Sense of well-being 10 years after stroke

The needs and difficulties during the return to work after a stroke: a systematic review and meta-synthesis of qualitative studies

PURPOSE

To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers.

MATERIALS AND METHODS

A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital.

RESULTS

Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients' group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges.

CONCLUSIONS

Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process.

How is the environment integrated into post-stroke rehabilitation? A qualitative study among community-dwelling persons with stroke who receive home rehabilitation in Sweden

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.

The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature

Background and Purpose:

Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.

Method:

Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.

Results:

While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.

Conclusions:

Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.

The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review

INTRODUCTION

Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke.

OBJECTIVES & METHODOLOGY

This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles.

FINDINGS

We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors.

CONCLUSION

More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.

The relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course

Objectives: The present study sets out to investigate the relation of cognitive abilities to well-being and its interplay with key life course proxies of cognitive reserve and social capital in a large sample of older adults.Method: Three thousand eighty older adults served as sample for the present study. Physical well-being (EuroQoL-5D questionnaire) and psychological well-being (Satisfaction with Life Scale) as well as cognitive performance in terms of verbal abilities (Mill Hill vocabulary scale), processing speed (Trail Making Test part A), and cognitive flexibility (Trail Making Test part B) were assessed. Participants reported information on education, occupation, cognitively stimulating leisure activities, the different languages regularly spoken as well as family and close friends.Results: Moderation analyses showed that the relation of cognitive performance to physical and psychological well-being was significantly attenuated in individuals with a higher cognitive level of the first job after education, a larger number of midlife and current cognitively stimulating leisure activities, a larger number of languages regularly spoken, a larger number of significant family members and friends, and more frequent contact with and more confidence in significant family members.Conclusion: Present data suggest that the relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course.

Situational Analysis: Community Care for Survivors of Stroke and Suggestions for Improving the Provision of Care

This descriptive qualitative study aimed to analyze the community care situation for survivors of stroke and provide suggestions for improving care. The study was conducted in a district of Chiang Mai Province. Purposive sampling was employed based on inclusion criteria to select 51 key informants comprised of 1) three health personnel, 2) 13 community leaders, 3) three local government officers, 4) 13 village health volunteers, and 5) 13 caregivers who took care of survivors of stroke. The data collection consisted of in-depth interviews and focus group discussions, based on the Expanded Chronic Care Model. Data were analyzed by content analysis. The results revealed that community care for survivors of stroke is mainly provided by family members. As well, our analysis revealed for survivors: 1) inadequate personal skills among caregivers and volunteers; 2) inefficient health services; 3) the lack of support for a caring system; 4) incomplete clinical information system; 5) no healthy public policy; and 6) lack of a supportive environment. We suggest that, to improve the care available to survivors of stroke, there needs to be: 1) development of supportive policies at both national and local government levels; 2) development and provision of guidelines for the care; and 3) a supportive caring system that includes health personnel, caregivers, and rehabilitation facilities, as well as support for the home and community-based environment. These results and suggestions will be useful to community nurses and stakeholders who are responsible to design caring for survivors of stroke.

Nursing students contribution to rehabilitation for home-dwelling patients

Home-dwelling rehabilitation has expanded in the last years in Norway. The goal is to strengthen self-care for those who have suffered acute impairment or has due to chronic diseases. The purpose of this study was to explore whether nursing students in home-based nursing care (HBNC) can contribute to patients' rehabilitation and mastery work during clinical placement. The study considered 121 undergraduate nursing students' HBNC clinical placements where they, in collaboration with patients, have designed and applied a rehabilitation plan. The duration of the clinical placements were 8 weeks and took place in the municipality of Oslo. Prior to the clinic placement, the students have followed an introductory course rehabilitation plan development. During the initial phase of the placement, the students an eight-step model for mapping the patient's values: 1) home, 2) close relatives, 3) physical activities, 4) friends, 5) job, 6) leisure activities, 7) body and appearance, and 8) spiritual and philosophical values. The students scaled the intensity of each value on a scale from 1 to 10. Through their clinical training a teacher and clinical supervisors have coached the students. The clinical placements have been followed by a written exam. Based on patients' values and resources, the students coached patients in self-care activities that brought the patients closer to their targets, whether it was on an activation or a participation level. The principal finding of this study was that the students in HBNC were adequately prepared to plan and carry out rehabilitation activities with patients.

Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography

Objective

To describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services.

Design

Systematic review and meta-ethnography.

Data sources

Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015).

Eligibility criteria

Primary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services.

Data synthesis

A set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria.

Results

51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke.

Limitations

Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems.

Conclusions

Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services.

Systematic review registration number

PROSPERO 2015:CRD42015026602

Should frail older adults be in long-term care facilities?

AIM

Home-based nursing care is relatively easy to access in Norway compared to the rest of Europe, and the threshold for applying for assistance is relatively low. The aim of the present study was to analyze factors that enable frail older adults to live in their own homes, with a low level of care burden stress.

METHODOLOGY

In 2015 and 2016, eight municipalities from different parts of Norway participated in a cross-sectional study. The quantitative part of the project consisted of assessing care of 71 older adults, aged ≥80 years, using a geriatric comprehensive assessment. The qualitative part consisted of semistructured telephone interviews with 14 leaders of nursing homes and home-based nursing care and interviews with 26 close relatives.

RESULTS

In this sample, 60% of the older adults were living alone, and 79% were at risk of permanent nursing home admission; 31% stated that they would be better-off at a higher caring level, mainly due to living alone. The relatives, their resources, and motivation to provide care seemed to be crucial for how long older adults with heavy care burden could stay at home. The municipalities offered a combination of comprehensive home care, day centers, and revolving short-term stays to enable them to live at home.

CONCLUSION

The results reveal that the need for home care services is steadily increasing. The relatives are coping with the physical care, far better than the uncertainties and worries about what could happen when the older adults stay alone. The number of beds in institutional care in each municipality depends on various factors, such as the inhabitants' life expectancy, social aspects, geography, well-functioning eldercare pathways, competence of the health professionals, and a well-planned housing policy.

Long-Term Predictors of Social and Leisure Activity 10 Years after Stroke

Background

Restrictions in social and leisure activity can have negative consequences for the health and well-being of stroke survivors. To support the growing number of people who are ageing with stroke, knowledge is needed about factors that influence such activity in a long-term perspective.

Aim

To identify long-term predictors of the frequency of social and leisure activities 10 years after stroke.

Method

145 stroke survivors in Sweden were followed-up at16 months and 10 years after a first-ever stroke. Data representing body functions, activities & participation, environmental factors and personal factors at 16 months after stroke, were used in multiple linear regression analyses to identify predictors of the activity frequency after 10 years, as assessed by the ‘Community, social and civic life’ sub-domain of the Frenchay Activities Index (FAI-CSC).

Results

At the 10-year follow-up the frequency of social and leisure activities varied considerably among the participants, with FAI-CSC scores spanning the entire score range 0–9 (mean/median 4.9/5.0). Several factors at 16 months post stroke were independently related to the long-term activity frequency. The final regression model included four significant explanatory variables. Driving a car (B = 0.999), ability to walk a few hundred meters (B = 1.698) and extent of social network (B = 1.235) had a positive effect on activity frequency, whereas an age ≥ 75 years had a negative effect (B = -1.657). This model explained 36.9% of the variance in the FAI-CSC (p<0.001).

Conclusion

Stroke survivors who drive a car, have the ability to walk a few hundred meters and have a wide social network at 16 months after a first-ever stroke are more likely to have a high frequency of social and leisure activities after 10 years, indicating that supporting outdoor mobility and social anchorage of stroke survivors during rehabilitation is important to counteract long-term inactivity.

Striving for a life worth living: stroke survivors' experiences of home rehabilitation

BACKGROUND

For mild-to-moderate stroke survivors, early supported discharge from hospital, followed by home rehabilitation is preferred over conventional care. How this mode of service contributes to recovery from stroke survivors' perspective needs further investigation.

AIM

The aim of this study was to explore mild-to-moderate stroke survivors' experiences with home rehabilitation after early supported discharge from hospital.

METHODS

A qualitative interpretive interview design was used in the context of a randomised controlled trial. A purposive sample of eight participants (45-80 years) was followed by an ambulant team, and a specific healthcare team provided home rehabilitation. Data were analysed using interpretive description, systematic text condensation and coping theory.

FINDINGS

A crucial determinant for the participants' hopes for a life worth living was the mutual confidence expressed in encounters with healthcare professionals and the participants' ability to make sense of their now-altered body. The professional caretakers' communication qualities and their ability to attend to individual needs were important. Help in processing the emotional reactions caused by a changed body and in socialising was requested by participants. Professional caretakers providing home rehabilitation should strive for a more flexible- and individually tailored service and should seek increased cooperation among stakeholders.

CONCLUSION

The focus on therapeutic communicative qualities, bodily changes, emotional processes, social concerns and long-term follow-up should be increased in order to achieve a more beneficial experience for stroke survivors.