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Elf M, Norin L, Meijering L, Pessah-Rasmussen H, Suhonen R, Zingmark M, Kylén M. Rehabilitation at Home With the Development of a Sustainable Model Placing the Person's Needs and Environment at Heart: Protocol for a Multimethod Project. JMIR Res Protoc 2024; 13:e56996. [PMID: 39042448 PMCID: PMC11303889 DOI: 10.2196/56996] [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: 02/02/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person's physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person's home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting. OBJECTIVE The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered. METHODS The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model. RESULTS This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026. CONCLUSIONS The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56996.
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Affiliation(s)
- Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lizette Norin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Louise Meijering
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, Netherlands
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Magnus Zingmark
- Department of Community Medicine and Rehabilitation, Umea University, Umea, Sweden
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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Cisek KK, Nguyen TNQ, Garcia-Rudolph A, Saurí J, Becerra Martinez H, Hines A, Kelleher JD. Predictors of social risk for post-ischemic stroke reintegration. Sci Rep 2024; 14:10110. [PMID: 38698076 PMCID: PMC11066106 DOI: 10.1038/s41598-024-60507-7] [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] [Received: 07/22/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
After stroke rehabilitation, patients need to reintegrate back into their daily life, workplace and society. Reintegration involves complex processes depending on age, sex, stroke severity, cognitive, physical, as well as socioeconomic factors that impact long-term outcomes post-stroke. Moreover, post-stroke quality of life can be impacted by social risks of inadequate family, social, economic, housing and other supports needed by the patients. Social risks and barriers to successful reintegration are poorly understood yet critical for informing clinical or social interventions. Therefore, the aim of this work is to predict social risk at rehabilitation discharge using sociodemographic and clinical variables at rehabilitation admission and identify factors that contribute to this risk. A Gradient Boosting modelling methodology based on decision trees was applied to a Catalan 217-patient cohort of mostly young (mean age 52.7), male (66.4%), ischemic stroke survivors. The modelling task was to predict an individual's social risk upon discharge from rehabilitation based on 16 different demographic, diagnostic and social risk variables (family support, social support, economic status, cohabitation and home accessibility at admission). To correct for imbalance in patient sample numbers with high and low-risk levels (prediction target), five different datasets were prepared by varying the data subsampling methodology. For each of the five datasets a prediction model was trained and the analysis involves a comparison across these models. The training and validation results indicated that the models corrected for prediction target imbalance have similarly good performance (AUC 0.831-0.843) and validation (AUC 0.881 - 0.909). Furthermore, predictor variable importance ranked social support and economic status as the most important variables with the greatest contribution to social risk prediction, however, sex and age had a lesser, but still important, contribution. Due to the complex and multifactorial nature of social risk, factors in combination, including social support and economic status, drive social risk for individuals.
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Affiliation(s)
- Katryna K Cisek
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland.
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic.
| | - Thi Nguyet Que Nguyen
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland
| | - Alejandro Garcia-Rudolph
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
| | - Joan Saurí
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | | | - Andrew Hines
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - John D Kelleher
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
- ADAPT Research Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic
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Segura E, Vilà-Balló A, Mallorquí A, Porto MF, Duarte E, Grau-Sánchez J, Rodríguez-Fornells A. The presence of anhedonia in individuals with subacute and chronic stroke: an exploratory cohort study. Front Aging Neurosci 2024; 16:1253028. [PMID: 38384938 PMCID: PMC10880106 DOI: 10.3389/fnagi.2024.1253028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Background Anhedonia refers to the diminished capacity to experience pleasure. It has been described both as a symptom of depression and an enduring behavioral trait that contributes its development. Specifically, in stroke patients, anhedonia has been closely linked to depression, resulting in reduced sensitivity to everyday pleasures and intrinsic motivation to engage in rehabilitation programs and maintain a healthy active lifestyle. This condition may hinder patients' recovery, diminishing their autonomy, functioning, and quality of life. Objective We aimed to explore the prevalence and level of anhedonia and those variables that might be associated in patients with both ischemic and hemorrhagic stroke at subacute and chronic phases of the disease. Methods We conducted an exploratory cohort study with a sample of 125 patients with subacute and chronic stroke presenting upper-limb motor deficits. We measured participants' level of anhedonia with four items from the Beck Depression Inventory-II that describe the symptoms of this condition: loss of pleasure, loss of interest, loss of energy, and loss of interest in sex. We also collected demographic and clinical information and evaluated motor and cognitive functions as well as levels of depression, apathy, and various mood states. The results were compared to a sample of 71 healthy participants of similar age, sex, and level of education. Results Stroke patients demonstrated a significantly higher prevalence (18.5-19.7%) and level of anhedonia compared to the healthy controls (4.3%), regardless of stroke phase, level of motor impairment, and other clinical variables. Furthermore, post-stroke anhedonia was associated with lower levels of motivation and higher levels of negative mood states such as fatigue and anger in the long term. Importantly, anhedonia level was superior in stroke patients than in healthy controls while controlling for confounding effects of related emotional conditions. Conclusion This study provides novel evidence on the prevalence, level and factors related to anhedonia post-stroke. We emphasize the importance of assessing and treating anhedonia in this population, as well as conducting large-scale cohort and longitudinal studies to test its influence on long-term functional and emotional recovery.
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Affiliation(s)
- Emma Segura
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Adrià Vilà-Balló
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Aida Mallorquí
- Clinical Health Psychology Section, Clinic Institute of Neuroscience, Hospital Clínic, Barcelona, Spain
| | - María F. Porto
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Esther Duarte
- Department of Physical and Rehabilitation Medicine, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Jennifer Grau-Sánchez
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Research Group on Complex Health Diagnoses and Interventions from Occupation and Care (OCCARE), Escola Universitària d'Infermeria i Teràpia Ocupacional, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Elf M, Slaug B, Ytterberg C, Heylighen A, Kylén M. Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:172-186. [PMID: 37287249 PMCID: PMC10621028 DOI: 10.1177/19375867231178313] [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: 06/09/2023]
Abstract
PURPOSE To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke. BACKGROUND Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse. METHODS In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis. RESULTS Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings. CONCLUSIONS Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.
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Affiliation(s)
- Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn Slaug
- Department of Health Sciences, Lund University, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Heylighen
- Research[x]Design, Department of Architecture, KU Leuven, Belgium
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Health Sciences, Lund University, Sweden
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Lavis H, van Vliet P, Tavener M. Stroke survivor, caregiver and therapist experiences of home-based stroke rehabilitation: a thematic synthesis of qualitative studies. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2180710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Heidi Lavis
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Paulette van Vliet
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Meredith Tavener
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
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Willems EMG, Vermeulen J, van Haastregt JCM, Zijlstra GAR. Technologies to improve the participation of stroke patients in their home environment. Disabil Rehabil 2022; 44:7116-7126. [PMID: 34607474 DOI: 10.1080/09638288.2021.1983041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To identify possible technological solutions that can contribute to stroke patients' participation at home. METHODS In this qualitative case study, data on factors that negatively influenced participation at home were collected via semi-structured interviews with stroke patients (n = 6). Additionally, data on possible technologies to improve this participation were collected via a group interview with experts (n = 4). The domains "cognition, mobility, self-care, and getting along" (International Classification of Functioning, Disability and Health) guided the data collection and interpretation; open, axial and selective coding was part of the analysis. RESULTS Patients reported 21 factors negatively influencing participation at home, including psychological, cognitive, and physical factors. Experts suggested technological solutions regarding these factors to increase participation of stroke patients; digital assistants, apps, and virtual reality were frequently mentioned. To facilitate the use of these technologies, experts indicated the importance of involving patients in their design. They also suggested that rehabilitation specialists and family members could support the uptake and use of technologies. CONCLUSIONS Various technologies were identified by experts as having the potential to improve the participation of stroke patients in their homes. Future research may study the influence of these technologies on the actual participation of stroke patients at home.Implications for rehabilitationThe identified technological solutions can support rehabilitation specialists in guiding stroke patients towards technologies that can support a patient's participation at home.Rehabilitation specialists can be champions in introducing, recommending and promoting technologies to stroke patients and their families, as well as in training them to use technologies.Virtual reality as a technology can be part of rehabilitation, not only to train stroke patients in daily life activities but also to increase empathy and understanding in caregivers and carers on stroke impairments.Rehabilitation specialists can recommend technologies integrated in daily life and presented as general consumer goods; stroke patients are more likely to adopt these kind of technologies.
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Affiliation(s)
- Esther M G Willems
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Jolanda C M van Haastregt
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - G A Rixt Zijlstra
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
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7
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Kylén M, Ytterberg C, von Koch L, Elf M. How is the environment integrated into post-stroke rehabilitation? A qualitative study among community-dwelling persons with stroke who receive home rehabilitation in Sweden. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1933-1943. [PMID: 34541725 DOI: 10.1111/hsc.13572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/17/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Studies have shown a need to consider environmental factors to best support the rehabilitation and recovery process after a stroke. In addition, despite intentions to increase individuals' participation in care and rehabilitation, patients and family members report weak participation. The aim of this study was to explore how the environment was integrated into rehabilitation at home from the perspective of patients after a stroke. We conducted as a qualitative study with 17 patients rehabilitated at home. Data on the participants' experiences of the rehabilitation process and their perceptions of how the environment was considered in the process were collected via interviews and analysed using qualitative content analysis. The main category that was constructed from the data was "Partial integration of person- environment dynamics in the rehabilitation", which was informed by three subcategories: (a) I recover in my home: Challenges and opportunities in the environment, (b) Following a generic approach to therapy: Limited integration of the environment, and (c) Informed more than involved. Our study showed that the environment was integrated in a limited manner. The participants were more informed about than involved in their planning of the rehabilitation. The results are important for informing the ongoing development of rehabilitation at home and person-centred care strategies.
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Affiliation(s)
- Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
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8
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Wang W, Babulal GM, Lin B, Mei Y, Zhang L, Liu Q, Guo Y, Zhang Z. A Chinese version of the Measure of Stroke Environment (MOSE): psychometric evaluation in stroke survivors. Disabil Rehabil 2022; 44:2879-2888. [PMID: 33202159 PMCID: PMC9893337 DOI: 10.1080/09638288.2020.1843720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To translate the MOSE from English to Chinese and investigate the psychometric properties of the Chinese-translated version of the Measure of Stroke Environment (MOSE). MATERIALS AND METHODS The MOSE was translated into Chinese using a cultural adaptation process. To validate this Chinese version, 311 stroke survivors were recruited to complete the questionnaire. The psychometric properties of the MOSE were evaluated by determining item analysis, test-retest reliability, internal consistency, content validity, construct validity, and floor/ceiling effects, respectively. RESULTS The MOSE was translated without any major difficulties. Regarding psychometric performances, a moderate level of correlation between the items and the domains (r > 0.4), and the significant differences in items between the high group and the low group were tested by independent sample t-tests (p < 0.05). The test-retest reliability was excellent (Intraclass Coefficient Correlation = 0.938). Very high internal consistency was also observed (Cronbach's α = 0.945, split-half reliability = 0.778). An acceptable I-CVI ranged from 0.714 to 1.000 and a high S-CVI of 0.973. Correlations with the subscales of the WHODAS 2.0 were significant in similar domains reflecting good convergent validity. No floor or ceiling effects were observed. CONCLUSION This study provides psychometric evidence supporting the use of the Chinese version of the MOSE among stroke survivors.IMPLICATIONS FOR REHABILITATIONThe Measure of Stroke Environment was translated into Chinese through a rigorous cultural adaptation process.MOSE-C is now a reliable and valid tool for Chinese-speaking survivors who have suffered from a stroke.It is necessary to assess the perceived environmental barriers of stroke survivors and develop targeted intervention programs in China.
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Affiliation(s)
- Wenna Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Ganesh M. Babulal
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Beilei Lin
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Leyun Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Qingxuan Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yunfei Guo
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Factors impacting the access and use of formal health and social services by caregivers of stroke survivors: an interpretive description study. BMC Health Serv Res 2022; 22:433. [PMID: 35365130 PMCID: PMC8975449 DOI: 10.1186/s12913-022-07804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence has shown that family and friend caregivers of stroke survivors are significantly and negatively impacted by caregiving. The negative effects of caregiving may persist over time suggesting that caregivers might benefit from ongoing engagement with supportive services. However, little is known about caregivers' use of formally funded health and social services, or the factors influencing their access to and use of these services. The aim of this study is to increase understanding of the factors that influence stroke caregivers' access and use of formal health and social services, from the perspective of stroke caregivers and healthcare providers. METHODS A qualitative study was conducted with stroke caregivers and health providers in Ontario, Canada using interpretive description. In-depth interviews were conducted with caregivers of survivors who experienced a stroke between six months to five years previous and healthcare providers who support caregivers and stroke survivors. All participants provided written informed consent. Interview data were analyzed using constant comparison to identify codes and develop key thematic constructs. RESULTS A total of 40 interviews were conducted with 22 stroke caregivers at an average 30-months post-stroke and 18 health providers. Factors that influenced stroke caregivers' access and use of services included: finances and transportation; challenges caregivers faced in caring for their health; trust that they could leave their family member and trust in health providers; limited information pertaining to services and a lack of suitable services; and the response of their social networks to their caregiving situation. CONCLUSION Stroke caregivers experience significant challenges in accessing and using formal health and social services. These challenges could be addressed by increasing availability of subsidized community-based supports such as respite and counselling tailored to meet the ongoing needs of caregivers. Systemic change is needed by the health system that readily includes and supports caregivers throughout the stroke recovery continuum, particularly in the community setting.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
| | - Patricia H Strachan
- School of Nursing, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
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Iwarsson S, Andersson N, Slaug B, Nilsson MH. People with Parkinson's disease and housing issues: A scoping review. Health Sci Rep 2022; 5:e511. [PMID: 35155833 PMCID: PMC8827270 DOI: 10.1002/hsr2.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIMS There is evidence that housing issues are associated with health outcomes as people age, but little is known in this respect regarding the specific population of people with Parkinson's disease (PD). The objective of this literature review was to identify and analyze the knowledge gap concerning people with PD and housing issues. METHODS Applying established guidelines for scoping reviews, a systematic literature search was done in relevant databases applying the following inclusion criteria: empirical studies including human participants with PD, addressing housing in the objective, hypothesis or research questions, and published in English in peer-reviewed journals. Data were analyzed using a framework of domains, factors, and variables influencing housing decisions among older people. RESULTS Twelve publications were identified, originating from a few researchers and with very different scopes. While the social dimension was scarcely attended to, the publications addressed all six domains of the analytical framework and 30% of the variables specified therein, but many were only used for descriptive purposes. CONCLUSION This scoping review reveals that there is a substantial knowledge gap regarding people with PD and housing issues. The knowledge gap is most evident in the social dimension, while the studies identified provide more information relating to the health dimension than what is the case in research on housing targeting the general aging population. Because society urgently needs evidence to support the development of housing policies and provide suitable housing for this vulnerable population, more research targeting people with PD and housing issues is warranted.
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Affiliation(s)
| | - Nilla Andersson
- Department of Health SciencesLund UniversityLundSweden
- Memory ClinicSkåne University HospitalMalmöSweden
| | - Björn Slaug
- Department of Health SciencesLund UniversityLundSweden
| | - Maria H. Nilsson
- Department of Health SciencesLund UniversityLundSweden
- Memory ClinicSkåne University HospitalMalmöSweden
- Clinical Memory Research Unit, Department of Clinical Sciences MalmöLund UniversityLundSweden
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Patient Participation and the Environment: A Scoping Review of Instruments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042003. [PMID: 35206191 PMCID: PMC8872044 DOI: 10.3390/ijerph19042003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/28/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022]
Abstract
Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O'Malley's framework to identify instruments intended to measure patient participation. We assessed those instruments' characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation.
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Pucciarelli G, Lyons KS, Petrizzo A, Ambrosca R, Simeone S, Alvaro R, Lee CS, Vellone E. Protective Role of Caregiver Preparedness on the Relationship Between Depression and Quality of Life in Stroke Dyads. Stroke 2021; 53:145-153. [PMID: 34496626 DOI: 10.1161/strokeaha.120.034029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads. METHODS We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling. RESULTS A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older (M=70.8, SD=11.9) than their caregivers (M=52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological (B=0.56, P<0.01) and environmental (B=0.58, P<0.01) QOL at baseline and social QOL over time (B=0.24, P<0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical (B=0.25, P<0.01) and environmental (B=0.18, P<0.05) QOL over time. CONCLUSIONS Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.
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Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (G.P.)
| | - Karen S Lyons
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (A.P.)
| | - Rossella Ambrosca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Ambrosca)
| | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (S.S.)
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Alvaro)
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (E.V.)
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Qiu X, Gao Y, Zhang Z, Cheng S, Zhang S. Fire Acupuncture versus conventional acupuncture to treat spasticity after stroke: A systematic review and meta-analysis. PLoS One 2021; 16:e0249313. [PMID: 33836008 PMCID: PMC8034732 DOI: 10.1371/journal.pone.0249313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Post-stroke spasm is currently a complex clinical problem that remains to be resolved. Due to its excellent efficacy and few side effects, clinicians have used fire acupuncture to treat post-stroke spasticity in China. OBJECTIVES The purpose of this study was to evaluate the clinical efficacy of fire acupuncture compared with conventional acupuncture to treat post-stroke spasms and provide a detailed summary of the commonly used acupoints. METHODS Eight databases (MEDLINE/PubMed, Web of Science, the Cochrane database, EMBASE, CBM, CNKI, WanFang, and VIP) were searched for randomized controlled trials (RCTs) published from database inception through August 30, 2020. RCTs that compared fire acupuncture with conventional acupuncture as a treatment intervention for patients with spasticity after stroke were included. Revman 5.3 software was used to calculate risk ratios (RR) and standard mean differences (SMD) with 95% confidence intervals (CI). Methodological evaluation or critical appraisal of the included articles was assessed using RoB-2. RESULTS Sixteen studies with a total of 1,118 patients were included. Although according to the standards of the Rob 2.0 tool, most studies are considered to have some problems. Comprehensive analysis of the results revealed a consistent trend indicating several advantages of using fire needles compared to conventional acupuncture in treating post-stroke spasms, including the effective rate, recovery rate, and improvement of multiple scales represented by MAS. Concerning secondary outcomes, using the scales of FMA, BI, or NDS in this random model meta-analysis, fire acupuncture exhibited better performance compared to acupuncture [SMD = 2.27, 95%CI [1.40,3.13 (random-effects model) ], [SMD = 1.46,95% CI [1.03,1.90 (random-effects model)], and [SMD = 0.90, 95%CI [0.44,1.35 (random-effects model)], respectively, with moderately high heterogeneity. When the effective rate was used as an outcome in the subgroup analysis, fire needles performed better than conventional acupuncture with respect to damage to the upper or lower limbs, and the thickness and depth of acupuncture. When the modified Ashworth scale (MAS) was used as the outcome, and the damage occurred in the lower extremity, the acupuncture depth exceeded 15mm, or the duration of stroke was longer than six months, the fire needles did not perform better than conventional acupuncture, [SMD = 0.01, 95%CI [-0.47,0.48 (fix-effects model)], [SMD = 0.21 [-0.51,0.93(random-effects model)], and [SMD = 0.76, 95%CI [-0.08,1.60 (random-effects model)], respectively. The acupoints identified with the highest frequencies in this study were Yang-meridian, including LI11-Quchi (nine times), LI4-Hegu (seven times), and ST36-Zusanli (five times). Moreover, no serious adverse effects were reported in any of the studies included in this analysis. CONCLUSIONS Despite several limitations, this was the first meta-analysis to focus on the treatment of post-stroke spasticity using fire needle acupuncture compared with conventional acupuncture. Our results confirmed that fire needles could provide a better clinical effect than conventional acupuncture, which will help standardize fire needle treatment strategies for post-stroke spasms.
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Affiliation(s)
- Xuan Qiu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, GuangZhou, China
- Guangzhou University of Traditional Chinese Medicine, GuangZhou, China
| | - Yicheng Gao
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, GuangZhou, China
- Guangzhou University of Traditional Chinese Medicine, GuangZhou, China
| | - Zhaoxu Zhang
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Sijia Cheng
- Guangzhou University of Traditional Chinese Medicine, GuangZhou, China
| | - Shuangmei Zhang
- Department of Rehabilitation, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), HangZhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, HangZhou, China
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Bach-Mortensen AM, Verboom B. Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers. Res Synth Methods 2020; 11:743-759. [PMID: 32845574 DOI: 10.1002/jrsm.1447] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews cataloguing the barriers to and facilitators of various outcomes are increasingly popular, despite criticisms of this type of review on philosophical, methodological, and practical grounds. The aims of this review are to appraise, analyze, and discuss the reporting and synthesis practices used in recently published barriers and facilitators reviews in health services research. METHODS All English-language peer-reviewed systematic reviews that synthesized research on barriers and facilitators in a health services context were eligible for inclusion. We searched 11 databases over a 13-month period (1 November 2017-30 November 2018) using an exhaustive list of search terms for "barrier(s)," "facilitator(s)," and "systematic review." RESULTS One hundred reviews were included. We found a high degree of variation in the synthesis practices used in these reviews, with the majority employing aggregative (rather than interpretive) approaches. The findings echo common critiques of this review type, including concerns about the reduction of complex phenomena to simplified, discrete factors. Although several reviews highlighted the "complexity" of barriers and facilitators, this was usually not analyzed systematically. Analysis of the subsample of reviews that explicitly discussed the barriers and facilitators approach revealed some common issues. These tended to be either conceptual/definitional (eg, ideas about interrelationships and overlap between factors) and methodological/practical (eg, challenges related to aggregating heterogeneous research). CONCLUSION Barriers and facilitators reviews should (a) clearly operationally define "barrier" and "facilitator," (b) explicitly describe how factors are extracted and subsequently synthesized, and (c) provide critical reflection on the contextual variability and reliability of identified factors.
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Affiliation(s)
| | - Ben Verboom
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Kylén M, Von Koch L, Pessah-Rasmussen H, Marcheschi E, Ytterberg C, Heylighen A, Elf M. The Importance of the Built Environment in Person-Centred Rehabilitation at Home: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2409. [PMID: 31284620 PMCID: PMC6651011 DOI: 10.3390/ijerph16132409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022]
Abstract
Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced acute care will be performed in hospitals. This-along with the increased healthcare needs of people with long-term conditions such as stroke and the rising demand for services to be more person-centred-will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient's recovery process remain unexplored. This paper presents a protocol with the purpose to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. The project uses a convergent parallel mixed-methods design, with ICF (International Classification of Functioning, Disability and Health) and person-environment theories as conceptual frameworks. Data will be collected during home visits 3 months after stroke onset. Medical records, questionnaires, interviews and observations will be used. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Data will be used to synthesise the contexts, mechanisms and outcomes that are important to support the rehabilitation process at home.
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Affiliation(s)
- Maya Kylén
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden.
| | - Lena Von Koch
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, SE-141 83 Huddinge, Sweden
- Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Hélène Pessah-Rasmussen
- Skåne University Hospital, Department of Neurology and Rehabilitation Medicine, 221 85 Lund, Sweden
- Lund University, Department of Clinical Sciences Lund, Neurology, 221 84 Lund, Sweden
| | - Elizabeth Marcheschi
- Arkitektur och samhällsbyggnadsteknik, Byggnadsdesign, ACE, Chalmers University, SE-412 96 Gothenburg, Sweden
| | - Charlotte Ytterberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, SE-141 83 Huddinge, Sweden
- Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Ann Heylighen
- KU Leuven, Department of Architecture, Research[x]Design, 3001 Leuven, Belgium
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden
- Arkitektur och samhällsbyggnadsteknik, Byggnadsdesign, ACE, Chalmers University, SE-412 96 Gothenburg, Sweden
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Yue XY, Feng ZQ, Yu XY, Hu JM, He XJ, Shu S. Fire-needle acupuncture for upper limb spastic paralysis after stroke: Study protocol for a randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:167-172. [PMID: 30922849 DOI: 10.1016/j.joim.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fire-needle acupuncture, an important kind of acupuncture therapy, has been clinically used to treat upper limb spastic paralysis (ULSP) after stroke. Clinical experience has indicated that fire-needle acupuncture treatment takes less time, requires fewer visits, and has more rapid results and fewer side effects compared to chemical medicine alternatives. This study will evaluate the effects of fire-needle acupuncture for ULSP in the context of standardized clinical research and provide high-quality data to inform clinical procedures and future study design. METHODS/DESIGN A randomized controlled trial will be carried out to evaluate the effects of fire-needle acupuncture therapy in patients with ULSP from stroke. ULSP patients (n = 120) will be recruited at Changhai Hospital in Shanghai, China. Patients will be randomly divided into three groups, including fire-needle acupuncture group (FAG), filiform-needle acupuncture group (FFAG) and rehabilitation treatment group (RTG). During the 3-week treatment, the FAG will be treated every two days, while FFAG and RTG will be treated 5 d in a row and then rest for 2 d. The Simplified Fugl-Meyer Motor Function Scale and Modified Ashworth Scale will be used as the primary outcome measures. Statistical analysis will be conducted by an independent statistician. DISCUSSION Through this study, the utility of fire-needle acupuncture in treating ULSP after stroke will be tested, and some specific claims of fire-needle acupuncture therapy will be evaluated, such as relieving spasm and muscular tension, improving activities of daily living, rapidity of response and less frequency of treatment compared with other treatments. TRIAL REGISTRATION Chinese Clinical Trial Registry (identifier: ChiCTR-IOR-17013875; registration date: 28 December 2016).
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Affiliation(s)
- Xin-Yu Yue
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200082, China
| | - Zhuo-Qi Feng
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200082, China
| | - Xi-Yi Yu
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200082, China
| | - Jia-Min Hu
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200082, China
| | - Xiao-Jing He
- Beijing He's SanTong Acupuncture and Fire-needle Moxibustion Clinic, Beijing 100032, China.
| | - Shi Shu
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200082, China; Basic Medical School, Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China.
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