Therapists' perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers

BACKGROUND

Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change.

AIM

This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers.

METHODS & PROCEDURES

Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement.

RESULTS

Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology.

CONCLUSION

These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers.

WHAT THIS PAPER ADDS

What is already known on this subject Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work? This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers.

What are the common areas of risk and their characteristics found in intermediate care from an occupational therapy perspective? A scoping review

Introduction

Engaging with risk is a certain and unavoidable part of occupational therapy. Intermediate care services are mostly accessed by older people with complex needs, yet little is known in the literature about the extent, type and nature of risk involved in these services.

Method

A scoping review was systematically conducted to map the common areas of risk (risk domains) from an occupational therapy perspective. Thematic analysis was conducted in order to identify the risk characteristics related to the literature reviewed.

Results

25 journal articles were identified and arranged into 10 risk domains: Falls, discharge, practice errors, activities of daily living, pressure care, frailty management, patient handling, loneliness, nutritional care and language barriers. Three risk characteristics were identified: (1) Risk awareness and identifying risk, (2) decision-making under risk and (3) improving safety.

Conclusion

Occupational therapists play a diverse role in migrating risk for older people which is not fully explored beyond addressing deficits in functional ability and hazardous environments. The process of how risk is controlled and reconciled with occupation and how positive risk-taking is facilitated are implicit and not directly addressed within the literature reviewed. The findings reveal gaps in knowledge and provide a foundation for further research.

Exploring the relationship between perceived susceptibility and severity of falling among older adults in Singapore

Introduction

Despite extensive research about improving the effectiveness of falls prevention interventions, at-risk individuals are not always willing recipients. Reasons for rejecting treatments are still poorly understood. Applying the health belief model (HBM), if perceived severity and susceptibility can be understood in the context of falling, this might better inform intervention designs.

Method

Sixty-two participants were recruited from inpatient wards at a local acute hospital. Participants completed two self-report questionnaires, the Staying Independent Checklist (SIC) and the Falls Efficacy Scale – International (FES-I), measuring perceived susceptibility and severity respectively.

Results

One-way ANOVA analysis revealed a significant association between FES-I total scores and SIC score categories [ F (1,60) = 6.277, p = .015].Stepwise regression with backward elimination also found that falls history (β = .292, p = .033), sex (β = .269, p = .042), and FIM lower body dressing (β = − .286, p = .035) had significant associations with FES-I scores.

Conclusion

Level of perceived susceptibility and severity of falling should be considered when determining if falls prevention interventions are relevant, regardless of functional ability and physical health status. Future research to determine the underlying mechanisms which drives health behaviours related to falls prevention should be conducted.

Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation

Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.

Stepping On after Stroke falls-prevention programme for community stroke survivors in Singapore: A feasibility study

Introduction

Intervention studies to date have shown limited evidence of falls reduction in community-dwelling stroke survivors. This study tests the acceptability and feasibility of the Stepping On after Stroke programme in Singapore.

Method

A pre–post-intervention study design was used over a 6-month period. Falls incidence was the main outcome measure, with the recruitment process and attendance rate recorded to test feasibility. Data analysis from evaluation questionnaires (descriptive statistics) and interviews (content analysis) were applied to determine acceptability.

Results

Eight stroke participants and seven caregivers completed the programme at two community sites facilitated by two programme leaders. Stroke participants achieved full attendance over the 7-week programme but family caregivers did not (38%). All participants highlighted their acceptability of the group-based falls-prevention programme. Both programme leaders achieved 92% fidelity in session delivery. Four stroke participants fell during the study period. Stroke participants demonstrated clinically meaningful improvements in community participation at 1 month post-intervention. Family caregivers reported no changes in pre–post evaluations.

Conclusion

The Stepping On after Stroke programme appears feasible and acceptable to therapists and service users in Singapore; however, caregivers’ participation was limited. Findings can be used to further improve the programme and its methodology before testing its effectiveness in a larger-scale trial.