Impact of social support on participation after stroke in Nigeria

Environmental determinants for participation among stroke survivors in Africa, a scoping review

Purpose

In this review, we aimed to determine the environmental factors that are influencing the participation of stroke survivors in Africa.

Methods

Four electronic databases were systematically searched from inception to August 2021, and identified articles were screened by the two authors of this review based on predetermined criteria. No date restrictions were imposed, and we included any type of paper, including gray literature. We followed the scoping review framework by Arksey and O'Malley, which was later revised by Levac et al. The whole finding is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR).

Results

A total of 584 articles were generated by the systematic search, and one article was added manually. After eliminating the duplicates, the titles and abstracts of 498 articles were screened. From the screening, 51 articles were selected for full article review, of which 13 met the criteria to be included. In total, 13 articles were reviewed and analyzed based on the international classification of functioning, disability, and health (ICF) framework of the environmental determinants. Products and technology; natural environment and human-made changes to environment; and services, systems, and policies were found to be barriers for stroke survivors to participate in their community. Conversely, stroke survivors are getting good support from their immediate family and health professionals.

Conclusion

This scoping review sought to identify the environmental barriers and the facilitators that are determining the participation of stroke survivors in Africa. The results of this study can serve as a valuable resource for policymakers, urban planners, health professionals, and other stakeholders involved in disability and rehabilitation. Nonetheless, additional research is necessary to validate the identified facilitators and barriers.

Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study

Objective

To describe the change in sleep duration during inpatient rehabilitation and to determine if sleep quality and sleep duration is associated with functional disability for individuals after stroke. It was hypothesized that participants who experienced optimal sleep during inpatient rehabilitation would have greater functional ability at discharge.

Design

Longitudinal observation study.

Setting

Inpatient rehabilitation unit at a large, urban hospital.

Participants

Thirty-seven individuals with acute stroke (N=37; mean age, 62.5±11.8y, male=20, female=17) were recruited from September 2018 to September 2019. Participants were invited to participate in the study by clinical personnel associated with their usual care as they were admitted to inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Participants were asked to wear an actigraph for the duration of their rehabilitation program to assess sleep. The first 3 nights of actigraphy data were averaged to obtain total sleep time (TST) and sleep efficiency (SE) at admission, and the last 3 nights were averaged for TST and SE at discharge. Functional disability (primary outcome was FIM) at admission and discharge was gathered from the participants’ medical records. One-way analysis of variance and chi-square analyses assessed for group differences, and regression modeling was used to determine if sleep was associated with functional ability at discharge.

Results

Sixteen participants (43%) were categorized as “good sleepers” and 21 (57%) were “poor sleepers” based on their TST at admission. Of the poor sleepers, 14 participants (66%) remained short duration sleepers (<7h at admission and discharge). Sleep outcomes did not significantly predict FIM score at discharge.

Conclusions

Most participants had less than optimal sleep duration during inpatient rehabilitation. Efforts may be warranted to optimize sleep during inpatient rehabilitation.

Perceived participation and autonomy post-stroke and associated factors: An explorative cross-sectional study

AIMS

To explore the level and associated factors of perceived participation and autonomy among stroke survivors in Shanghai, China.

DESIGN

Cross-sectional explorative study.

METHODS

From January to December 2018, 431 patients presenting at the neurology departments of three hospitals with a confirmed diagnosis of stroke were recruited. Impact on Participation and Autonomy Questionnaire, modified Rankin Scale, Self-efficacy for Managing Chronic Disease six-item Scale, Medical Coping Modes Questionnaire and Multidimensional Scale of Perceived Social Support were applied to measure their participation, physical function, self-efficacy, coping styles, and social support.

RESULTS

The average score of perceived participation and autonomy was 41.30 (SD 21.22); and 54.3%, 46.9%, 21.6%, and 7.7% of the participants reported poor participation in social relations, family role, autonomy indoors, and autonomy outdoors. Age, physical function, self-efficacy, friend support, and knowledge of stroke were predictors of post-stroke participation. Physical function and self-efficacy were the most relevant factors of nearly all domains of participation except autonomy outdoors, while predictors of autonomy outdoors were social support, resignation coping style, and knowledge of stroke.

CONCLUSION

The stroke patients experienced insufficient participation compared with previous studies in western countries. Patients' physical function and self-efficacy were particularly important and contributed to their participation, while the patient's age, perceived social support, coping styles, and knowledge of stroke also played a role in formulating participation.

IMPACT

The results may be used to provide nurses with a better understanding of the participation among stroke patients and assist them in promoting the post-stroke participation. Nurses should pay special attention to those with older age, worse physical function, lower self-efficacy, less support, little stroke-related knowledge, or who applied resignation coping style since those patients might experience lower participation in their daily life. It needs further studies to explore the causal effects of self-efficacy, coping styles, and social support on post-stroke participation.

Contextual determinants of participation after stroke: a systematic review of quantitative and qualitative studies

PURPOSE

From a patient's perspective, participation is a major determinant of quality of life. We aimed to review contextual factors, both personal and environmental, potentially associated with post-stroke participation.

METHODS

PubMed, PsycINFO, and Web of Science were searched for original quantitative and qualitative studies that investigated contextual factors of post-stroke participation, measured participation as the primary outcome, and met inclusion criteria.

RESULTS

Socio-demographic determinants were mostly unrelated with participation or showed discordant and inconclusive results. Although less investigated, psychosocial/psychological factors, particularly self-esteem and acceptance, were associated with participation in most studies. Motivation was found in qualitative studies, but discordant in quantitative ones. Environmental factors were even less investigated and mainly in qualitative studies among patients with communication disabilities. Among these, social support and attitude of others appeared to be major determinants of participation as well as physical environment and societal environment (services and polices).

CONCLUSIONS

Personal factors, particularly psychological and psychosocial factors, were identified as positively associated with post-stroke participation. Environmental factors such as support, relationships, and positive attitudes towards patients were major facilitators of participation as well as physical environment and accessibility to appropriate services. Most of these factors are modifiable and should be addressed to improve patient participation.Implications for RehabilitationPsychosocial factors (motivational aspects, acceptance of a new condition, self-esteem) and environmental factors (social support, attitudes towards the patient, physical environment, access to health, social services and policies) were identified as determinants of post-stroke participation.A structured evaluation of determinants of participation may be used in clinical practice to propose appropriate support and then improve patients' recoveryPrograms to improve patients' psychosocial skills such as self-esteem, acceptance, motivation should be tested and implemented, and policies to develop appropriate services accessibility should be encouraged.

The relationship between social support and participation in stroke: A systematic review

Background

The incidence of cerebrovascular accidents with its devastating effects on individuals is increasing. Post-stroke, restrictions in participation are common and social support could have an influence on this. Social support provided to individuals post-stroke is vital, but the relationship between social support and participation is not well understood.

Objectives

This review aimed to systematically determine the relationship between social support and participation post-stroke, based on the literature available.

Method

Ebscohost, Science Direct, Biomed Central, Cochrane Library, Google Scholar, Pedro Central and Wiley Online were the electronic databases searched between 2001 and 2016. Articles were deemed to be eligible if they met the inclusion criteria and successfully underwent scrutiny to determine their relevance and methodological quality, using tools from the Critical Appraisal Skills Programme and Milton Keynes Primary Trust. A narrative synthesis method was used to analyse the included studies.

Results

A total of 54 articles were identified after screening, and six articles were deemed eligible for inclusion. The articles consisted of cross-sectional, qualitative and cohort studies. Articles showed distinct, significant relationships between social support and participation where the quality and quantity of social support were important. High levels of social support had a positive influence on participation, social and leisure activities, as well as returning to work post-stroke.

Conclusion

A positive relationship exists between social support and participation post-stroke. Health professionals need to include social support interventions when attempting to manage the individual with stroke holistically, as this will have positive effects on participation.

Preferred rehabilitation setting among stroke survivors in Nigeria and associated personal factors

BACKGROUND

Incorporating patients' preferences in the care they receive is an important component of evidence-based practice and patient-centred care.

OBJECTIVE

This study assessed stroke patients' preferences regarding rehabilitation settings.

METHODS

A cross-sectional design was used to examine preferences of stroke patients receiving physiotherapy at three hospitals in Northern Nigeria. Personal factors and preferred rehabilitation setting data were obtained using the Modified Rankin Scale (to assess global disability) and a researcher-developed questionnaire. Associations between preferences and personal factors were explored using bivariate statistics.

RESULTS

Sixty stroke patients whose mean age was 53.6 ± 14.8 years participated in the study. Most of the participants (38.3%) preferred an outpatient setting, 19 (31.7%) preferred rehabilitation in their homes, 14 chose inpatient rehabilitation (23.3%), while 4 (6.7%) preferred the community. Age and source of finance were significantly associated with preferences. The majority (66.7%) of those aged ≥ 65 years expressed a preference for rehabilitation in the home or community (X2 = 6.80; p = 0.03). Similarly, most of the participants (53.3%) who depended on family finances preferred home- or community-based rehabilitation, while most of those who depended on employment income for finances preferred an outpatient rehabilitation setting (X2 = 16.80; p = 0.01).

CONCLUSION

A preference for rehabilitation in outpatient facilities predominated followed by home-based rehabilitation, and preferences varied based on age and source of finance. These variations in preferences have implications for making rehabilitation decisions.