9 weeks. Average standardized caregiver strain was 21.9 (0-100), increasing with stroke severity and comorbidity burden. Women caregivers reported higher strain than men. Treatment allocation was not associated with caregiver strain. CONCLUSIONS This sample of mild stroke and TIA survivors received significant assistance from familial caregivers. However, caregiver strain was relatively low. Findings support the importance of familial caregiving in stroke, the continued disproportionate burden on women within the family, and the need for future research on caregiver support.
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Affiliation(s)
- Barbara J. Lutz
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Anna M. Kucharska-Newton
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sara B. Jones
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew A. Psioda
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sabina B. Gesell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sylvia W. Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna M. Johnson
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Meghan D Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Samantha Levy
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Janet K Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, USA
| | - Aileen Chou
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, USA
| | - Joan Celestino
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Pamela W. Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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27
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Mack A, Hildebrand M. Education and Support Interventions for Caregivers of Persons With Stroke (January 1, 1999-December 31, 2019). Am J Occup Ther 2022; 76:23261. [PMID: 35302595 DOI: 10.5014/ajot.2022.763003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from a systematic review on stroke and education and support interventions for caregivers of people with stroke.
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Affiliation(s)
- Amanda Mack
- Amanda Mack, OT, OTD, MS, OTR, is Instructor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, MA;
| | - Mary Hildebrand
- Mary Hildebrand, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, MA
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28
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Li T, Zhang YP, Kong JJ, Kong M, Meng G, Shi WX. Effect of "timing it right" on comprehensive unmet needs and psychological pain in patients with head and neck cancer undergoing radiotherapy: a randomized controlled trial. Support Care Cancer 2022; 30:6573-6582. [PMID: 35488009 DOI: 10.1007/s00520-022-07072-9] [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: 01/17/2022] [Accepted: 04/18/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We assessed the effectiveness of "timing it right" (TIR) applications in patients undergoing radiotherapy for head and neck cancer through a carefully designed TIR intervention program. The assessment in this study emphasized the impact of the TIR intervention on the unmet needs and psychological pain of patients with head and neck cancer at different stages of radiotherapy. METHODS In total, 140 radiotherapy patients were randomly recruited into two study groups: (1) the TIR intervention group received routine nursing follow-up and comprehensive nursing intervention based on TIR, and (2) the control group received routine nursing care. Assessments were conducted at baseline, before discharge, and 3 months and 6 months after discharge. The comprehensive needs and psychological pain of patients with radiotherapy were measured using the Comprehensive Needs Assessment Tool in Cancer for Patients (CNAT) and the Distress Thermometer (DT), respectively. A linear mixed model was applied to analyze the effects. RESULTS A total of 137 patients completed the study. Compared to the control group, the TIR group showed significant improvements in information needs, health and psychological problems, healthcare staff, physical symptoms, health facilities and services, religious/spiritual support, and psychological pain (F=8.503, p=0.004; F=1.896, p=0.003; F=12.422, p<0.001; F=9.634, p=0.001; F=7.310, p=0.006; F=1.684, p=0.009; F=1.692, p=0.041). In addition to practical support, the remaining indicators differed significantly by time point, group, and group-time interaction. CONCLUSIONS The patient support application based on TIR can effectively address unmet needs and improve psychological pain, supporting TIR as an effective psychological management and intervention strategy for radiotherapy patients in the early stage of long-term rehabilitation. TRIAL REGISTRATION Chictr.org.cn Chi CTR2100047960.
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Affiliation(s)
- Teng Li
- School of Nursing, Xi'an Jiaotong University Health Science Center, No.76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.,School of Nursing, Xi'an Medical University, Xi'an, Shaanxi, 710021, People's Republic of China
| | - Yin-Ping Zhang
- School of Nursing, Xi'an Jiaotong University Health Science Center, No.76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
| | - Jun-Juan Kong
- School of Nursing, Xi'an Jiaotong University Health Science Center, No.76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.,Department of Radiotherapy, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Min Kong
- School of Nursing, Xi'an Jiaotong University Health Science Center, No.76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Ge Meng
- School of Nursing, Xi'an Jiaotong University Health Science Center, No.76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Wen-Xin Shi
- School of Nursing, Xi'an Jiaotong University Health Science Center, No.76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
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29
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Termoz A, Delvallée M, Damiolini E, Marchal M, Preau M, Huchon L, Mazza S, Habchi O, Bravant E, Derex L, Nighoghossian N, Cakmak S, Rabilloud M, Denis A, Schott AM, Haesebaert J. Co-design and evaluation of a patient-centred transition programme for stroke patients, combining case management and access to an internet information platform: study protocol for a randomized controlled trial - NAVISTROKE. BMC Health Serv Res 2022; 22:537. [PMID: 35459183 PMCID: PMC9027042 DOI: 10.1186/s12913-022-07907-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Stroke affects many aspects of life in stroke survivors and their family, and returning home after hospital discharge is a key step for the patient and his or her relatives. Patients and caregivers report a significant need for advice and information during this transition period. Our hypothesis is that, through a comprehensive, individualised and flexible support for patients and their caregivers, a patient-centred post-stroke hospital/home transition programme, combining an Internet information platform and telephone follow-up by a case manager, could improve patients’ level of participation and quality of life. Methods An open parallel-group randomized trial will be conducted in two centres in France. We will recruit 170 adult patients who have had a first confirmed stroke, and were directly discharged home from the stroke unit with a modified Rankin score ≤3. Intervention content will be defined using a user-centred approach involving patients, caregivers, health-care professionals and social workers. Patients randomized to the intervention group will receive telephonic support by a trained case manager and access to an interactive Internet information platform during the 12 months following their return home. Patients randomized to the control group will receive usual care. The primary outcome is patient participation, measured by the “participation” dimension score of the Stroke Impact Scale 6 months after discharge. Secondary outcomes will include, for patients, quality of life, activation, care consumption, as well as physical, mental and social outcomes; and for caregivers, quality of life and burden. Patients will be contacted within one week after discharge, at 6 and 12 months for the outcomes collection. A process evaluation alongside the study is planned. Discussion Our patient-centred programme will empower patients and their carers, through individualised and progressive follow-up, to find their way around the range of available healthcare and social services, to better understand them and to use them more effectively. The action of a centralised case manager by telephone and the online platform will make it possible to disseminate this intervention to a large number of patients, over a wide area and even in cases of geographical isolation. Trial registration: ClinicalTrials NCT03956160, Posted: May-2019 and Update: September-2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07907-5.
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Affiliation(s)
- Anne Termoz
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France. .,Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France.
| | - Marion Delvallée
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
| | - Eléonore Damiolini
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Mathilde Marchal
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Marie Preau
- Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
| | - Laure Huchon
- Médecine Physique et Réadaptation, Hospices Civils de Lyon, Hôpital Henry Gabrielle, Lyon, France
| | - Stéphanie Mazza
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
| | - Ouazna Habchi
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Estelle Bravant
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Norbert Nighoghossian
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Serkan Cakmak
- Service Neuro-vasculaire, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Muriel Rabilloud
- Service de Biostatistique et Bioinformatique Hospices Civils de Lyon Pôle Santé Publique, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, Université Claude Bernard Lyon 1, CNRS, UMR 5558, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Angélique Denis
- Service de Biostatistique et Bioinformatique Hospices Civils de Lyon Pôle Santé Publique, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, Université Claude Bernard Lyon 1, CNRS, UMR 5558, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Anne-Marie Schott
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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30
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Burns SP, Lutz BJ, Magwood GS. 'Timing it Right': needs of African American adults with stroke and their caregivers across the care continuum. ETHNICITY & HEALTH 2022; 27:420-434. [PMID: 31752519 DOI: 10.1080/13557858.2019.1693512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 11/02/2019] [Indexed: 06/10/2023]
Abstract
Objective: African Americans are disproportionately affected by stroke in the United States (US). The purpose of this study is to explore experiences, wants, and needs of African Americans with stroke and their family caregivers residing in the stroke belt across the care continuum using the 'Timing It Right' (TIR) framework as a conceptual guide.Design: We conducted a series of focus groups among 20 African Americans living with stroke and 19 family caregivers. Focus groups were audio-recorded and transcribed verbatim. For this secondary analysis, we coded qualitative data using the TIR framework.Results: Participants in this sample identified pre-stroke needs in addition to the TIR phases that span across the care continuum and into community living. We identified four important contextual factors and real-world conditions that operate in the background and influence the post-stroke needs of this specific population across the TIR framework: (1) religion, faith, and church, (2) healthcare delivery, (3) community, and (4) sentinel events.Conclusions: We propose a TIR model that expands upon the original TIR framework which includes factors important for consideration when developing and delivering community-based interventions among African Americans with stroke and family caregivers in the southeastern US.
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Affiliation(s)
- Suzanne Perea Burns
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
| | - Barabara J Lutz
- College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Gayenell S Magwood
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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31
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Kontou E, Thomas SA, Cobley C, Fisher R, Golding-Day MR, Walker MF. A Biopsychosocial Intervention for Stroke Carers (BISC): development and description of the intervention. Health Psychol Behav Med 2022; 10:92-103. [PMID: 34993008 PMCID: PMC8725872 DOI: 10.1080/21642850.2021.2016412] [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] [Indexed: 11/24/2022] Open
Abstract
Objective Family members of stroke survivors are often not supported for their caring role, with many reporting adjustment difficulties. This paper describes the development and content of a group-based intervention for informal carers of stroke survivors. Method The intervention is based on the theoretical foundation of the biopsychosocial model with the aim to understand and address the physical, psychological and social factors of caring for stroke survivors. Findings from a comprehensive literature review and a qualitative study with carers and stroke professionals were synthesized to guide the intervention development. The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework to describe the intervention. Results The intervention integrates cognitive-behavioural approaches via the identification of the biopsychosocial (physical, emotional, social) factors that can have an impact on the well-being of carers. It includes education on stroke-specific topics and advice on coping strategies. It consists of six structured two-hour group sessions facilitated in a community setting. It provides information and support on adjusting to the caring role in the first year post-stroke. Intervention materials were designed for addressing carers’ specific needs using psychological techniques, such as problem-solving, goal setting and relaxation exercises. Conclusion We have underlined the importance for describing and reporting the process of intervention development for complex interventions in the context of stroke rehabilitation. An intervention addressing the needs of informal stroke carers (Biopsychosocial Intervention for Stroke Carers; BISC) has been developed and described. BISC was further evaluated in a single-centre feasibility randomized controlled trial.
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Affiliation(s)
- Eirini Kontou
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK.,Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Shirley A Thomas
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Christine Cobley
- Department of Clinical Psychology, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Miriam R Golding-Day
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Marion F Walker
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
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Wang J, Cui J, Tu S, Yang R, Zhao L. Resilience and caregiving ability among caregivers of people with stroke: The mediating role of uncertainty in illness. Front Psychiatry 2022; 13:788737. [PMID: 36483138 PMCID: PMC9723154 DOI: 10.3389/fpsyt.2022.788737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In China, stroke survivors are usually cared for by their family members. However, the caregiving ability of these informal caregivers remain inadequate during the hospitalization of their family members following a sudden onset of a stroke, and this sudden need for care overwhelms caregivers even after the hospital discharge. Therefore, research is required to identify predictors of caregiving ability that could be targeted in future interventions aimed at improving caregiving skills and reducing the burden on caregivers who care for stroke survivors. MATERIALS AND METHODS From August 2019 to February 2020, stroke survivors were hospitalized for the first time, and their family caregivers were registered via convenience sampling. Caregiver demographic information, resilience status, uncertainty in illness, caregiving ability, and patients' severity of stroke were measured using standardized questionnaires. Structural equation modeling was used to test the proposed model, where caregiver resilience and stroke severity predicted caregiving ability directly, and uncertainty in illness mediated the association between caregiver resilience and caregiving ability. RESULTS A total of 306 dyads were included in the study. The tested model fit the data well (χ2 = 118.2, df = 64, RMSEA = 0.053, CFI = 0.946, TLI = 0.923). Statistically significant pathways linked caregivers' resilience status to uncertainty in illness (β = -0.558, S.E. = 0.022, P < 0.01), caregivers' resilience to the status of caregiving ability (β = -0.269, S.E. = 0.013, P < 0.01) and caregivers' uncertainty about the illness to caregiving ability (β = 0.687, S.E. = 0.051, P < 0.01). We also found that caregivers' uncertainty in illness mediated the association between caregivers' resilience and caregiving ability (β = -0.384, S.E. = 0.061, P < 0.01). CONCLUSIONS Our structural equation modeling result identified resilience and uncertainty about the illness as predictors of the caregiving ability of informal family caregivers who suffered from care burdens. Supporting family caregivers to build their resilience and reduce illness uncertainty may improve caregiving for stroke survivors.
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Affiliation(s)
- Jinyao Wang
- West China School of Nursing, Sichuan University, Chengdu, China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Cui
- West China Hospital, Sichuan University, Chengdu, China
| | - Shuangyan Tu
- West China School of Nursing, Sichuan University, Chengdu, China.,Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Yang
- West China Hospital, Sichuan University, Chengdu, China
| | - Lihong Zhao
- West China School of Nursing, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Wasilewski MB, Kokorelias KM, Nonoyama M, Dale C, McKim DA, Road J, Leasa D, Tandon A, Goldstein R, Rose L. The experience of family caregivers of ventilator-assisted individuals who participated in a pilot web-based peer support program: A qualitative study. Digit Health 2022; 8:20552076221134964. [DOI: 10.1177/20552076221134964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/05/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Family caregivers play an important role supporting the day-to-day needs of ventilator-assisted individuals (VAIs) living at home. Peer-to-peer communication can help support these caregivers and help them sustain caregiving in the community. Online peer-support has been suggested as a way to help meet caregivers’ support needs. Methods A qualitative descriptive approach was used to elicit the perspectives of support received from caregivers who participated in a pilot web-based peer support program from October to December 2018. Data were collected through the transcripts of weekly online peer-to-peer group chats. Data were analyzed using an integration of thematic and framework analysis. Results In total, eight caregivers and five peer mentors participated in the pilot. All five mentors and four of the caregivers participated in the weekly chats. We identified three themes, a) The experience of caregivers is characterized by unique challenges related to the complexity of VAI care including technology; b) Mentors and caregiver participants reciprocally share support; c) Despite hardships, there are things that make caregiving easier and joyful. Discussion Our results add to the growing body of evidence pointing to the importance of online communities for supporting vulnerable caregivers. The reciprocal element of peer support, where trained mentors and untrained participants both benefit from support, can help sustain peer-support interventions. Despite the challenges of providing care to a VAI, there are facilitators that may help ease the caregiving experience and caregivers can benefit from ongoing support that is tailored to their needs along the caregiving trajectory.
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Affiliation(s)
- Marina B. Wasilewski
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kristina M. Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mika Nonoyama
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Douglas A McKim
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeremy Road
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Leasa
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Anu Tandon
- Division of Respiratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Woodward AT, Fritz MC, Hughes AK, Coursaris CK, Swierenga SJ, Freddolino PP, Reeves MJ. Effect of transitional care stroke case management interventions on caregiver outcomes: the MISTT randomized trial. SOCIAL WORK IN HEALTH CARE 2021; 60:1-14. [PMID: 34933665 DOI: 10.1080/00981389.2021.2009958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
This study reports on outcomes for 169 caregivers enrolled in the Michigan Stroke Transitions Trial (MISTT), an RCT of social work case management for stroke patients returning home. A mixed-model approach examined the mean change from 7- to 90-days post-discharge with group-by-time interactions for differences between treatment groups. Caregivers reported few life changes or depressive symptoms from caregiving. There was no significant change over time or treatment effects. Negative aspects of stroke caregiving may take longer to develop. Focused caregiver assessment at discharge and a better understanding of how caregiving develops over time may improve the type and timing of support.
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Affiliation(s)
- Amanda T Woodward
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Michele C Fritz
- Dean's Office, Academic Programs, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Anne K Hughes
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | | | - Sarah J Swierenga
- Professor of Practice in User Experience, Department of Media and Information, Michigan State University, East Lansing, Michigan, USA
| | - Paul P Freddolino
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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Abstract
OBJECTIVE Family caregiving research has evolved since its inception in the late 1970s. The objective of this brief report was to summarize the research areas and findings to date with the goal of highlighting directions for future research. DESIGN Narrative review. SETTING Not applicable. PARTICIPANTS Published scientific articles in neurological populations including spinal cord injury, traumatic brain injury, and stroke. INTERVENTIONS Not applicable. OUTCOME MEASURES Not applicable. RESULTS Caregiving research began with a description of the impact of providing care on caregiver health and wellbeing. Intervention research followed to support caregivers in their role and improve caregiving outcomes. Recent reviews conclude a "one size fits all" intervention will not be sufficient to support caregivers. New research suggests caregivers have different patterns of adjustment to the caregiving role highlighting heterogeneity in the caregiving population. Research is also advancing to support patients and families as they transition across care environments by enhancing the timing of intervention delivery. Health care systems do not routinely adopt evidence-based caregiver interventions. As a result, recent research has begun to identify factors that influence the adoption of evidence-based caregiver interventions by health care systems. Ultimately, family centered care that addresses the needs of not only the patient but also the caregiver may be the best way to meet the needs of a heterogeneous group of caregivers across the care continuum. CONCLUSIONS Family caregivers make an important contribution to the health and wellbeing of individuals with spinal and other neurological conditions. Ultimately, system changes, like family centered care, may be best suited to meet the complex needs of this heterogeneous group of caregivers.
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Affiliation(s)
- Jill I. Cameron
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Jill I. Cameron, Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 160–500 University Ave., Office room 922, Toronto, ONM5G 1V7, Canada; Ph: 416-978-2041 (office); 416-523-4689 (cell). ; @Caregiving_UofT
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Kokorelias KM, Naglie G, Gignac MA, Rittenberg N, Cameron JI. A qualitative exploration of how gender and relationship shape family caregivers' experiences across the Alzheimer's disease trajectory. DEMENTIA 2021; 20:2851-2866. [PMID: 33998323 PMCID: PMC8678646 DOI: 10.1177/14713012211019502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Caregiving experiences are not static. They change across the disease trajectory and care continuum. However, it is not clear how caregiver gender or relationship type is related to evolving caregiver experiences over time. This qualitative study informed by constructivist grounded theory and framework analysis explored the experiences over time of men and women who were adult children and spousal caregivers to persons with Alzheimer's disease. Forty spousal (10 husbands and 10 wives) and adult children (10 sons and 10 daughters) caregivers to persons with Alzheimer's disease were interviewed using a semi-structured interview guide. Our findings suggest the experiences of caregiving, examined through a gender and relationship type lens, are complex and variable. The caregiving experience was not related to gender or relationship type alone, but often to a combination of the two. For instance, spousal caregivers did not immediately accept the diagnosis, with wives being more optimistic than husbands about a slow progression of the disease. Adult children caregivers were concerned about the ways the caregiving role would impact their personal and career obligations and sought ways to mitigate the changes to their daily lives. Sons and husband caregivers largely utilized home and community health services to assist with personal care tasks, whereas daughters and wives utilized the same services to allow them to complete other caregiving tasks (e.g., housekeeping). Recognition of the complex inter-relationships among gender and relationship type on caregiving experiences supports the need for family-centered interventions. This article also extends sex and gender research as it highlights that an in-depth understanding of the caregiving experience cannot be understood by gender alone and relationship type must also be considered.
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Affiliation(s)
| | - Gary Naglie
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Rotman Research Institute, 7942Baycrest Health Sciences, Toronto, ON, Canada
| | - Monique Am Gignac
- Dalla Lana School of Public Health, 274071University of Toronto, Toronto, ON, Canada; 7966Institute for Work and Health, Toronto, ON, Canada
| | - Nira Rittenberg
- Department of Occupational Therapy and Occupational Sciences, 7938The Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, The Temerty Faculty of Medicine, University of Toronto; Rehabilitation Sciences Institute, 12366University of Toronto, Toronto, ON, Canada
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Wang Y, Tyagi S, Hoenig H, Lee KE, Venketasubramanian N, Menon E, De Silva DA, Yap P, Tan BY, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Ning C, Cheong A, Koh GCH. Burden of informal care in stroke survivors and its determinants: a prospective observational study in an Asian setting. BMC Public Health 2021; 21:1945. [PMID: 34702247 PMCID: PMC8547090 DOI: 10.1186/s12889-021-11991-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal caregiving is an integral part of post-stroke recovery with strenuous caregiving demands often resulting in caregiving burden, threatening sustainability of caregiving and potentially impacting stroke survivor's outcomes. Our study aimed to examine and quantify objective and subjective informal care burden after stroke; and to explore the factors associated with informal care burden in Singapore. METHODS Stroke patients and their informal caregivers were recruited from all five tertiary hospitals in Singapore from December 2010 to September 2013. Informal care comprised of assistance provided by informal caregivers with any of the activities of daily living. Informal care burden was measured by patients' likelihood of requiring informal care, hours of informal care required, and informal caregivers' Zarit's Burden Score. We examined informal care burden at 3-months and 12-months post-stroke. Generalized linear regressions were applied with control variables including patients' and informal caregivers' demographic characteristics, arrangement of informal care, and patients' health status including stroke severity (measured using National Institute of Health Stroke Scale), functional status (measured using Modified Rankin Scale), self-reported depression, and common comorbidities. RESULTS Three hundred and five patients and 263 patients were examined at 3-months and 12-months. Around 35% were female and 60% were Chinese. Sixty three percent and 49% of the patients required informal care at 3-months and 12-months point, respectively. Among those who required informal care, average hours required per week were 64.3 h at 3-months and 76.6 h at 12-months point. Patients with higher functional dependency were more likely to require informal care at both time points, and required more hours of informal care at 3-months point. Female informal caregivers and those caring for patients with higher functional dependency reported higher Zarit's Burden. While informal caregivers who worked full-time reported higher burden, those caring for married stroke patients reported lower burden at 3-months point. Informal caregivers who co-cared with foreign domestic workers, i.e.: stay-in migrant female waged domestic workers, reported lower burden. CONCLUSIONS Informal care burden remains high up to 12-months post-stroke. Factors such as functional dependency, stroke severity, informal caregiver gender and co-caring with foreign domestic workers were associated with informal care burden.
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Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, 508 Fulton St, Durham, NC, 27705, USA
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Mount Elizabeth, #11-14/15, Mount Elizabeth Medical Centre, Singapore, 228510, Singapore
| | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, 585 North Bridge Rd, Level 9 Raffles Specialist Centre, Singapore, 188770, Singapore
| | - Edward Menon
- St. Andrew's Community Hospital, 8 Simei Street 3, Singapore, 529895, Singapore
| | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital campus, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Philip Yap
- Dept of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Central Yishun, Singapore, 768828, Singapore
| | - Boon Yeow Tan
- St. Luke's Hospital, 2 Street 11 Bukit Batok, Singapore, 659674, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Yan Hoon Ang
- Dept of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Central Yishun, Singapore, 768828, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital campus, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
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Kristensson L, Björkdahl A. Experience of Information Provision at the Stroke Unit From the Perspective of Relatives to Stroke Survivors. Rehabil Process Outcome 2021; 9:1179572720947086. [PMID: 34497469 PMCID: PMC8282136 DOI: 10.1177/1179572720947086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/11/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Stroke not only affects the stroke survivor, it also significantly affects their families. Given the important supportive role that relatives of stroke survivor have, they should receive information that helps them plan and cope with the new situation. The objective of the study was to explore how relatives to stroke survivors perceived the information provided by the stroke unit. Methods: This qualitative study was based on extensive semi-structured interviews with an inductive approach. A heterogeneous convenience sample of relatives to stroke survivor (n=14) was selected. Qualitative content analysis served to analyze the transcribed interview texts. Results: The content analysis yielded four categories, each with 2–3 subcategories. The overall theme was “to be acknowledged or not”: it encompassed the underlying meaning and the relationships between the categories. The four categories were as follows: shifting information needs; striving for information; lacking of continuity and structure; and taking part and being acknowledged. Conclusions: The study highlighted that the relatives of stroke survivors have a strong need for information and showed that the relatives experienced that they did not always feel satisfactorily informed and supported by the healthcare professionals in the stroke unit. A challenge for the healthcare professionals was to be able to give the right information at the right time and in the appropriate way. The study also showed that when the relatives were acknowledged and invited to participate in the rehabilitation process, they were less anxious of the discharge.
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Affiliation(s)
- Linda Kristensson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg.,Institute of Neuroscience and Physiology, Department of Occupational Therapy, Sahlgrenska Academy, University of Gothenburg
| | - Ann Björkdahl
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg.,Institute of Social Science, Ersta Sköndal Bräcke University Collage, Campus Bräcke, Gothenburg
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O'Neill B, Linden M, Ramsay P, Darweish Medniuk A, Outtrim J, King J, Blackwood B. Development of the support needs after ICU (SNAC) questionnaire. Nurs Crit Care 2021; 27:410-418. [PMID: 34387920 PMCID: PMC9290803 DOI: 10.1111/nicc.12695] [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] [Received: 10/21/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
Aims To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services.
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Affiliation(s)
- Brenda O'Neill
- Centre for Health and Rehabilitation Technologies, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Pam Ramsay
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | | | - Joanne Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK
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Burton LJ, Forster A, Johnson J, Crocker TF, Tyson SF, Wray F, Clarke DJ. Experiences and views of receiving and delivering information about recovery in acquired neurological conditions: a systematic review of qualitative literature. BMJ Open 2021; 11:e045297. [PMID: 33906841 PMCID: PMC8088240 DOI: 10.1136/bmjopen-2020-045297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To review and synthesise qualitative literature relating to the views, perceptions and experiences of patients with acquired neurological conditions and their caregivers about the process of receiving information about recovery; as well as the views and experiences of healthcare professionals involved in delivering this information. DESIGN Systematic review of qualitative studies. DATA SOURCES MEDLINE, Embase, AMED, CINAHL, PsycINFO, Web of Science and the Cochrane library were searched from their inception to July 2019. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data from the included studies and assessed quality using an established tool. Thematic synthesis was used to synthesise the findings of included studies. RESULTS Searches yielded 9105 titles, with 145 retained for full-text screening. Twenty-eight studies (30 papers) from eight countries were included. Inductive analysis resulted in 11 descriptive themes, from which 5 analytical themes were generated: the right information at the right time; managing expectations; it's not what you say, it's how you say it; learning how to talk about recovery and manage emotions; the context of uncertainty. CONCLUSIONS Our findings highlight the inherent challenges in talking about recovery in an emotional context, where breaking bad news is a key feature. Future interventions should focus on preparing staff to meet patients' and families' information needs, as well as ensuring they have the skills to discuss potential recovery and break bad news compassionately and share the uncertain trajectory characteristic of acquired neurological conditions. An agreed team-based approach to talking about recovery is recommended to ensure consistency and improve the experiences of patients and their families.
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Affiliation(s)
- Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Johnson
- School of Psychology, University of Leeds Faculty of Biological Sciences, Leeds, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Chen L, Xiao LD, Chamberlain D, Newman P. Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review. J Clin Nurs 2021; 30:2786-2807. [PMID: 33872424 DOI: 10.1111/jocn.15807] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care. BACKGROUND Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period. DESIGN A systematic review and meta-synthesis. METHODS A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied. RESULTS The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home. CONCLUSIONS Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care. RELEVANCE TO CLINICAL PRACTICE Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.
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Affiliation(s)
- Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Tyagi S, Koh GCH, Luo N, Tan KB, Hoenig H, Matchar DB, Yoong J, Chan A, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Ng YL, Tan CS. Role of caregiver factors in outpatient medical follow-up post-stroke: observational study in Singapore. BMC FAMILY PRACTICE 2021; 22:74. [PMID: 33853544 PMCID: PMC8048235 DOI: 10.1186/s12875-021-01405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
Background Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke. Method Stroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0–3 months (early) and 4–12 months (late) post-stroke. Results For the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits. Conclusion We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01405-z.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, Durham, NC, USA
| | - David B Matchar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Angelique Chan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Yu Li Ng
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
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Chong WFW, Ng LH, Ho RMH, Koh GCH, Hoenig H, Matchar DB, Yap P, Venketasubramanian N, Tan KB, Ning C, Menon E, Chang HM, De Silva DA, Lee KE, Tan BY, Young SHY, Ng YS, Tu TM, Ang YH, Yeo TT, Merchant RA, Kong KH, Singh R, Ng YL, Cheong A. Stroke Rehabilitation Use and Caregiver Psychosocial Health Profiles in Singapore: A Latent Profile Transition Analysis. J Am Med Dir Assoc 2021; 22:2350-2357.e2. [PMID: 33812841 DOI: 10.1016/j.jamda.2021.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify and describe caregiver profiles based on their psychosocial health characteristics over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at 12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and 12 months post-stroke after accounting for covariates. DESIGN Latent profile transition analysis of caregiver psychosocial health with stroke rehabilitation use at 12 month post-stroke as outcome. SETTING AND PARTICIPANTS A total of 149 stroke patient-caregiver dyads from the Singapore Stroke Study. METHODS Cross-sectional latent profile analyses were conducted on caregiver psychosocial health indicators of burden, depression, health status, quality of relationship with patient, and social support. Changes in latent profile classification over 3 time points (baseline, 3 months, and 12 months post-stroke) were analyzed using latent transition analysis. A transition model with stroke rehabilitation use at 12 months post-stroke as the outcome was tested after accounting for covariates. RESULTS Two distinct caregiver psychosocial health latent profiles were found across time: nondistressed and distressed. Most caregivers were classified as nondistressed and remained nondistressed over time. Distressed caregivers at baseline were 76% likely to become nondistressed at 12 month post-stroke. Regardless of profile transition patterns, nondistressed caregivers at 12 months post-stroke tended to have cared for stroke rehabilitation nonusers at 12 months post-stroke. Patient depression explained profile classification at 3 months and 12 months post-stroke. After accounting for covariates, rehabilitation users at 3 months post-stroke tended to continue using rehabilitation at 12 months post-stroke only when they had nondistressed caregivers at 3 months post-stroke. CONCLUSIONS AND IMPLICATIONS Whether caregiver adaptation explains the associations between the latent profile transition patterns and rehabilitation use at 12 months post-stroke should be examined. Early psychosocial health assessment and sustained support should be made available to stroke caregivers to enhance their well-being and subsequent patient rehabilitation participation.
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Affiliation(s)
- Wayne F W Chong
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore; GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore.
| | - Leong Hwee Ng
- GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore
| | - Ringo M-H Ho
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore
| | - Gerald C H Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; Office of Healthcare Transformation, Ministry of Health, Singapore, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Science, Durham Veterans Administration Medical Center, Durham, NC, USA; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David B Matchar
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore, Singapore; Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | | | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; InfoComm, Technology and Data Group, Ministry of Health, Singapore, Singapore, Singapore
| | - Chou Ning
- CHOU Neuroscience Clinic, Farrer Park Hospital, Singapore, Singapore, Singapore; Chou Neurosurgery Pte Ltd, Gleneagles Hospital, Singapore, Singapore, Singapore
| | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore, Singapore, Singapore
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Deidre A De Silva
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore, Singapore
| | | | - Sherry H Y Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University of Singapore, Singapore, Singapore, Singapore
| | - Reshma A Merchant
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Department of Medicine (Division of Geriatric Medicine), National University Hospital, Singapore, Singapore, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yu Li Ng
- Manpower Planning and Strategy, Ministry of Health, Singapore, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore
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Zhang X, Lin JL, Gao R, Chen N, Huang GF, Wang L, Gao H, Zhuo HZ, Chen LQ, Chen XH, Li H. Application of the hospital-family holistic care model in caregivers of patients with permanent enterostomy: A randomized controlled trial. J Adv Nurs 2021; 77:2033-2049. [PMID: 33523488 DOI: 10.1111/jan.14691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the effectiveness of the hospital-family holistic care model based on the theory of 'Timing It Right' in caregivers of patients with permanent enterostomy. DESIGN A prospective randomized controlled trial. METHODS One hundred and twenty-five caregivers of patients with permanent enterostomy were recruited from 1 May 2017-31 August 2019. They were randomized into either intervention group (N = 62) or control group (N = 63). The control group received routine care and follow-up, while the intervention group received routine care, follow-up, and hospital-family holistic care intervention based on 'Timing It Right'. The care ability, psychological distress, and life quality of the caregivers were evaluated between the groups before the intervention, at discharge, and 3 and 6 months after discharge. RESULTS One hundred and eleven caregivers completed the study (88.8%). At 3 and 6 months after discharge, the care ability and life quality in the intervention group were significantly better than those in the control group (t = 8.506/9.783, t = 22.652/26.179, p < 0.05) based on the t tests, and the psychological distress was lower than that in the control group. The ostomy adaptability of the control group was significantly lower than that in the intervention group (p < 0.001) based on the t tests, and the χ2 test showed that ostomy complication was more than that in the intervention group (23.81% vs. 12.90% and 34.92% vs. 19.35%; p < 0.05) at 3 and 6 months after discharge. The interaction between time and group showed that the effect of time factor varied with the group and the four evaluation indexes in the intervention group gradually improved with the extension of the observation time and were better than those in the control group based on generalized estimating equation model. CONCLUSION The hospital-family holistic care model based on 'Timing It Right' can effectively improve the care ability of caregivers of patients with permanent enterostomy, reduce psychological distress, and improve the quality of life. IMPACT The caregivers of patients with permanent enterostomy showed dynamic changes in their care experience and needs at different stages of the disease. The hospital-family holistic care intervention strategy based on 'Timing It Right' can effectively improve the caregiver's care ability, alleviate psychological distress, and improve the quality of life. Additionally, improving the patients' stoma adaptability and reducing the incidence of complications related to ostomy.
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Affiliation(s)
- Xi Zhang
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Jin Ling Lin
- Nursing School of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Rui Gao
- Department of Pathology, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Ning Chen
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Gui Fang Huang
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Long Wang
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Hong Gao
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Hui Zhen Zhuo
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Li Qi Chen
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Xiao Huan Chen
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
| | - Hong Li
- Nursing School of Fujian Medical University, Fuzhou, Fujian Province, China.,Department of Nursing, Fujian Provincial Hospital, Fujian Medical University Affiliated Clinical Provincial Medical Institute, Fuzhou, Fujian Province, China
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Patchwood E, Woodward-Nutt K, Rhodes SA, Batistatou E, Camacho E, Knowles S, Darley S, Grande G, Ewing G, Bowen A. Organising Support for Carers of Stroke Survivors (OSCARSS): a cluster randomised controlled trial with economic evaluation. BMJ Open 2021; 11:e038777. [PMID: 33436463 PMCID: PMC7805348 DOI: 10.1136/bmjopen-2020-038777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Investigated clinical effectiveness and cost-effectiveness of a person-centred intervention for informal carers/caregivers of stroke survivors. DESIGN Pragmatic cluster randomised controlled trial (cRCT) with economic and process evaluation. SETTING Clusters were services, from a UK voluntary sector specialist provider, delivering support primarily in the homes of stroke survivors and informal carers. PARTICIPANTS Adult carers in participating clusters were referred to the study by cluster staff following initial support contact. INTERVENTIONS Intervention was the Carer Support Needs Assessment Tool for Stroke: a staff-facilitated, carer-led approach to help identify, prioritise and address the specific support needs of carers. It required at least one face-to-face support contact dedicated to carers, with reviews as required. Control was usual care, which included carer support (unstructured and variable). OUTCOME MEASURES Participants provided study entry and self-reported outcome data by postal questionnaires, 3 and 6 months after first contact by cluster staff. PRIMARY OUTCOME 3-month caregiver strain (Family Appraisal of Caregiving Questionnaire, FACQ). SECONDARY OUTCOMES FACQ subscales of caregiver distress and positive appraisals of caregiving, mood (Hospital Anxiety and Depression Scale) and satisfaction with stroke services (Pound). The economic evaluation included self-reported healthcare utilisation, intervention costs and EQ-5D-5L. RANDOMISATION AND MASKING Clusters were recruited before randomisation to intervention or control, with stratification for size of service. Cluster staff could not be masked as training was required for participation. Carer research participants provided self-reported outcome data unaware of allocation; they consented to follow-up data collection only. RESULTS Between 1 February 2017 and 31 July 2018, 35 randomised clusters (18 intervention; 17 control) recruited 414 cRCT carers (208 intervention; 206 control). Study entry characteristics were well balanced. PRIMARY OUTCOME MEASURE intention-to-treat analysis for 84% retained participants (175 intervention; 174 control) found mean (SD) FACQ carer strain at 3 months to be 3.11 (0.87) in the control group compared with 3.03 (0.90) in the intervention group, adjusted mean difference of -0.04 (95% CI -0.20 to 0.13). Secondary outcomes had similarly small differences and tight CIs. Sensitivity analyses suggested robust findings. Intervention fidelity was not achieved. Intervention-related group costs were marginally higher with no additional health benefit observed on EQ-5D-5L. No adverse events were related to the intervention. CONCLUSIONS The intervention was not fully implemented in this pragmatic trial. As delivered, it conferred no clinical benefits and is unlikely to be cost-effective compared with usual care from a stroke specialist provider organisation. It remains unclear how best to support carers of stroke survivors. To overcome the implementation challenges of person-centred care in carers' research and service development, staff training and organisational support would need to be enhanced. TRIAL REGISTRATION NUMBER ISRCTN58414120.
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Affiliation(s)
- Emma Patchwood
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
| | - Kate Woodward-Nutt
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
| | - Sarah A Rhodes
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Evridiki Batistatou
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Knowles
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Darley
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Gunn Grande
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Division of Nursing Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gail Ewing
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
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Darley S, Knowles S, Woodward-Nutt K, Mitchell C, Grande G, Ewing G, Rhodes S, Bowen A, Patchwood E. Challenges implementing a carer support intervention within a national stroke organisation: findings from the process evaluation of the OSCARSS trial. BMJ Open 2021; 11:e038129. [PMID: 33436462 PMCID: PMC7805355 DOI: 10.1136/bmjopen-2020-038129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/02/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine the implementation of an intervention to support informal caregivers and to help understand findings from the Organising Support for Carers of Stroke Survivors (OSCARSS) cluster randomised controlled trial (cRCT). DESIGN Longitudinal process evaluation using mixed methods. Normalisation process theory informed data collection and provided a sensitising framework for analysis. SETTING Specialist stroke support services delivered primarily in the homes of informal carers of stroke survivors. PARTICIPANTS OSCARSS cRCT participants including carers, staff, managers and senior leaders. INTERVENTION The Carer Support Needs Assessment Tool for Stroke (CSNAT-Stroke) intervention is a staff-facilitated, carer-led approach to help identify, prioritise and address support needs. RESULTS We conducted qualitative interviews with: OSCARSS cRCT carer participants (11 intervention, 10 control), staff (12 intervention, 8 control) and managers and senior leaders (11); and obtained 140 responses to an online staff survey over three separate time points. Both individual (carer/staff) and organisational factors impacted implementation of the CSNAT-Stroke intervention and how it was received by carers. We identified four themes: staff understanding, carer participation, implementation, and learning and support. Staff valued the idea of a structured approach to supporting carers, but key elements of the intervention were not routinely delivered. Carers did not necessarily identify as 'carers', which made it difficult for staff to engage them in the intervention. Despite organisational enthusiasm for OSCARSS, staff in the intervention arm perceived support and training for implementation of CSNAT-Stroke as delivered primarily by the research team, with few opportunities for shared learning across the organisation. CONCLUSIONS We identified challenges across carer, staff and organisation levels that help explain the OSCARSS cRCT outcome. Ensuring training is translated into practice and ongoing organisational support would be required for full implementation of this type of intervention, with emphasis on the carer-led aspects, including supporting carer self-identification. TRIAL REGISTRATION NUMBER ISRCTN58414120.
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Affiliation(s)
- Sarah Darley
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Sarah Knowles
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Kate Woodward-Nutt
- NIHR Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Manchester, UK
| | - Claire Mitchell
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah Rhodes
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Emma Patchwood
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
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Sun N, Wei L, Wang H, Wang X, Gao M, Hu X, Shi S. Qualitative study of the psychological experience of COVID-19 patients during hospitalization. J Affect Disord 2021; 278:15-22. [PMID: 32949869 PMCID: PMC7444461 DOI: 10.1016/j.jad.2020.08.040] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) continues to spread across the globe, but patient experiences are rarely documented. OBJECTIVE To explore the psychology of COVID-19 patients during hospitalization. METHODS A phenomenological and robust sampling approach was employed. Sixteen patients admitted to the First Affiliated Hospital of Henan University of Science and Technology with COVID-19 from 20th January to 1st March 2020 were selected. Data were collected through semi-structured interviews, phone calls, or face-to-face interviews using quarantine measures. Data were analyzed using the Colaizzi method. RESULTS The psychological experience of COVID-19 patients during hospitalization could be summarized into five themes. Firstly, attitudes toward the disease included fear, denial, and stigma during the early stages, which gradually developed into acceptance in the later stages. Secondly, the major source of stress included the viral nature of the disease, quarantine measures, and concerns regarding the health of family members. Thirdly, reactions of body and mind included disease stage-dependent emotional responses, excessive attention to symptoms, rumination, and changes in diet, sleep, and behavior. Fourthly, supportive factors included psychological adjustments, medical care, and family and social support. Finally, the disease resulted in psychological growth and patients viewed problems with gratitude through the cherishing of life, family, bravery, and tenacity. CONCLUSION COVID-19 patients gradually changed their attitude toward the disease and displayed emotional responses dependent on the stage of the disease. Negative emotions dominated during the early stages but gradually gave way to mixed positive and negative emotions. Active guidance of psychological growth may therefore promote physical and mental recovery in COVID-19 patients.
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Affiliation(s)
- Niuniu Sun
- Humanities Teaching and Research Office, School of Nursing, Henan University of Science and Technology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Luoqun Wei
- Department of Infection, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Hongyun Wang
- Department of Infection, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.
| | - Xianru Wang
- Department of Infection, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Mingxia Gao
- Department of Infection, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xinjun Hu
- Department of Infection, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Suling Shi
- Department of Infection, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.
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48
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Elsheikh MA, Moriyama M, Rahman MM, Kako M, El-Monshed AH, Zoromba M, Zehry H, Khalil MH, Amr M. Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e041637. [PMID: 33323445 PMCID: PMC7745514 DOI: 10.1136/bmjopen-2020-041637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Caring for stroke survivors creates high levels of care burden among family caregivers. Previous initiatives at alleviating the care burden have been unsuccessful. The proposed study aims to evaluate the effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors. Based on the perceived needs of family caregivers, this intervention takes into account scientific recommendations to combine three different approaches: skill-building, psychoeducation and peer support. METHODS AND ANALYSIS Using a prospective, randomised, open-label, parallel-group design, 110 family caregivers will be enrolled from Dakahlia Governorate, Egypt between December 2019 and May 2020, and randomly assigned to either the intervention group or the control group. The tailored multidimensional intervention will be administered for 6 months, including three home visits, six home-based telephone calls and one peer support session. The primary outcome is the care burden as measured using the Zarit Burden Interview. Secondary outcomes include changes in the family caregivers' perceived needs (Family Needs Questionnaire-Revised), coping strategies (Brief-Coping Orientation to Problems Experienced) and quality of life (WHO Quality of Life-BREF). Outcomes evaluation will be conducted at baseline (T0), month 3 (T1) and month 6 (T2). Independent t-test will be performed to compare the mean values of study variables between the two groups at both T1 and T2. After adjusting for confounding variables, analysis of covariance will be used to assess the effect of the intervention. In addition, repeated measures analysis of variance will be conducted to assess changes in effect over time. ETHICS AND DISSEMINATION This study was approved by the Research Ethics Committee of the Faculty of Nursing, Mansoura University, Mansoura, Egypt (P.0195). The results will be published in a scientific peer-reviewed journal, and findings will be disseminated at the local and international levels. TRIAL REGISTRATION NUMBER NCT04211662.
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Affiliation(s)
- Mahmoud Ahmed Elsheikh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ahmed Hashem El-Monshed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Mohamed Zoromba
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Hamada Zehry
- New Mansoura General Hospital, Neurology, Ministry of Health and Population, Mansoura, Egypt
| | | | - Mostafa Amr
- Psychiatry, Mansoura University Faculty of Medicine, Mansoura, Egypt
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49
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Hughes AK, Cummings CE. Grief and Loss Associated With Stroke Recovery: A Qualitative Study of Stroke Survivors and Their Spousal Caregivers. J Patient Exp 2020; 7:1219-1226. [PMID: 33457568 PMCID: PMC7786670 DOI: 10.1177/2374373520967796] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite a focus on physical and cognitive outcomes, stroke survivors are also impacted by emotional and mental health challenges. Additionally, their caregivers may experience decreased well-being due to increased burden and role adjustment. A small body of literature characterizes this experience as a form of grief and loss. This study seeks to explore experiences of grief and loss reported by stroke survivors and caregivers, using Holbrook's 4-stage bereavement model. This cross-sectional, qualitative study was conducted among adult stroke survivors (n = 9) and their spousal caregivers (n = 5). Focus groups on experiences of recent hospitalizations and transitions home were transcribed, coded, and thematic analysis was conducted, identifying a major theme of loss. Data were reanalyzed guided by Holbrook's model. Common themes were losses and changes experienced by patients/caregivers, disbelief, and lack of understanding. Subthemes of denial and confusion were present. Less prevalent themes were loss of existing support systems and silver lining. Stroke survivors and caregivers experienced a range of negative emotions, impacting behaviors, self-perception, roles, and social support. Awareness of these issues can improve practice with those affected by stroke.
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Affiliation(s)
- Anne K Hughes
- School of Social Work, Michigan State University, East Lansing, MI, USA
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50
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Montero-Cuadrado F, Galán-Martín MÁ, Sánchez-Sánchez J, Lluch E, Mayo-Iscar A, Cuesta-Vargas Á. Effectiveness of a Physical Therapeutic Exercise Programme for Caregivers of Dependent Patients: A Pragmatic Randomised Controlled Trial from Spanish Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207359. [PMID: 33050179 PMCID: PMC7601365 DOI: 10.3390/ijerph17207359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 01/22/2023]
Abstract
Female family caregivers (FFCs) constitute one of the basic supports of socio-health care for dependence in developed countries. The care provided by FFCs may impact their physical and mental health, negatively affecting their quality of life. In order to alleviate the consequences of providing care on FFCs, the Spanish Public Health System has developed the family caregiver care programme (FCCP) to be applied in primary care (PC) centres. The effectiveness of this programme is limited. To date, the addition of a physical therapeutic exercise (PTE) programme to FCCP has not been evaluated. A randomised multicentre clinical trial was carried out in two PC centres of the Spanish Public Health System. In total, 68 FFCs were recruited. The experimental group (EG) performed the usual FCCP (4 sessions, 6 h) added to a PTE programme (36 sessions in 12 weeks) whereas the control group performed the usual FCCP performed in PC. The experimental treatment improved quality of life (d = 1.17 in physical component summary), subjective burden (d = 2.38), anxiety (d = 1.52), depression (d = 1.37) and health-related physical condition (d = 2.44 in endurance). Differences between the groups (p < 0.05) were clinically relevant in favour of the EG. The experimental treatment generates high levels of satisfaction.
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Affiliation(s)
- Federico Montero-Cuadrado
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and Leon Public Health System (Sacyl), 47011 Valladolid, Spain; (F.M.-C.); (M.Á.G.-M.)
| | - Miguel Ángel Galán-Martín
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and Leon Public Health System (Sacyl), 47011 Valladolid, Spain; (F.M.-C.); (M.Á.G.-M.)
| | - Javier Sánchez-Sánchez
- Department of Physical Activity and Sports Sciences, University Pontificia of Salamanca, 37002 Salamanca, Spain;
- Research Group “Planning and assessment of training and athletic performance”, 37002 Salamanca, Spain
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain;
- Pain in Motion “International Research Group”, 1090 Brussels, Belgium
- Department of Human Physiology and Rehabilitation Sciences, Faculty of Physiotherapy, Vrije University Brussels, B-1050 Brussels, Belgium
| | - Agustín Mayo-Iscar
- Department of Statistics and Operational Research and IMUVA, University of Valladolid, 47005 Valladolid, Spain;
| | - Ántonio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Heath Sciences, University of Malaga, 19071 Málaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, QLD 4000, Australia
- Correspondence:
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