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Chen Z, Zhou X, Jiang L, Song C, Wang S, Zhao H, Liu J, Ma X, Yu J. Knowledge, attitudes, and practices of family caregivers for patients with cerebral infarction toward home-based care. Front Public Health 2024; 12:1436423. [PMID: 39228843 PMCID: PMC11368753 DOI: 10.3389/fpubh.2024.1436423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/26/2024] [Indexed: 09/05/2024] Open
Abstract
Objective This study aimed to assess the knowledge, attitudes, and practices (KAP) among family caregivers of patients with cerebral infarction toward home-based care. Methods This web-based cross-sectional study was conducted between October 2023 and February 2024 at Yancheng Third People's Hospital. A self-designed questionnaire was developed to collect demographic information, and assess the KAP among family caregivers of patients with cerebral infarction toward home-based care. Results A total of 761 questionnaires were included in the study. Among the participants, 453 (59.53%) were female, and 548 (72.01%) lived with the patients. The mean knowledge, attitudes and practices scores were 6.67 ± 1.73 (possible range: 0-9), 32.95 ± 2.46 (possible range: 9-45), and 28.64 ± 4.39 (possible range: 8-40), respectively. Path analysis showed the direct effect of knowledge on both attitudes (β = 0.885, p < 0.001) and practices (β = 1.295, p < 0.001), as well as of attitudes on practices (β = 0.838, p < 0.001). Conclusion Family caregivers of patients with cerebral infarction have sufficient knowledge, positive attitudes and proactive practices toward home-based care. However, they still exhibit deficiencies in certain aspects of knowledge, attitudes, and practice. Developing personalized educational strategies may be instrumental in enhancing family caregivers' knowledge of home-based care. This, in turn, could improve their attitudes and elevate their practice levels.
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Affiliation(s)
| | - Xiaohua Zhou
- Department of Neurology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People's Hospital, Yancheng, China
| | | | | | - Shufang Wang
- Department of Neurology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People's Hospital, Yancheng, China
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Knox S, Downer B, Haas A, Ottenbacher KJ. Successful Discharge to Community From Home Health Less Likely for People in Late Stages of Dementia. J Geriatr Phys Ther 2024; 47:77-84. [PMID: 38133896 PMCID: PMC10990837 DOI: 10.1519/jpt.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND PURPOSE Several studies have established the efficacy of home health in meeting the health care needs of people with Alzheimer disease and related dementias (ADRD) and helping them to remain at home. However, transitioning to the community after discharge from home health presents challenges to patient safety and quality of life. The severity of an individual's functional impairments, cognitive limitations, and behavioral and psychological symptoms may compound these challenges. The purpose of this study was to examine the association between dementia severity and successful discharge to community (DTC) from home health. METHODS This was a retrospective study of 142 376 Medicare beneficiaries with ADRD. Successful DTC was defined as having no unplanned hospitalization or death within 30 days of DTC from home health. Successful DTC rates were calculated, and multilevel logistic regression was used to estimate the relative risk (RR) of successful DTC, by dementia severity category, adjusted for patient and clinical characteristics. Six dementia severity categories were identified using a crosswalk between items on the Outcome and Assessment Information Set and the Functional Assessment Staging Tool. RESULTS AND DISCUSSION Successful DTC occurred in 71.2% of beneficiaries. Beneficiaries in the 2 most severe dementia categories had significantly lower risk of successful DTC (category 6: RR = 0.90, 95% CI = 0.889-0.910; category 7: RR = 0.737, 95% CI = 0.704-0.770) than those in the least severe dementia category. The RR of successful DTC for people with ADRD decreased as the level of independence with oral medication management decreased and when there was an overall greater need for caregiver assistance. CONCLUSIONS Patient status at the time of admission to home health is associated with outcomes after discharge from home health. Early identification of people in advanced stages of ADRD provides an opportunity to implement strategies to facilitate successful DTC while people are still receiving home care services. The severity of ADRD and availability of caregiver assistance should be key considerations in planning for successful DTC for people with ADRD.
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Affiliation(s)
- Sara Knox
- Division of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Brian Downer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, Texas, 77555 United States
| | - Allen Haas
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Kenneth J. Ottenbacher
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, Texas, 77555 United States
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Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev 2021; 11:CD001919. [PMID: 34813082 PMCID: PMC8610078 DOI: 10.1002/14651858.cd001919.pub4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety. SEARCH METHODS We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews. SELECTION CRITERIA Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence. MAIN RESULTS We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being. AUTHORS' CONCLUSIONS Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
| | - Peter Knapp
- Department of Health Sciences, University of York and the Hull York Medical School, York, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
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Li J, Lowres N, Koo FK, Gallagher R. A systematic review of quantitative and qualitative literature on health professionals' experiences communicating with Chinese immigrants. Int J Nurs Pract 2021; 27:e12960. [PMID: 34013647 DOI: 10.1111/ijn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/31/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to determine health professionals' experiences communicating with Chinese immigrants and identify potential education barriers. BACKGROUND Health professionals caring for Chinese immigrants often encounter communication barriers, leading to uncertainty of quality of care. DESIGN This study is a quantitative and qualitative systematic review. DATA SOURCES MEDLINE, Scopus, CINAHL, PubMed and Google Scholar were searched, limited to 1980 to October 2020. REVIEW METHODS Articles were included if they reported results about health professional communication with Chinese patients. Quality was appraised using Consolidated Criteria for Reporting Qualitative Research guidelines and thematic synthesis conducted. RESULTS Of 1363 articles, seven studies were included. These described provider-patient communication in primary care, oncology and palliative settings only. Three core themes were identified: (1) family-centred health communication where family controls provider-patient information exchange; (2) mismatch of provider-patient health beliefs and knowledge on diet, nutrition, traditional medicine, place for death and disease prevention and (3) mismatch of language and resources as skilled providers proficient in specific dialects are limited; communication resources are perceived as infrequently available and content is insufficient. CONCLUSION Studies describing health professionals' experiences communicating with Chinese immigrants are limited. Key barriers identified included cultural and language disparities and communication resources are inadequate to support health professionals' needs.
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Affiliation(s)
- Jialin Li
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Lowres
- Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Fung Kuen Koo
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
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Yang Y, Mu A, Wang Y. Early path nursing improves neurological function recovery in patients with intracerebral hemorrhage: Protocol for a randomized controlled trial. Medicine (Baltimore) 2021; 100:e24020. [PMID: 33429767 PMCID: PMC7793312 DOI: 10.1097/md.0000000000024020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To explore the influence of the early path nursing on life quality and the neurological function recovery in the intracerebral hemorrhage (ICH) patients. METHODS The experiment was implemented from January 2018 to October 2020 at the First Affiliated Hospital of Soochow University. The experiment was granted through the Research Ethics Committee of the First Affiliated Hospital of Soochow University (2017033). In this experiment, the criteria for inclusion includes: hemorrhagic stroke diagnosed via the MRI or head CT; over 18 years of age; patients with motor dysfunction; The Glasgow Coma Scale > 12. The patients with these symptoms will be excluded: severe cognitive impairment; ischemic stroke; onset time > 3 days; and severe complications. The scale used for the evaluation the neurological function is the American Stroke Scale. This scale contains a total of eleven items, that is, the movements of upper and lower limb, the consciousness level, gaze, visual field, etc. Other outcomes include patient satisfaction and complications. RESULTS Evaluation the neurological function and quality of life will be shown in Table 1. CONCLUSION The early path nursing can promote the neurological function recovery in the ICH patients. TRIAL REGISTRATION NUMBER researchregistry6327.
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Finn C, Boland P. Male family carers' experiences of formal support - a meta-ethnography. Scand J Caring Sci 2020; 35:1027-1037. [PMID: 33107643 DOI: 10.1111/scs.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/11/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men represent a growing proportion of unpaid family carers across Europe. Comparative studies have proposed male carers experience their caring role differently to females; men are less likely to avail of formal support services than women. Social ideas around masculinity have been linked to the help-seeking behaviours of male carers, as well as men's attitudes around accessing formal support. More understanding about this role from the perspective of male carers is required. METHODS The study followed a meta-ethnography process starting with a systematic literature search of five electronic databases. The methodological quality of the selected studies was evaluated using the Mc Master checklist. Using NVivo 12 software, primary data were analysed and themes throughout the papers were identified. Results were synthesised as a meta-ethnography that retained direct quotes from the studies. RESULTS Two themes and five sub-themes were developed from the data. The first theme was 'Men's experiences of formal support' which contained sub-themes 'Reluctance to step back', 'A space to share emotions' and 'Education diminishes burden'. The second theme was 'Coping without Formal Support' with sub-themes 'Satisfied without help' and 'Duty prevents help seeking'. CONCLUSIONS Fear of perceived failure and a loss of control in the caring relationship were key factors in men's low trust and dissatisfaction with available services. To engage more male carers, formal service providers should acknowledge men's wish to be seen as competent in the care role as well as their desire to stay involved in decision-making around care for their family member. Support services that were collaborative, education-based and gender-sensitive were favoured by male carers.
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Affiliation(s)
- Caroline Finn
- Castletroy, University of Limerick, Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Ageing Research Centre (ARC), Health Research Institute, University of Limerick, Limerick, Ireland
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Manola M, Petropoulou K, Calogero F. Gap in stroke patients' and carers' education. J Frailty Sarcopenia Falls 2020; 4:26-28. [PMID: 32300713 PMCID: PMC7155370 DOI: 10.22540/jfsf-04-026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 11/03/2022] Open
Abstract
Stroke is a multidimensional illness as it affects various aspects in a person's quality of life. The rehabilitation team focuses mainly on complications but there seems to be a gap in the education of the patients and their carers in skills relevant to the competencies required for community, aged care, health, housing and disability support services. Stroke patients' and carers' education-training, as well as their satisfaction has not been studied adequately. The current article presents important studies in the field about the association of patients' and carers' satisfaction and based on authors' opinion suggests appropriate interventions in order to improve the health of the patients.
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Affiliation(s)
- Margialena Manola
- 2 Rehabilitation Department, National Rehabilitation Center, Athens, Greece
| | | | - Foti Calogero
- Physical and Rehabilitation Medicine Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
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Liao B, Liang M, Ouyang Q, Song H, Chen X, Su Y. Psychological Nursing of Patients With Stroke in China: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:569426. [PMID: 33362596 PMCID: PMC7759468 DOI: 10.3389/fpsyt.2020.569426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
The present study aimed to evaluate the efficacy of psychological nursing of patients with stroke in China. The Embase, PubMed, Cochrane Library, CNKI, and Wanfang databases were searched from inception to February 1, 2020. Randomized controlled trials (RCTs) reporting the efficacy of psychological nursing of patients with stroke were included. Revman 5.3 and Stata 15.0 were used for data analysis. Twelve RCTs and 1,013 patients with stroke were included in this systematic review and meta-analysis. The results revealed a significant difference in the Hamilton depression score between the psychological nursing and usual care groups. The meta-analysis of three studies (n = 235) that used a depressive symptom control of ≥25% as the outcome measure showed a significant difference between the two groups. In addition, significant differences were detected in the National Institute of Health stroke scale score and activities of daily living score between the two groups. The present meta-analysis suggests that in China, compared to the usual care, psychological nursing is more effective for alleviating depressive symptoms, improving neurological rehabilitation, and recovering the ability of daily life.
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Affiliation(s)
- Bingye Liao
- Department of Operating Room, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minni Liang
- Department of Operating Room, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiuyi Ouyang
- Department of Operating Room, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongqin Song
- Department of Operating Room, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Chen
- Department of Operating Room, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuejiao Su
- Department of Operating Room, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Denham AM, Baker AL, Spratt NJ, Wynne O, Hunt SA, Bonevski B, Kumar R. YouTube as a resource for evaluating the unmet needs of caregivers of stroke survivors. Health Informatics J 2019; 26:1599-1616. [PMID: 31722610 DOI: 10.1177/1460458219873538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Content produced by caregivers of stroke survivors on the online video-sharing platform YouTube may be a good source of knowledge regarding caregivers' unmet needs. We aimed to examine the content, quantity and quality of YouTube videos that target and discuss the needs and concerns of caregivers of stroke survivors. YouTube was systematically searched using six search strings, and the first 20 videos retrieved from each search were screened against the inclusion criteria. A pre-determined coding schedule was used to report the rate of unmet needs in each video. Twenty-six videos were included in the analysis. In total, 291 unmet needs were reported by caregivers of stroke survivors, an average of 11.2 unmet needs per video. The most common unmet needs domain was 'Impact of Caregiving on Daily Activities' (44%). Most videos were developed in the United States (61.5%) and featured spouses of stroke survivors (65.47%). Content produced by caregivers of stroke survivors on YouTube may be used as a tool for caregivers to provide and receive support through online communication. YouTube videos offer insight into the unmet needs of caregivers of stroke survivors and may be used as an additional resource for stroke services to support caregivers.
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Kim SH, Huizenga DE, Handzic I, Ditwiler RE, Lazinski M, Ramakrishnan T, Bozeman A, Rose DZ, Reed KB. Relearning functional and symmetric walking after stroke using a wearable device: a feasibility study. J Neuroeng Rehabil 2019; 16:106. [PMID: 31455358 PMCID: PMC6712835 DOI: 10.1186/s12984-019-0569-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gait impairment is a common consequence of stroke and typically involves a hemiparetic or asymmetric walking pattern. Asymmetric gait patterns are correlated with decreased gait velocity and efficiency as well as increased susceptibility to serious falls and injuries. RESEARCH QUESTION This paper presents an innovative device worn on a foot for gait rehabilitation post stroke. The device generates a backward motion to the foot, which is designed to exaggerate the existing step length asymmetry while walking over ground. We hypothesize this motion will decrease gait asymmetry and improve functional walking in individuals with chronic stroke. METHODS Six participants with chronic stroke, more than one year post stroke, received four weeks of gait training with three sessions per week. Each session included 30 min of walking over ground using the wearable device. Gait symmetry and functional walking were assessed before and after training. RESULTS All participants improved step length symmetry, and four participants improved double limb support symmetry. All participants improved on all three functional outcomes (gait velocity, Timed Up and Go Test, and 6-Minute Walk Test), and five participants improved beyond the minimal detectable change or meaningful change in at least one functional outcome. CONCLUSION The results indicate that the presented device may help improve stroke patients' walking ability and warrant further study. A gait training approach using this new device may enable and expand long-term continuous gait rehabilitation outside the clinic following stroke. TRIAL REGISTRATION NCT02185404. Registered July 9, 2014, https://clinicaltrials.gov/ct2/show/NCT02185404.
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Affiliation(s)
- Seok Hun Kim
- University of South Florida, School of Physical Therapy and Rehabilitation Sciences, Tampa, FL, USA
| | | | - Ismet Handzic
- Moterum Technologies Inc., Greenville, SC, USA
- University of South Florida, Department of Mechanical Engineering, Tampa, FL, USA
| | | | - Matthew Lazinski
- University of South Florida, School of Physical Therapy and Rehabilitation Sciences, Tampa, FL, USA
| | - Tyagi Ramakrishnan
- Northern New Mexico College, Espanola, NM, USA
- University of South Florida, Department of Mechanical Engineering, Tampa, FL, USA
| | - Andrea Bozeman
- University of South Florida Department of Neurology, Tampa, FL, USA
| | - David Z Rose
- University of South Florida Department of Neurology, Tampa, FL, USA
| | - Kyle B Reed
- University of South Florida, Department of Mechanical Engineering, Tampa, FL, USA.
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Denham AM, Wynne O, Baker AL, Spratt NJ, Bonevski B. The unmet needs of carers of stroke survivors: An evaluation of Google search results. Health Informatics J 2019; 26:934-944. [PMID: 31213117 DOI: 10.1177/1460458219852530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Google is the most used search engine in the world, and likely to be used by caregivers of stroke survivors to find online forums and online communities to connect with other caregivers. This study aims to identify the types of websites accessed by caregivers of stroke survivors to connect with other caregivers, and analyse the online content produced by caregivers to identify their unmet needs. The first 20 websites from eight search strings entered into Google were systematically reviewed. Unmet needs on included websites were identified using a pre-determined coding schedule. Six websites were analysed. Most were discussion boards (n = 5, 83%) developed by organisations in the United States (n = 4, 66.6%). Overall, 2124 unmet needs appeared in 896 posts from caregivers. 'Emotional and psychological' were the most reported needs across posts (n = 765, 36%). Content produced on websites may address social isolation and provide insight into delivering and developing services to meet the needs of caregivers of stroke survivors.
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Affiliation(s)
- Alexandra Mj Denham
- The University of Newcastle, Australia; Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | | | - Neil J Spratt
- The University of Newcastle, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, Australia; Department of Neurology, Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, Australia
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Leland NE, Roberts P, De Souza R, Hwa Chang S, Shah K, Robinson M. Care Transition Processes to Achieve a Successful Community Discharge After Postacute Care: A Scoping Review. Am J Occup Ther 2019; 73:7301205140p1-7301205140p9. [PMID: 30839269 DOI: 10.5014/ajot.2019.005157] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Readmissions to health care facilities are undesirable outcomes that indicate the quality of the care transitions. Although there is a growing evidence-base for preventing readmissions, the focus has been on acute care. Postacute care (PAC) patients are often excluded from these studies, and thus there is limited evidence guiding practitioners' efforts to facilitate an effective community transition after PAC rehabilitation. To provide direction for PAC research and clinical practice, this scoping review summarizes current community transition interventions and identifies practices that facilitate successful community discharge. Thirteen care processes emerged from 35 studies, of which 5 were included in at least 60% of the studies, including coaching on the care transition process, medical self-management, medication self-management, scheduling follow-up medical services, and telephone follow-up. These findings can inform the development, evaluation, and implementation of PAC community transition interventions.
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Affiliation(s)
- Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, FGSA, is Associate Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA;
| | - Pamela Roberts
- Pamela Roberts, PhD, OTR/L, SCFES, FAOTA, CPHQ, FNAP, FACRM, is Executive Director and Professor, Department of Physical Medicine and Rehabilitation, and Executive Director Academic and Physician Informatics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Roxanne De Souza
- Roxanne De Souza, OTR/L, is Student, University of Southern California, Los Angeles
| | - Sun Hwa Chang
- Sun Hwa Chang, OTR/L, is Student, University of Southern California, Los Angeles
| | - Kruti Shah
- Kruti Shah, is Student, University of Southern California, Los Angeles
| | - Marla Robinson
- Marla Robinson, Msc OTR/L, BCPR, FAOTA, is Assistant Director, Department of Therapy Services, The University of Chicago Medical Center, Chicago, IL
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Boakye NT, Scott R, Parsons A, Betteridge S, Smith MA, Cluckie G. All change: a stroke inpatient service's experience of a new clinical neuropsychology delivery model. BMJ Open Qual 2019; 8:e000184. [PMID: 30815580 PMCID: PMC6361325 DOI: 10.1136/bmjoq-2017-000184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 11/20/2022] Open
Abstract
Adults presenting to stroke services are frequently faced with the challenge of adjusting to a different life following a stroke. Difficulties often include cognitive impairments, such as memory deficits, attention and language difficulties, and mood disturbances such as anxiety and depression. It has been highlighted that psychological care for this group is just as important as physical rehabilitation. Psychological expertise may therefore be required for the multitude of problems that occur after a stroke. UK National guidelines recommend routine assessment and management of mood and cognition after stroke. The aim of this study was to evaluate a new stroke clinical neuropsychology service developed by the Department of Neuropsychology and Clinical Health Psychology, in order to meet the needs of stroke survivors and their families referred into a large acute hospital. This involved using a different skill mix of staff across one post delivering a service in an acute inpatient stroke unit. This model was evaluated and results revealed that the model delivered increased patient access to neuropsychological support, an expansion in provision of clinical work, along with positive multidisciplinary team feedback. This finding is key as where resources are limited, clinical services may benefit from adopting a ‘skill mix’ model to meet the varying needs of their patients in a timely manner. This model serves to raise the value of psychology to medical services.
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Affiliation(s)
- Ndidi T Boakye
- Department of Neuropsychology and Clinical Health, St George's University Hospitals, London, UK
| | - Richard Scott
- Department of Neuropsychology and Clinical Health, St George's University Hospitals, London, UK
| | - Aisling Parsons
- Department of Neuropsychology and Clinical Health, St George's University Hospitals, London, UK
| | - Shai Betteridge
- Department of Neuropsychology and Clinical Health, St George's University Hospitals, London, UK
| | - Melody A Smith
- Department of Neuropsychology and Clinical Health, St George's University Hospitals, London, UK
| | - Gill Cluckie
- Stroke Service, Department of Neurosciences, St George's University Hospitals, London, UK
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Wong C, Leland NE. Clinicians' Perspectives of Patient Engagement in Post-Acute Care: A Social Ecological Approach. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2018; 36:29-42. [PMID: 29805191 DOI: 10.1080/02703181.2017.1407859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aims To identify rehabilitation providers' perspectives on barriers and facilitators of patient engagement in hip fracture patients in skilled nursing facilities (SNFs) within the social ecological model. Methods We conducted 13 focus groups in SNFs throughout Los Angeles County comprised of rehabilitation staff (n=99). Focus groups were audio-recorded and transcribed. A secondary analysis of themes related to patient engagement were identified and organized within the social ecological model. Results Clinicians identified barriers and facilitators of patient engagement across all levels of the social ecological model: public policy (e.g., insurance), organizational (e.g., facility culture), interpersonal (e.g., clinicians fostering self-reflection), and intrapersonal (e.g., patients' anxiety). Conclusions Examining barriers and facilitators to patient engagement has highlighted areas which need to be sustained and improved. Thus, these findings future efforts to enhance patient engagement in order can to optimize patient healthcare decisions.
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Affiliation(s)
- Carin Wong
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California
| | - Natalie E Leland
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California.,Davis School of Gerontology, University of Southern California
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Denham AM, Baker AL, Spratt NJ, Wynne O, Hunt S, Sharma-Kumar R, Bonevski B. The unmet needs of caregivers of stroke survivors: A review of the content of YouTube videos (Preprint). JMIR Rehabil Assist Technol 2018. [DOI: 10.2196/11052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Araújo O, Lage I, Cabrita J, Teixeira L. Training informal caregivers to care for older people after stroke: A quasi-experimental study. J Adv Nurs 2018; 74:2196-2206. [PMID: 29752812 DOI: 10.1111/jan.13714] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 03/01/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
AIMS This study aimed at evaluating whether training on practical skills involved in providing care reduces the burden experienced by informal caregivers and improves their general health condition. BACKGROUND A substantial number of informal caregivers lack skills to deliver poststroke assistance to older people after hospital discharge, which leads to burden situations as well as mental and physical health deterioration of the former. DESIGN A quasi-experimental design. METHODS This study involved 174 informal caregivers of older people who overcame a stroke. The control group (N = 89) received the usual type of care delivered in healthcare units. The experimental group (N = 85) adopted the InCARE programme for 1 week (T0), 1 month (T1) and 3 (T2) months and received telephone support by counselling caregivers on the subsequent 3rd, 6th, 8th and 10th weeks to hospital discharge. It aimed at facilitating the caregiver's adjustment to the demands of a poststroke stage and at increasing knowledge and practical skills to support the decision-making. Data collection occurred between February-December 2014 at the Community Home Care Services in northern Portugal. RESULTS The experimental group obtained significantly better results regarding practical skills as well as lower burden levels and a better general mental health condition when compared with the control group 1 (T1) and 3 (T2) months after intervention. CONCLUSION Findings suggest that our programme improved practical skills, helped reduce burden levels with better scores and improvement regarding general mental health condition of informal caregivers.
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Affiliation(s)
- Odete Araújo
- School of Nursing, University of Minho, Braga, Portugal
- Health Sciences Research Unit, Nursing (UICISA:E-UMinho), Portugal
- Research Group "AgeingC: Ageing Cluster", CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Isabel Lage
- School of Nursing, University of Minho, Braga, Portugal
| | - José Cabrita
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Laetitia Teixeira
- Research Group "AgeingC: Ageing Cluster", CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
- Institute for the Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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Leland NE, Lepore M, Chang SH, Wong C, Freeman L, Crum K, Gillies H, Nash P. Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners. Disabil Rehabil 2018; 40:646-654. [PMID: 28110561 PMCID: PMC5522785 DOI: 10.1080/09638288.2016.1273973] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 01/17/2023]
Abstract
AIM The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation. METHODS Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners' perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach. RESULTS Seven themes emerged: objectives of care; first 72 h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration. CONCLUSIONS Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners' perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners' perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation. While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers. Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.
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Affiliation(s)
- Natalie E. Leland
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
- Davis School of Gerontology at University of Southern California, Los Angeles, California, USA
- Aging, Disability, and Long-Term Care program at RTI International, Washington, DC, USA
| | - Michael Lepore
- Aging, Disability, and Long-Term Care program at RTI International, Washington, DC, USA
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA
| | - Sun Hwa Chang
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Carin Wong
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Lynn Freeman
- Aegis Therapies, Plano, Texas USA
- Post-Acute Therapeutics and Health Clinical Research Institute, Seattle, Washington USA
| | - Karen Crum
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | | | - Paul Nash
- Center for Innovative Aging at Swansea University, Swansea, Wales, UK
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Xu T, O'Loughlin K, Clemson L, Lannin NA, Dean C, Koh G. Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives. Disabil Rehabil 2017; 41:1044-1054. [PMID: 29277114 DOI: 10.1080/09638288.2017.1419293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants' experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. METHODS Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. RESULTS All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor's safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. CONCLUSIONS Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Implications for rehabilitation Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers. A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.
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Affiliation(s)
- Tianma Xu
- a Ageing Work and Health Research Group, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Health & Social Sciences Cluster , Singapore Institute of Technology , Singapore
| | - Kate O'Loughlin
- a Ageing Work and Health Research Group, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Lindy Clemson
- a Ageing Work and Health Research Group, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Natasha A Lannin
- c Department of Community and Clinical Allied Health , La Trobe Clinical School La Trobe University , Melbourne , Australia
| | - Catherine Dean
- d Department of Health Professions, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Gerald Koh
- e Saw Swee Hock School of Public Health , National University of Singapore , Singapore
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Walker MF, Thomas SA, Whitehead PJ, Condon L, Fisher RJ, Kontou E, Benford P, Cobley C. Biopsychosocial Intervention for Stroke Carers (BISC): protocol for a feasibility randomised controlled trial (RCT). BMJ Open 2017; 7:e018309. [PMID: 29061630 PMCID: PMC5665302 DOI: 10.1136/bmjopen-2017-018309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Reducing length of hospital stay for stroke survivors often creates a shift in the responsibility of care towards informal carers. Adjustment to the caregiving process is experienced by many carers as overwhelming, complex and demanding and can have a detrimental impact on mental and physical health and well-being. National policy guidelines recommend that carers' needs are considered and addressed; despite this, few interventions have been developed and empirically evaluated. We developed a biopsychosocial intervention in collaboration with carers of stroke survivors. Our aim is to determine whether the intervention can be delivered in a group setting and evaluated using a randomised controlled trial (RCT). METHODS AND ANALYSIS Feasibility RCT and nested qualitative interview study. We aim to recruit up to 40 stroke carers within 1 year of the stroke onset. Carers are randomised to usual care or usual care plus biopsychosocial intervention. Each intervention group will consist of five stroke carers. The intervention will focus on: psychoeducation, psychological adjustment to stroke, strategies for reducing unwanted negative thoughts and emotions and problem-solving strategies. The main outcome is the feasibility of conducting an RCT. Carer outcomes at 6 months include: anxiety and depression, quality of life and carer strain. Data are also collected from stroke survivors at baseline and 6 months including: level of disability, anxiety and depression, and quality of life. ETHICS AND DISSEMINATION Favourable ethical opinion was provided by East Midlands - Nottingham2 Research Ethics Committee (14/EMI/1264). This study will determine whether delivery of the biopsychosocial intervention is feasible and acceptable to stroke carers within a group format. It will also determine whether it is feasible to evaluate the effects of the biopsychosocial intervention in an RCT. We will disseminate our findings through peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN15643456; Pre-results.
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Affiliation(s)
- Marion F Walker
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Shirley A Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Phillip J Whitehead
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Laura Condon
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Rebecca J Fisher
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Eirini Kontou
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Penny Benford
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Christine Cobley
- Department of Clinical Psychology, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
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Katbamna S, Manning L, Mistri A, Johnson M, Robinson T. Balancing satisfaction and stress: carer burden among White and British Asian Indian carers of stroke survivors. ETHNICITY & HEALTH 2017; 22:425-441. [PMID: 27744714 DOI: 10.1080/13557858.2016.1244740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers' experiences of caring, factors contributing to their stress, and strategies used to overcome stress. DESIGN A qualitative approach involving in-depth interviews was used to explore informal carers' experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers. Socio-demographic data of carers and stroke survivors were collected at one, and three to six months by dedicated stroke research nurses. RESULTS A total of 37 interviews with carers caring for stroke survivors with a wide range of physical and mental impairments were completed. A majority of carers had assumed the task of caring within a few weeks of the stroke. Irrespective of ethnicity, carers' emotional and physical well-being was undermined by the uncertainty and unpredictability of caring for stroke survivors, and meeting their expectations and needs. The strain of managing social obligations to care was common to all carers irrespective of gender and ethnicity, but the higher levels of anxiety and depression reported by Indian British female carers appeared to stem from the carers' pre-existing physical ailments, their cultural and religious beliefs, and household arrangements. Carers' strain in extended households was exacerbated by the additional responsibility of caring for other dependent relatives. CONCLUSION Since the role of carers is clearly indispensable in the successful rehabilitation of survivors, it is vital to ensure that their well-being is not undermined by a lack of information and training, and that their need for professional support is prioritised.
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Affiliation(s)
- Savita Katbamna
- a Department of Health Science , University of Leicester , UK
| | - Lisa Manning
- b Department of Stroke Medicine , University Hospitals of Leicester NHS Trust , Leicester , UK
| | - Amit Mistri
- b Department of Stroke Medicine , University Hospitals of Leicester NHS Trust , Leicester , UK
| | - Mark Johnson
- c School of Applied Social Sciences, Mary Seacole Research Centre , De Montfort University , Leicester , UK
| | - Thompson Robinson
- d Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease , University of Leicester , Leicester , UK
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Misconceptions about Stroke: Causal Attributions for Stroke-Related Symptoms Reflect the Age of the Survivor. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
With visible disabilities, observers tend to overgeneralise from the disability. In contrast, with invisible disabilities such as traumatic brain injury and stroke, observers often fail to allow for challenges resulting from the disability. Persons who have suffered a stroke claim that people misunderstand their symptoms and stigmatise them as a result of these symptoms. This misunderstanding, which happens particularly with young survivors of stroke, may reflect people's causal attributions for symptoms that follow a stroke. Using a scenario design, this cross-sectional study examined whether people attribute ambiguous symptoms that may result from stroke to other causes (the stroke survivor's personality and age) and whether these attributions reflect the age of the stroke survivor. Participants (N = 120) read scenarios describing a male who was aged either 22, 72, or whose age was unstated and who showed four symptom changes: fatigue, depression, irritability and reduced friendships. For each symptom change, participants rated three causal attributions: the person's age, his personality and stroke. The age of the person in the scenario affected attributions; when the person in the scenario was 22, participants attributed his symptoms significantly more to his personality than to his age or stroke, whereas when he was 72, participants attributed his symptoms more to his age than to his personality or stroke and when his age was unstated, they attributed his symptoms equally to age, stroke and personality. Because misattributions for stroke symptoms hinder rehabilitation, therapy can target people's misattributions to enhance rehabilitation for survivors of stroke.
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Krishnan S, Pappadis MR, Weller SC, Stearnes M, Kumar A, Ottenbacher KJ, Reistetter TA. Needs of Stroke Survivors as Perceived by Their Caregivers: A Scoping Review. Am J Phys Med Rehabil 2017; 96:487-505. [PMID: 28628537 PMCID: PMC5493392 DOI: 10.1097/phm.0000000000000717] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Caregivers usually are not involved while planning the stroke survivor's medical and rehabilitation goals and interventions. This review aimed to identify the needs of stroke survivors as perceived by their caregivers. DESIGN A literature search from 2003 to 2014 was conducted using Medline, CINAHL, PsychINFO, and Google Scholar. Sixty-six studies were included. Most studies excluded did not encompass caregivers' perspectives. Four reviewers screened the titles, abstracts, and full texts of the articles for inclusion. The data extracted from these studies were synthetized into metathemes. RESULTS Fifty-two qualitative, ten quantitative survey, and four mixed-methods studies were included in the final synthesis. The studies came from 11 countries. The data synthesis produced following three metathemes: (a) body functional needs, including psychological function, physical function, cognitive function, and uncertainty related to function; (b) activity and participatory needs, including healthy lifestyle, physical activities, speech, independence, cognitive activities, and uncertainty related to activities and participation; and (c) environmental needs, encompassing support, services, safety, accommodation and accessibility, and uncertainty related to environmental factors. CONCLUSIONS This scoping review identified a range of needs of stroke survivors as perceived by their caregivers. Incorporating the caregiver's preferences and values into clinical decisions may improve outcomes among stroke survivors.
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Affiliation(s)
- Shilpa Krishnan
- Department of Occupational therapy, University of Texas Medical Branch
| | | | - Susan C. Weller
- Preventive Medicine and Community Health, University of Texas Medical Branch
| | | | - Amit Kumar
- Department of Health Services, Policy and Practice, Brown University
| | | | - Timothy A. Reistetter
- Department of Occupational therapy, University of Texas Medical Branch
- Division of Rehabilitation Sciences, University of Texas Medical Branch
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Pesantes MA, Brandt LR, Ipince A, Miranda JJ, Diez-Canseco F. An exploration into caring for a stroke-survivor in Lima, Peru: Emotional impact, stress factors, coping mechanisms and unmet needs of informal caregivers. eNeurologicalSci 2017; 6:33-50. [PMID: 28989982 PMCID: PMC5627498 DOI: 10.1016/j.ensci.2016.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/17/2016] [Accepted: 11/02/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Understanding local complexities and challenges of stroke-related caregiving are essential to develop appropriate interventions. Our study aimed to characterize the impact of post-stroke care among caregivers in a setting of transitioning economy. MATERIALS AND METHODS Qualitative study based on in-depth interviews with primary caregivers of stroke survivors in Lima, Peru. Transcribed data was organized into the emotional impact of caregiving, main stress factors and coping mechanisms to deal with the caregiving role, as well as the unmet needs of caregivers. RESULTS We interviewed twelve caregivers, mean age 52.5 years, 8/12 were females, who were either the spouse or child of the stroke survivor. Stroke patients had a median age of 70 years, range 53-85 years. All participants reported having experienced emotional stress and depressive symptoms as a result of caregiving. Although most had family support, reduced social activities and added unanticipated financial burdens increased caregiver's stress. None of the caregivers had received training in post-stroke care tasks after the patient's discharge and only a few had received some psychological support, yet almost all expressed the need to see a professional to improve their mental health. Keeping a positive attitude towards their relative's physical post-stroke condition was a key coping mechanism. CONCLUSIONS In the absence of structured institutional responses, family members endure with the provision of care for stroke survivors, a task escorted by major emotional, financial, and social strains. This burden could be prevented or curtailed if caregivers were to be targeted by interventions providing psychological and financial support, together with basic training on post-stroke care.
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Affiliation(s)
- M. Amalia Pesantes
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima, Peru
| | - Lena R. Brandt
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima, Peru
| | - Alessandra Ipince
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima, Peru
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Kim LH, Leland NE. Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017; 34:155-168. [PMID: 28989216 DOI: 10.1080/02703181.2016.1267295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS Occupational and physical therapy in post-acute care (PAC) has reached the point where quality indicators for hip fracture are needed. This study characterizes the practitioners' prioritized hip fracture rehabilitation practices, which can guide future quality improvement initiatives. METHODS Ninety-two practitioners participating in a parent mixed methods study were asked to rank a series of evidence-based best practices across five clinical domains (assessment, intervention, discharge planning, caregiver training and patient education). RESULTS Prioritized practices reflected patient-practitioner collaboration, facilitating an effective discharge, and preventing adverse events. The highest endorsed care processes include: developing meaningful goals with patient input (84%) in assessment, using assistive devices in intervention (75%) and patient education (65%), engaging the patient and caregiver (50%) in discharge planning, and fall prevention (60%) in caregiver education. CONCLUSIONS Practitioners identified key care priorities. This study lays the foundation for future work evaluating the extent to which these practices are delivered in PAC.
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Affiliation(s)
- Lauren H Kim
- Davis School of Gerontology, University of Southern California
| | - Natalie E Leland
- Davis School of Gerontology, University of Southern California.,Chan Division of Occupational Science and Occupational Therapy.,Health Services Policy & Practice, Brown University
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Thomas KE, Broady TR, James CL. Exploring manual handling practices by informal carers. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.7.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Manual handling is a significant component in the role of an informal carer. This research aimed to understand the manual handling needs and practices of informal primary carers. Methods: This qualitative study utilised semi-structured face-to-face interviews to gather data from one male and female carer living in the community with a spouse with Parkinson's disease. Using comparative thematic analysis, categories and themes emerged from the detailed descriptions of the lived experiences. Findings: Three main themes emerged from the data: 1. Carer experience: manual handling was a daily task, however care recipients sometimes assisted in a modified environment; and carers utilised previous experiences; 2. Equipment: a variety of prescribed and non-prescribed equipment was used, however limited training was provided; 3. Perceived needs: identified needs included education on manual handling techniques, physical exercises for carers, equipment information, financial assistance for equipment and increased formal support. Conclusions: A lack of assistance for Australian informal carers with manual handling in relation to information provision, training and awareness of equipment and supports was highlighted. There is a need for increased carer awareness of services and support group networks, as well as for health professionals to deliver relevant advice to carers as part of service provision to care recipients.
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Affiliation(s)
- Kate E Thomas
- Occupational therapist, Prince of Wales Hospital, Sydney, Australia
| | - Timothy R Broady
- Senior research and development officer, Carers NSW, Sydney, Australia
| | - Carole L James
- Associate professor, School of Health Sciences, University of Newcastle, NSW, Australia
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Davoody N, Koch S, Krakau I, Hägglund M. Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services. BMC Med Inform Decis Mak 2016; 16:66. [PMID: 27267889 PMCID: PMC4895891 DOI: 10.1186/s12911-016-0307-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/01/2016] [Indexed: 12/04/2022] Open
Abstract
Background Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients’ information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes. Methods Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed. Content analysis was used to analyse the data. Stroke patients’ information needs was explored using patient journey model. Results Four main events (discharge from hospital, discharge from rehab clinic, coming home, and clinical encounters) and two phases (at rehab clinic, at home) have been identified in patients’ post-discharge journey. The main categories identified in this study indicate that patients not only need to have access to health related information about their care and rehabilitation processes but also practical guidance through healthcare and community services. Patients also have different information needs at different events and during different phases. Potential supportive eHealth services were suggested by the researchers considering different parts of the patients’ journeys. Conclusions Patient journey models and qualitative analysis of patients’ information needs are powerful tools that can be used to improve healthcare from a patient perspective. As patients’ understanding of their illness changes over time, their need of more flexible support throughout the care and rehabilitation processes increases. To design appropriate eHealth services that meet patients’ information needs, it is imperative to understand the current care and rehabilitation processes and identify patients’ information needs throughout their journey.
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Affiliation(s)
- Nadia Davoody
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Sabine Koch
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Ingvar Krakau
- Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Maria Hägglund
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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Araújo O, Lage I, Cabrita J, Teixeira L. Development and psychometric properties of ECPICID-AVC to measure informal caregivers’ skills when caring for older stroke survivors at home. Scand J Caring Sci 2016; 30:821-829. [DOI: 10.1111/scs.12291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/22/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Odete Araújo
- School of Nursing; University of Minho; Braga Portugal
| | - Isabel Lage
- School of Nursing; University of Minho; Braga Portugal
| | - José Cabrita
- Faculty of Pharmacy; University of Lisbon; Lisbon Portugal
| | - Laetitia Teixeira
- Research and Education Unit on Ageing (UNIFAI); Institute for the Biomedical Sciences Abel Salazar; University of Porto; Porto Portugal
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Morrow EM, Nicholson C. Carer engagement in the hospital care of older people: an integrative literature review. Int J Older People Nurs 2016; 11:298-314. [DOI: 10.1111/opn.12117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/08/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | - Caroline Nicholson
- Florence Nightingale Faculty of Nursing and Midwifery; King's College London; London UK
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Piccenna L, Lannin NA, Gruen R, Pattuwage L, Bragge P. The experience of discharge for patients with an acquired brain injury from the inpatient to the community setting: A qualitative review. Brain Inj 2016; 30:241-51. [DOI: 10.3109/02699052.2015.1113569] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Greenwood N, Holley J, Ellmers T, Mein G, Cloud G. Qualitative focus group study investigating experiences of accessing and engaging with social care services: perspectives of carers from diverse ethnic groups caring for stroke survivors. BMJ Open 2016; 6:e009498. [PMID: 26826148 PMCID: PMC4735197 DOI: 10.1136/bmjopen-2015-009498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Informal carers, often family members, play a vital role in supporting stroke survivors with post-stroke disability. As populations age, numbers of carers overall and those from minority ethnic groups in particular, are rising. Carers from all ethnic groups, but especially those from black and minority ethnic groups frequently fail to access support services, making understanding their experiences important. The study therefore explored the experiences of carers of stroke survivors aged 45+ years from 5 ethnic groups in accessing and receiving social care services after hospital discharge. DESIGN This qualitative study used 7 recorded focus groups with informal carers of stroke survivors. Data were analysed thematically focusing on similarities and differences between ethnic groups. SETTING Carers were recruited from voluntary sector organisations supporting carers, stroke survivors and black and minority ethnic groups in the UK. PARTICIPANTS 41 carers from 5 ethnic groups (Asian Indian, Asian Pakistani, black African, black Caribbean, white British) participated in the focus groups. RESULTS Several interconnected themes were identified including: the service gap between hospital discharge and home; carers as the best person to care and cultural aspects of caring and using services. Many themes were common to all the included ethnic groups but some related to specific groups. CONCLUSIONS Across ethnic groups there were many similarities in the experiences of people caring for stroke survivors with complex, long-term care needs. Accessing services demands effort and persistence on carers' part. If carers believe services are unsatisfactory or that they, rather than formal services, should be providing support for stroke survivors, they are unlikely to persist in their efforts. Cultural and language differences add to the challenges black and minority ethnic group carers face.
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Affiliation(s)
- Nan Greenwood
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - Jess Holley
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - Theresa Ellmers
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - Gill Mein
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - Geoffrey Cloud
- Department of Neurology, St George's Healthcare NHS Trust, London, UK
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Pound C, Greenwood N. The human dimensions of post-stroke homecare: experiences of older carers from diverse ethnic groups. Disabil Rehabil 2016; 38:1987-99. [DOI: 10.3109/09638288.2015.1107783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carole Pound
- Centre for Qualitative Research, Bournemouth University, Bournemouth, UK
| | - Nan Greenwood
- Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, London, UK
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Bakas T, Jessup NM, McLennon SM, Habermann B, Weaver MT, Morrison G. Tracking patterns of needs during a telephone follow-up programme for family caregivers of persons with stroke. Disabil Rehabil 2015; 38:1780-90. [PMID: 26680007 DOI: 10.3109/09638288.2015.1107767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Programmes that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation. The purpose of this study was to explore patterns of perceived needs and skill-building during a stroke caregiver intervention programme. METHOD Descriptive statistics were used to analyse data from 123 stroke caregivers enrolled in the intervention group of a randomised controlled clinical trial. Caregivers received eight weekly telephone sessions, with a booster session a month later. At each session, the Caregiver Needs and Concerns Checklist (CNCC) was used to identify and prioritise current needs that were then addressed through skill-building strategies. RESULTS Perceived needs changed over time. Information about stroke was the highest priority need during Session 1. Managing survivor emotions and behaviours was the highest priority for Sessions 2 through 4. Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs. Physical and instrumental care needs were relatively low but stable across all nine sessions. Skill-building was consistently high, though it peaked during Sessions 2 and 3. CONCLUSIONS Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation. Implications for Rehabilitation Family caregivers of stroke survivors play an essential role in the rehabilitation process of the stroke survivor. Identifying and addressing the priority needs and concerns of stroke caregivers during the early discharge period enables caregivers to provide sustained support for the stroke survivor. Rehabilitation professionals are in a key position to address evolving caregiver needs and concerns as they transition to home settings with follow-up care.
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Affiliation(s)
- Tamilyn Bakas
- a School of Nursing , Indiana University , Indianapolis , IN , USA ;,b College of Nursing , University of Cincinnati , Cincinnati , OH , USA
| | - Nenette M Jessup
- c Clinical Trials Office , Indiana University Simon Cancer Center , Indianapolis , IN , USA
| | - Susan M McLennon
- a School of Nursing , Indiana University , Indianapolis , IN , USA
| | - Barbara Habermann
- d School of Nursing , University of Delaware College of Health Sciences , Newark , DE , USA
| | - Michael T Weaver
- e College of Nursing , University of Florida , Gainesville , FL , USA
| | - Gwendolyn Morrison
- f Department of Economics , Indiana University Purdue University at Indianapolis , IN , USA
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Older people and decision-making following acute stroke in China: ‘hiding’ as a barrier to active involvement. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15000549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACTDecision-making among older patients with stroke, their families and professionals has been extensively studied in a Western context, but there has been little prior work in China. The study reported here explored how decision-making took place between older people with stroke, their family carers and professionals in an acute care context in mainland China using a constructivist grounded theory approach. Data were collected through semi-structured interviews, participant observation and documentary analysis. Constant comparative analysis of the data was carried out. This paper focuses on the key social process of ‘hiding’ and its dynamic relationship with the core category ‘keeping the peace’. In order to meet the traditional Chinese cultural value of ‘maintaining harmony’, both family carers and professionals hid essential information from older stroke survivors who, as a consequence, were effectively precluded from playing an active role in major decisions. In understanding ‘hiding’, the paper draws upon both Chinese cultural values and ‘awareness context theory’ and in so doing questions the relevance to the Chinese context of key Western notions such as involvement in health-care decision-making. A better understanding of the experiences of decision-making processes between older people with stroke, their family carers and professionals in China will help professionals to provide the best possible support and care whilst promoting informed decision-making amongst all concerned.
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Demir YP, Balci NÇ, Ünlüer NÖ, Uluğ N, Dogru E, Kilinç M, Yildirim SA, Yilmaz Ö. Three different points of view in stroke rehabilitation: patient, caregiver, and physiotherapist. Top Stroke Rehabil 2015; 22:377-85. [PMID: 25823910 DOI: 10.1179/1074935714z.0000000042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The similarities or differences of the three some (physiotherapists, patients, and caregivers) thought about the process of stroke rehabilitation can play a key role in the success of rehabilitation. OBJECTIVE The aim of this qualitative study was to investigate the perspectives of the three some, with regard to the two themes of the study: (1) What are the problems faced by the patients after stroke?; and (2) What does recovery after stroke mean to you? METHODS The qualitative questions and possible answers were prepared by four physiotherapists. The answers were matched to International Classification of Functioning (ICF) components. Seventy patients who were having treatment as in-patient rehabilitation centers, their caregivers, and physiotherapists were invited to the study. After the questions were asked and the possible response choices were presented, subjects were asked to prioritize these response choices. RESULTS One hundred and fifty-nine subjects, including 53 patients, 53 caregivers, and 53 physiotherapists, were included to the study. When the theme 1 were examined, we found that the patients' first priority was functional abilities (ICF: body function and structure) such as using the hands and feet while the caregivers and physiotherapists prioritized self-care problems (ICF: activity and participation). The most common response to the theme 2 was "being in same health condition before the disease" (ICF: activity and participation) among the patients and caregivers and "being able to move arm and leg on the affected side" (body function and structure) among the physiotherapists. CONCLUSION As a conclusion, problems faced by the patients, caregivers, and physiotherapists were perceived under the same ICF domain and that caregivers' and physiotherapists' priorities were the same.
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Morris R. Meeting the psychological needs of community-living stroke patients and carers: a study of third sector provision. Disabil Rehabil 2015; 38:52-61. [PMID: 25731861 DOI: 10.3109/09638288.2015.1014932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To elucidate how community stroke staff in a major third sector organisation experienced their role and understood and responded to clients' psychological needs. METHOD In stage 1, three focus groups of 28 staff in total were recorded, transcribed and analysed using inductive thematic analysis. Themes were authenticated by new staff groups. In stage 2, these themes informed the construction of a questionnaire delivered through the organisation's intranet by "Survey Monkey". RESULTS Five themes emerged from the focus groups: background and context; perceptions of clients' psychological issues; approaches to meeting psychological needs; the experience of working with psychological needs and sources of support; aspirations for future development. Four themes were used in constructing the questionnaire. Responses from 144 staff with diverse qualifications and experience were received; over half encountered 16 (of 35) psychological issues at least once per week. Stroke survivors' needs predominated over carers' needs. Skills used to address psychological problems were identified, also training and support needs and future aspirations. Support needs included information, training and access to specialist consultants. CONCLUSIONS Psychological issues were central in the work of third sector community stroke staff; psychological skills were routinely used. Attention to means of supporting and developing these skills is required. IMPLICATIONS FOR REHABILITATION Service leaders and commissioners should be aware that third sector community stroke staff frequently deal with a diverse range of psychological issues and perceive psychological care as central. Service leaders should consider providing training in assessment and management of mood and cognition, risk assessment and management and basic counselling. Staff should be provided with access to specialist consultation and better information about psychological aspects of referrals. There is uncertainty about key methods for supporting the delivery of psychological care (supervision, mentoring and peer support) which requires consideration.
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Affiliation(s)
- Reg Morris
- a Clinical Psychology, School of Psychology, Cardiff University, and Cardiff and Vale University Health Board , Cardiff , UK
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36
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Smith SD, Gignac MA, Richardson D, Cameron JI. Differences in the Experiences and Support Needs of Family Caregivers to Stroke Survivors: Does Age Matter? Top Stroke Rehabil 2015; 15:593-601. [DOI: 10.1310/tsr1506-593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Eames S, Hoffmann T, McKenna K, Worrall L. Community-Based Stroke Information for Clients with Stroke and Their Carers: Is There Congruency Between Actual and Recommended Practice? Top Stroke Rehabil 2015; 15:295-306. [DOI: 10.1310/tsr1504-295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Howells A, Morris R, Darwin C. A Questionnaire to Assess Carers’ Experience of Stroke Rehabilitation. Top Stroke Rehabil 2015; 19:256-67. [DOI: 10.1310/tsr1903-256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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El Masry Y, Mullan B, Hackett M. Psychosocial Experiences and Needs of Australian Caregivers of People with Stroke: Prognosis Messages, Caregiver Resilience, and Relationships. Top Stroke Rehabil 2015; 20:356-68. [DOI: 10.1310/tsr2004-356] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Tsai PC, Yip PK, Tai JJ, Lou MF. Needs of family caregivers of stroke patients: a longitudinal study of caregivers' perspectives. Patient Prefer Adherence 2015; 9:449-57. [PMID: 25834409 PMCID: PMC4370911 DOI: 10.2147/ppa.s77713] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND After a stroke, patients often suffer from varying degrees of disability that require acute inpatient treatment and extended care at home. Therefore, the caregivers assume multiple responsibilities that can result in stress, particularly when their own needs are inadequately addressed during the patient's recovery. OBJECTIVES This study aimed to explore the changing needs of family caregivers of stroke patients and factors related to the needs in four stages, before the transfer from intensive care unit to neurological unit, before discharge, 2 weeks post-hospitalization, and 3 months post-hospitalization. METHODS The design of this study was based on longitudinal research, and the participants were family caregivers of stroke patients. Sixty family caregivers were recruited in this study. Data were collected at four time points by questionnaire. RESULTS We found that the total number of needs of family caregivers decreased as the illness duration increased and that needs differed significantly between the four time points (P<0.01). Although the needs were different in each stage, health information, professional support, and community networks were the leading need domains in all four stages. The major factors affecting the care needs of family caregivers were the National Institutes of Health Stroke Scale scores of patients on admission, length of hospital stay, and physical dependence of patients. CONCLUSION Family caregivers expected to obtain assistance and related care information from professionals during the course of the disease. Assessing the needs of family caregivers is important for health care workers in understanding problems from the caregivers' perspectives. Relevant information and counseling should be provided to family caregivers to help them access support when needed.
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Affiliation(s)
- Pei-Chun Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Keung Yip
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - John Jen Tai
- Department of Statistics and Information Science, College of Management, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Correspondence: Meei-Fang Lou, School of Nursing, College of Medicine, National Taiwan University, 1, Section 1, Jen-Ai Road, Taipei 10063, Taiwan, Tel +886 2 2312 3456 ext 88441, Fax +886 2 2321 9913, Email
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Forster A, Dickerson J, Melbourn A, Steadman J, Wittink M, Young J, Kalra L, Farrin A. The development and implementation of the structured training programme for caregivers of inpatients after stroke (TRACS) intervention: the London Stroke Carers Training Course. Clin Rehabil 2014; 29:211-20. [PMID: 25057000 DOI: 10.1177/0269215514543334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the content and delivery of the adapted London Stroke Carers Training Course intervention evaluated in the Training Caregivers after Stroke (TRACS) trial. SETTING The London Stroke Carers Training Course is a structured training programme for caregivers of inpatients who are likely to return home after their stroke. The course was delivered by members of the multidisciplinary team while the patient was in the stroke unit with one recommended 'follow through' session after discharge home. INTERVENTION The intervention consists of 14 training components (six mandatory) that were identified as important knowledge/skills that caregivers would need to be able to care for the stroke patient after discharge home. Following national training days, the London Stroke Carers Training Course was disseminated to intervention sites by the cascade method of implementation. RESULTS The intervention was adapted for implementation across a range of stroke units. Training days were well attended (median 2.5 and 2.0 attendees per centre for the first and second days, respectively) and the feedback positive, demonstrating 'face validity' for the intervention. However cascading of this training to other members of the multidisciplinary team was not consistent, with 7/18 centres recording no cascade training. CONCLUSION The adapted London Stroke Carers Training Course provided a training programme that could be delivered in a standardised, structured way in a variety of stroke unit settings throughout the UK. The intervention was well received by stroke unit staff, however, the cascade method of implementation was not as effective as we would have wished.
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Affiliation(s)
- Anne Forster
- Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
| | - Josie Dickerson
- Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
| | | | | | - Margreet Wittink
- Princess Royal University Hospital, Kings College Hospital NHS Trust, London, UK
| | - John Young
- Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
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Abstract
The purposes of this study were to develop and validate a measure of unmet resource needs of the caregivers of survivors of stroke and to describe the caregivers' unmet needs during 1 year. A longitudinal, descriptive design was used to test the reliability and validity of the Unmet Resource Needs (URN) measure. Item development was based on literature review and preliminary study findings. A stress and coping conceptual model framed the hypotheses. Psychometric testing was based on 6-month postdischarge data (n = 166). Content and structural construct validity, internal consistency reliability through 1 year, and concurrent validity were tested. Change in URN over time was examined. Content validity was supported by floor and ceiling effects less than 5%. Principal axis factoring yielded a 12-item, two-factor solution reflecting general and technology unmet needs. Internal consistency reliability was satisfactory for the total scale and subscales at all times, excepting the baseline three-item technology scale (α = .56). Concurrent validity was supported by significant correlations with model constructs (threat, positive problem solving, depression, preparedness; p < .01) in the expected direction. Functional status and resource use were not associated with the URN. Repeated measures analysis of variance (n = 123) indicated a significant decrease in unmet needs from baseline to 3, 6, and 12 months postdischarge (p < .001). Nevertheless, 42% reported one or more unmet needs at year 1. Assessment and counseling on unmet needs is indicated throughout the caregiving trajectory to reduce negative outcomes.
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Steultjens E, Jellema S. Early applied stroke carers training programme was not more effective than usual care. Aust Occup Ther J 2014; 61:210-1. [DOI: 10.1111/1440-1630.12127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Esther Steultjens
- CAPs Advisory Board Member; University of Applied Sciences HAN; Nijmegen The Netherlands
- Faculty of Health and Social Studies; University of Applied Sciences HAN; Nijmegen The Netherlands
| | - Sandra Jellema
- School of Allied Health; University of Applied Sciences HAN; Nijmegen The Netherlands
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Rochette A, Racine E, Lefebvre H, Lacombe J, Bastien J, Tellier M. Ethical issues relating to the inclusion of relatives as clients in the post-stroke rehabilitation process as perceived by patients, relatives and health professionals. PATIENT EDUCATION AND COUNSELING 2014; 94:384-389. [PMID: 24290239 DOI: 10.1016/j.pec.2013.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/03/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To document the ethical issues regarding the systematic inclusion of relatives as clients in the post-stroke rehabilitation process. METHODS A two-phase qualitative design consisting of in-depth interviews with relatives and stroke-clients (Phase 1) and three focus groups with relatives, stroke-clients and health professionals (Phase 2). Data was audio recorded. Transcribed interviews and focus groups content were rigorously analyzed by two team members. RESULTS The interview sample was composed of 25 relatives and of 16 individuals with a first stroke whereas the three focus group sample size varied from 5 to 7 participants. Four main themes emerged: (1) overemphasis of caregiving role with an unclear legitimacy of relative to also be a client; (2) communication as a key issue to foster respect and a family-centered approach; (3) availability and attitudes of health professionals as a facilitator or a barrier to a family-centered approach; and (4) constant presence of relatives as a protective factor or creating a perverse effect. CONCLUSION/PRACTICE IMPLICATIONS The needs of relatives are well known. The next step is to legitimize their right to receive services and to acknowledge the combined clinical and ethical value of including them post-stroke. Interdisciplinary health care approaches and communication skills should be addressed.
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Affiliation(s)
- Annie Rochette
- Montreal University, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada.
| | - Eric Racine
- Montreal University, Quebec, Canada; McGill University, Montreal, Canada; Montreal Clinical Research Institute (IRCM), Canada
| | - Helene Lefebvre
- Montreal University, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
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Forster A, Dickerson J, Young J, Patel A, Kalra L, Nixon J, Smithard D, Knapp M, Holloway I, Anwar S, Farrin A. A structured training programme for caregivers of inpatients after stroke (TRACS): a cluster randomised controlled trial and cost-effectiveness analysis. Lancet 2013; 382:2069-76. [PMID: 24054816 DOI: 10.1016/s0140-6736(13)61603-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most patients who have had a stroke are dependent on informal caregivers for activities of daily living. The TRACS trial investigated a training programme for caregivers (the London Stroke Carers Training Course, LSCTC) on physical and psychological outcomes, including cost-effectiveness, for patients and caregivers after a disabling stroke. METHODS We undertook a pragmatic, multicentre, cluster randomised controlled trial with a parallel cost-effectiveness analysis. Stroke units were eligible if four of five criteria used to define a stroke unit were met, a substantial number of patients on the unit had a diagnosis of stroke, staff were able to deliver the LSCTC, and most patients were discharged to a permanent place of residence. Stroke units were randomly assigned to either LSCTC or usual care (control group), stratified by geographical region and quality of care, and using blocks of size 2. Patients with a diagnosis of stroke, likely to return home with residual disability and with a caregiver providing support were eligible. The primary outcome for patients was self-reported extended activities of daily living at 6 months, measured with the Nottingham Extended Activities of Daily Living (NEADL) scale. The primary outcome for caregivers was self-reported burden at 6 months, measured with the caregivers burden scale (CBS). We combined patient and caregiver costs with primary outcomes and quality-adjusted life-years (QALYs) to assess cost-effectiveness. This trial is registered with controlled-trials.com, number ISRCTN 49208824. FINDINGS We assessed 49 stroke units for eligibility, of which 36 were randomly assigned to either the intervention group or the control group. Between Feb 27, 2008, and Feb 9, 2010, 928 patient and caregiver dyads were registered, of which 450 were in the intervention group, and 478 in the control group. Patients' self-reported extended activities of daily living did not differ between groups at 6 months (adjusted mean NEADL score 27·4 in the intervention group versus 27·6 in the control group, difference -0·2 points [95% CI -3·0 to 2·5], p value=0·866, ICC=0·027). The caregiver burden scale did not differ between groups either (adjusted mean CBS 45·5 in the intervention group versus 45·0 in the control group, difference 0·5 points [95% CI -1·7 to 2·7], p value=0·660, ICC=0·013). Patient and caregiver costs were similar in both groups (length of the initial stroke admission and associated costs were £13,127 for the intervention group and £12,471 for the control group; adjusted mean difference £1243 [95% CI -1533 to 4019]; p value=0·380). Probabilities of cost-effectiveness based on QALYs were low. INTERPRETATION In a large scale, robust evaluation, results from this study have shown no differences between the LSCTC and usual care on any of the assessed outcomes. The immediate period after stroke might not be the ideal time to deliver structured caregiver training. FUNDING Medical Research Council.
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Affiliation(s)
- Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK.
| | - Josie Dickerson
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
| | - Anita Patel
- Institute of Psychiatry, King's College London, London, UK
| | - Lalit Kalra
- Department of Stroke Medicine, King's College London, London, UK
| | - Jane Nixon
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - David Smithard
- Department of Stroke Medicine, King's College London, London, UK
| | - Martin Knapp
- Institute of Psychiatry, King's College London, London, UK; Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Shamaila Anwar
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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Huang LL, Lee CF, Hsieh CL, Chen MH. Upper extremity rehabilitation equipment for stroke patients in Taiwan: usage problems and improvement needs. Occup Ther Int 2013; 20:205-14. [PMID: 24190420 DOI: 10.1002/oti.1360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to survey occupational therapists for the usage problems and for their improvement needs for upper extremity rehabilitation equipment (UERE). A questionnaire was given to experienced occupational therapists from 113 hospitals that provide occupational therapy services with three or more professional full-time therapists. A total of 48 hospitals sent back questionnaires, and 184 valid questionnaires were received. Most of the UERE had two major problems: The base of the equipment was unstable, and the equipment was uninteresting to use. The therapists reported that three major needs for design improvement in the UERE were adjustability of functions, exchangeability of components and recording of movement data. Some therapists had suggestions for designing new types of UERE, such as manual dexterity training equipment, activities of daily living oriented equipment, sensory re-education equipment, arm supination and pronation training equipment, and wrist extension training equipment. These findings reveal the genuine user needs of upper extremity devices and provide useful applications to the development and re-design of these devices. However, obtaining opinions primarily from experienced occupational therapists may pose a methodological limitation of this study. In future research, it is advised to include patients' opinions and also investigate whether a clinician's years of experience would affect his or her viewpoint of usage problems and improvement needs of the UERE.
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Affiliation(s)
- Lan-Ling Huang
- Graduate School of Design, National Yunlin University of Science and Technology, Douliou, Taiwan
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Sun Y, Lee SH, Heng BH, Chin VS. 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore. BMC Neurol 2013; 13:133. [PMID: 24088308 PMCID: PMC3850698 DOI: 10.1186/1471-2377-13-133] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/18/2013] [Indexed: 11/27/2022] Open
Abstract
Background Stroke is the 4th leading cause of death and 1st leading cause of disability in Singapore. However the information on long-term post stroke outcomes for Singaporean patients was limited. This study aimed to investigate the post stroke outcomes of 5-year survival and rehospitalization due to stroke recurrence for hemorrhagic and ischemic stroke patients in Singapore. The outcomes were stratified by age, ethnic group, gender and stroke types. The causes of death and stroke recurrence were also explored in the study. Methods A multi-site retrospective cohort study. Patients admitted for stroke at any of the three hospitals in the National Healthcare Group of Singapore were included in the study. All study patients were followed up to 5 years. Kaplan-Meier was applied to study the time to first event, death or rehospitalization due to stroke recurrence. Cox proportional hazard model was applied to study the time to death with adjustment for stroke type, age, sex, ethnic group, and admission year. Cumulative incidence model with competing risk was applied for comparing the risks of rehospitalization due to stroke recurrence with death as the competing risk. Results Totally 12,559 stroke patients were included in the study. Among them, 59.3% survived for 5 years; 18.4% were rehospitalized due to stroke recurrence in 5 years. The risk of stroke recurrence and mortality increased with age in all stroke types. Gender, ethnic group and admitting year were not significantly associated with the risk of mortality or stroke recurrence in hemorrhagic stroke. Male or Malay patient had higher risk of stroke recurrence and mortality in ischemic stroke. Hemorrhagic stroke had higher early mortality while ischemic stroke had higher recurrence and late mortality. The top cause of death among died stroke patients was cerebrovascular diseases, followed by pneumonia and ischemic heart diseases. The recurrent stroke was most likely to be the same type as the initial stroke among rehospitalized stroke patients. Conclusions Five year post-stroke survival and rehospitalization due to stroke recurrence as well as their associations with patient demographics were studied for different stroke types in Singapore. Specific preventive strategies are needed to target the high risk groups to improve their long-term outcomes after acute stroke.
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Affiliation(s)
- Yan Sun
- Department of Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore.
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Creasy KR, Lutz BJ, Young ME, Ford A, Martz C. The impact of interactions with providers on stroke caregivers' needs. Rehabil Nurs 2013; 38:88-98. [PMID: 23529947 DOI: 10.1002/rnj.69] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Preparation for caregiving is improved through engaged interactions between stroke family caregivers and healthcare providers throughout the care trajectory. We explored caregivers' perceptions about interactions with providers in rehabilitation, and how these experiences affected caregiver preparation. DESIGN Seventeen caregivers, included in this grounded theory study, were interviewed during a rehabilitation stay and postdischarge. Data were analyzed using dimensional and comparative analysis. FINDINGS Caregivers described interactions with providers on a continuum from collaborative to disconnected, and a range of strategies to enhance interactions. CONCLUSIONS Caregivers want to be actively engaged with providers during inpatient rehabilitation and collaborative interactions enhance preparedness and care satisfaction. RELEVANCE Family members should be assessed for caregiving capacity and interactions between providers and caregivers should be individualized to specific needs. Providers must also be aware that many caregivers are not active information seekers. They must engage caregivers who may not even know what questions to ask.
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Affiliation(s)
- Kerry Rae Creasy
- College of Nursing, University of Florida, Gainesville, FL, USA.
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Parveen S, Morrison V, Robinson CA. Ethnicity, familism and willingness to care: important influences on caregiver mood? Aging Ment Health 2013; 17:115-24. [PMID: 22934683 DOI: 10.1080/13607863.2012.717251] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Few studies have to date examined the effects of ethnicity on caregiver motivations, coping responses and mood. This theoretically informed study uses the socio-cultural model of stress and coping to explore these relationships amongst a White-British and British South-Asian caregiver sample. METHOD A total of 235 primary family caregivers were recruited for a cross-sectional questionnaire survey; of which 162 were White-British and 73 were British South-Asian. RESULTS British South-Asian caregivers differed from White-British caregivers on several variables within the stress-coping framework. British South-Asian caregivers were younger, had significantly higher levels of familism, used significantly more behavioural disengagement and religious coping and reported having significantly less support than White-British caregivers. White-British caregivers were more likely to make use of substances and humour as coping methods, and also in these caregivers, familism was significantly related to caregiver depression. Whilst levels of willingness to care did not differ between the two caregiver groups, opposing relationships were seen in the association between willingness to care and caregiver anxiety. Regression analyses found that self-blame explained a significant proportion of variance in South-Asian anxiety and depression, whereas depression amongst White-British caregivers was associated with high use of substances, low use of humour and low mean satisfaction with support. CONCLUSION These findings offer support to the socio-cultural model of stress and coping in that coping is associated with two outcomes (anxiety and depression), but motivational factors are also highlighted which have additional implications for the development of culturally specific interventions aimed at reducing caregiver distress.
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Affiliation(s)
- Sahdia Parveen
- School of Psychology, Bangor University, Bangor, North Wales, UK.
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Eames S, Hoffmann T, Worrall L, Read S, Wong A. Randomised controlled trial of an education and support package for stroke patients and their carers. BMJ Open 2013; 3:bmjopen-2012-002538. [PMID: 23657469 PMCID: PMC3651972 DOI: 10.1136/bmjopen-2012-002538] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education. This study aimed to evaluate the effects of an education package which utilised both strategies on the knowledge, health and psychosocial outcomes of stroke patients and carers. DESIGN Multisite, randomised trial comparing usual care with an education and support package. SETTING Two acute stroke units. PARTICIPANTS Patients and their carers (N=138) were randomised (control n=67, intervention n=71) of which data for 119 participants (control n=59, intervention n=60) were analysed. INTERVENTION The package consisted of a computer-generated, tailored written information booklet and verbal reinforcement provided prior to, and for 3 months following, discharge. OUTCOME MEASURES Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors. The primary outcome was stroke knowledge (score range: 0-25). Secondary outcomes were: self-efficacy (1-10), anxiety and depression (0-21), ratings of importance of information (1-10), feelings of being informed (1-10), satisfaction with information (1-10), caregiver burden (carers) (0-13) and quality of life (patients) (1-5). RESULTS Intervention group participants reported better: self-efficacy for accessing stroke information (adjusted mean difference (MD) of 1.0, 95% CI 0.3 to 1.7, p=0.004); feeling informed (MD 0.9, 95% CI 0.2 to 1.6, p=0.008); and satisfaction with medical (MD 2.0, 95% CI 1.1 to 2.8, p<0.001); practical (MD 1.1, 95% CI 0.3 to 1.9, p=0.008), services and benefits (MD 0.9, 95% CI 0.1 to 1.8, p=0.036) and secondary prevention information (MD 1.7, 95% CI 0.9 to 2.5, p<0.001). There was no significant effect on other outcomes. CONCLUSIONS Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information, but other outcomes were not significantly affected. Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies. ACTRN12608000469314.
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Affiliation(s)
- Sally Eames
- Brighton Health Campus & Services, Brighton, Queensland, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia and School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Linda Worrall
- Communication Disability Centre and the CCRE in Aphasia Rehabilitation, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Stephen Read
- Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andrew Wong
- Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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