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Sivertsen M, De Jaegher H, Alstadhaug KB, Arntzen EC, Normann B. The precarity of patient participation - a qualitative interview study of experiences from the acute stroke and rehabilitation journey. Physiother Theory Pract 2024; 40:1265-1280. [PMID: 36345567 DOI: 10.1080/09593985.2022.2140319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Active patient participation is an important factor in optimizing post-stroke recovery, yet it is often low, regardless of stroke severity. The reasons behind this trend are unclear. PURPOSE To explore how people who have suffered a stroke, perceive the transition from independence to dependence and whether their role in post-stroke rehabilitation influences active participation. METHODS In-depth interviews with 17 people who have had a stroke. Data were analyzed using systematic text condensation informed by the concept of autonomy from enactive theory. RESULTS Two categories emerged. The first captures how the stroke and the resultant hospital admission produces a shift from being an autonomous subject to "an object on an assembly line." Protocol-based investigations, inactivity, and a lack of patient involvement predominantly determine the hospital context. The second category illuminates how people who have survived a stroke passively adapt to the hospital system, a behavior that stands in contrast to the participatory enablement facilitated by community. Patients feel more prepared for the transition home after in-patient rehabilitation rather than following direct discharge from hospital. CONCLUSION Bodily changes, the traditional patient role, and the hospital context collectively exacerbate a reduction of individual autonomy. Thus, an interactive partnership between people who survived a stroke and multidisciplinary professionals may strengthen autonomy and promote participation after a stroke.
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Affiliation(s)
- Marianne Sivertsen
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromsoe, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
| | - Hanne De Jaegher
- Department of Philosophy, University of the Basque Country, Avenida de Tolosa, San Sebastián, Spain
- University of Sussex School of Psychology, Brighton, UK
| | - Karl Bjørnar Alstadhaug
- Department of Clinical Medicine, UiT the Arctic University of Norway, Langnes, Tromsoe, Norway
- Department of Neurology, Nordland Hospital Trust, Bodoe, Norway
| | - Ellen Christin Arntzen
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
| | - Britt Normann
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
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Lin Q, Dong X, Huang T, Zhou H. Developmental trajectory of care dependency in older stroke patients. Front Neurol 2024; 15:1374477. [PMID: 38836003 PMCID: PMC11148867 DOI: 10.3389/fneur.2024.1374477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
Background Stroke is the leading cause of death in China. Older stroke survivors often have other chronic conditions, not only musculoskeletal deterioration due to age, but also changes in body image that can be brought on by stroke and other diseases, making them unable to take good care of themselves and dependent on others. The degree of dependency affects the rehabilitation progress of stroke survivors and shows dynamic changes that need to be recognized. Objectives This study investigates the trajectory of dependency changes in older stroke patients with comorbidities and analyze the influencing factors. Methods Grounded in the Chronic Illness Trajectory Framework (CITF), a longitudinal study was conducted from February 2023 to October 2023, tracking 312 older stroke patients with comorbidities admitted to two tertiary hospitals in Guangzhou. Care dependency levels were assessed using Care Dependency Scale on admission day 5 (T0), at discharge (T1), 1 month post-discharge (T2), and 3 months post-discharge (T3). Growth Mixture Model were utilized to identify trajectory categories, and both univariate analysis and multivariate logistic regression methods were employed to explore factors associated with different developmental trajectories. Results A total of four developmental trajectories were fitted, C1 (high independence-slow increased group, 52.0%), C2 (moderate independence-rapid increased group, 13.0%), C3 (moderate independence-slow increased group, 25.0%), and C4 (low independence-increased and decreased group, 10.0%). Length of hospital stay, place of residence, level of social support, residual functional impairments, NIHSS score, and BI index independently influence the trajectory categories. Conclusion There is heterogeneity in care dependency among older stroke patients with comorbidities. Most patients gradually reduce their dependency and become more independent, but others remain dependent for an extended period of time. It is recommended to focus on patients who live in rural areas, have low social support, have high admission NIHSS scores and have residual functional impairment, and provide them with personalized continuity of care and rehabilitation services in order to reduce care dependency and the burden of care, and to improve patients' quality of life.
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Affiliation(s)
- Qinger Lin
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaohang Dong
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tianrong Huang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongzhen Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
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Björkdahl A, Rafsten L, Petersson C, Sunnerhagen KS, Danielsson A. Effect of very early supported discharge versus usual care on activi-ties of daily living ability after mild stroke: a randomized controlled trial. J Rehabil Med 2023; 55:jrm12363. [PMID: 37615492 PMCID: PMC10464824 DOI: 10.2340/jrm.v55.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke. DESIGN A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. Patients: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild. METHODS The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke. RESULTS Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p = 0.039) at 4 weeks post-discharge and 3 and 4.5 (p = 0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p = 0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke. CONCLUSION Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results.
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Affiliation(s)
- Ann Björkdahl
- nstitute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ²Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Rafsten
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cathrine Petersson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Danielsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Lennon O, Crystal A, Kwan M, Tierney C, Gallagher A, Murphy S. Perspectives and Experiences of Cardiac Rehabilitation after Stroke—A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10081579. [PMID: 36011236 PMCID: PMC9408632 DOI: 10.3390/healthcare10081579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
Cardiac rehabilitation (CR) after stroke has been proven to be a safe and feasible secondary prevention intervention. Limited qualitative data capture people’s experiences and perceptions of attending CR following stroke, but with none addressing translational aspects when CR is delivered as routine clinical care. Using a phenomenological, qualitative approach, four semi-structured focus groups were conducted with 15 individuals (60% male) who had completed CR during their stroke care pathway. Our inductive thematic analysis identified five themes. The first centred on recognising stroke as a cardiovascular disease and the applicability of CR post-stroke. The second addressed how peer understanding, camaraderie, and medical supervision created a safe and supportive environment. The third identified how the programme-built confidence supported longer-term healthy lifestyle choices in physical activity, diet, and smoking. The penultimate theme addressed the period from hospital discharge to attending CR as a time of uncertainty where many participants experienced cognitive difficulties, mood disturbances, and mental fatigue without adequate support. Lastly, participants identified unmet needs in their care pathway that included a lack of information about their referral to CR, the programme content, and accessing local supports ahead of CR. Ongoing and unmet needs both during and after CR related to self-management of secondary prevention medications, neurological issues, post-stroke fatigue, and the lack of structured support following CR completion.
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Affiliation(s)
- Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
- Correspondence: ; Tel.: +35-31-7166-508
| | - Alexandra Crystal
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Michelle Kwan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Caoimhe Tierney
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Anne Gallagher
- Heart House, Mater Misericordiae University Hospital, D07 KH4C Dublin, Ireland
| | - Sean Murphy
- Stroke Services, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
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Sammut M, Haracz K, Shakespeare D, English C, Crowfoot G, Fini N, Nilsson M, Janssen H. Physical Activity After Transient Ischemic Attack or Mild Stroke Is Business as Usual. J Neurol Phys Ther 2022; 46:189-197. [PMID: 35727994 DOI: 10.1097/npt.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Regular, sustained moderate-to-vigorous physical activity (MVPA) is a recommended strategy to reduce the risk of recurrent stroke for people who have had transient ischemic attack (TIA) or mild stroke. This study aimed to explore attitudes toward, and experience of engaging in physical activity by adults following a TIA or mild stroke. METHODS Constructivist grounded theory methodology informed data collection and analysis. Interviews from 33 adults with TIA or mild stroke (mean age 65 [SD 10] years, 48% female, 40% TIA) were collected. RESULTS Business as usual characterized physical activity engagement post-TIA or mild stroke. Most participants returned to prestroke habits, as either regular exerciser or nonexerciser, with only a small number making changes. Influencing factors for physical activity participation included information, challenges, strategies, and support. Business as usual was associated with a perceived lack of information to suggest a need to change behaviors. Nonexercisers and those who decreased physical activity emphasized challenges to physical activity, while regular exercisers and those who increased physical activity focused on strategies and support that enabled participation despite challenges. DISCUSSION AND CONCLUSION Information about the necessity to engage in recommended physical activity levels requires tailoring to the needs of the people with TIA or mild stroke. Helpful information in combination with support and strategies may guide how to navigate factors preventing engagement and might influence the low level of physical activity prevalent in this population.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A376).
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Affiliation(s)
- Maria Sammut
- School of Health Sciences, University of Newcastle, Newcastle, Australia (M.S., K.H., D.S., C.E); School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia (G.C.); Department of Physiotherapy, University of Melbourne, Parkville, Australia (N.F.); Centre for Rehab Innovations, University of Newcastle, Newcastle, Australia (M.N.); and Hunter New England Local Health District, Newcastle, Australia (H.J.)
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Ding W, Chen J, Liu J, Lin B, Li S, Li F, Guo J, Li Y, Li J. Development and validation of the Health Education Adherence Scale for Stroke Patients: a cross-sectional study. BMC Neurol 2022; 22:69. [PMID: 35227225 PMCID: PMC8883719 DOI: 10.1186/s12883-022-02597-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Due to the lack of health education adherence assessment tools for stroke patients, the assessment of health education adherence in this population is insufficient, which hinders the prevention and rehabilitation of stroke. This study aims to develop and validate a Health Education Adherence Scale for Stroke Patients (HEAS-SP). Methods A cross-sectional design with a purposive sampling method was used for this study. Six hundred and fifty-four eligible participants completed the demographic questionnaire and the HEAS-SP. The data collection lasted for 7 months, from March 1stto September 30th in 2019. Item analysis and exploratory and confirmatory factor analysis were employed to develop and validate the HEAS-SP. Results The item analysis, exploratory and confirmatory factor analysis resulted in a 20-item HEAS-SP with 4 domains: medication adherence, diet adherence, rehabilitation exercise adherence, and healthy lifestyle adherence. The four-domain model demonstrated acceptable model fit indexes and the 20-item HEAS-SP demonstrated acceptable reliability and validity. Conclusion The 20-item HEAS-SP was shown to have acceptable reliability and validity for assessing health education adherence with respect to diet, medication, rehabilitation exercise and healthy lifestyle in stroke patients, making it a potential basis for developing targeted interventions for stroke patients.
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Affiliation(s)
- Weiwei Ding
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junya Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Beibei Lin
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shihen Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fengzhen Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junyi Guo
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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E Wurzinger H, Abzhandadze T, Rafsten L, Sunnerhagen KS. Dependency in Activities of Daily Living During the First Year After Stroke. Front Neurol 2021; 12:736684. [PMID: 34819908 PMCID: PMC8606514 DOI: 10.3389/fneur.2021.736684] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation. Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke. Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed. Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke. Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.
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Affiliation(s)
- Hannah E Wurzinger
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Rafsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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8
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Sammut M, Haracz K, English C, Shakespeare D, Crowfoot G, Nilsson M, Janssen H. Participants' Perspective of Engaging in a Gym-Based Health Service Delivered Secondary Stroke Prevention Program after TIA or Mild Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11448. [PMID: 34769964 PMCID: PMC8583419 DOI: 10.3390/ijerph182111448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/21/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022]
Abstract
People who have had a transient ischemic attack (TIA) or mild stroke have a high risk of recurrent stroke. Secondary prevention programs providing support for meeting physical activity recommendations may reduce this risk. Most evidence for the feasibility and effectiveness of secondary stroke prevention arises from programs developed and tested in research institute settings with limited evidence for the acceptability of programs in 'real world' community settings. This qualitative descriptive study explored perceptions of participation in a secondary stroke prevention program (delivered by a community-based multidisciplinary health service team within a community gym) by adults with TIA or mild stroke. Data gathered via phone-based semi-structured interviews midway through the program, and at the end of the program, were analyzed using constructivist grounded theory methods. A total of 51 interviews from 30 participants produced two concepts. The first concept, "What it offered me", describes critical elements that shape participants' experience of the program. The second concept, "What I got out of it" describes perceived benefits of program participation. Participants perceived that experiences with peers in a health professional-led group program, held within a community-based gym, supported their goal of changing behaviour. Including these elements during the development of health service strategies to reduce recurrent stroke risk may strengthen program acceptability and subsequent effectiveness.
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Affiliation(s)
- Maria Sammut
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of New-Castle, Callaghan, NSW 2308, Australia; (K.H.); (C.E.); (D.S.); (M.N.); (H.J.)
| | - Kirsti Haracz
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of New-Castle, Callaghan, NSW 2308, Australia; (K.H.); (C.E.); (D.S.); (M.N.); (H.J.)
| | - Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of New-Castle, Callaghan, NSW 2308, Australia; (K.H.); (C.E.); (D.S.); (M.N.); (H.J.)
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2308, Australia
| | - David Shakespeare
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of New-Castle, Callaghan, NSW 2308, Australia; (K.H.); (C.E.); (D.S.); (M.N.); (H.J.)
| | - Gary Crowfoot
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Michael Nilsson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of New-Castle, Callaghan, NSW 2308, Australia; (K.H.); (C.E.); (D.S.); (M.N.); (H.J.)
- Centre for Rehab Innovations, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Heidi Janssen
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of New-Castle, Callaghan, NSW 2308, Australia; (K.H.); (C.E.); (D.S.); (M.N.); (H.J.)
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2308, Australia
- Hunter New England Local Health District, Community and Aged Care Services Community Stroke Team, New Lambton Heights, NSW 2308, Australia
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Bridgwood BM, Wilson A, Clarke D, Eborall H. Understanding TIA: an ethnographic study of TIA consultations. Fam Pract 2020; 37:530-534. [PMID: 32016372 DOI: 10.1093/fampra/cmaa004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transient ischaemic attack (TIA) is a transient episode of neurological dysfunction. Rapid access TIA clinics have been set up as integrated 'one-stop' clinics that aim to investigate, diagnose, educate and implement treatment to reduce the risk of further TIA/stroke. OBJECTIVE This study aimed to examine how TIA consultations were conducted by observing the consultations and then interviewing patients. METHODS This ethnographic study observed fifteen patient-clinician consultations where a diagnosis of TIA was made within three different TIA outpatient clinics in the East Midlands. All fifteen patients, their accompanying family-members/carers and three stroke clinicians were interviewed. Data analysis was informed by the constant comparative approach. RESULTS There was considerable variation in the conduct of these consultations across sites and clinicians. This resulted in variation in patient experience and knowledge after the consultation including the ability to recognize TIA-associated risk factors and their management. As TIA symptoms resolve, patients may reduce their need to seek health care services in addition to demonstrating reduced concordance with secondary stroke prevention. Health professionals recognize that this single appointment provides patients with a large amount of information which may be difficult to process. Importantly, there was little discussion about future symptoms and how to respond. A management plan, which considered a patient's health belief, knowledge and encouraged the involvement of family members, improved information recall. CONCLUSIONS TIA is a complex medical diagnosis with multiple risk factors that may make the management complex and hence difficult for patients to undertake. Our findings found variability in the conduct, provision of information and patient understanding. Guidance on nationally agreed consultation framework may prove useful. Improved patient education may include individualized/sustained education utilizing multidisciplinary team members across family/primary and secondary care, video or greater online education and improved general public education.
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Affiliation(s)
| | - Andrew Wilson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Clarke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
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Unsworth DJ, Mathias JL, Dorstyn DS, Koblar SA. Are patient educational resources effective at deterring stroke survivors from considering experimental stem cell treatments? A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:1373-1381. [PMID: 32081514 DOI: 10.1016/j.pec.2020.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate whether online resources developed to educate people about the risks associated with experimental stem cell (SC) treatments influence stroke survivors' attitudes about the safety and effectiveness of these treatments. METHODS Adult stroke survivors who had not previously received SC treatments (N = 112) were recruited from international stroke advocacy/support groups for a prospective, parallel-group randomized controlled trial. Participants indicated whether they were considering SC treatments (yes/no) prior to, immediately following, and 30-days after reading/viewing the International Society for Stem Cell Research booklet or Stem Cell Network video. Participant attitudes regarding the safety, effectiveness, accessibility and affordability of SC treatments were examined on each occasion, and compared to those of a waitlist control group. RESULTS Significantly fewer participants were considering SC treatments immediately after reading the SC research booklet (p =.031), although neither intervention had any impact after 30-days (p >.05). Waitlist and intervention groups reported positive attitudes toward SC treatments at each assessment. CONCLUSIONS Stroke survivor attitudes toward SC treatments were initially influenced by the patient booklet, however these changes were not maintained. PRACTICAL IMPLICATIONS Clinicians are encouraged to initiate discussions about experimental SC treatments during inpatient rehabilitation and to reinforce the risks throughout subsequent care.
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Affiliation(s)
- D J Unsworth
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - J L Mathias
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - D S Dorstyn
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - S A Koblar
- Stroke Research Programme, University of Adelaide School of Medicine, South Australian Health and Medical Research (SAHMRI), Adelaide, South Australia, Australia; Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Roberts PS, Krishnan S, Burns SP, Ouellette D, Pappadis MR. Inconsistent Classification of Mild Stroke and Implications on Health Services Delivery. Arch Phys Med Rehabil 2020; 101:1243-1259. [PMID: 32001257 PMCID: PMC7311258 DOI: 10.1016/j.apmr.2019.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/24/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To conduct a scoping review on classifications of mild stroke based on stroke severity assessments and/or clinical signs and symptoms reported in the literature. DATA SOURCES Electronic searches of PubMed, PsycINFO (Ovid), and Cumulative Index to Nursing and Allied Health (CINAHL-EBSCO) databases included keyword combinations of mild stroke, minor stroke, mini stroke, mild cerebrovascular, minor cerebrovascular, transient ischemic attack, or TIA. STUDY SELECTION Inclusion criteria were limited to articles published between January 2003 and February 2018. Inclusion criteria included studies (1) with a definition of either mild or minor stroke, (2) written in English, and (3) with participants aged 18 years and older. Animal studies, reviews, dissertations, blogs, editorials, commentaries, case reports, newsletters, drug trials, and presentation abstracts were excluded. DATA EXTRACTION Five reviewers independently screened titles and abstracts for inclusion and exclusion criteria. Two reviewers independently screened each full-text article for eligibility. The 5 reviewers checked the quality of the included full-text articles for accuracy. Data were extracted by 2 reviewers and verified by a third reviewer. DATA SYNTHESIS Sixty-two studies were included in the final review. Ten unique definitions of mild stroke using stroke severity assessments were discovered, and 10 different cutoff points were used. The National Institutes of Health Stroke Scale was the most widely used measure to classify stroke severity. Synthesis also revealed variations in classification of mild stroke across publication years, time since stroke, settings, and medical factors including imaging, medical indicators, and clinical signs and symptoms. CONCLUSIONS Inconsistencies in the classification of mild stroke are evident with varying use of stroke severity assessments, measurement cutoff scores, imaging tools, and clinical or functional outcomes. Continued work is necessary to develop a consensus definition of mild stroke, which directly affects treatment receipt, referral for services, and health service delivery.
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Affiliation(s)
| | - Shilpa Krishnan
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, Georgia
| | | | - Debra Ouellette
- Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Monique R Pappadis
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
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12
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Magaard G, StÅLnacke BM, SÖrlin A, Öhberg F, Berggren S, Grollmuss E, Hu X. Identifying Sub-Acute Rehabilitation Needs Among Individuals After Transient Ischaemic Attack Using Rehab-Compass as a Simple Screening Tool in the Outpatient Clinic. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2019; 2:1000018. [PMID: 33884119 PMCID: PMC8008729 DOI: 10.2340/20030711-1000018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
Objective To evaluate comprehensive unmet rehabilitation needs by using a novel graphic screening tool, Rehab-Compass, among individuals in the sub-acute stage after first-ever transient ischaemic attack. Methods A pilot prospective cohort study investigated 47 individuals with first-ever transient ischaemic attack in an outpatient clinic setting. By using Rehab-Compass, based on well-validated patient-reported outcome measure questionnaires, this study examined comprehensive unmet rehabilitation needs among individuals at 4-month follow-up after the onset of transient ischaemic attack. Results Rehab-Compass identified that most participants were independent in their daily lives (modified Rankin Scale; mRS 0-1) with a relatively good quality of life (median EuroQol 5 dimensions (EQ-5D) 0.85), but certain limitations in participation in their daily lives. Rehab-Compass showed that, at 4 months after transient ischaemic attack, the most common condition affected was mood (reported by 89% of participants), followed by bladder function (70%), sexual life (52%), strength (51%) and fatigue (26%). Symptoms of depression and anxiety were reported by 6% and 17% of participants, respectively. Conclusion This pilot study indicates that RehabCompass might be a suitable simple screening tool for use in the outpatient clinic setting to identify the multidimensional rehabilitation needs of individuals after transient ischaemic attack.
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Affiliation(s)
- Gustaf Magaard
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | | | - Ann SÖrlin
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Fredrik Öhberg
- Department of Radiation Sciences/Biomedical Engineering, University Hospital of Northern Sweden, Umeå, Sweden
| | - Stina Berggren
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Emma Grollmuss
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Jeffares I, Merriman NA, Rohde D, McLoughlin A, Scally B, Doyle F, Horgan F, Hickey A. A systematic review and meta-analysis of the effects of cardiac rehabilitation interventions on cognitive impairment following stroke. Disabil Rehabil 2019; 43:773-788. [PMID: 31339368 DOI: 10.1080/09638288.2019.1641850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The cardiac rehabilitation model has potential as an approach to providing rehabilitation following stroke. This review aims to identify evidence for the participation of stroke patients in cardiac/cardiovascular rehabilitation programs internationally, whether or not such programs offer a cognitive intervention as part of treatment, and the impact of rehabilitation on post-stroke cognitive function. METHOD Five electronic databases were searched from inception to 1 May 2019, namely: MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials, and the Web of Science. Eligible studies included both randomized and non-randomized studies of cardiac rehabilitation-type interventions which measured cognitive function in patients with transient ischemic attack (TIA) or stroke. RESULTS Of 14,153 records reviewed, nine studies which delivered cardiac rehabilitation-type interventions to stroke patients were finally included. Only three of these studies delivered cognitive rehabilitation as part of the intervention. Cardiac rehabilitation had no statistically significant effect on cognitive function in five randomized controlled trials (standardized mean difference= 0.28, 95% CI= -0.16 to 0.73) or in three one group pre-post studies (standardized mean difference= 0.15, 95% CI= -0.03 to 0.33). CONCLUSIONS This review highlights that there are very few studies of delivery of cardiac rehabilitation to stroke patients and that the inclusion of cognitive interventions is even less common, despite the high prevalence of post-stroke cognitive impairment.IMPLICATIONS FOR REHABILITATIONThe cardiac rehabilitation model has the potential to be expanded to include patients post-stroke given the commonality of secondary prevention needs, thereby becoming a cardiovascular rehabilitation model.Up to half of patients experience cognitive impairment after stroke; suggesting that a post-stroke cardiovascular rehabilitation model should incorporate specific cognitive strategies for patients.This systematic review identified three cardiovascular rehabilitation programmes which delivered cognitive rehabilitation as part of treatment; however, evidence for efficacy is weak.
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Affiliation(s)
- Isabelle Jeffares
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Affraic McLoughlin
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brendan Scally
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Palstam A, Törnbom M, Sunnerhagen KS. Experiences of returning to work and maintaining work 7 to 8 years after a stroke: a qualitative interview study in Sweden. BMJ Open 2018; 8:e021182. [PMID: 30012785 PMCID: PMC6082484 DOI: 10.1136/bmjopen-2017-021182] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To explore how persons experienced return to work (RTW) and their work situation 7 to 8 years after a stroke. DESIGN An explorative qualitative design with individual interviews. The data analysis was inductive thematic and three researchers collaborated during the analysis process. PARTICIPANTS The study population included five women and eight men who had a stroke during 2009-2010, received care at the Sahlgrenska University Hospital in Gothenburg, Sweden and RTW after stroke and it was a heterogenic sample based on age, occupation, stroke severity and time to RTW. RESULTS The analysis led to four themes; motivated and RTW while struggling with impairments, mixed feelings in the RTW process, still at work though restricted and social support for a sustainable work situation. The themes revealed that participants were motivated to RTW while struggling with impairments. The RTW process evoked mixed feelings of worry and grief over lost functions but also acceptance and gratitude for being able to work. Although maintaining work 7 to 8 years after experiencing a stroke, most were restricted in some way. Fatigue and cognitive impairments meant having to set limits, omit work tasks and rest at work, but also rest during free time and refraining from social activities in order to manage work. Participants avoided work-related stress if they could because of aggravated symptoms and/or fear of a new stroke. Support from supervisors and colleagues was often crucial for a sustainable work situation. CONCLUSION Maintaining work can be a continuous struggle with invisible impairments many years after a stroke. Strategies for managing work are dependent on each individual work situation, where support and understanding at work seem to be crucial for a sustainable work situation.
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Affiliation(s)
- Annie Palstam
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Törnbom
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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