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Sun B, Wang N, Li K, Yang Y, Zhang F. The mediating effects of hope on the relationships of social support and self-esteem with psychological resilience in patients with stroke. BMC Psychiatry 2024; 24:340. [PMID: 38715019 PMCID: PMC11075303 DOI: 10.1186/s12888-024-05744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE To explore the mediating effect of hope in the relationships between social support and self-esteem with psychological resilience among patients with stroke survivors in early rehabilitation. METHODS A cross-sectional study design was adopted. Data from a cross-sectional survey of 210 patients undergoing early stroke rehabilitation were analyzed using structural equation modeling. The variables of interest were measured using the Connor Davidson Resilience Scale, the Social Support Rating Scale, the Herth Hope Index, and the Self-Esteem Scale. This article reports according to the STROBE checklist. RESULTS A positive relationship was found between social support and psychological resilience (β1 = 0.548), which was mediated by hope (β2 = 0.114), and social support had significant direct effect on resilience (β3 = 0.434). A positive relationship was also found between self-esteem and psychological resilience (β4 = 0.380), which was mediated by hope (β5 = 0.200), and self-esteem had significant direct effect on resilience (β6 = 0.179). CONCLUSION According to the results of this study, some strategies can be incorporated into the rehabilitation process to enhance psychological resilience, such as cultivating individual personality characteristics and improving patients' social relationships. In the future, we need to explore methods for improving psychological resilience among patients with stroke in combination with their risk factors to improve their quality of life and reduce the incidence of post-stroke depression.
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Affiliation(s)
- Boru Sun
- Emergency Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Nan Wang
- Rehabilitation Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ke Li
- Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Yang
- Nursing Department, Shengjing Hospital China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, P.R. China.
| | - Fengjiao Zhang
- Teaching Group of Nursing Department, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, P.R. China.
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2
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Hamilton-Bruce MA, Young J, Nottle C, Hazel SJ, Milton AG, McDowall S, Mani B, Koblar S. Developing and Planning a Protocol for Implementing Health Promoting Animal Assisted Interventions (AAI) in a Tertiary Health Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6780. [PMID: 37754639 PMCID: PMC10531378 DOI: 10.3390/ijerph20186780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
The Ottawa Charter identifies that multiple levels of government, non-government, community, and other organizations should work together to facilitate health promotion, including in acute settings such as hospitals. We outline a method and protocol to achieve this, namely an Action Research (AR) framework for an Animal Assisted Intervention (AAI) in a tertiary health setting. Dogs Offering Support after Stroke (DOgSS) is an AR study at a major tertiary referral hospital. AAI has been reported to improve mood and quality of life for patients in hospitals. Our project objectives included applying for funding, developing a hospital dog visiting Action Research project, and, subsequent to ethics and governance approvals and finance, undertaking and reporting on the Action Research findings. The Action Research project aimed to investigate whether AAI (dog-visiting) makes a difference to the expressed mood of stroke patients and their informal supports (visiting carers/family/friends), and also the impact these visits have on hospital staff and volunteers, as well as the dog handler and dog involved. We provide our protocol for project management and operations, setting out how the project is conducted from conception to assess human and animal wellbeing and assist subsequent decision-making about introducing dog-visiting to the Stroke Unit. The protocol can be used or adapted by other organizations to try to avoid pitfalls and support health promotion in one of the five important action areas of the Ottawa Charter, namely that of reorienting health services.
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Affiliation(s)
- M. Anne Hamilton-Bruce
- Stroke Research Programme, Basil Hetzel Institute, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South 5011, Australia;
| | - Janette Young
- Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia; (J.Y.); (C.N.)
| | - Carmel Nottle
- Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia; (J.Y.); (C.N.)
| | - Susan J. Hazel
- School of Animal and Veterinary Science, The University of Adelaide, Roseworthy Campus, Roseworthy 5371, Australia;
| | - Austin G. Milton
- Adelaide Medical School, The University of Adelaide, Adelaide 5005, Australia; (A.G.M.); (S.K.)
| | - Sonya McDowall
- School of Animal and Veterinary Science, The University of Adelaide, Roseworthy Campus, Roseworthy 5371, Australia;
| | - Ben Mani
- Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia; (J.Y.); (C.N.)
| | - Simon Koblar
- Adelaide Medical School, The University of Adelaide, Adelaide 5005, Australia; (A.G.M.); (S.K.)
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3
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Murray CM, Weeks S, van Kessel G, Guerin M, Watkins E, Mackintosh S, Fryer C, Hillier S, Stanley M. Perspectives of choice and control in daily life for people following brain injury: A qualitative systematic review and meta‐synthesis. Health Expect 2022; 25:2709-2725. [DOI: 10.1111/hex.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Carolyn M. Murray
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Scott Weeks
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | | | - Michelle Guerin
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | | | - Shylie Mackintosh
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Caroline Fryer
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Susan Hillier
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Mandy Stanley
- School of Medical and Health Sciences Edith Cowan University Joondalup Western Australia Australia
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Reeves MJ, Thetford C, McMahon N, Forshaw D, Brown C, Joshi M, Watkins C. Life and Leisure Activities following Stroke or Transient Ischaemic Attack (TIA): An Observational, Multi-Centre, 6-Month Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13848. [PMID: 36360725 PMCID: PMC9655688 DOI: 10.3390/ijerph192113848] [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: 09/20/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine changes in leisure participation following stroke/transient ischaemic attack (TIA) and explore its relationship to modifiable and non-modifiable participant characteristics. DESIGN An observational study design with self-report questionnaires collected at two time points (baseline and 6-months). SETTING The study was conducted across 21 hospital sites in England, Wales, and Northern Ireland. PARTICIPANTS Participants were aged 18+ and had experienced a first or recurrent stroke or TIA and had a post-stroke/TIA modified Rankin score (mRS) of ≤3. PROCEDURE Research practitioners at each site approached potential participants. Individuals who agreed to participate completed a baseline questionnaire whilst an inpatient or at a first post-stroke/TIA clinic appointment. A follow-up questionnaire was posted to participants with a freepost return envelope. Two questionnaires were developed that collected demographic information, pre-stroke/TIA mRS, social circumstances (e.g., employment situation) and incorporated the shortened Nottingham Leisure Questionnaire (sNLQ). RESULTS The study recruited eligible participants (N = 3295); 2000 participants returned questionnaires at follow-up. Data showed three participant variables were significant predictors of engagement in leisure activities post-stroke/TIA: age, sex, and deprivation decile. There was an overall decline in the number and variety of leisure activities, with an average loss of 2.2 activities following stroke/TIA. Only one activity, "exercise/fitness" saw an increase in engagement from baseline to follow-up; watching TV remained stable, whilst participation in all other activities reduced between 10% and 40% with an average activity engagement reduction of 22%. CONCLUSIONS Some groups experienced a greater reduction in activities than others-notably older participants, female participants, and those living in a low socioeconomic area. REGISTRATION researchregistry4607. STRENGTHS AND LIMITATIONS OF THIS STUDY 1. This is the largest-ever study to survey life and leisure activity engagement following stroke/TIA. 2. Survey responses were self-reported retrospectively and, therefore, may have been misreported, or misremembered. 3. Despite the large cohort, there were few participants, and so respondents, from ethnic minority groups.
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Affiliation(s)
- Matthew J. Reeves
- UCLan Research Centre for Sport, Physical Activity & Performance, University of Central Lancashire, Preston PR1 2HE, UK
- Lancashire Institute for Global Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
| | - Clare Thetford
- Stroke Research Team, University of Central Lancashire, Preston PR1 2HE, UK
| | - Naoimh McMahon
- Division of Health Research, University of Lancaster, Lancaster LA1 4YW, UK
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Chris Brown
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Miland Joshi
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Caroline Watkins
- Lancashire Institute for Global Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
- Stroke Research Team, University of Central Lancashire, Preston PR1 2HE, UK
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
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5
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Böttger T, Dennhardt S, Knape J, Marotzki U. "Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10465. [PMID: 36078184 PMCID: PMC9518532 DOI: 10.3390/ijerph191710465] [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: 06/30/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.
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Affiliation(s)
- Tabea Böttger
- Institute of Health Science, Faculty of Medicine, University of Lübeck, 23562 Lübeck, Germany
- Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Holzminden, Göttingen (HAWK), 31134 Hildesheim, Germany
| | - Silke Dennhardt
- Physio- and Occupational Therapy Program, Faculty of Health, Alice Salomon Hochschule Berlin (ASH), University of Applied Sciences, 12627 Berlin, Germany
| | - Julia Knape
- Independent Researcher, 10439 Berlin, Germany
| | - Ulrike Marotzki
- Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Holzminden, Göttingen (HAWK), 31134 Hildesheim, Germany
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6
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Zhang Y, Mou Y, Zhang Y, Wang J, Kong F. Psychological experience and social reintegration needs of young stroke patients: a systematic review and meta-aggregation of qualitative studies. J Community Health Nurs 2022; 39:150-169. [PMID: 35653793 DOI: 10.1080/07370016.2022.2077074] [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 The visible physical dysfunction and invisible psychological effects after stroke prevent young patients from returning to their pre-stroke roles and social activities. PURPOSE/AIM To comprehensively analyze the psychological experience and social reintegration needs of young stroke patients, which may be beneficial for improving quality of life and social reintegration after stroke. METHODS We conducted a comprehensive literature search of 10 databases. The screening and quality assessment of the included articles were performed by the Qualitative Assessment and Review Instrument (QARI). Meta-aggregation was conducted to synthesize the findings of the included studies. We summarized the certainty of confidence using the Confidence in Evidence from Reviews of Qualitative Research (CERQual) approach. RESULTS A total of 5506 studies were screened, of which 12 were included. Data synthesis suggested two new themes: (a) the self-growth process from denial of stroke to accepting stroke (high CERQual confidence), and (b) desire to regain pre-stroke normality, but having difficulty in the social reintegration process (high CERQual confidence). CONCLUSION Stroke, as a traumatic event, disrupts the life structure of young patients, and their needs of reintegration are not adequately considered. Interventions based on the principle of individuation should focus on this issue to restore continuity in life after stroke.
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Affiliation(s)
- Yongli Zhang
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China.,College of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Yating Mou
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China.,College of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Yunqian Zhang
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Jingmei Wang
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Fanyi Kong
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
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7
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'Still living with it even though it's gone': Using interpretive phenomenological analysis to explore shared experiences of living with and beyond breast, prostate, and colorectal cancer. Eur J Oncol Nurs 2021; 56:102067. [PMID: 34896970 DOI: 10.1016/j.ejon.2021.102067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Living with and beyond cancer is an increasingly common experience. While research is uncovering valuable individual experiences of those living with and beyond cancer, it has been argued that this idiographic approach is limited in outlook, reach and impact. This study contributes to the understanding of what it means to live with and beyond cancer by complementing idiographic knowledge with multiple perspectives from a group of participants who are living with and beyond cancer, to explore how individual experiences may be relevant to others. METHOD Semi-structured interviews were conducted with people who had received treatment for breast (n = 6), prostate (n = 6) or colorectal cancer (n = 6). Data were analysed using interpretive phenomenological analysis. The early findings were then shared with a wider group of people who had received treatment for breast, prostate or colorectal cancer (n = 26) in six focus groups, to explore whether they had similar experiences. RESULTS While individual accounts of living with and beyond cancer detail unique features specific to each person's experience, focus group discussions illustrated how participant life worlds interact and overlap. The findings identified thematic similarities within and between individual and group levels and across cancer types. Three super-ordinate themes describe the shared experience of living with and beyond cancer: i) the cancer shock, ii) managing cancer and getting through and iii) getting over cancer. CONCLUSIONS A multiple perspective approach informs our understanding of shared experiences of living with and beyond cancer. This knowledge can be used to direct, design, and deliver relevant supportive cancer care.
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8
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The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.
Method:
Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.
Results:
While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.
Conclusions:
Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.
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Suddick KM, Cross V, Vuoskoski P, Stew G, Galvin KT. Holding space and transitional space: stroke survivors' lived experience of being on an acute stroke unit. A hermeneutic phenomenological study. Scand J Caring Sci 2021; 35:104-114. [PMID: 32065418 PMCID: PMC7984029 DOI: 10.1111/scs.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/01/2022]
Abstract
Despite substantial reorganisation of stroke unit provision in the United Kingdom, limited qualitative research has explored how stroke survivors experience the acute stroke unit. This hermeneutic phenomenological study used accounts from four stroke survivors who experienced one of two acute stroke units. Through detailed analysis, the acute stroke unit emerged as a meaningful space, in two distinct but interconnected forms. As holding space, the unit was understood to offer protection and safe haven, as the stroke survivors looked to cope and respond to the temporal, bodily, biographical disruption and significant vulnerability brought about by stroke and by being in hospital. Holding was fulfilled by different people (including their fellow stroke survivors) and reflected a human response to human need and existential vulnerability. This space, and the practices within it, functioned to hold them intimately but also at a distance from their prestroke lifeworld. As such, the acute stroke unit holding space was intertwined with how it supported, encouraged or provoked transition. In the transitional space of the acute stroke unit, stroke survivors described how they survived the hospital-healthcare space, stroke unit and poststroke space. This paper articulates how transition was meaningfully signified through its absence or presence, as they transformed, relinquished or re-asserted their 'self', and in one case, recovered whilst 'in there'. The findings of this study provide phenomenological insight into stroke survivors' lived experience, the meaningful holding and transitional contribution of the unit, and how these spatial forms were intertwined. These insights are discussed in relation to the existing evidence base and stroke unit provision.
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Affiliation(s)
| | - Vinette Cross
- School of Health SciencesUniversity of BrightonEastbourneUK
- Centre for Health and Social Care ImprovementSchool of Health and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Pirjo Vuoskoski
- School of Health SciencesUniversity of BrightonEastbourneUK
- Present address:
Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Graham Stew
- School of Health SciencesUniversity of BrightonEastbourneUK
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10
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Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, Farrin A. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified.
Objectives
The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations).
Design
Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales.
Setting
The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales.
Participants
Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services.
Data sources
Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified.
Intervention
Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks.
Results
A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains.
Conclusions
We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation.
Future work
Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation.
Trial registration
Current Controlled Trials ISRCTN38920246.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, School of Medicine, University of Leeds, Leeds, UK
| | | | - Josie Dickerson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gill Carter
- Patient and public involvement contributor, York, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robbie Foy
- Division of Primary Care, Palliative Care and Public Health, School of Medicine, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Arvin Prashar
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ross Atkinson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca J Hawkins
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicola Cornwall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Laetitia Schmitt
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Speed
- Patient and public involvement contributor, York, UK
| | - Katie Grenfell
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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11
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Jackson SM, Solomon SD, Barker RN. Recovering is about living my life, as it evolves: perspectives of stroke survivors in remote northwest Queensland. Disabil Rehabil 2021; 44:3843-3852. [PMID: 33625948 DOI: 10.1080/09638288.2021.1890242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Recovering from stroke in remote Australia has rarely been considered, even though rehabilitation services are generally scarce. The primary purpose of this study was to explore stroke recovery, from the perspective of stroke survivors in remote northwest Queensland (NWQ), to explicate the lens through which they view recovering. The secondary purpose was to explore the role of technology to support stroke survivors in remote locations along their recovery journey. METHODS A qualitative study was undertaken using elements of constructivist grounded theory for data collection and analysis. Semi-structured interviews were conducted with fifteen stroke survivors and two partners living, working or travelling in remote NWQ. RESULTS From the participants' perspective, recovering in a remote area after stroke is about living my life, as it evolves by endeavouring to recover my way and navigating my recovery in my world. Technology was only considered helpful when it supported participants to recover their way in their world. CONCLUSION Recovering from stroke from the perspective of stroke survivors in remote NWQ is about living their life, as they want it to be, and as it unfolds within their own context. Technology only has a place when it can support them to recover their way in their world. These findings reinforce the importance of health professionals listening, learning about, and enabling stroke survivors along their recovery journey, within their remote context and support network.Implications for RehabilitationRecovering from the perspective of stroke survivors is about living their life as it evolves.To support stroke survivors from remote areas, health professionals need to listen to and learn from each stroke survivor about what matters to them, what works for them, and about their world; including the challenges (e.g., switching between services) and enablers (e.g., community support) as the stroke survivor perceives them.Finding ways to utilise the strengths within and around them, may improve the recovery process for the stroke survivor in a remote area, ensuring they can access care that meets their needs in their world.Working together with stroke survivors, health professionals need to consider how technology could help them to live their life, while recovering their way and in their world.
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Affiliation(s)
- Sarah M Jackson
- College of Healthcare Sciences, James Cook University, Townsville, Australia.,Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - S D Solomon
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - R N Barker
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia.,College of Healthcare Sciences, James Cook University, Cairns, Australia
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12
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Prevalence of Worsening Problems Using Post-Stroke Checklist and Associations with Quality of Life in Patients with Stroke. J Stroke Cerebrovasc Dis 2020; 29:105406. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
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13
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Becker I, Maleka MD, Stewart A, Jenkins M, Hale L. Community reintegration post-stroke in New Zealand: understanding the experiences of stroke survivors in the lower South Island. Disabil Rehabil 2020; 44:2815-2822. [PMID: 33135947 DOI: 10.1080/09638288.2020.1839792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Optimal community reintegration is a key rehabilitation outcome post-stroke. This concept has been investigated in many countries but not qualitatively in New Zealand. We explored perceptions about community reintegration of stroke survivors living in southern New Zealand. METHOD Qualitative interviews were used to collect data. Recruitment was via local stroke clubs, inviting adult stroke survivors (stroke duration > six months, any severity or type) living in the lower South Island. Data were analysed using the General Inductive Approach. RESULTS Eight stroke survivors (two female, six males; age range 50-80 years, mean 66 years (SD = 12); mean time since stroke 6.5 (SD = 4) years) participated. Participants' perceptions of what is integral to reintegration into their community were shaped by four themes, namely: (1) personal relationships, (2) re-establishing normality (old and new), (3) purpose in life, and (4) independence. CONCLUSIONS Stroke survivors in New Zealand hold many similar perceptions about optimal community reintegration with those living elsewhere. Key to successful community reintegration, irrespective of geography, culture and ethnicity, appears to be involvement in meaningful activities, and reduced reliance on others whilst maintaining or developing good social relationships. These fundamental components are then contextually nuanced by what is meaningful and important to the individual.IMPLICATIONS FOR REHABILITATIONOptimal community reintegration post-stroke is arguably the key goal of rehabilitation, and thus should be enabled and measured.To optimise community reintegration post-stroke, rehabilitation should focus on enabling stroke survivors' social relationships, independent community mobility, and engagement in meaningful activities.Optimal community reintegration post-stroke is however contextual. Rehabilitation professionals must understand what each patient considers successful community reintegration to be for them and tailor their rehabilitation accordingly.
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Affiliation(s)
- Ines Becker
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Morake Douglas Maleka
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Aimee Stewart
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Matthew Jenkins
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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14
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Kimmel B, Anderson JA, Walder A, Martin L, Shegog R. Veteran stroke survivors' lived experiences after being discharged home: a phenomenological study. Disabil Rehabil 2020; 44:2372-2384. [PMID: 33126821 DOI: 10.1080/09638288.2020.1836041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability in adults and second cause of death in the United States. Survivors face challenges postdischarge, including risks in self-management (SM) following prescribed regimens. Although SM education can help develop skills to control risk factors for stroke recurrence, little is known about lived experiences of patients adopting SM. AIMS To examine Veterans' lived poststroke experiences after discharge and their experiences in SM goal setting/attainment. METHODS Patients within one year of discharge from a Veterans Administration Medical Center in the United States with two risk factors for stroke recurrence were enrolled and received an SM workbook. Eight patients were interviewed (six males, two females; mean age 62: range 45-80). Part I concerned lived experience. Part II described experiences with goal setting and attainment. Data were analyzed inductively, identifying common experiences. Deductive analysis described goal setting and attainment. Transcript reviews identified SM themes and strategies. RESULTS Lived experiences included 1) uncertainty about life, 2) anger and frustration, and 3) healthcare system challenges. Coping skills and setting goals to manage risks were critical for physical and emotional functioning. CONCLUSIONS SM coping and goal setting aided recovery and improved life quality among Veterans after stroke. SM interventions assisted in regaining physical and emotional function. Findings may help in design of interventions for survivors, using SM and goal setting and attainment.IMPLICATIONS FOR REHABILITATIONSeveral implications for clinical practice were identified:Providers should acknowledge Veterans' challenges and struggles after their stroke and help Veterans to re-establish social identity, enhance self-esteem and improve mood.More emphasis should be given to the Veterans' caregivers' availability and willingness to help with their loved one's recovery, work reinstatement status and financial struggles.Recognition of the importance of the social context of recovery after a stroke is important, as nonmedical social interaction is often overlooked.Improvements are needed in the area of providers working with social workers and physical, occupational and mental health therapists to arrange more inpatient and outpatient treatments, including more frequent home visits.Veterans should be strongly encouraged to attend self-management diabetes education classes and smoking cessation and weight-loss programs offered for free within the Veterans Health Administration system.Self-management strategies using goal-setting and attainment concepts may assist individuals with stroke to regain physical and emotional functions, subsequently preventing another stroke.
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Affiliation(s)
- Barbara Kimmel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jane A Anderson
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Annette Walder
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lindsey Martin
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ross Shegog
- Department of Health Prevention and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA
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15
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Hoffmann M, Gustafsson L, Di Tommaso A. Exploring stroke survivors' experiences and understandings of occupational therapy. Scand J Occup Ther 2020; 29:165-174. [PMID: 33054465 DOI: 10.1080/11038128.2020.1831060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Occupational therapists view people with stroke as occupational beings who may experience occupational issues. Concurrently, occupational therapy practice is guided by research evidence that supports predominantly impairment-based practices. There has been limited exploration of how people with stroke experience and understand occupational therapy in the context of the potential tension between the professional philosophy and the research-based evidence. AIMS/OBJECTIVE To explore the experience and understanding of occupational therapy with stroke survivors. MATERIAL AND METHODS Interpretative phenomenology guided semi-structured interviews with nine participants from five states across Australia. RESULTS Three themes emerged: Understanding of occupational therapy grows by 'doing' outlines how participants understood occupational therapy based on their individual experiences over time; Personal factors influence the experience highlights how participants had diverse expectations for recovery that influenced their occupational therapy experience. Context shapes occupational therapy experience identified that the therapeutic relationship and context of occupational therapy were important factors in shaping experiences. CONCLUSION Both impairment-based and occupation-based therapy were considered valuable aspects of occupational therapy, representing the proposed tension between the professional philosophy and research-based evidence. Occupation-based and client-centred practice was more often experienced in the outpatient setting, with challenges described for both within the inpatient setting.
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Affiliation(s)
- Mikhala Hoffmann
- Former Student Occupational Therapist, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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16
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Tang EYH, Price C, Stephan BCM, Robinson L, Exley C. Impact of Memory Problems Post-stroke on Patients and Their Family Carers: A Qualitative Study. Front Med (Lausanne) 2020; 7:267. [PMID: 32637417 PMCID: PMC7317277 DOI: 10.3389/fmed.2020.00267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Memory problems post-stroke are common and for some, these problems could then progress to a dementia illness. Once in the community, stroke-survivors are looked after by their family doctors although there is evidence that these patients may struggle to access appropriate help in the community for these problems. Although a stroke-survivor may be physically capable of performing daily tasks, they and their families may have to learn to manage and adapt to their new memory deficits. There is often less focus on cognitive recovery post-stroke from clinical services perhaps because of the lack of awareness and evidence of these adaptations. There is also good evidence that organized stroke care improves physical recovery but no equivalent evidence for the effectiveness of cognitive rehabilitation. The aim of this qualitative study was to report the impact of memory problems on the stroke-survivor and their family once they are living in the community. Methods: Semi-structured interviews were conducted with patients and family carers to gain an in-depth understanding of their experiences. Participants were invited to take part in an interview at around six and 12-months post-stroke. A topic guide was developed to explore participant's care experiences post-stroke when they have also presented with memory difficulties. Data collection and analysis were iterative; all transcripts were anonymized. The data were thematically analyzed. Results: Twenty-two interviews were conducted. Five family carers and ten stroke-survivors were interviewed at six-months post-stroke, of these eight stroke-survivors and four family carers agreed to a 12-month follow-up interview. They identified several areas of impact: (1) impact on daily life; (2) emotional impact; and (3) compensating strategies implemented in response to impact. Conclusion: Living with stroke combined with memory impairment can have negative effects on the stroke-survivor and their family once in the community. Health professionals and services in the community need to recognize the burden of managing symptoms post-stroke for these individuals and their families. Understanding the impact can enable more effective community and specialist support to be provided particularly if we were to also identify those who may then be at risk of a future dementia illness.
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Affiliation(s)
- Eugene Y H Tang
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Christopher Price
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Blossom C M Stephan
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Nottingham, United Kingdom
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
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17
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Purton J, Sim J, Hunter SM. The experience of upper-limb dysfunction after stroke: a phenomenological study. Disabil Rehabil 2020; 43:3377-3386. [PMID: 32223456 DOI: 10.1080/09638288.2020.1743775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Stroke can bring about a profound disruption to people's lives, but what is less understood is the effect that specific dysfunctions can have. The aim of this study was to explore stroke survivors' experiences of upper-limb dysfunction over time. METHODS 13 adult stroke survivors engaged in a series of up to four semi-structured interviews over an 18-month period after stroke. Data were interpreted through a method based on framework analysis. An interpretive phenomenological approach guided the research. RESULTS Upper-limb dysfunction brought substantial challenges for people, identified in a main theme of an altered way of life. Subordinate themes that contributed to this alteration were challenges in personal care, participating in meaningful and valued activities, and managing life roles and relationships. The second main theme was the disrupted self, with subordinate themes of feeling devalued, disrupted self-image and changes in identity. CONCLUSION The impact of upper-limb dysfunction on people's lives after stroke should be understood and acknowledged by rehabilitation professionals. Restoring some functional upper-limb activity could play an important role in enabling a person to regain a meaningful life and a coherent sense of self after stroke.IMPLICATIONS FOR REHABILITATIONUpper-limb dysfunction after stroke, and the loss of bimanual hand function, can profoundly alter a person's life, rendering them unable to manage simple tasks of personal care, participate in valued activities and fulfil important life roles.These functional and social limitations can then disrupt their sense of self, with feelings of low self-worth, and changes in self-image and identity.It is important that these changes in stroke survivors' lives are acknowledged and understood by rehabilitation professionals. More prolonged periods of therapy for recovery of upper-limb function, or for developing compensatory strategies, should be considered so that people can regain some meaning in life and maintain a coherent sense of self.
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Affiliation(s)
- Judy Purton
- School of Science, Technology and Health, York St John University, York, UK.,School of Allied Health Professions, Keele University, Keele, UK
| | - Julius Sim
- School of Allied Health Professions, Keele University, Keele, UK.,School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Susan M Hunter
- School of Allied Health Professions, Keele University, Keele, UK
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18
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Pereira CM, Greenwood N, Jones F. From recovery to regaining control of life - the perspectives of people with stroke, their carers and health professionals. Disabil Rehabil 2020; 43:2897-2908. [PMID: 32036730 DOI: 10.1080/09638288.2020.1722263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: To understand how people with stroke and carers adapt over time, and how health professionals support transition to home.Method: A multi-perspective, prospective, qualitative, longitudinal study was conducted using in-depth semi-structured interviews one and six months after inpatient discharge. Twenty-four participants (eight triads, including people with stroke, carers and health professionals) were included. Thematic and narrative analysis facilitated identification of cross-cutting themes according to individual trajectories post-stroke.Findings: A major theme: "regaining control of life" suggested a shift in perspective after six months at home. Four sub-themes help to understand the triads' perspectives over time: i) importance of team involvement; ii) differences in perceived roles within the triad; iii) differences in expectations and collaboration within the triad and iv) planning a different future. People who were involved in supporting adaptation and rehabilitation processes were reported differently between triads and over time, showing the complexity of interrelations. A reduction in professional involvement was matched by changes in participants' goals and expectations.Conclusion: Findings suggest the importance of a dyadic perspective and a gradual increase in people with stroke and carers' active engagement. Professionals' approach throughout rehabilitation should be modified according to people with stroke and carers' changing needs and expectations.IMPLICATIONS FOR REHABILITATIONDivergence in perspectives about priorities and goals between the person with stroke their carers and healthcare professionals can lead to the creation of different agendas within rehabilitation.An open dialogue and decision-making process that involves both the person with stroke and carers is highly recommended for the identification of shared rehabilitation goals and to support ongoing recovery post discharge.A tailored approach to rehabilitation is required which focusses on shared priorities and includes individual or collective support for the person with stroke and their carers.Ongoing consultation about the desires of the person with stroke about rehabilitation, priorities and goals is important in order to tailor the professional approach to the stage individuals are at with their coping and adjustment post stroke.
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Affiliation(s)
- Carla Mendes Pereira
- Department of Physiotherapy, School of Health Care, Setubal Polytechnic Institute, Setúbal, Portugal
| | - Nan Greenwood
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
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19
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Sørensen KE, Dreyer P, Rasmussen M, Simonsen CZ, Andersen G. Experiences and needs of patients on the endovascular therapy pathway after acute ischaemic stroke: Being helpless and next to yourself. Nurs Open 2020; 7:299-306. [PMID: 31871714 PMCID: PMC6917975 DOI: 10.1002/nop2.391] [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] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 11/08/2022] Open
Abstract
Aims To explore the experiences and needs of patients on the endovascular therapy pathway. Design A qualitative design using a phenomenological-hermeneutic approach. Methods Semi-structured interviews and participant observations were carried out. Data were collected from April 2016-January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline. Results The findings of this study show that the impact of stroke goes far beyond physical disability. During the structural analysis, four themes were identified: (1) Acute admission to a stroke unit - an overwhelming and blurred experience. (2) Being helpless and next to yourself. (3) The important care when you worry about dying. (4) Poststroke feelings of loneliness and uncertainty.
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Affiliation(s)
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | - Mads Rasmussen
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | | | - Grethe Andersen
- Department of NeurologyAarhus University HospitalAarhus NDenmark
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20
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Xiao L, Gao Y, Zeng K, Zhang L. Perceived participation and its determinants among young and middle-aged stroke survivors following acute care one month after discharge. Disabil Rehabil 2019; 43:648-656. [PMID: 31437066 DOI: 10.1080/09638288.2019.1636314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe the perceived participation and assess its determinants among young and middle-aged stroke patients following acute care one month after discharge in mainland China. METHODS Two hundred and twenty-three patients were consecutively recruited from two tertiary hospitals and were followed up 1 month after discharge in the outpatient department or their communities to assess their participation by using the Impact on Participation and Autonomy Questionnaire, with 23 patients lost to follow-up. Determinants (i.e., sociodemographic, diseased-related, physical, psychological, and social factors) of participation were identified in four domains: indoor autonomy; outdoor autonomy; family role; and social life. RESULTS The overall perceived participation of our respondents was good to fair. Forty-six (23.0%), 32 (16.0%), 13 (6.5%), and 19 (9.5%) perceived their participation as "very good" in the domains of indoor autonomy, family role, outdoor autonomy and social life, respectively. Stroke severity, depressive symptoms, and social support were the common determinants of participation for all the domains, with stroke severity being the strongest correlate. Activities of daily living was associated with indoor autonomy, family role, and outdoor autonomy, but not associated with social life. CONCLUSIONS The perceived participation of our respondents is relatively optimistic. Physical health along with mental and social status can affect participation. Tailored strategies should be implemented early in the rehabilitation phase to promote stoke survivors' participation in all the domains.Implications for rehabilitationAlthough the overall perceived participation of young and middle-aged stroke patients was fair to good, attention should be paid to their family roles.The strategies should be mainly focused on reducing the stroke severity to improve patients' participation.Improving patients' depressive symptom and social support can also be helpful for improving their participation.
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Affiliation(s)
- Lin Xiao
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yulin Gao
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Kai Zeng
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- School of Nursing, Southern Medical University, Guangzhou, China
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21
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Palstam A, Sjödin A, Sunnerhagen KS. Participation and autonomy five years after stroke: A longitudinal observational study. PLoS One 2019; 14:e0219513. [PMID: 31283800 PMCID: PMC6613678 DOI: 10.1371/journal.pone.0219513] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Stroke is the second most common cause of disability in the world. The purpose of this study was to evaluate the participation and autonomy of persons with stroke, five years after a stroke, and to explore potential associations between factors and perceived restrictions in participation and autonomy. METHODS This five-year follow-up survey study included individuals diagnosed with a first-time stroke during 2009-2010, in Gothenburg. The survey included the Impact of Participation and Autonomy-questionnaire (IPA-E), which comprised five domains: Autonomy Indoor, Family Role, Autonomy Outdoor, Work & Education, and Social Life & Relationships. Logistic regression analyses were used to analyze factors associated with participation restrictions. RESULTS At 5 years after a stroke, 457 patients were alive; of these, 281 responded to the follow-up survey. Participation restrictions were most pronounced in the IPA-E domains of Autonomy Outdoors, Work/Education, and Social Life and Relationships. In contrast, restrictions were less pronounced in the IPA-E domains of Autonomy Indoors and Family Role. Severe stroke, older age, and female sex predicted participation restrictions at five years after a stroke. Participation restrictions were partly explained by feelings of depression at five years after stroke. Problems associated with participation restrictions were most frequently observed in the areas of mobility, leisure, and help/support from other people. CONCLUSION This study showed that participation and autonomy were restricted among persons with stroke at five years after the stroke. The domains perceived as most restricted were those that required high levels of physical, social, and cognitive abilities.
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Affiliation(s)
- Annie Palstam
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Astrid Sjödin
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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22
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Verberne D, Tse T, Matyas T, Baum C, Post M, Carey L, van Heugten C. Comparing Participation Outcome Over Time Across International Stroke Cohorts: Outcomes and Methods. Arch Phys Med Rehabil 2019; 100:2096-2105. [PMID: 31158335 DOI: 10.1016/j.apmr.2019.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/25/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To enable a direct comparison of participation levels in the first year post-stroke, assessed by different outcome measures internationally. DESIGN Two prospective stroke cohort studies following persons from stroke onset to 12 months post-stroke. SETTING Community. PARTICIPANTS Persons with stroke (N=495), not living at a nursing home, from Australia STroke imAging pRevention and Treatment-Prediction and Prevention to Achieve optimal Recovery Endpoints after stroke (START-PrePARE; n=100) and the Netherlands (Restore4stroke; n=395). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Activity Card Sort-Australia and Utrecht Scale for Evaluation of Rehabilitation-Participation. Activity domains were matched across measures to find common denominators and original scoring methods were recoded, hereby enabling a direct comparison of retained activities. RESULTS Ninety-one (START-PrePARE) and 218 (Restore4stroke) persons with stroke were included for analyses. No major differences in background characteristics were observed between the cohorts; the Dutch cohort suffered from slightly more severe stroke. A higher level of participation was observed (radar charts) in the first months post-stroke for the Australian cohort than in the Dutch cohort, especially for unpaid work (P<.003). At 12 months post-stroke, participation levels were similar, without significant differences in retained activities using the defined common denominators (P>.003). CONCLUSIONS An international comparison of actual activities that persons re-engage in in the first year post-stroke was achieved using a new method and recoding of data. High levels of participation were observed in both cohorts. Unpaid work showed different frequencies at 2-3 months, contributing to different trajectories over time across cultures. Important insights were gained. Although valuable information is inevitably lost with recoding, the approach may assist future studies on the harmonization of data across cohorts, particularly for 1 of the key outcomes of stroke: participation.
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Affiliation(s)
- Daan Verberne
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience, Maastricht, The Netherlands; Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Tamara Tse
- Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia; Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; St. Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - Thomas Matyas
- Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia; Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Marcel Post
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia; Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Caroline van Heugten
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience, Maastricht, The Netherlands; Limburg Brain Injury Centre, Maastricht, The Netherlands; Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht, the Netherlands.
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23
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Mairami FF, Warren N, Allotey PA, Reidpath DD. Contextual factors that shape recovery after stroke in Malaysia. Disabil Rehabil 2019; 42:3189-3198. [PMID: 30950658 DOI: 10.1080/09638288.2019.1588399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose: A stroke is a sudden event which may leave individuals and their families ill-prepared to deal with the resultant disability. Several contextual factors can influence the recovery process. These factors, internal and external, exist interactively in the lived experiences of the survivors. The limited availability of rehabilitation centres that are located in urban centres meant that recovery predominately occurred outside of the biomedical health and instead relied upon the resources available to individuals and their families.Methods: A qualitative approach with data from in-depth interviews and observations were used to identify contextual factors that shaped recovery following stroke in a community. Twenty-seven individuals with stroke were drawn from a health and demographic surveillance system in Malaysia.Results: Hope and optimism, coping strategies, motivation and support from family and friends, and the use of alternative and complementary medicine shaped the process of recovery within a context where infrastructure is extremely limited.Conclusion: The identification of factors that facilitate the recovery process provides a background in which health care providers can utilise to improve their understanding of the stroke experience. Such understanding could be instrumental in aiding health professionals to offer the most effective help to their clients.Implications for rehabilitationIdentification of contextual factors provides a background for the understanding of the stroke experience.Incorporation of religion into rehabilitation could support and maintain hope in recovery for the survivors and aid acceptance.A collaboration of healthcare professionals with traditional medicine therapists may prove beneficial for the rehabilitation of stroke survivors in Malaysia.
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Affiliation(s)
- Fatima Fanna Mairami
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Narelle Warren
- School of Social Sciences, Monash University, Clayton Campus, Melbourne, Australia
| | - Pascale A Allotey
- UN University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.,South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
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24
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Edmondson D, Birk JL, Ho VT, Meli L, Abdalla M, Kronish IM. A challenge for psychocardiology: Addressing the causes and consequences of patients' perceptions of enduring somatic threat. AMERICAN PSYCHOLOGIST 2018; 73:1160-1171. [PMID: 30525797 PMCID: PMC6619434 DOI: 10.1037/amp0000418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The enduring somatic threat (EST) model of posttraumatic stress disorder (PTSD) due to life-threatening medical events suggests that PTSD-like symptoms represent patients' sensitization to cues of ongoing threat in the body. In this article, we review research on the prevalence and consequences of such reactions in cardiovascular disease patients, discuss early tests of the EST model, and then report a new test of the EST model in 143 patients enrolled during their first acute coronary syndrome (ACS; i.e., non-ST elevation myocardial infarction or unstable angina-colloquially, "heart attack"). Invasive coronary revascularization procedures are commonly used to reduce secondary ACS risk and may reduce patients' EST, as revascularized patients often report being "cured." We assessed ACS patients' initial threat perceptions during emergency department (ED) evaluation and followed them for 1 month for PTSD symptoms (specific for ACS, by telephone). We compared PTSD symptoms in participants who were revascularized (n = 65), catheterized but not revascularized (n = 35), and medically managed (n = 43). PTSD symptoms were lower for revascularized versus medically managed participants (B = -5.32, 95% confidence interval [-9.77, -0.87]), t(98.19) = -2.37, p = .020. In a multiple regression model adjusted for clinical and psychosocial covariates, the interaction of threat perception in the ED and ACS management group was significant (greater ED threat predicted greater 1-month PTSD symptoms only in medically managed participants). These findings offer further support for the EST model and suggest that psychological interventions to preempt patients' development of EST should be considered in the hospital. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Donald Edmondson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Jeffrey L Birk
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Vivian T Ho
- Department of Medicine, College of Physicians & Surgeons, Columbia University
| | - Laura Meli
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Marwah Abdalla
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
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25
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Pallesen H, Næss-Schmidt ET, Kjeldsen SS, Pedersen SKS, Sørensen SL, Brunner I, Nielsen JF. "Stroke - 65 Plus. Continued Active Life": a study protocol for a randomized controlled cross-sectoral trial of the effect of a novel self-management intervention to support elderly people after stroke. Trials 2018; 19:639. [PMID: 30454014 PMCID: PMC6245630 DOI: 10.1186/s13063-018-2961-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Elderly people represent the majority of stroke cases worldwide. Post-stroke sequelae frequently lead to a more isolated life. Restricted social relations render older individuals with stroke a vulnerable group, especially in terms of social reintegration. Reintegration into the community after a stroke largely depends on support from the family. However, close relatives are at risk of becoming overburdened. The aim of this study is to investigate the effect of a novel self-management intervention to support elderly people after stroke. Methods/Design Randomized controlled trial. Two weeks before discharge from a rehabilitation hospital/center, individuals with stroke aged > 65 years will be randomized either to a group receiving conventional neurorehabilitation (control) or to an additional novel self-management intervention. In the intervention group, patients with stroke will be offered eight self-management sessions of 45–60 min duration by a physiotherapist or an occupational therapist during a period of nine months after discharge. Inclusion will continue until at least 35 individuals in each group have been recruited. Study outcome measurements: Stroke Self-efficacy Questionnaire, a short version of Stroke Specific Quality of Life Scale, Impact on Participation and Autonomy and Caregiver Burden Scale. Furthermore, physical activity will be assessed using accelerometers. All outcomes except “impact on participation” and “autonomy” will be assessed at baseline, three months, and nine months after discharge. Impact on participation and autonomy will be assessed at three and nine months after discharge. Patient, informal caregiver, and therapist satisfaction will be examined by way of questionnaires and interviews. Discussion Self-management interventions are promising strategies for rehabilitation, potentially increasing self-efficacy, quality of life, as well as participation and autonomy. The introduction of a novel self-management intervention in combination with traditional physical and occupational therapy may enhance recovery after stroke and quality of life and lessen the burden on relatives. This trial “Stroke - 65 Plus. Continued Active Life,” will provide further evidence of self-management strategies to clinicians, patients, and health economists. Trial registration ClinicalTrials.gov, NCT03183960. Registered on 12 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2961-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark.
| | | | - Simon Svanborg Kjeldsen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Sedsel Kristine Stage Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Susanne Lillelund Sørensen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Iris Brunner
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
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26
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Rutherford SJ, Hocking C, Theadom A, McPherson KM. Exploring challenges at 6 months after stroke: what is important to patients for self-management? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.11.565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Self-management models have recently been applied to stroke, but the most effective components are yet to be determined. To inform the ongoing refinement of stroke self-management programmes, this study explored challenges at 6 months after stroke. Methods: A total of 53 stroke survivors and 26 significant others were interviewed 6 months after stroke. Results were analysed qualitatively using thematic analysis. Findings: Stroke was experienced as a shocking and frightening event regardless of severity, and participants struggled to manage the consequences of their stroke. The stroke experience occurred within the context of more than one chronic condition and with competing demands of everyday life. Participants struggled to formulate a model of causation for their stroke, yet this appeared a necessary basis for action. Conclusions: The findings suggest that health care targeted at enhancing self-management, including self-management programmes, may benefit from encompassing a specific focus on participants' beliefs as an important foundation for recovery after stroke.
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Affiliation(s)
- Sandy J Rutherford
- Lecturer, occupational therapy; Research officer, Centre for Person Centred Research, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Clare Hocking
- Professor of occupational science and therapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Associate professor, National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Kathryn M McPherson
- Chief Executive Officer, Health Research Council of New Zealand, and Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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27
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Rannikko S, Stolt M, Suhonen R, Leino-Kilpi H. Ethical issues in the care of patients with stroke: A scoping review. J Clin Nurs 2018; 28:20-31. [PMID: 30184289 DOI: 10.1111/jocn.14661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/25/2018] [Accepted: 08/30/2018] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES The aim was to identify and analyse the ethical issues in the care of patients with stroke (PwS). The goal was to understand the nature of the existing knowledge on the topic and to identify whether there are ethical issues specific to the care of PwS. BACKGROUND Stroke is a disease with possible multiple effects on the patient's overall condition and experienced ethical issues in the care. Additionally, stroke impacts the life of the significant other. For health professionals, the care of PwS is challenging at different stages of the care process. The care of stroke includes several ethically sensitive situations from the perspectives of all participants. DESIGN Scoping review. METHODS The review was conducted following the five-stage methodological framework of Arksey and O'Malley (2005). The literature search was conducted in several electronic databases and complemented with a manual search, resulting in 15 reviewed articles. The analysis was conducted by charting descriptive numerical data and by content analysis of the narrative representations. RESULTS The studies focused on hospital or rehabilitation contexts and a high number of studies had a qualitative approach. Three main themes were identifiable: "decision-making as an ethically challenging act," "care process-specific ethical issues" and "environmental ethical issues." CONCLUSIONS Ethical issues occur at different stages of the care process of PwS and from the viewpoints of all those involved. However, not all the recognised ethical issues were stroke specific. As the number of the reviewed articles was limited, more research is needed for a comprehensive understanding of the topic. RELEVANCE TO CLINICAL PRACTICE Individual health professionals may use the results in observing their own action from an ethical perspective and to deepen the ethical understanding of the care of PwS. In health care organisations, the results may be used in developing the ethical quality of care.
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Affiliation(s)
| | - Minna Stolt
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,City of Turku, Welfare Division, Turku, Finland
| | - Riitta Suhonen
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Helena Leino-Kilpi
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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28
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Mairami FF, Warren N, Allotey PA, Mak JS, Reidpath DD. Documenting the impact of stroke in a middle-income country: a Malaysian case study. Disabil Rehabil 2018; 42:102-113. [PMID: 30183424 DOI: 10.1080/09638288.2018.1493544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: Stroke is an abrupt event that often leaves survivors with long term disabilities, causing role changes, and financial strains on households. The profound impact of stroke on survivors may lead to a decline in quality of life due to the physical, psychological, and social difficulties they experience. Taking Malaysia as an example, this study aimed to explore the impact of stroke on survivors and how health services influence their recovery in low and middle-income countries (LMIC).Method: An ethnographic approach with data obtained primarily through in-depth interviews was used. Twenty-seven participants identified as having suffered a stroke were drawn from a health and demographic surveillance system in Malaysia.Results: The physical and social disruption of the lives of stroke survivors was intensified by the resultant financial constraints placed upon individuals, families and households, compounded by inadequate support from the health, and welfare systems. Despite the disruption to their lives, most participants were, at least in part, able to reestablish their lives through various factors that include a strong family support and active coping strategies.Conclusion: In LMIC, recovery can be shaped by the family unit and through active coping strategies especially those in relation to spirituality.Implications for rehabilitationThe impact of stroke on survivors and lack of specialized stroke care compromise the recovery process and quality of life for stroke survivors in low and middle-income countries.Support from the family and reinforcement of religious coping were judged to successfully aid recovery.Physical and emotional impairments as well as psychosocial wellbeing of survivors in the context of environmental factors need to be addressed.
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Affiliation(s)
- Fatima Fanna Mairami
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Narelle Warren
- School of Social Sciences, Clayton Campus, Monash University, Melbourne, Australia
| | - Pascale A Allotey
- UN University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Jun Shin Mak
- School of Social Sciences, Clayton Campus, Monash University, Melbourne, Australia
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.,South East Asia Community Observatory (SEACO), Monash University, Segamat, Johor, Malaysia
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29
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Verberne DPJ, Post MWM, Köhler S, Carey LM, Visser-Meily JMA, van Heugten CM. Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors. Neurorehabil Neural Repair 2018; 32:821-833. [PMID: 30178696 PMCID: PMC6146317 DOI: 10.1177/1545968318796341] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background. Many persons with stroke experience physical, cognitive, and emotional problems that contribute to restrictions in social participation. There is, however, a lack of knowledge on the long-term course of participation over time post-stroke. Objective. To describe the time course of participation up to 2 years post-stroke and to identify which demographic and stroke-related factors are associated with this time course. Methods. This was a multicenter, prospective cohort study following 390 persons with stroke from hospital admission up to 2 years (at 2, 6, 12, and 24 months). Multilevel modeling with linear and quadratic time effects was used to examine the course of the frequency of vocational and social/leisure activities, experienced restrictions, and satisfaction with participation. Results. The frequency of vocational activities increased up to 1 year post-stroke and leveled off thereafter. Older and lower-educated persons showed less favorable courses of participation than younger and higher-educated persons, respectively. The frequency of social/leisure activities decreased post-stroke. Participation restrictions declined up to 1 year post-stroke and leveled off thereafter. Persons dependent in activities of daily living (ADL) kept experiencing more restrictions throughout time than independent persons. Satisfaction with participation increased slightly over time. Conclusions. Changes in participation occurred mostly in the first year post-stroke. Particularly older and lower-educated persons, and those dependent in ADL showed less favorable courses of participation up to 2 years post-stroke. Clinicians can apply these findings in identifying persons most at risk of long-term unfavorable participation outcome and, thus, target rehabilitation programs accordingly.
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Affiliation(s)
- Daan P J Verberne
- 1 Maastricht University Medical Center, Netherlands.,2 Limburg Brain Injury Center, Maastricht, Netherlands
| | - Marcel W M Post
- 3 Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,4 University of Groningen, Netherlands
| | | | - Leeanne M Carey
- 5 La Trobe University, Melbourne, Australia.,6 Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Johanna M A Visser-Meily
- 3 Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,7 University Utrecht, Netherlands
| | - Caroline M van Heugten
- 1 Maastricht University Medical Center, Netherlands.,2 Limburg Brain Injury Center, Maastricht, Netherlands.,8 Maastricht University, Netherlands
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30
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Connolly T, Mahoney E. Stroke survivors’ experiences transitioning from hospital to home. J Clin Nurs 2018; 27:3979-3987. [DOI: 10.1111/jocn.14563] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/02/2018] [Accepted: 06/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ellen Mahoney
- Connell School of Nursing; Boston College; Chestnut Hill Massachusetts
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31
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Mah J, Jutai JW, Finestone H, Mckee H, Carter M. Usability of a Low-Cost Head Tracking Computer Access Method following Stroke. Assist Technol 2018; 27:158-71. [PMID: 26427744 DOI: 10.1080/10400435.2015.1006343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Assistive technology devices for computer access can facilitate social reintegration and promote independence for people who have had a stroke. This work describes the exploration of the usefulness and acceptability of a new computer access device called the Nouse™ (Nose-as-mouse). The device uses standard webcam and video recognition algorithms to map the movement of the user's nose to a computer cursor, thereby allowing hands-free computer operation. Ten participants receiving in- or outpatient stroke rehabilitation completed a series of standardized and everyday computer tasks using the Nouse™ and then completed a device usability questionnaire. Task completion rates were high (90%) for computer activities only in the absence of time constraints. Most of the participants were satisfied with ease of use (70%) and liked using the Nouse™ (60%), indicating they could resume most of their usual computer activities apart from word-processing using the device. The findings suggest that hands-free computer access devices like the Nouse™ may be an option for people who experience upper motor impairment caused by stroke and are highly motivated to resume personal computing. More research is necessary to further evaluate the effectiveness of this technology, especially in relation to other computer access assistive technology devices.
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Affiliation(s)
- Jasmine Mah
- a Interdisciplinary School of Health Sciences , University of Ottawa , Ottawa , Canada
| | - Jeffrey W Jutai
- a Interdisciplinary School of Health Sciences , University of Ottawa , Ottawa , Canada
| | - Hillel Finestone
- b Bruyère Research Institute , Ottawa , Canada.,c Bruyère Continuing Care , Ottawa , Canada.,d Division of Physical Medicine and Rehabilitation, Faculty of Medicine , University of Ottawa , Ottawa , Canada
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32
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Thomas CM, Allison R, Latour JM. Using blogs to explore the lived-experience of life after stroke: "A journey of discovery I never wanted to take". J Adv Nurs 2017; 74:579-590. [PMID: 28910496 DOI: 10.1111/jan.13457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
AIMS To explore the lived-experiences of stroke survivors as expressed in blogs and to discover the role the blogs play in the writers' lives. BACKGROUND Stroke can be a devastating, life changing event. Previous qualitative studies tend to examine one aspect of life after stroke. As stroke often has multiple effects, it is necessary to look widely at its lived-experience. New resources which can enable researchers to explore the lived-experience of stroke are blogs. DESIGN Phenomenological exploration using an interpretive thematic analysis. METHODS The Internet was searched for stroke survivors' blogs (January-March 2016) using pre-set criteria, seeking blogs with entries over an extended time (>1 year). Suitable blogs were identified and codes of meaning were identified and developed into categories, subthemes and themes. FINDINGS Eight blogs were identified for analysis. Of the 40 categories, eight subthemes were assimilated; internal dialogue, emotions, transition, stroke effects, health care, "in the world", relationships, rehabilitation. Two main themes were identified related to perspectives of lived-experience; Internal relationship with "self" and External relationship with "the world". Participants expressed loss and initially strove to regain their "old" lives, their focus being recovery and independence. CONCLUSION Stroke survivors must transition from their previous life to a new and initially unwelcome way of being. Rehabilitation should respect this process and support stroke survivors as they undertake this individual journey.
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Affiliation(s)
- Caroline M Thomas
- Torbay and South Devon NHS Foundation Trust, Torquay, UK.,School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.,School of Nursing, Midwifery and Paramedicine, Faculty of Human Science, Curtin University, Perth, WA, Australia
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33
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Loft MI, Poulsen I, Esbensen BA, Iversen HK, Mathiesen LL, Martinsen B. Nurses’ and nurse assistants’ beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit-A qualitative study. J Clin Nurs 2017; 26:4905-4914. [DOI: 10.1111/jocn.13972] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mia I Loft
- Department of Neurology; Rigshospitalet; Glostrup Denmark
- Department of Nursing Science; Institute of Public Health; Aarhus University; Aarhus C Denmark
| | - Ingrid Poulsen
- Department of Nursing Science; Institute of Public Health; Aarhus University; Aarhus C Denmark
- Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC); Clinic of Neurorehabilitation; TBI unit Rigshospitalet; Hvidovre Denmark
| | - Bente A Esbensen
- Copenhagen Centre for Arthritis Research (COPECARE); Centre for Rheumatology and Spine Diseases VRR; Head and Orthopaedics Centre; Rigshospitalet - Glostrup; Glostrup Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Helle K Iversen
- Department of Neurology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Bente Martinsen
- Department of Public Health; Section of Nursing; Faculty of Health; Aarhus University; Copenhagen NV Denmark
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34
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Zhang L, Yan T, You L, Gao Y, Li K, Zhang C. Functional activities and social participation after stroke in rural China: a qualitative study of barriers and facilitators. Clin Rehabil 2017; 32:273-283. [DOI: 10.1177/0269215517719486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To explore the perspectives of stroke survivors in China’s rural areas, particularly with respect to environmental barriers and facilitators related to their functional activity and social participation. Design: Qualitative content analysis. A cross-sectional study. Setting: In-depth interviewing in the participants’ homes. Subjects: In total, 18 community-dwelling stroke survivors in the rural areas of China. Results: The sub-themes to functional activity and social participation were restricted life-space mobility, reduced daily activities, and shrunken social networks. The main environmental facilitator was family support, which positively affected all facets of the participants’ lives, including assistance in daily living, assistance in gaining access to healthcare, and performing environmental modifications. The main barriers involved were physical barriers (toilet barriers, lack of assistive devices, barriers to getting out) and vague and complex regulations. Conclusion: Stroke survivors in rural China experienced environmental barriers mainly including physical barriers and complex regulations. The nuclear family’s support is an important environmental facilitator.
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Affiliation(s)
- Lifang Zhang
- School of Nursing, Youjiang Medical University for Nationalities, Baise, China
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yan Gao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Chunbo Zhang
- Huatuo Zaizao Philanthropic Fund Organization, Guangzhou, China
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35
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Pallesen H, Lund LB, Jensen M, Roenn-Smidt H. The body participating: a qualitative study of early rehabilitation participation for patients with severe brain injury and low level of consciousness. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1347706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Arhus, Denmark
| | | | - Marianne Jensen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Arhus, Denmark
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36
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37
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Hawkins RJ, Jowett A, Godfrey M, Mellish K, Young J, Farrin A, Holloway I, Hewison J, Forster A. Poststroke Trajectories: The Process of Recovery Over the Longer Term Following Stroke. Glob Qual Nurs Res 2017; 4:2333393617730209. [PMID: 28932766 PMCID: PMC5600296 DOI: 10.1177/2333393617730209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/18/2017] [Accepted: 07/02/2017] [Indexed: 11/17/2022] Open
Abstract
We adopted a grounded theory approach to explore the process of recovery experienced by stroke survivors over the longer term who were living in the community in the United Kingdom, and the interacting factors that are understood to have shaped their recovery trajectories. We used a combination of qualitative methods. From the accounts of 22 purposively sampled stroke survivors, four different recovery trajectories were evident: (a) meaningful recovery, (b) cycles of recovery and decline, (c) ongoing disruption, (d) gradual, ongoing decline. Building on the concept of the illness trajectory, our findings demonstrate how multiple, interacting factors shape the process and meaning of recovery over time. Such factors included conception of recovery and meanings given to the changing self, the meanings and consequences of health and illness experiences across the life course, loss, sense of agency, and enacting relationships. Awareness of the process of recovery will help professionals better support stroke survivors.
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Affiliation(s)
| | - Adam Jowett
- Coventry University, Coventry, United Kingdom
| | | | | | - John Young
- University of Leeds, Leeds, United Kingdom
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | | | | | | | - Anne Forster
- University of Leeds, Leeds, United Kingdom
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
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Satink T, Josephsson S, Zajec J, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. Self-management develops through doing of everyday activities-a longitudinal qualitative study of stroke survivors during two years post-stroke. BMC Neurol 2016; 16:221. [PMID: 27846820 PMCID: PMC5111179 DOI: 10.1186/s12883-016-0739-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/29/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A description of the complexity of the process of self-management and the way stroke survivors give meaning to their process of self-management post-stroke is lacking. This study explores how stroke survivors managed their lives, gave meaning to their self-management post-stroke and how this evolved over time. METHODS Data was generated through participant observations and interviews of 10 stroke survivors at their homes at 3, 6, 9, 15 and 21 months post-discharge. A constant comparative method was chosen to analyse the data. RESULTS 'Situated doing' was central in stroke survivors' simultaneous development of self-management and their sense of being in charge of everyday life post-stroke. Doing everyday activities provided the stroke survivors with an arena to explore, experience, evaluate, develop and adapt self-management and being in charge of everyday activities and daily life. The influence of stroke survivors' partners on this development was sometimes experienced as empowering and at other times as constraining. Over time, the meaning of self-management and being in charge changed from the opinion that self-management was doing everything yourself towards self-managing and being in charge, if necessary, with the help of others. Moreover, the sense of self-management and being in charge differed among participants: it ranged from managing only at the level of everyday activities to full role management and experiencing a meaningful and valuable life post-stroke. CONCLUSIONS The findings of this study indicate the doing of activities as an important arena in which to develop self-management and being in charge post-stroke. Stroke self-management programs could best be delivered in stroke survivors' own environment and focus on not only stroke survivors but also their relatives. Furthermore, the focus of such interventions should be on not only the level of activities but also the existential level of self-management post-stroke.
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Affiliation(s)
- Ton Satink
- Department of Occupational, Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health, Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
- Research Group, Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Staffan Josephsson
- Division of Occupational Therapy, Department of Neurobiology, Caring Science and Society, Karolinska Institute, Stockholm, Sweden
- Department of Applied Social Sciences, NTNU, Norwegian University og Technology and Science, Trondheim, Norway
| | - Jana Zajec
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith H. C. Cup
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert J. M. de Swart
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Group, Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health, Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
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Corr S, Neill G, Turner A. Comparing an Occupational Therapy Definition and Consumers' Experiences: A Q Methodology Study. Br J Occup Ther 2016. [DOI: 10.1177/030802260506800802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occupational therapy has been defined as a complex intervention (Creek 2003), on behalf of the College of Occupational Therapists. This definition was generated from a study involving occupational therapists but not consumers of services. The aim of the present study was to explore how Creek's (2003) definition of occupational therapy compared with the experience of ex-consumers whose contact with occupational therapy had been through stroke services. A Q methodology study was conducted with 16 participants recruited through stroke clubs in two large cities. A Q-sort pack of 32 statements was developed based upon Creek's (2003) definition of occupational therapy. Participants sorted the statements along a ‘least to most’ continuum, indicating how much each statement reflected their own experience of receiving occupational therapy. Following analysis, six factors were identified which suggested that, for these participants, occupational therapy: facilitated and improved their sense of self; recognised the importance of being heard; provided practical assistance; assisted with maintaining autonomy; generated the desire for involvement; and had general benefits. The factors identified reflected aspects of Creek's (2003) definition of occupational therapy and suggested congruence in certain concepts between the professional body and consumers. Although limited by the fact that the participants had accessed different occupational therapy services some time ago, this study also introduces a method of obtaining consumers' views of occupational therapy.
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Maratos M, Huynh L, Tan J, Lui J, Jarus T. Picture This: Exploring the Lived Experience of High-Functioning Stroke Survivors Using Photovoice. QUALITATIVE HEALTH RESEARCH 2016; 26:1055-1066. [PMID: 27194645 DOI: 10.1177/1049732316648114] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An increasing number of high-functioning stroke survivors are present with minimal functional impairments and are often discharged with reduced access to community reintegration. Our objectives were to explore the lived experience of high-functioning stroke survivors and to identify gaps in community and rehabilitation services. Photovoice was used with five high-functioning stroke survivors to photo-document their experiences. A modified inductive thematic analysis was used, and meanings behind the photographs were elicited through four focus group sessions followed by photography exhibitions. Five themes emerged: lack of understanding and consideration for persons with disability, emotional and behavioral impacts after stroke, self-reliance and dependence on others, importance of appropriate and accessible services, and financial determinants of quality of life. By including service users' voices; investing in adapted, community-based programs; and providing educational programs for creating attitudinal change among service providers, the polarization between who can and cannot access services will be reduced.
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Affiliation(s)
- Marie Maratos
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Linh Huynh
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Tan
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordon Lui
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tal Jarus
- The University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Stroke is the third leading cause of death of people in the world today and the highest cause of disability and handicap, producing a huge burden on individuals and society more broadly. Yet unlike its counterpart acute myocardial infarction (AMI), little has been done to promote early intervention in evolving strokes. Recommendations from the American Heart Association and more recently the European Stroke Initiative are available; however, in Australia (as with many other countries) practice guidelines are scarce and clinicians largely operate in an ad hoc manner with little awareness of ‘best practice’. The controversial role of thrombolysis with limitations in respect to selecting appropriate patients, in addition to a small window of opportunity for therapeutic beneficial effects and a high risk for haemorrhage, has inhibited its widespread application. As such, emergent stroke management clearly lags behind that of AMI–both with respect to the range of treatment options and the application of best practice. This paper reviews the literature regarding best practice management of evolving stroke and the crucial role of nurses in triaging and managing patients to deliver optimal outcomes within the Australian context.
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Satink T, Josephsson S, Zajec J, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. Negotiating role management through everyday activities: narratives in action of two stroke survivors and their spouses. Disabil Rehabil 2016; 38:2354-64. [PMID: 26854923 DOI: 10.3109/09638288.2015.1129442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To manage social roles is a challenging part of self-management post-stroke. This study explored how stroke survivors act as role managers with their spouses in the context of everyday activities. METHOD Two stroke survivors with a first time stroke living at home with a spouse were included. Data were generated through participant observations at their own environment at 3, 6, 9, 15 and 21 months post-discharge. The narrative analysis focused on the actions of participants. RESULTS Daily activities can be understood as an arena where role management and a meaningful live is negotiated and co-constructed with others. Everyday activities gave stroke survivors and their spouses insight into stroke survivors' capacities in daily situations. This was sometimes empowering, and other times conflicting when a spouse had negative perceptions of the abilities of the stroke survivors. CONCLUSION The findings add to the current understanding of self-management and role management with regard to how these are situated in everyday activities. Daily activities can help both spouses to reflect and understand about self-management, role management and comanagement in daily life. Moreover, observing stroke survivors in everyday situations provides professionals with concrete pictures of stroke survivors' performance and self-management in interaction with their spouses. Implications for Rehabilitation Self-management is a dynamic process in which individuals actively manage a chronic condition and finally live a meaningful life with a long-term chronic condition; self-management can be divided into medical, role, and emotional management; comanagement is when individuals activate resources and use the capacities of other persons to manage a situation together. Self-management is situated in everyday activities. Everyday activities give stroke survivors ánd their partners impressions about stroke survivors' self-management abilities post-stroke in an everyday context. Everyday activities give stroke survivors ánd their partners an arena where role management and a meaningful life are negotiated and coconstructed through doing. Observing stroke survivors in everyday situations provides professionals a concreter picture of stroke survivors' self-management and comanagement with their partners than can be obtained from an informal interview.
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Affiliation(s)
- Ton Satink
- a Department of Occupational Therapy and Research Group Neurorehabilitation , HAN University of Applied Sciences , Nijmegen , The Netherlands ;,b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Staffan Josephsson
- c Department of Neurobiology, Division of Occupational Therapy , Caring Science and Society, Karolinska Institute , Stockholm , Sweden ;,d Department of Occupational Therapy, Faculty of Health Science , Sør-Trøndelag University College , Trondheim , Norway
| | - Jana Zajec
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Edith H C Cup
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Bert J M de Swart
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands ;,e Research Group Neurorehabilitation , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
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Todd A, Holmes H, Pearson S, Hughes C, Andrew I, Baker L, Husband A. 'I don't think I'd be frightened if the statins went': a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals. BMC Palliat Care 2016; 15:13. [PMID: 26822776 PMCID: PMC4731932 DOI: 10.1186/s12904-016-0086-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily. In this context, the perspective of patients, their carers and the healthcare professionals responsible for prescribing and monitoring their medication is important for developing deprescribing strategies. The aim of this study was to explore the lived experience of patients, carers and healthcare professionals in the context of medication use in life-limiting illness. Methods In-depth interviews, using a phenomenological approach: methods of transcendental phenomenology were used for the patient and carer interviews, while hermeneutic phenomenology was used for the healthcare professional interviews. Results The study highlighted that medication formed a significant part of a patient’s day-to-day routine; this was also apparent for their carers who took on an active role-as a gatekeeper of care-in managing medication. Patients described the experience of a point in which, in their disease journey, they placed less importance on taking certain medications; healthcare professionals also recognize this and refer it as a ‘transition’. This point appeared to occur when the patient became accepting of their illness and associated life expectancy. There was also willingness by patients, carers and healthcare professionals to review and alter the medication used by patients in the context of life-limiting illness. Conclusions There is a need to develop deprescribing strategies for patients with life-limiting illness. Such strategies should seek to establish patient expectations, consider the timing of the discussion about ceasing treatment and encourage the involvement of other stakeholders in the decision-making progress.
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Affiliation(s)
- Adam Todd
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK.
| | - Holly Holmes
- Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center, Houston, TX, USA.
| | - Sallie Pearson
- Faculty of Pharmacy and School of Public Health, The University of Sydney, Sydney, Australia.
| | - Carmel Hughes
- School of Pharmacy, Queen's University, Belfast, UK.
| | - Inga Andrew
- St Benedict's Hospice and Centre for Specialist Palliative Care, Ryhope, Sunderland, UK.
| | - Lisa Baker
- St Benedict's Hospice and Centre for Specialist Palliative Care, Ryhope, Sunderland, UK.
| | - Andy Husband
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK.
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Rochette A, Gaulin P, Chamelian L, Hebert L, Lapierre M, Deschaintre Y. Circumstances surrounding the onset of stroke: a qualitative study. J Adv Nurs 2015; 72:641-9. [PMID: 26586146 DOI: 10.1111/jan.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/28/2022]
Abstract
AIM To document perceptions of circumstances spontaneously associated with the occurrence of the stroke on that particular day. BACKGROUND Known triggers of stroke include birthday or negative emotions. However, specific circumstances relating to that birthday or emotion have not yet been documented. DESIGN Phenomenological perspective where data were collected between October 2011-June 2012. METHOD In-depth interviews conducted 5-8 weeks post stroke with 37 participants, with a mean age of 56·3 years (sd 11·9) and 40·5% (14/37) of whom were female. An interview guide composed of open-ended questions and developed with experts was used to explore in detail free associations surrounding the stroke. All interviews were audiotaped and transcribed. Data were rigorously analysed by two team members and discussed in team meetings until reaching consensus on essential themes. FINDINGS Relationships emerged as being the overarching theme related to stroke triggers with the interrelated subthemes of: (1) birthday or anniversary; (2) parenting; (3) being sick seen as a benefit; and (4) alcohol or drug abuse. The stroke happened on a day which was related in some way to a relationship with a significant other affected by tension, a lack of transparency or an overinvestment of emotional/affective state. CONCLUSIONS There is a need to address individuals' beliefs as a part of secondary prevention interventions to be truly client-centred, which the phenomenological perspective allows. Relationships as a potential source of stress should be added as a theme to discuss with patients for a holistic approach to stroke prevention including psychosocial factors.
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Affiliation(s)
- Annie Rochette
- Montreal University, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | - Philippe Gaulin
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | - Laury Chamelian
- Montreal University, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal, Notre-Dame, Quebec, Canada
| | - Lucie Hebert
- Montreal University, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal, Notre-Dame, Quebec, Canada
| | - Marlene Lapierre
- Centre Hospitalier de l'Université de Montréal, Notre-Dame, Quebec, Canada
| | - Yan Deschaintre
- Montreal University, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal, Notre-Dame, Quebec, Canada
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Nordin Å, Sunnerhagen KS, Axelsson ÅB. Patients' expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study. BMC Neurol 2015; 15:235. [PMID: 26572860 PMCID: PMC4647613 DOI: 10.1186/s12883-015-0492-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients' expectations of coming home very early after stroke with support and rehabilitations at home. METHOD This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0-5 days before discharge and the material was analyzed with qualitative content analysis. RESULTS Four main categories containing 11 subcategories were found. The VESD team was expected to provide "Support towards independency", by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to "A new and unknown situation", causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, "Returning to one's own setting" described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. "A new everyday life" waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. CONCLUSIONS The participants described mixed expectations such as insecurity and fear, and on the other hand, longing to come home. Moreover, they had a high degree of confidence in the expected support of the VESD team. The health professionals at the hospital may build on this trust to reduce the patients' insecurity for coming home. In addition, it may be beneficial to explore the patients' expectations thoroughly in front of discharge, as certain feelings and thoughts could complicate or support the home coming process. Thus, a greater attention on such expectations may facilitate the patient's transition from hospital to home after stroke.
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Affiliation(s)
- Åsa Nordin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Sunnaas Rehabilitation Hospital, Nesodden, Oslo, Norway.
| | - Åsa B Axelsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Latchem J, Kitzinger J, Kitzinger C. Physiotherapy for vegetative and minimally conscious state patients: family perceptions and experiences. Disabil Rehabil 2015; 38:22-9. [PMID: 25669235 PMCID: PMC4696242 DOI: 10.3109/09638288.2015.1005759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/03/2015] [Accepted: 01/06/2015] [Indexed: 12/02/2022]
Abstract
PURPOSE To examine family perceptions of physiotherapy provided to relatives in vegetative or minimally conscious states. METHOD Secondary thematic analysis of 65 in-depth narrative interviews with family members of people in vegetative or minimally conscious states. RESULTS Families place great significance on physiotherapy in relation to six dimensions: "Caring for the person", "Maximising comfort", "Helping maintain health/life", "Facilitating progress", "Identifying or stimulating consciousness" and "Indicating potential for meaningful recovery". They can have high expectations of what physiotherapy may deliver but also, at times, express concerns about physiotherapy's potential to cause pain or distress, or even constitute a form of torture if they believe there is no hope for "meaningful" recovery. CONCLUSION Physiotherapists can make an important contribution to supporting this patient group and their families but it is vital to recognise that family understandings of physiotherapy may differ significantly from those of physiotherapists. Both the delivery and the withdrawal of physiotherapy is highly symbolic and can convey (inadvertent) messages to people about their relative's current and future state. A genuine two-way dialogue between practitioners and families about the aims of physiotherapeutic interventions, potential outcomes and patients' best interests is critical to providing a good service and establishing positive relationships and appropriate treatment. IMPLICATIONS FOR REHABILITATION Families of people in PVS or MCS consider physiotherapy as a vital part of good care. Clear communication is critical if therapeutic input is withdrawn or reduced. The purpose of physiotherapy interventions can be misinterpreted by family members. Physiotherapists need to clarify what physiotherapy can, and cannot, achieve. Families can find some interventions distressing to witness--explaining to families what interventions involve, what they can expect to see (and hear) may be helpful. Physiotherapists and families can attribute different meanings to physiotherapy. Physiotherapists need to identify how families view interventions and modify their explanations accordingly to enhance information sharing.
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Affiliation(s)
- Julie Latchem
- School of Social Sciences, Cardiff University,
Cardiff,
UK
| | - Jenny Kitzinger
- School of Journalism, Media and Cultural Studies, Cardiff University,
Cardiff,
UK
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Gorst T, Lyddon A, Marsden J, Paton J, Morrison SC, Cramp M, Freeman J. Foot and ankle impairments affect balance and mobility in stroke (FAiMiS): the views and experiences of people with stroke. Disabil Rehabil 2015; 38:589-96. [DOI: 10.3109/09638288.2015.1052888] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Venna VR, McCullough LD. Role of social factors on cell death, cerebral plasticity and recovery after stroke. Metab Brain Dis 2015; 30:497-506. [PMID: 24748365 PMCID: PMC4206683 DOI: 10.1007/s11011-014-9544-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/04/2014] [Indexed: 12/27/2022]
Abstract
Stroke is a serious global health care problem. It is now is the fourth leading cause of death and the primary cause of adult disability in the United States. Substantial evidence from both experimental and clinical studies has demonstrated that social isolation (SI) can increase stroke incidence and impair recovery. Epidemiological studies demonstrate that an increasing number of patients are living alone, and as the aging population increases, loneliness will only increase in prevalence. SI is increasingly identified as an independent risk factor for all-cause mortality. In contrast, individuals with high levels of social support exhibit more rapid and extensive functional and cognitive recovery after a wide variety of pathological insults, including stroke. Clinical data suggests that SI is an important risk factor for increased mortality and delayed functional recovery following ischemic stroke. Attesting to the importance of mortality and behavioral factors in stroke outcome is that these same effects can be reproduced in animal models of experimental stroke. This has allowed researchers to identify several mechanistic changes that occur with affiliative interactions. These include decreased systemic inflammation, elaboration of growth factors including brain derived neurotropic factor (BDNF), enhanced neurogenesis, and improved neuroimmune responsiveness in group housed animals. These may mediate the beneficial effects of social interaction on improving stroke recovery and reducing neuronal death. In this review we provide an overview of the effects of SI on ischemic injury and recovery and discuss their clinical and therapeutic implications.
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Affiliation(s)
- Venugopal Reddy Venna
- Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut 06030, USA
| | - Louise D. McCullough
- Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut 06030, USA
- Department of Neurology, 263 Farmington Avenue, Farmington, Connecticut 06030, USA
- The Stroke Center at Hartford Hospital, 85 Jefferson Street, Hartford Connecticut 06102, USA
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Anderson S, Marlett NJ. The Language of Recovery: How Effective Communication of Information Is Crucial to Restructuring Post-Stroke Life. Top Stroke Rehabil 2015; 11:55-67. [PMID: 15592990 DOI: 10.1310/npc4-01yv-p66q-vm9r] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Providing appropriate and effective information to people with stroke and their families has been identified as a key component to successful practice. Researchers continue to focus on "lack of information" as being the lack of specific technical medical information rather than the communication of practical knowledge and how people use that knowledge to restructure life after stroke. To meet patients' expectations and achieve better outcomes in stroke, professionals need access to communication theory, research, and training. OBJECTIVES Improve stroke communication systematically. METHOD This article will examine stroke communication using a three-part framework: 1. Utilize theory to clearly conceptualize how communication influences stroke outcome. 2. Identify components and mechanisms of communication content to positively influence stroke outcome. 3. Develop goals and strategies for putting content skills into stroke communication practice. CONCLUSION Relatively little is known about the content and structure of informal communication transactions between stroke survivors, families, and health care professionals and how they accommodate (or resist) realignment of identity after stroke. The professional discourse attempts to ensure realistic expectations of recovery whereas stroke survivors and families complain about the negative discourses, how possibilities for life after stroke are presented, and the hopelessness that this creates. More research is required into how these different discourses affect outcomes.
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