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Makihara A, Kanai M, Izawa KP, Kubo H, Inamoto A, Ogura A, Kubo I, Shimada S. The Association between fatigue and physical activity in patients hospitalized with subacute stroke. Top Stroke Rehabil 2024; 31:457-463. [PMID: 38159262 DOI: 10.1080/10749357.2023.2293337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Little is known about the association between fatigue and physical activity in patients hospitalized with subacute stroke. OBJECTIVES The aim of this study was to investigate the association between fatigue and physical activity in patients hospitalized with subacute stroke. METHODS This cross-sectional study enrolled 244 consecutive patients with stroke who were admitted to a subacute rehabilitation ward at our hospital. We assessed fatigue with the Fatigue Assessment Scale (FAS) and used an accelerometer (Active style Pro HJA750-C, OMRON) to record the mean duration of sedentary behavior, light-intensity physical activity (LIPA), and moderate-to-vigorous-intensity physical activity (MVPA). We assessed all factors at 1 month after stroke. Multivariate linear regression analysis revealed the associations between FASscore and objectively measured physical activity. RESULTS In total, we analyzed 85 patients. The duration of the sedentary behavior was significantly associated with the FAS score (β = 1.46, p = 0.037) and the Functional Balance Scale score (β = -1.35, p = 0.045). The LIPA time was significantly associated only with the FBS score (β = 1.38, p = 0.045), whereas MVPA was not associated with any variable.
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Affiliation(s)
- Ayano Makihara
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Masashi Kanai
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
- Institute of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan
| | - Kazuhiro P Izawa
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Asami Inamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Asami Ogura
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Ikko Kubo
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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2
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Erikson A, Ranner M, Guidetti S, von Koch L. In search of self after stroke: a longitudinal qualitative study in the context of client-centred rehabilitation. Int J Qual Stud Health Well-being 2023; 18:2282513. [PMID: 38010156 PMCID: PMC11000675 DOI: 10.1080/17482631.2023.2282513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE The aim was to illuminate the experiences of stroke survivors returning to everyday life in the year following stroke, in the context of client-centred rehabilitation. METHODS Four men who participated in a client-centred rehabilitation program were followed during the first year after stroke. Semi-structured interviews were conducted, allbut the first in the participants' home. The data were analysed using a grounded theory approach. RESULTS The results revealed a process with the overarching core category; The "new" self becomes reality through challenging everyday experiences, and five main categories driving the process: 1) Striving for structure in a "new" chaotic world, 2) Homecoming an ambiguous experience, 3) Reaching the "new" self through reflections of self-understanding, 4) Socialising in new circumstances, and 5) Realising a new reality. CONCLUSIONS While in hospital, stroke survivors can have unrealistic expectations. When at home they can begin to realise their actual capacity . To find a "new" self after a stroke can involve time-consuming and taxing processes of reflections of self-understanding. Engagement in self-selected meaningful and valued activities can support stroke survivors' reconstruction of the "new" self but not all stroke survivors may succeed in finding their "new" self during the first year after stroke.
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Affiliation(s)
- Anette Erikson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Ranner
- Health Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Susanne Guidetti
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, and Karolinska University Hospital, Women’s Health and Allied Health Professionals Theme, Stockholm, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Karolinska University Hospital, Theme Heart & Vascular and Neuro, Stockholm, Sweden
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Purton J, Sim J, Hunter SM. Stroke survivors' views on their priorities for upper-limb recovery and the availability of therapy services after stroke: a longitudinal, phenomenological study. Disabil Rehabil 2023; 45:3059-3069. [PMID: 36111388 DOI: 10.1080/09638288.2022.2120097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Forty percent of stroke survivors have a persistent lack of function in the upper limb, causing significant disability. Most personal-care tasks and meaningful activities require bi-manual function of both upper limbs. However, lower-limb mobility is often viewed as the priority in stroke services. Perspectives of stroke survivors on priorities for upper-limb recovery and therapy have not been investigated in detail. Therefore, this study aimed to explore their views. MATERIALS AND METHODS Thirteen stroke survivors each engaged in up to four semi-structured interviews over 18 months. A phenomenological approach guided the research. RESULTS Three themes were identified. Priorities change on coming home: recovery of walking is a priority early after stroke but upper-limb recovery becomes equally important over time, particularly once living at home. Limited therapy services: therapy has a short duration, prioritizes lower-limb mobility, and is short-lived in the community; people feel abandoned by services. Active partners in recovery: stroke survivors want intermittent access to review and advice so they can be active partners with therapists to manage their upper-limb recovery. CONCLUSION Therapy services should recognize stroke survivors' changing priorities and work with them as active partners in upper-limb recovery. Intermittent access to review and advice should be included in service design.Implications for rehabilitationStroke survivors' priorities may change over time from recovery of walking toward upper-limb recovery.Post-stroke services can be perceived as insufficient to meet the needs of stroke survivors who want to participate actively in rehabilitation of their upper limb.Stroke survivors may prefer services that are more flexible to provide regular review of their progress, access to guidance and support to self-manage their recovery.
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Affiliation(s)
- Judy Purton
- School of Allied Health Professions, Keele University, Keele, UK
- School of Science, Technology and Health, York St John University, York, UK
| | - Julius Sim
- School of Allied Health Professions, Keele University, Keele, UK
- School of Medicine, Keele University, Keele, UK
| | - Susan M Hunter
- School of Allied Health Professions, Keele University, Keele, UK
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Amoah D, Prior S, Mather C, Schmidt M, Bird ML. Exploring the Unmet Needs of Young Adults with Stroke in Australia: Can Technology Help Meet Their Needs? A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6450. [PMID: 37568991 PMCID: PMC10418600 DOI: 10.3390/ijerph20156450] [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: 06/16/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
The post-stroke needs of young adults with stroke are not being met, as most resources are tailored to older people with stroke. This includes technology-based applications, which are being used more frequently in stroke rehabilitation. There is limited data on technology usage to support the unique needs of young adults with stroke in Australia. This study aimed to explore the unmet needs of young adults aged 18-30 years with stroke and ascertain how technology can help meet those needs to improve quality of life and participation. Sixteen in-depth semi-structured interviews were conducted with young adults with stroke (n = 10), healthcare professionals (n = 3) and caregivers of young adults with stroke (n = 3). The interviews were transcribed verbatim and analyzed inductively. Five themes were generated: 'Support for recovery', 'Availability of specific resources', 'Continuity of care', 'Adjustment' and 'Knowledge'. This study revealed the unique needs of young adults under 30 years with stroke who requested more targeted post-stroke support, age-specific resources and improved awareness on young stroke, with technology playing a pivotal role in all these interventions. We suggest co-designing technology-based solutions with young people after stroke to maximize their effectiveness in improving quality of life and participation in this unique cohort.
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Affiliation(s)
- Dinah Amoah
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
| | - Sarah Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia
| | - Carey Mather
- Australian Institute of Health Service Management, University of Tasmania, Hobart, TAS 7001, Australia
| | - Matthew Schmidt
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
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Kevdzija M. “Everything looks the same”: wayfinding behaviour and experiences of stroke inpatients in rehabilitation clinics. Int J Qual Stud Health Well-being 2022; 17:2087273. [PMID: 35694793 PMCID: PMC9196714 DOI: 10.1080/17482631.2022.2087273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To examine stroke inpatients’ real-life wayfinding behaviour and how the built environment of rehabilitation clinics might influence their behaviour and experiences. Methods Stroke inpatients in seven rehabilitation clinics were observed (n = 70), each over the course of 12 consecutive hours. Their paths through the clinic and the locations of encountered wayfinding-related events were mapped on the floor plans and described in the written notes. The observations were supplemented by a survey asking patients about their wayfinding experiences. Results For a third of observed patients, at least one wayfinding-related event was observed on the observation day, and 50% of patients reported getting lost in their clinic at least once. Most wayfinding-related events occurred between patient rooms and therapy rooms, and patients frequently relied on backtracking or the help of the staff to find their way. Clinics’ layout organization was found to play a role in the wayfinding behaviour of patients. Conclusions Wayfinding is a common challenge that stroke inpatients encounter in rehabilitation clinics. Avoiding multiple decision nodes on the paths between patient rooms and therapy rooms and creating distinct identities for corridor segments in the decision nodes and the areas in front of elevators would likely improve wayfinding performance.
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Affiliation(s)
- Maja Kevdzija
- Chair of Social and Health Care Buildings and Design, Technische Universität Dresden, Faculty of Architecture, Dresden, Germany
- TU Wien, Faculty of Architecture and Planning, Institute of Architecture and Design, Vienna, Austria
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6
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Understanding the facilitators and barriers of stroke survivors' adherence to recovery-oriented self-practice: a thematic synthesis. Disabil Rehabil 2022; 44:6608-6619. [PMID: 34460334 DOI: 10.1080/09638288.2021.1968512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Stroke survivors receive considerable rehabilitation efforts as inpatients, but one-on-one therapy decreases after discharge. The gap between the amount of required therapy and the lack of its availability in this phase of care may be partly overcome by self-practice. However, patient's adherence to prescribed programs is often low. While single studies have examined factors affecting adherence in this specific case, they have not been reviewed and synthesised previously. METHODS A thematic synthesis of qualitative studies explored factors affecting stroke survivors' adherence to prescribed, recovery-oriented self-practice. Five databases were systematically searched for references: Medline, Psycinfo, CINAHL, Embase, and ASSIA. Quality assessment was undertaken using the CASP tool. RESULTS From 1308 references, 68 potential papers were read in full, and 12 were included in the review. An overarching theme was identified as: "Tailoring and personalization rather than standardization." It was informed by the following three analytical themes: "The meaning of 'self' in self-practice," "Identifying self-practice as a team effort," and "Self-practice that is grounded in one's reality." CONCLUSION To have a positive effect on adherence to self-practice, clinicians are advised to spend time learning about each individual's life circumstances, so they can tailor proposed exercise programs to patients' personal situations, preferences, and needs.IMPLICATIONS FOR REHABILITATIONThe topic of patient's adherence to self-practice of prescribed exercise is a common concern, often voiced by frustrated rehabilitation health professionals. Bridging the gap between the patient's needs for post-discharge intensive therapy and the inability of healthcare systems to provide it could be filled partly by self-practice.Adherence to self-practice has become even more essential since the COVID 19 pandemic and the decrease in face-to-face delivery of rehabilitation due to social distancing requirements.Adherence to exercise is a broad topic. Reasons for poor adherence differ between patient populations and the exercises they are prescribed. This study focuses on post-discharge stroke survivors' adherence to recovery targeted exercise that could be described as repetitive and less physically demanding movements and functions.Reviewed studies were qualitative and usually included a relatively small number of participants within a specific context. Using thematic synthesis, we combined these small pieces of the puzzle into a larger picture, to produce recommendations that could be drawn on by clinicians to improve self-practice adherence.
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Vaalburg AM, Wattel E, Boersma P, Hertogh C, Gobbens R. Goal-setting in geriatric rehabilitation: Can the nursing profession meet patients' needs? A narrative review. Nurs Forum 2021; 56:648-659. [PMID: 33625738 PMCID: PMC8451803 DOI: 10.1111/nuf.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To provide an overview of patients' needs concerning goal-setting, and indications of how those needs can be met by nurses. METHODS A narrative review. Pubmed and Cinahl were searched through March 1, 2020 for: patients' experiences concerning goal-setting and the role of nursing in rehabilitation. Additional articles were found through snowballing. A total of 22 articles were reviewed on patients' experiences, and 12 on the nursing role. RESULTS Patients need to be prepared for collaborating in goal-setting and to receive an explanation about their part in that process. The multiplicity of disciplines may cloud patients' understanding of the process. The nurse's planning of the rehabilitation process should be aimed at resolving this issue. Goals need to be meaningful, and patients need support in attaining them. The interpretive, integrative, and consoling functions of Kirkevold's nursing role are suitable to meet these needs. CONCLUSIONS Both the literature about patients' needs regarding goal-setting and the nursing role make clear that the way nurses work in rehabilitation can gain in clarity. Strengthening the role of nurses will improve the goal-setting process for patients. Interprofessional collaboration, clear work procedures, continuity of care, time and trust, and the physical environment all are important to reinforce this role.
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Affiliation(s)
- Anne Marie Vaalburg
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Elizabeth Wattel
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
| | - Cees Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
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8
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Takashi N, McCarthy MJ, Suzuki R, Ogahara K, Ono-Kihara M, Kihara M, Nakayama T. Association of patient quality of life with the degree of agreement in the perceptions of patient disability within the stroke patient-rehabilitation therapist dyad: a cross-sectional study in postdischarge rehabilitation setting. BMJ Open 2021; 11:e043824. [PMID: 33952542 PMCID: PMC8103374 DOI: 10.1136/bmjopen-2020-043824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The purpose of study was to explore the association between patient physical and psychological quality of life (QOL) with the degree of agreement in perceptions of patient disability within the stroke patient-rehabilitation therapist dyad. DESIGN Cross-sectional dyadic study with a tablet-based structured questionnaire. SETTING Rehabilitation, nursing and long-term care facilities that provide rehabilitation services in the Kanagawa prefecture, Japan. PARTICIPANTS The 81 dyads of a male patient with stroke living at home and the rehabilitation therapist in charge of the eligible patient were recruited from March 2019 to February 2020. METHOD Patient physical and psychological QOL was measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule V.2.0 (DAS). DAS scores of patients and therapists were classified into two (high and low) and three (high, medium, low) categories, respectively, and six patterns of agreement about patient function were created and used in the analysis. Generalised estimating equations were used to examine multivariable associations between WHOQOL scores in patients and the degree of agreement within dyads adjusting for other covariates and clustering effects. RESULTS Among 81 enrolled dyads, 48 (59.3%) were classified into one of four disagreement groups (low medium, low high, high medium, high low). When the patient appraised himself as having mild disability, the degree of patient-therapist disagreement was negatively associated with patient's physical and psychological QOL. When the patient appraised himself as having severe disability, his physical and/or psychological QOL was poorer, regardless of the degree of agreement. CONCLUSIONS Disagreement in the perception of disability within patient-rehabilitation therapist dyad could be associated with patient's poor QOL, especially when the patient perceives himself as having mild disability. Reaching an agreement about patient disability is needed in the delivery of rehabilitation care for patients with stroke living at home to improve their QOL.
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Affiliation(s)
- Naoki Takashi
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
| | - Michael J McCarthy
- College of Social and Behavioral Sciences, Department of Social Work, Northern Arizona University, Flagstaff, Arizona, USA
| | - Rie Suzuki
- Department of Public Health & Health Sciences, University of Michigan Flint, Flint, Michigan, USA
| | - Kakuya Ogahara
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Masako Ono-Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Masahiro Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Takeo Nakayama
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
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9
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Brouwer-Goossensen D, den Hertog HM, Mastenbroek-de Jong MA, van Gemert-Pijnen LJEWC, Taal E. Patient perspectives on health-related behavior change after transient ischemic attack or ischemic stroke. Brain Behav 2021; 11:e01993. [PMID: 33662179 PMCID: PMC8035466 DOI: 10.1002/brb3.1993] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Unhealthy lifestyle is common among patients with ischemic stroke or TIA. Hence, health-related behavior change may be an effective way to reduce stroke recurrence. However, this is often difficult to carry out successfully. We aimed to explore patients' perspectives on health-related behavior change, support in this change, and sustain healthy behavior. METHODS We conducted a descriptive qualitative study with in-depth, semistructured interviews in eighteen patients with recent TIA or ischemic stroke. Interviews addressed barriers, facilitators, knowledge, and support of health-related behavior change framed by the protection motivation theory. All interviews were transcribed and thematically analyzed. RESULTS Patients seem unable to adequately appraise their own health-related behavior. More than half of the patients were satisfied with their lifestyle and felt no urgency to change. Self-efficacy as coping factor was the most important determinant (both barrier and facilitator). Fear as threat factor was named as facilitator for health-related behavior change by half of the patients. Most of the patients did not need support or already received support in changing health behavior. Patients indicated knowledge, guidelines, and social support as most needed to support and preserve a healthy lifestyle. CONCLUSION This study suggests that patients with recent TIA or ischemic stroke often do not have a high intention to change health-related behavior. The results fit well within the framework of the protection motivation theory. As many patients seem unable to adequately appraise their health behaviors, interventions should focus on increasing knowledge of healthy behavior and improving self-efficacy and social support.
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Affiliation(s)
| | | | | | | | - Erik Taal
- University of Twente, Twente, The Netherlands
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10
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Keating J, Borschmann K, Johns H, Churilov L, Bernhardt J. Young Stroke Survivors' Preferred Methods of Meeting Their Unique Needs: Shaping Better Care. Neurology 2021; 96:e1701-e1710. [PMID: 33568545 DOI: 10.1212/wnl.0000000000011647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine how young stroke survivors want their unmet needs to be addressed, we undertook an international online survey of people living with stroke. METHODS Participants self-selected to complete an online survey that included a questionnaire on demographics and stroke-related characteristics, the Young Stroke Needs Screening Tool, and a questionnaire on how they wanted their needs to be met. RESULTS One hundred seventy-one responses were received (68% female respondents, mean age 45 years, interquartile range 36-51 years). Preferences for methods of meeting needs varied depending on the domain of need and participants' demographic and stroke-related characteristics. Face-to-face contact with a health care professional was a popular means of meeting needs, but methods outside of a traditional health care setting such as a succinct list of tips or peer support were widely acceptable and sometimes preferred. CONCLUSION This work provides the impetus for developing alternative methods of meeting young stroke survivors' needs, many of which are not resource intensive or do not require an appointment with a health care professional.
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Affiliation(s)
- Jessica Keating
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Karen Borschmann
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Hannah Johns
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Leonid Churilov
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Julie Bernhardt
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia.
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11
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Beckwée D, Lefeber N, Bautmans I, Cuypers L, De Keersmaecker E, De Raedt S, Kerckhofs E, Nagels G, Njemini R, Perkisas S, Scheys E, Swinnen E. Muscle changes after stroke and their impact on recovery: time for a paradigm shift? Review and commentary. Top Stroke Rehabil 2020; 28:104-111. [PMID: 32588773 DOI: 10.1080/10749357.2020.1783916] [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: 02/08/2023]
Abstract
In stroke rehabilitation there is a growing body of evidence that not all patients have the same potential to recover. Understanding the processes that give rise to the heterogeneous treatment responses in stroke survivors will lay foundations for any conceivable advance in future rehabilitation interventions. This review was set out to shine new light on the debate of biomarkers in stroke rehabilitation by linking fundamental insights from biogerontological sciences to neurorehabilitation sciences. In particular, skeletal muscle changes and inflammation are addressed as two potential constructs from which biomarkers for stroke rehabilitation can be derived. Understanding the interplay between these constructs as well as their relation to recovery could enhance stroke rehabilitation in the future. The rationale for the selection of these constructs is three-fold: first, recent stroke literature emphasizes the importance of identifying muscle wasting (also called stroke-induced muscle wasting) in stroke patients, a concept that is widely investigated in geriatrics but less in the stroke population. Second, insights from transdisciplinary research domains such as gerontology have shown that inflammation has severe catabolic effects on muscles, which may impede rehabilitation outcomes such as gait recovery. Last, it has been proven that (high-intensity) muscle strengthening exercises have strong anti-inflammatory effects in a non-stroke population. Therefore, an evidence-based rationale is presented for developing research on individual changes of muscle and inflammation after a stroke.
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Affiliation(s)
- David Beckwée
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Frailty in Ageing Research Department, Vrije Universiteit Brussel , Brussels, Belgium.,Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp , Wilrijk, Belgium
| | - Nina Lefeber
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Ivan Bautmans
- Frailty in Ageing Research Department, Vrije Universiteit Brussel , Brussels, Belgium
| | - Lotte Cuypers
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Emma De Keersmaecker
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Sylvie De Raedt
- Universitair Ziekenhuis Brussel , Neurology Department, Jette, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Guy Nagels
- Universitair Ziekenhuis Brussel , Neurology Department, Jette, Belgium
| | - Rose Njemini
- Frailty in Ageing Research Department, Vrije Universiteit Brussel , Brussels, Belgium
| | - Stany Perkisas
- University Center of Geriatrics, University of Antwerp , Antwerp, Belgium
| | - Ellen Scheys
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
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12
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Falkenberg HK, Mathisen TS, Ormstad H, Eilertsen G. "Invisible" visual impairments. A qualitative study of stroke survivors` experience of vision symptoms, health services and impact of visual impairments. BMC Health Serv Res 2020; 20:302. [PMID: 32293430 PMCID: PMC7158142 DOI: 10.1186/s12913-020-05176-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Visual impairments (VIs) have a negative impact on life and affect up to 60% of stroke survivors. Despite this, VIs are often overlooked. This paper explores how persons with VIs experience vision care within stroke health services and how VIs impact everyday life the first 3 months post stroke. METHODS Individual semi-structured interviews were conducted with 10 stroke survivors 3 months post stroke, and analyzed using qualitative content analysis. RESULTS The main theme, "Invisible" visual impairments, represents how participants experience VIs as an unknown and difficult symptom of stroke and that the lack of attention and appropriate visual care leads to uncertainty about the future. VIs were highlighted as a main factor hindering the participants living life as before. The lack of acknowledgement, information, and systematic vision rehabilitation leads to feelings of being unsupported in the process of coping with VIs. CONCLUSION VIs are unknown symptoms pre stroke and sequelas after stroke that significantly affect everyday life. VIs and vision rehabilitation needs more attention through all phases of stroke health services. We request a greater awareness of VIs as a presenting symptom of stroke, and that visual symptoms should be included in stroke awareness campaigns. Further, we suggest increased competence and standardized evidence-based clinical pathways for VIs to advance all stroke health services including rehabilitation in order to improve outcomes and adaptation to future life for stroke survivors with VIs.
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Affiliation(s)
- Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway. .,USN Research Group of Older Peoples` Health, University of South-Eastern Norway, Drammen, Norway.
| | - Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.,USN Research Group of Older Peoples` Health, University of South-Eastern Norway, Drammen, Norway
| | - Heidi Ormstad
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Grethe Eilertsen
- USN Research Group of Older Peoples` Health, University of South-Eastern Norway, Drammen, Norway.,Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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13
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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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14
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O’Connell EL, Lawson DW, New PW, Stolwyk RJ. Agreement between patients and nurses of neurobehavioral disability following stroke in an inpatient rehabilitation setting. Disabil Rehabil 2019; 42:2868-2875. [DOI: 10.1080/09638288.2019.1572792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elissa L. O’Connell
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Melbourne, Australia
| | - David W. Lawson
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Peter W. New
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Melbourne, Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Renerus J. Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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15
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Shipley J, Luker J, Thijs V, Bernhardt J. How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia. Disabil Rehabil 2019; 42:1697-1704. [DOI: 10.1080/09638288.2018.1534278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jessica Shipley
- Royal Melbourne Hospital, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Julie Luker
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Neurology Department, Austin Health, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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16
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Shipley J, Luker J, Thijs V, Bernhardt J. The personal and social experiences of community-dwelling younger adults after stroke in Australia: a qualitative interview study. BMJ Open 2018; 8:e023525. [PMID: 30559157 PMCID: PMC6303598 DOI: 10.1136/bmjopen-2018-023525] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine the personal and social experiences of younger adults after stroke. DESIGN Qualitative study design involving in-depth semi-structured interviews and rigorous qualitative descriptive analysis informed by social constructionism. PARTICIPANTS Nineteen younger stroke survivors aged 18 to 55 years at the time of their first-ever stroke. SETTING Participants were recruited from urban and rural settings across Australia. Interviews took place in a clinic room of the Florey Institute of Neuroscience and Mental Health (Melbourne, Australia), over an online conference platform or by telephone. RESULTS Four main themes emerged from the discourses: (1) psycho-emotional experiences after young stroke; (2) losing pre-stroke life construct and relationships; (3) recovering and adapting after young stroke; and (4) invalidated by the old-age, physical concept of stroke. While these themes ran through the narratives of all participants, data analysis also drew out interesting variation between individual experiences. CONCLUSIONS For many younger adults, stroke is an unexpected and devastating life event that profoundly diverts their biography and presents complex and continued challenges to fulfilling age-normative roles. While adaptation, resilience and post-traumatic growth are common, this study suggests that more bespoke support is needed for younger adults after stroke. Increasing public awareness of young stroke is also important, as is increased research attention to this problem.
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Affiliation(s)
- Jessica Shipley
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Julie Luker
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Neurology Department, Austin Health, Melbourne, Victoria, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
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17
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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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18
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van Seben R, Smorenburg SM, Buurman BM. A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives. Clin Rehabil 2018; 33:128-140. [PMID: 30103621 PMCID: PMC6311617 DOI: 10.1177/0269215518791663] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To characterize how rehabilitation goals of older patients change over time and to explore professionals' attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals. DESIGN: Qualitative interview study. SETTING: Three geriatric rehabilitation centers. SUBJECTS: Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited. METHODS: Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed. RESULTS: During inpatient rehabilitation, participants' main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge. CONCLUSION: During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge.
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Affiliation(s)
- Rosanne van Seben
- 1 Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bianca M Buurman
- 1 Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.,3 ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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19
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Chalmers C, Leathem J, Bennett S, McNaughton H, Mahawish K. The efficacy of problem solving therapy to reduce post stroke emotional distress in younger (18-65) stroke survivors. Disabil Rehabil 2017; 41:753-762. [PMID: 29172817 DOI: 10.1080/09638288.2017.1408707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the efficacy of problem solving therapy for reducing the emotional distress experienced by younger stroke survivors. METHOD A non-randomized waitlist controlled design was used to compare outcome measures for the treatment group and a waitlist control group at baseline and post-waitlist/post-therapy. After the waitlist group received problem solving therapy an analysis was completed on the pooled outcome measures at baseline, post-treatment, and three-month follow-up. RESULTS Changes on outcome measures between baseline and post-treatment (n = 13) were not significantly different between the two groups, treatment (n = 13), and the waitlist control group (n = 16) (between-subject design). The pooled data (n = 28) indicated that receiving problem solving therapy significantly reduced participants levels of depression and anxiety and increased quality of life levels from baseline to follow up (within-subject design), however, methodological limitations, such as the lack of a control group reduce the validity of this finding. CONCLUSION The between-subject results suggest that there was no significant difference between those that received problem solving therapy and a waitlist control group between baseline and post-waitlist/post-therapy. The within-subject design suggests that problem solving therapy may be beneficial for younger stroke survivors when they are given some time to learn and implement the skills into their day to day life. However, additional research with a control group is required to investigate this further. This study provides limited evidence for the provision of support groups for younger stroke survivors post stroke, however, it remains unclear about what type of support this should be. Implications for Rehabilitation Problem solving therapy is no more effective for reducing post stroke distress than a wait-list control group. Problem solving therapy may be perceived as helpful and enjoyable by younger stroke survivors. Younger stroke survivors may use the skills learnt from problem solving therapy to solve problems in their day to day lives. Younger stroke survivors may benefit from age appropriate psychological support; however, future research is needed to determine what type of support this should be.
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Affiliation(s)
| | - Janet Leathem
- a School of Psychology , Massey University , Wellington , New Zealand
| | - Simon Bennett
- a School of Psychology , Massey University , Wellington , New Zealand
| | - Harry McNaughton
- b Stroke/Rehabilitation Research , Medical Research Institute of New Zealand , Wellington , New Zealand
| | - Karim Mahawish
- c Older Persons Rehabilitation Services , Rotorua Hospital , Rotorua , New Zealand
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20
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Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disabil Rehabil 2017; 41:396-404. [DOI: 10.1080/09638288.2017.1393698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mia Ingerslev Loft
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
- Clinic of Neurorehabilitation, TBI unit, Rigshospitalet, Hvidovre, Denmark
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21
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Worthington E, Hawkins L, Lincoln N, Drummond A. The day-to-day experiences of people with fatigue after stroke: Results from the Nottingham Fatigue After Stroke study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.10.449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esme Worthington
- Research Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Louise Hawkins
- Stroke Association Postgraduate Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Nadina Lincoln
- Professor of Clinical Psychology, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Avril Drummond
- Professor of Healthcare Research, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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22
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Arowoiya AI, Elloker T, Karachi F, Mlenzana N, Khuabi LAJN, Rhoda A. Using the World Health Organization's Disability Assessment Schedule (2) to assess disability in community-dwelling stroke patients. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:343. [PMID: 30135900 PMCID: PMC6093092 DOI: 10.4102/sajp.v73i1.343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/12/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Measurement of the extent of disability post-stroke is important to determine the impact of disability on these individuals and the effectiveness of interventions aimed at reducing the impact of their disability. Instruments used to measure disability should, however, be culturally sensitive. OBJECTIVE The aim of this study was to conduct a disability assessment using the World Health Organization's Disability Assessment Schedule 2.0 (WHODAS). METHODS A cross-sectional design was used. The study population included a conveniently selected 226 stroke patients living within community settings. These patients were followed up 6-12 months following the onset of the stroke and are currently residing in the community. Disability was measured using the WHODAS 2.0 and the data were analysed using descriptive and inferential statistics in Statistical Package for Social Sciences (SPSS). The WHODAS 2.0 enabled the assessment of disability within the domains of cognition, mobility, self-care, getting along with others, household activities, work activities and participation. Ethical clearance for the study was obtained from the University of the Western Cape. RESULTS In this sample, the domain mostly affected were household activities, with 38% having extreme difficulty with conducting these activities. This was followed by mobility (27%) and self-care (25%) being the domains that participants also had extreme difficulty with. Getting along with others was the domain that most (51%) of the participants had no difficulty with. ANOVA one-way test showed no significant association of participation restrictions with demographics factors. CONCLUSION Rehabilitation of patients with stroke should focus on the patient's ability to engage in household activities, mobility and self-care.
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Affiliation(s)
- Ayorinde I Arowoiya
- Department of Physiotherapy, Faculty of Community & Health Science, University of the Western Cape, South Africa
| | - Toughieda Elloker
- Department of Physiotherapy, Faculty of Community & Health Science, University of the Western Cape, South Africa
| | - Farahana Karachi
- Department of Physiotherapy, Faculty of Community & Health Science, University of the Western Cape, South Africa
| | - Nondwe Mlenzana
- Department of Physiotherapy, Faculty of Community & Health Science, University of the Western Cape, South Africa
| | - Lee-Ann Jacobs-Nzuzi Khuabi
- Division of Occupational Therapy, Department of Interdisciplinary Health Sciences, University of Stellenbosch, South Africa
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty of Community & Health Science, University of the Western Cape, South Africa
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23
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Abstract
Depression and fatigue are common after stroke and negatively impact the quality of life of stroke survivors. The biological bases of these symptoms are unknown, but an abundance of data point to a role for inflammation. This review highlights evidence supporting the contribution of inflammation to poststroke depression and poststroke fatigue. Potential treatments for poststroke depression and poststroke fatigue are explored, with a special emphasis on those that modulate the immune response.
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Affiliation(s)
- Kyra J Becker
- University of Washington School of Medicine, Seattle, WA, USA.
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24
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Olofsson A, Andersson SO, Carlberg B. ‘If only I manage to get home I'll get better’-Interviews with stroke patients after emergency stay in hospital on their experiences and needs. Clin Rehabil 2016; 19:433-40. [PMID: 15929513 DOI: 10.1191/0269215505cr788oa] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To find out about the experiences of stroke patients concerning their falling ill, their stay in hospital, discharge and homecoming. Design: Qualitative methods using in-depth interviews. Subjects and setting: Nine strategically chosen patients and in five cases near family members were interviewed in their homes four months post stroke and following care at the Stroke Centre, University Hospital of Northern Sweden, Umea°. Results: Three main categories with subcategories were brought to the fore from the interviews: ‘Responsible and implicated’, ’Depersonalized object for caring measures’ and ‘The striving for repersonalization and autonomy’. The patients got the most important insights and understanding about their state and the consequences when they came home. Conclusion: The three main categories that were found mirror the crisis which becoming ill entails and the process gone through when the individual takes control again of his or her life. The patients saw coming home as an important factor for their recovery and rehabilitation. The health care system needs to develop strategies to make use of the power of this attitude with the patients and to use the patients' own milieu in rehabilitation after stroke.
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Affiliation(s)
- A Olofsson
- Stroke Centre, University Hospital of Northern Sweden, Umeå, Sweden
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25
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Reunanen MAT, Talvitie U, Järvikoski A, Pyöriä O, Härkäpää K. Client’s role and participation in stroke physiotherapy encounters: an observational study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.1080/21679169.2016.1181207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Brouwer-Goossensen D, Genugten LV, Lingsma H, Dippel D, Koudstaal P, Hertog HD. Determinants of intention to change health-related behavior and actual change in patients with TIA or minor ischemic stroke. PATIENT EDUCATION AND COUNSELING 2016; 99:644-650. [PMID: 26561311 DOI: 10.1016/j.pec.2015.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/07/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess determinants of intention to change health-related behavior and actual change in patients with TIA or ischemic stroke. METHODS In this prospective cohort study, 100 patients with TIA or minor ischemic stroke completed questionnaires on behavioral intention and sociocognitive factors including perception of severity, susceptibility, fear, response-efficacy and self-efficacy at baseline. Questionnaires on physical activity, diet and smoking were completed at baseline and at 3 months. Associations between sociocognitive factors and behavioral intention and actual change were studied with multivariable linear and logistic regression. RESULTS Self-efficacy, response efficacy, and fear were independently associated with behavioral intention, with self-efficacy as the strongest determinant of intention to increase physical activity (aBeta 0.40; 95% CI 0.12-0.71), adapt a healthy diet (aBeta 0.49; 95% CI 0.23-0.75), and quit smoking (aBeta 0.51; 95% CI 0.13-0.88). Intention to change tended to be associated with actual health-related behavior change. CONCLUSION Self-efficacy, fear, and response-efficacy were determinants of intention to change health-related behavior after TIA or ischemic stroke. PRACTICE IMPLICATIONS These determinants of intention to change health-related behavior after TIA or ischemic stroke should be taken into account in the development of future interventions promoting health-related behavior change in these group of patients.
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Affiliation(s)
| | - Lenneke van Genugten
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Peter Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Heleen den Hertog
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
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27
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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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Reunanen MAT, Järvikoski A, Talvitie U, Pyöriä O, Härkäpää K. Individualised home-based rehabilitation after stroke in eastern Finland--the client's perspective. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:77-85. [PMID: 25676161 DOI: 10.1111/hsc.12190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
Reintegration into society is one of the main purposes of post-stroke rehabilitation. The experiences of clients returning home after a stroke have been studied before. There is, however, little knowledge about activities carried out during home-based rehabilitation interventions and about the involvement of clients in the process. This study focused on clients' experiences of a 3-month individualised, home-based rehabilitation programme supervised by a multidisciplinary team. The data were collected in 2009-2010, and it was based on interviews with 14 clients (48-83 years of age) conducted approximately 7 months after stroke. In the thematic analysis, five main topics describing the goals and functions of the home-based rehabilitation were identified as follows: (i) learning strategies for solving problems in daily activities at home and in the community; (ii) receiving exercise coaching; (iii) exploring community services and facilities; (iv) having a dialogue with professionals; and (v) engaging in activities aimed at returning to work. Implementing rehabilitation activities in the home environment seemed to enhance the participants' active involvement and their ability to evaluate themselves and to set goals for their recovery. Work was an important goal for clients of working age, but work-related tasks were not sufficiently integrated with home-based rehabilitation. A challenge for local communities is to provide health promotion and recreation services that are also suitable for persons with limited functioning.
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Affiliation(s)
- Merja A T Reunanen
- Department of Health Care, Mikkeli University of Applied Sciences, Savonlinna, Finland
| | - Aila Järvikoski
- Faculty of Social Sciences, University of Lapland, Rovaniemi, Finland
| | - Ulla Talvitie
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Outi Pyöriä
- Department of Health Care, Mikkeli University of Applied Sciences, Savonlinna, Finland
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Screening Poststroke Fatigue; Feasibility and Validation of an Instrument for the Screening of Poststroke Fatigue throughout the Rehabilitation Process. J Stroke Cerebrovasc Dis 2016; 25:188-96. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/04/2015] [Accepted: 09/17/2015] [Indexed: 11/18/2022] Open
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Young and midlife stroke survivors' experiences with the health services and long-term follow-up needs. J Neurosci Nurs 2015; 47:27-35. [PMID: 25565592 DOI: 10.1097/jnn.0000000000000107] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this qualitative study was to explore young and midlife stroke survivors' experiences with the health services and to identify long-term follow-up needs. Sixteen participants from two cohorts were interviewed in-depth. The interviews were analyzed applying a hermeneutic-phenomenological analysis. The participants struggled to gain access to follow-up health services. They felt that whether they were systematically followed up was more coincidental than planned. Young and midlife stroke survivors thus appear vulnerable to falling outside the follow-up system. Those participants who received some follow-up care perceived it as untailored to their specific needs. To be considered supportive, the follow-up programs must be in line with their long-term needs, take into account their particular challenges as young and midlife stroke survivors, and be planned in close collaboration with the individual patient. To secure systematic and follow-up health services tailored to the individual, knowledgeable and committed healthcare professionals should play a prominent role within the community health services.
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Ormstad H, Eilertsen G. A biopsychosocial model of fatigue and depression following stroke. Med Hypotheses 2015; 85:835-41. [DOI: 10.1016/j.mehy.2015.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/02/2015] [Indexed: 11/28/2022]
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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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Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2015; 96:1698-708.e10. [PMID: 25847387 DOI: 10.1016/j.apmr.2015.03.017] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies. DATA SOURCES MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included. STUDY SELECTION Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus. DATA EXTRACTION Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis. DATA SYNTHESIS Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm. CONCLUSIONS The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.
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Affiliation(s)
- Julie Luker
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| | - Elizabeth Lynch
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Susanne Bernhardsson
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia; Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Sweden
| | - Leanne Bennett
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Taule T, Strand LI, Skouen JS, Råheim M. Striving for a life worth living: stroke survivors' experiences of home rehabilitation. Scand J Caring Sci 2015; 29:651-61. [PMID: 25648326 DOI: 10.1111/scs.12193] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/10/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND For mild-to-moderate stroke survivors, early supported discharge from hospital, followed by home rehabilitation is preferred over conventional care. How this mode of service contributes to recovery from stroke survivors' perspective needs further investigation. AIM The aim of this study was to explore mild-to-moderate stroke survivors' experiences with home rehabilitation after early supported discharge from hospital. METHODS A qualitative interpretive interview design was used in the context of a randomised controlled trial. A purposive sample of eight participants (45-80 years) was followed by an ambulant team, and a specific healthcare team provided home rehabilitation. Data were analysed using interpretive description, systematic text condensation and coping theory. FINDINGS A crucial determinant for the participants' hopes for a life worth living was the mutual confidence expressed in encounters with healthcare professionals and the participants' ability to make sense of their now-altered body. The professional caretakers' communication qualities and their ability to attend to individual needs were important. Help in processing the emotional reactions caused by a changed body and in socialising was requested by participants. Professional caretakers providing home rehabilitation should strive for a more flexible- and individually tailored service and should seek increased cooperation among stakeholders. CONCLUSION The focus on therapeutic communicative qualities, bodily changes, emotional processes, social concerns and long-term follow-up should be increased in order to achieve a more beneficial experience for stroke survivors.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital (HUH), Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physiotherapy, HUH, Bergen, Norway
| | - Jan Sture Skouen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physical Medicine and Rehabilitation, HUH, Bergen, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Schuck SO, Whetstone A, Hill V, Levine P, Page SJ. Game-Based, Portable, Upper Extremity Rehabilitation in Chronic Stroke. Top Stroke Rehabil 2015; 18:720-7. [DOI: 10.1310/tsr1806-720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Satink T, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. How is self-management perceived by community living people after a stroke? A focus group study. Disabil Rehabil 2014; 37:223-30. [DOI: 10.3109/09638288.2014.918187] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Taule T, Råheim M. Life changed existentially: a qualitative study of experiences at 6-8 months after mild stroke. Disabil Rehabil 2014; 36:2107-19. [PMID: 24670126 DOI: 10.3109/09638288.2014.904448] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore experiences of mild-stroke survivors in the context of early supported discharge. The meanings patients attributed to activities and participation in the home recovery process were our main interest. METHODS Eight participants (45-80 years) from a randomised controlled study were selected for this sub-study. This purposive sample had received rehabilitation in their homes in the post-stroke acute phase of recovery as part of the larger study. Extensive interview data were analysed using an interpretive strategy and systematic text condensation. Coping theory was included in later stages of analysis. FINDINGS The mild-stroke survivors' stories revealed that life had changed profoundly. Differences and similarities in experienced changes were related to: self-perceived health, the body, practical activities, taking part in society, and self-perception. The findings showed the ways in which life changed for mild-stroke survivors, experienced challenges, and survivors' thoughts about the future. CONCLUSIONS Mild-stroke rehabilitation should focus more strongly on basic concerns related to self-perceived health, self-perception, and body, since these dimensions seem to complicate daily activities and close relationships. Professionals should also be aware of patients who experience an uncertain situation and unresolved rehabilitation needs, which still can be present 6-8 months after the stroke. IMPLICATIONS FOR REHABILITATION When living with mild stroke, entrance to practical and social activities seemed founded on the patients' perception of the body and self as comprehensible or not. Comprehending their own changed body and sense of self seem to be a long-term process when living with mild stroke. It is suggested that long-term follow-up be incorporated in home rehabilitation service, also in the context of early supported discharge. This may contribute to help patient cope more optimally with activities and participation of importance to them.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital , Bergen , Norway and
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Hole E, Stubbs B, Roskell C, Soundy A. The patient's experience of the psychosocial process that influences identity following stroke rehabilitation: a metaethnography. ScientificWorldJournal 2014; 2014:349151. [PMID: 24616623 PMCID: PMC3927748 DOI: 10.1155/2014/349151] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/19/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Patient experience is increasingly being recognised as a key health outcome due to its positive correlation with quality of life and treatment compliance. The aim of this study was to create a model of how patient's experiences of rehabilitation after stroke influence their outcome. METHODS A metaethnography of qualitative articles published since 2000 was undertaken. A systematic search of four databases using the keywords was competed. Original studies were included if at least 50% of their data from results was focused on stroke survivors experiences and if they reflected an overarching experience of stroke rehabilitation. Relevant papers were appraised for quality using the COREQ tool. Pata analysis as undertaken using traditional processes of extracting, interpreting, translating, and synthesizing the included studies. RESULTS Thirteen studies were included. Two themes (1) evolution of identity and (2) psychosocial constructs that influence experience were identified. A model of recovery was generated. CONCLUSION The synthesis model conceptualizes how the recovery of stroke survivors' sense of identity changes during rehabilitation illustrating changes and evolution over time. Positive experiences are shaped by key psychosocial concepts such as hope, social support, and rely on good self-efficacy which is influenced by both clinical staff and external support.
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Affiliation(s)
- E. Hole
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
| | - B. Stubbs
- School of Health and Social Care, University of Greenwich, London SE10 9LS, UK
| | - C. Roskell
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
| | - A. Soundy
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
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Sadler E, Daniel K, Wolfe CDA, McKevitt C. Navigating stroke care: the experiences of younger stroke survivors. Disabil Rehabil 2014; 36:1911-7. [PMID: 24467678 DOI: 10.3109/09638288.2014.882416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Although stroke is associated with ageing, a significant proportion of strokes occur in younger people. Younger stroke survivors have experienced care available as inappropriate to their needs. However, insufficient attention has been paid to how the social context shapes their experiences of care. We investigated this question with younger stroke survivors in Greater London, UK. METHOD We conducted in-depth interviews with individuals aged between 24 and 62 years. Interviews were analysed thematically, with interpretation informed by Bourdieu's concepts of field, capital and habitus. RESULTS In the acute care setting it was implicit for participants that expertise and guidance was to be prioritised and largely this was reported as what was received. Individuals' cultural capital shaped expectations to access information, but health care professionals' symbolic capital meant they controlled its provision. After discharge, professional guidance was still looked for, but many felt it was limited or unavailable. It was here that participants' social, cultural and economic capital became more important in experiences of care. CONCLUSIONS The field of stroke shaped younger stroke survivors' experiences of care. Navigating stroke care was contingent on accessing different forms of capital. Differences in access to these resources influenced longer term adjustment after stroke. IMPLICATIONS FOR REHABILITATION Stroke care can be conceptualised as a temporal field of social activity and relationships which shapes variations in experiences of care among younger stroke survivors, and differences in expectations of support at different time points after stroke. On entering the field of stroke participants reported needing health care professional guidance and expertise to manage the acute event, yet difficulties accessing information in hospital limited the agency of some individuals wanting to take an active role in their recovery. After discharge from hospital variations in experiences of care among participants were more evident, with a number still seeking professional guidance, and requiring the capital and agency to navigate the field of stroke. Despite international efforts to improve the quality of acute care, effective models of community stroke care still need to be developed.
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Affiliation(s)
- Euan Sadler
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London , London , United Kingdom and
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Kuluski K, Dow C, Locock L, Lyons RF, Lasserson D. Life interrupted and life regained? Coping with stroke at a young age. Int J Qual Stud Health Well-being 2014; 9:22252. [PMID: 24461569 PMCID: PMC3901846 DOI: 10.3402/qhw.v9.22252] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/14/2022] Open
Abstract
Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients’ life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an “altered sense of self,” a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives. A holistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children.
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Affiliation(s)
- Kerry Kuluski
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;
| | - Clare Dow
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Louise Locock
- Health Experiences Research Group, Department of Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, The Joint Research Office, The Churchill Hospital, Headington, UK; Green Templeton College, University of Oxford, Oxford, UK
| | - Renee F Lyons
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana Faculty of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Lasserson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Rochette A, Korner-Bitensky N, Bishop D, Teasell R, White CL, Bravo G, Côté R, Green T, Lebrun LH, Lanthier S, Kapral M, Bayley M. The YOU CALL-WE CALL randomized clinical trial: Impact of a multimodal support intervention after a mild stroke. Circ Cardiovasc Qual Outcomes 2013; 6:674-9. [PMID: 24221841 DOI: 10.1161/circoutcomes.113.000375] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. METHODS AND RESULTS This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92; YOU=94) with a mean age of 62.5 ± 12.5 years, and 42.5% were women. No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures (effect sizes ranged from 0.25 to 0.7). The only significant change for both groups from 6 months to 1 year (n=139) was in the social domains of the LIFE-H (increment in score, 0.4/9 ± 1.3 [95% confidence interval, 0.1-0.7]; effect size, 0.3). Qualitatively, the WE CALL intervention was perceived as reassuring, increased insight, and problem solving while decreasing anxiety. Only 6 of 94 (6.4%) YOU CALL participants availed themselves of the intervention. CONCLUSIONS Although the 2 groups improved equally over time, WE CALL intervention was perceived as helpful, whereas YOU CALL intervention was not used. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN95662526.
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Duxbury S, Depaul V, Alderson M, Moreland J, Wilkins S. Individuals with stroke reporting unmet need for occupational therapy following discharge from hospital. Occup Ther Health Care 2013; 26:16-32. [PMID: 23899105 DOI: 10.3109/07380577.2011.621514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT The purpose of this study was to identify the characteristics and needs of individuals with stroke who report an unmet need for occupational therapy following discharge from hospital. Needs were assessed using a semi-structured interview and a survey in a sample of 209 adults hospitalized with a stroke. Participants were divided into three groups-those needing occupational therapy; those receiving occupational therapy, and those neither needing nor receiving occupational therapy. Thirteen percent (n = 28) reported an unmet need for occupational therapy and were more dependent in activities of daily living (ADL) before and after their stroke and had lower acute functional independence measure (FIM) scores than the comparison groups (p < .05). Participants with unmet needs for occupational therapy were more likely to report unmet needs related to upper extremity function, basic and instrumental ADL, leisure, assistive devices, and the resumption of social roles.
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Affiliation(s)
- Shari Duxbury
- 1Department of Occupational Therapy, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Ali M, Fulton R, Quinn T, Brady M. How well do standard stroke outcome measures reflect quality of life? A retrospective analysis of clinical trial data. Stroke 2013; 44:3161-5. [PMID: 24052510 DOI: 10.1161/strokeaha.113.001126] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Quality of life (QoL) is important to stroke survivors yet is often recorded as a secondary measure in acute stroke randomized controlled trials. We examined whether commonly used stroke outcome measures captured aspects of QoL. METHODS We examined primary outcomes by National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and modified Rankin Scale (mRS), and QoL by Stroke Impact Scale (SIS) and European Quality of Life Scale (EQ-5D) from the Virtual International Stroke Trials Archive (VISTA). Using Spearman correlations and logistic regression, we described the relationships between QoL mRS, NIHSS, and BI at 3 months, stratified by respondent (patient or proxy). Using χ2 analyses, we examined the mismatch between good primary outcome (mRS ≤1, NIHSS ≤5, or BI ≥95) but poor QoL, and poor primary outcome (mRS ≥3, NIHSS ≥20, or BI ≤60) but good QoL. RESULTS Patient-assessed QoL had a stronger association with mRS (EQ-5D weighted score n=2987, P<0.0001, r=-0.7, r2=0.53; SIS recovery n=2970, P<0.0001, r=-0.71, r2=0.52). Proxy responses had a stronger association with BI (EQ-5D weighted score n=837, P<0.0001, r=0.78, r2=0.63; SIS recovery n=867, P<0.0001, r=0.68, r2=0.48). mRS explained more of the variation in QoL (EQ-5D weighted score=53%, recovery by SIS v3.0=52%) than NIHSS or BI and resulted in fewer mismatches between good primary outcome and poor QoL (P<0.0001, EQ-5D weighted score=8.5%; SIS recovery=10%; SIS-16=4.4%). CONCLUSIONS The mRS seemed to align closely with stroke survivors' interests, capturing more information on QoL than either NIHSS or BI. This further supports its recommendation as a primary outcome measure in acute stroke randomized controlled trials.
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Affiliation(s)
- Myzoon Ali
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (M.A., M.B.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Western Infirmary, United Kingdom (M.A., R.F., T.Q.)
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Tistad M, von Koch L, Sjöstrand C, Tham K, Ytterberg C. What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke--amount, place, operator or timing? Health Expect 2013; 16:e24-35. [PMID: 23796012 PMCID: PMC3883089 DOI: 10.1111/hex.12095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 12/22/2022] Open
Abstract
Background and Objective To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self‐reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. Methods The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self‐reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home‐based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. Results Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd–4th quarters of the first year (OR 8.36, CI 1.40–49.88 P = 0.020) were more likely to report met rehabilitation needs. Conclusion For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self‐reported met needs for rehabilitation.
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Affiliation(s)
- Malin Tistad
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Patients' Views on the Impact of Stroke on Their Roles and Self: A Thematic Synthesis of Qualitative Studies. Arch Phys Med Rehabil 2013; 94:1171-83. [DOI: 10.1016/j.apmr.2013.01.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/18/2012] [Accepted: 01/03/2013] [Indexed: 11/21/2022]
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Donnellan C, O'Neill D. Baltes' SOC model of successful ageing as a potential framework for stroke rehabilitation. Disabil Rehabil 2013; 36:424-9. [PMID: 23701114 DOI: 10.3109/09638288.2013.793412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this paper is to explore approaches used to address some stroke rehabilitation interventions and to examine the potential use of one of the life-span theories called the Baltes' model of selective optimisation with compensation (SOC) as a potential framework. KEY FINDINGS AND IMPLICATIONS Some of the key considerations for a stroke rehabilitation intervention framework are highlighted including accommodating for the life management changes post stroke, alterations in self-regulation, acknowledge losses and focusing on a person-centred approach for transition from acute rehabilitation to the home or community setting. The Baltes' SOC model is then described in terms of these considerations for a stroke rehabilitation intervention framework. CONCLUSIONS AND RECOMMENDATIONS The Baltes' SOC model may offer further insights, including ageing considerations, for stroke rehabilitation approaches and interventions. It has potential to facilitate some of the necessary complexities of adjustment required in stroke rehabilitation. However, further development in terms of empirical support is required for using the model as a framework to structure stroke rehabilitation intervention. Implications for Rehabilitation There is a scarcity of theoretical frameworks that can facilitate and be inclusive for all the necessary complexities of adjustment, required in stroke rehabilitation. In addition to motor recovery post stroke, rehabilitation intervention frameworks should be goal orientated; address self-regulatory processes; be person-centred and use a common language for goal planning, setting and attainment. The Baltes' SOC model is one such framework that may address some of the considerations for stroke rehabilitation, including motor recovery and other life management aspects.
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Affiliation(s)
- C Donnellan
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin , Ireland
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Muina-Lopez R, Guidon M. Impact of post-stroke fatigue on self-efficacy and functional ability. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.792868] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stenfors-Hayes T, Hult H, Dahlgren MA. A phenomenographic approach to research in medical education. MEDICAL EDUCATION 2013; 47:261-70. [PMID: 23398012 DOI: 10.1111/medu.12101] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research. METHODS This paper introduces phenomenography as a viable qualitative approach for use in medical education research. RESULTS A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education. CONCLUSION We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change.
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Affiliation(s)
- Terese Stenfors-Hayes
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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Gallacher K, Jani B, Morrison D, Macdonald S, Blane D, Erwin P, May CR, Montori VM, Eton DT, Smith F, Batty DG, Mair FS. Qualitative systematic reviews of treatment burden in stroke, heart failure and diabetes - methodological challenges and solutions. BMC Med Res Methodol 2013; 13:10. [PMID: 23356353 PMCID: PMC3568050 DOI: 10.1186/1471-2288-13-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment burden can be defined as the self-care practices that patients with chronic illness must perform to respond to the requirements of their healthcare providers, as well as the impact that these practices have on patient functioning and well being. Increasing levels of treatment burden may lead to suboptimal adherence and negative outcomes. Systematic review of the qualitative literature is a useful method for exploring the patient experience of care, in this case the experience of treatment burden. There is no consensus on methods for qualitative systematic review. This paper describes the methodology used for qualitative systematic reviews of the treatment burdens identified in three different common chronic conditions, using stroke as our exemplar. METHODS Qualitative studies in peer reviewed journals seeking to understand the patient experience of stroke management were sought. Limitations of English language and year of publication 2000 onwards were set. An exhaustive search strategy was employed, consisting of a scoping search, database searches (Scopus, CINAHL, Embase, Medline & PsycINFO) and reference, footnote and citation searching. Papers were screened, data extracted, quality appraised and analysed by two individuals, with a third party for disagreements. Data analysis was carried out using a coding framework underpinned by Normalization Process Theory (NPT). RESULTS A total of 4364 papers were identified, 54 were included in the review. Of these, 51 (94%) were retrieved from our database search. Methodological issues included: creating an appropriate search strategy; investigating a topic not previously conceptualised; sorting through irrelevant data within papers; the quality appraisal of qualitative research; and the use of NPT as a novel method of data analysis, shown to be a useful method for the purposes of this review. CONCLUSION The creation of our search strategy may be of particular interest to other researchers carrying out synthesis of qualitative studies. Importantly, the successful use of NPT to inform a coding frame for data analysis involving qualitative data that describes processes relating to self management highlights the potential of a new method for analyses of qualitative data within systematic reviews.
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