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Højgaard Nejst C, Glintborg C. Hope as experienced by people with acquired brain injury in a rehabilitation-or recovery process: a qualitative systematic review and thematic synthesis. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1376895. [PMID: 38807900 PMCID: PMC11131419 DOI: 10.3389/fresc.2024.1376895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024]
Abstract
Background There has been an increasing interest in the concept of hope within the field of brain injury rehabilitation. Existing reviews have nevertheless focused on stroke, leaving out the broad population of people with acquired brain injury (ABI). Furthermore a majority of the included studies in those reviews excluded the subgroup of people with communication difficulties, thus primarily giving voice to a select group of people with ABI. Methods A qualitative systematic review was conducted with the purpose of systematically reviewing and thematically synthesise findings about hope as experienced by adults with ABI in a rehabilitation or recovery process. The search strategy included peer-reviewed qualitative studies published after 2000 in English or Scandinavian languages. Searches of EBSCO databases incorporating CINAHL, MEDLINE, and PsycINFO were conducted together with SocINDEX, Social Work Abstracts, Eric and Web of Science. Ten qualitative studies were included, and the Critical Appraisal Skills Program (CASP) was used for assessing the quality and relevance of the ten studies. Qualitative findings were synthesized using Thomas and Harden's methodology. Results Through a thematic synthesis eleven subthemes were identified relating to experiences of hope. These were grouped into four analytical themes: (1) hope a two folded phenomenon; (2) time and temporality; (3) progress, goals and visibility and (4) the alliance; a balancing act requiring good communication skills. Conclusion This review has shown that even though hope has both a positive and negative side to it, it is necessary as a driving force for people with ABI in terms of supporting them to keep going and not give up. Rehabilitation professionals are advised to embrace the ambiguity of hope, customizing the support of hope to each person with ABI. Attention is needed on how to make progress visible for persons with ABI during their rehabilitation process just as rehabilitation professionals should acknowledge the alliance with the person with ABI as a core component of rehabilitation. This requires a focus on professionals' communication skills if hope promoting relationships between professionals and persons with ABI are to be achieved.
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Affiliation(s)
- Camilla Højgaard Nejst
- Neurorehabilitation Copenhagen, Municipality of Copenhagen, Copenhagen, Denmark
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Chalotte Glintborg
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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Bright FAS, Ibell-Roberts C, Wilson BJ. Psychosocial well-being after stroke in Aotearoa New Zealand: a qualitative metasynthesis. Disabil Rehabil 2024; 46:2000-2013. [PMID: 37198959 DOI: 10.1080/09638288.2023.2212178] [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: 06/28/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Psychosocial well-being is key to living well after stroke, but often significantly affected by stroke. Existing understandings consider well-being comes from positive mood, social relationships, self-identity and engagement in meaningful activities. However, these understandings are socioculturally located and not necessarily universally applicable. This qualitative metasynthesis examined how people experience well-being after a stroke in Aotearoa New Zealand. MATERIAL AND METHODS This metasynthesis was underpinned by He Awa Whiria (Braided Rivers), a model which prompts researchers to uniquely engage with Māori and non-Māori knowledges. A systematic search identified 18 articles exploring experiences of people with stroke in Aotearoa. Articles were analysed using reflexive thematic analysis. RESULTS We constructed three themes which reflect experiences of well-being: connection within a constellation of relationships, being grounded in one's enduring and evolving identities, and being at-home in the present whilst (re)visioning the future. CONCLUSION Well-being is multi-faceted. In Aotearoa, it is inherently collective while also deeply personal. Well-being is collectively achieved through connections with self, others, community and culture, and embedded within personal and collective temporal worlds. These rich understandings of well-being can open up different considerations of how well-being is supported by and within stroke services.
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Affiliation(s)
- Felicity A S Bright
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Claire Ibell-Roberts
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Bobbie-Jo Wilson
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
- Department of Physiotherapy, Auckland University of Technology, Auckland, New Zealand
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Bright FAS, Ibell-Roberts C, Featherstone K, Signal N, Wilson BJ, Collier A, Fu V. 'Physical well-being is our top priority': Healthcare professionals' challenges in supporting psychosocial well-being in stroke services. Health Expect 2024; 27:e14016. [PMID: 38469645 DOI: 10.1111/hex.14016] [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: 10/10/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Following stroke, a sense of well-being is critical for quality of life. However, people living with stroke, and health professionals, suggest that well-being is not sufficiently addressed within stroke services, contributing to persistent unmet needs. Knowing that systems and structures shape clinical practice, this study sought to understand how health professionals address well-being, and to examine how the practice context influences care practice. METHODS Underpinned by Interpretive Description methodology, we interviewed 28 health professionals across multiple disciplines working in stroke services (acute and rehabilitation) throughout New Zealand. Data were analysed using applied tension analysis. RESULTS Health professionals are managing multiple lines of work in stroke care: biomedical work of investigation, intervention and prevention; clinical work of assessment, monitoring and treatment; and moving people through service. While participants reported working to support well-being, this could be deprioritised amidst the time-oriented pressures of the other lines of work that were privileged within services, rendering it unsupported and invisible. CONCLUSION Stroke care is shaped by biomedical and organisational imperatives that privilege physical recovery and patient throughput. Health professionals are not provided with the knowledge, skills, time or culture of care that enable them to privilege well-being within their work. This has implications for the well-being of people with stroke, and the well-being of health professionals. In making these discourses and culture visible, and tracing how these impact on clinical practice, we hope to provide insight into why well-being work remains other to the 'core' work of stroke, and what needs to be considered if stroke services are to better support people's well-being. PATIENT OR PUBLIC CONTRIBUTIONS People with stroke, family members and people who provide support to people with stroke, and health professionals set priorities for this research. They advised on study conduct and have provided feedback on wider findings from the research.
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Affiliation(s)
- Felicity A S Bright
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Claire Ibell-Roberts
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Katie Featherstone
- Geller Institute of Ageing and Memory, University of West London, London, UK
| | - Nada Signal
- Department of Physiotherapy, Auckland University of Technology, Auckland, New Zealand
| | - Bobbie-Jo Wilson
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Aileen Collier
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Vivian Fu
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Oshvandi K, Torabi M, Khazaei M, Khazaei S, Yousofvand V. Impact of Hope on Stroke Patients Receiving a Spiritual Care Program in Iran: A Randomized Controlled Trial. JOURNAL OF RELIGION AND HEALTH 2024; 63:356-369. [PMID: 36435926 PMCID: PMC9702748 DOI: 10.1007/s10943-022-01696-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
This study sought to examine the effect of a spiritual program on the hope of stroke patients in Iran. The present study was a randomized controlled trial that included 108 stroke patients referred to Besat Hospital, Hamadan, Iran, in 2021. Participants were randomized to either the intervention group (n = 54) or control group (n = 54). The data were collected before the intervention by using the demographic information form, Snyder's Adult Hope Scale (AHS), the Modified Rankin Scale (MRS), and after the intervention, the Snyder's Adult Hope Scale (AHS). The intervention group received four sessions of 45-60 min (one session per week) that included a spiritual needs assessment, religious care, spiritual supportive care, and evaluation of benefits. After the intervention, a significant between-group difference was observed (p < 0.001). There was also a significant increase in the mean of hope scores in the intervention group from baseline to follow-up (within-group difference) (p < 0.001), while there was no significant difference between baseline and follow-up in the control group (p = 0.553). (IRCT 20160110025929N36 and date: 2021/09/27).
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Affiliation(s)
- Khodayar Oshvandi
- Department of Medical Surgical Nursing, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Torabi
- Chronic Diseases (Home Care) Research Centre, Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mojtaba Khazaei
- Besat Educational and Medical Center, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Vahid Yousofvand
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
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Archer B, Azios JH, Douglas NF, Strong KA, Worrall L, Simmons-Mackie N. "I Could Not Talk . . . She Did Everything . . . She's Now My Sister": People With Aphasia's Perspectives on Friends Who Stuck Around. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:349-368. [PMID: 38048335 DOI: 10.1044/2023_ajslp-23-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE Aphasia may decrease the capacity to develop and maintain friendships. The aim of this study was to better understand the perspectives of people with aphasia on why some friendship bonds remain strong and some do not. Furthermore, we wanted to explore how age and aphasia severity shape views on friendship. METHOD We interviewed 27 people with aphasia about their experiences of friendship before and after the onset of aphasia. We then used framework analysis and reflexive thematic analysis to interpret the interview data. RESULTS From the interviews, we created four major themes concerning how friend relationships had been impacted by aphasia: (a) Not all bonds have the same chance of surviving the onset of aphasia; (b) people with aphasia's closest friends took active steps to keep relationships strong; (c) if friends knew some basic information about aphasia, bonds would stay stronger; (d) positive affective aspects of friendship play an important role in keeping bonds strong. We also noted differences in friendship experiences that appeared to be influenced by age and aphasia severity of participants. CONCLUSIONS Interview data provided actionable ideas including focusing on friends who are likely to be responsive to help with maintaining the friendship, providing them with strategies to keep the friendship active and communication meaningful, and acknowledging the positive impact that this will have on the friend recovering from aphasia. More research is needed to develop programs that empower people with aphasia to maintain their friendships. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24688671.
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Affiliation(s)
- Brent Archer
- Department of Communication Sciences and Disorders, Bowling Green State University, OH
| | - Jamie H Azios
- Department of Communicative Disorders, University of Louisiana at Lafayette
| | - Natalie F Douglas
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
| | - Katie A Strong
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nina Simmons-Mackie
- Department of Communication Sciences and Disorders, Southeastern Louisiana University, Hammond
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Nåden D, Bjørk IT. Individuals living with a liver transplant - a follow-up study exploring mental, emotional and existential issues 10 years after transplantation. Int J Qual Stud Health Well-being 2023; 18:2233279. [PMID: 37410873 DOI: 10.1080/17482631.2023.2233279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/02/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Going through a liver transplantation is by many recipients considered mentally and emotionally burdensome. AIM The aim of this study was to explore individuals' mental, emotional and existential experiences living with a liver transplant during a period of approximately ten years. METHODOLOGICAL DESIGN The methodology in this study is based on Gadamer's hermeneutics. Galvin and Todres' conceptual framework on well-being was applied in the interpretation process. RESEARCH METHODS Both researchers conducted interviews, which took the form of conversations. We made use of Brinkmann and Kvales' three types of interpretation. ETHICAL ISSUES AND APPROVAL The study was approved by the Ombudsman for Privacy of the Norwegian Social Data Services and is based on informed consent and confidentiality. RESULTS Three themes emerged through interpretation: 1. From great suffering to gratitude and a humble attitude towards life. 2. From living in uncertainty to leading a normal life. 3. From hopelessness and anxiety to an indifferent attitude towards life. CONCLUSION This study showed that the process of receiving a new liver and living with it, had changed most of the participants' attitudes towards life in a humble way. Some persons struggled with life and experienced depression anxiety, as well as lack of energy.
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Affiliation(s)
- Dagfinn Nåden
- Department of Nursing, Faculty of Health, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ida Torunn Bjørk
- Department of Public Health Science, Faculty of Medicine, University of Oslo, Blindern, Oslo
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Tierney-Hendricks C, Miller J, Lopez RP, Conger S, Vallila-Rohter S. 'It's been an extraordinary journey': Experience of engagement from the perspectives of people with post-stroke aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2008-2021. [PMID: 37300434 DOI: 10.1111/1460-6984.12911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Engagement is recognized as an important factor in aphasia treatment response and outcomes, yet gaps remain in our understanding of engagement and practices that promote engagement from the client perspective. AIMS The purpose of this phenomenological study was to explore how clients with aphasia experience engagement during their inpatient aphasia rehabilitation. METHODS & PROCEDURES An interpretative phenomenological analysis approach guided the study design and analysis. Data were collected through in-depth interviews with nine clients with aphasia, recruited through purposive sampling, during their inpatient rehabilitation admission. Analysis was completed using a variety of analytic techniques including coding, memoing, triangulation between coders and team discussion. OUTCOMES & RESULTS The analysis revealed that for clients with aphasia in the acute phrase of recovery, the rehabilitation process resembles travelling on a journey through a foreign land. Successful engagement in the journey was accomplished when one had a therapist who served as a trusted guide and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. CONCLUSIONS & IMPLICATIONS Engagement is a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. Findings from this work have implications for measuring engagement, training student clinicians to be skilled facilitators in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. WHAT THIS PAPER ADDS What is already known on the subject Engagement is recognized as an important factor in rehabilitation treatment response and outcomes. Prior literature suggests that the therapist plays a critical role in facilitating engagement within the client-provider relationship. Communication impairments associated with aphasia may negatively impact a client's ability to develop interpersonal connections and participate in the rehabilitation process. There is a dearth of research directly exploring the topic of engagement in aphasia rehabilitation, particularly from the perspective of clients with aphasia. Capturing the client perspective can provide novel insights regarding practices to foster and maintain engagement in aphasia rehabilitation. What this paper adds to existing knowledge This interpretative phenomenological study revealed that for individuals with aphasia in the acute phase of recovery, the rehabilitation process resembles travelling on a sudden and foreign journey. Successful engagement in the journey was accomplished when one had a therapist who served as a 'trusted guide' and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. Through the client experience, engagement is seen as a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. What are the potential or actual clinical implications of this work? The current study highlights the complexity and nuance of engagement within the rehabilitation context, which has implications for measuring engagement, training student clinicians to be skilled in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. It is necessary to recognize that client and provider interactions (and thus engagement) are embedded in and influenced by the broader healthcare system. With this in mind, a patient-centred approach to engagement in aphasia care delivery cannot be achieved through individual efforts only and may require prioritization and action at the systems level. Future work is needed to explore barriers and facilitators to enacting engagement practices, in order to develop and test strategies to support practice change.
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Affiliation(s)
- Carla Tierney-Hendricks
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Jennifer Miller
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Speech Therapy Department, Sheltering Arms Institute, Richmond, VA, USA
| | - Ruth Palan Lopez
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Sarah Conger
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Sofia Vallila-Rohter
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
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Paynter C, Mathers S, Gregory H, Vogel AP, Cruice M. The impact of communication on healthcare involvement for people living with motor neurone disease and their carers: A longitudinal qualitative study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1318-1333. [PMID: 35860953 PMCID: PMC9796182 DOI: 10.1111/1460-6984.12757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Communication and cognitive impairments are known barriers to shared decision-making. Most people diagnosed with motor neurone disease (MND) will develop a motor speech impairment over the disease course. Some will develop cognitive, linguistic or behavioural disturbance. Despite this, the impact of communication and cognitive impairment on personal healthcare decision-making in MND is not well known. AIMS This exploratory, longitudinal study aimed to capture the perspectives of people living with MND (plwMND) and family members on managing their healthcare with, or in anticipation of, a communication impairment. METHODS & PROCEDURES Semi-structured interviews and functional assessments were conducted with plwMND and family members over one to three time points between December 2017 and January 2020. Participants were recruited from a specialist MND clinic using a maximum variation sampling approach. Interview transcripts were analysed using trajectory data analysis: a matrix-based approach for thematic analysis of longitudinal data. The study was underpinned by interpretive descriptive methodology. OUTCOMES & RESULTS A total of 19 plwMND with a range of MND phenotypes and 15 family members were recruited. Disease progression and participant withdrawal resulted in attrition, however 12 plwMND and seven family members participated at all three time points. Consistent cognitive screening was not feasible, which limited the opportunity to explore the impact of cognitive change. An overarching theme 'Communicating takes effort' was identified and illustrates the efforts required to compensate for, or circumnavigate, impairments to maintain involvement in healthcare. Assistance from family and accommodation from healthcare professionals (HCPs) was needed for ongoing engagement. Where plwMND were dependent on alternative communication devices, this assistance was essential and primarily carried out by family members. Despite these efforts, the quality, quantity and accuracy of communication were sometimes compromised. Participants equated good communication with receiving good healthcare, and some expressed anxiety in the anticipation of being unable to express their needs to healthcare workers. CONCLUSION & IMPLICATIONS Communication impairment has a direct impact on healthcare involvement. This study demonstrates the effort required by plwMND and their carers to maintain or maximize ongoing involvement. This effort may not always be visible to HCPs. This information may prompt clinicians to consider the best ways to conduct clinical consultations to accommodate patients' abilities. Compromised communication experiences can be moderated by accommodations and support from HCPs and appropriate adjustments in the health system. Asking patients about their communication preferences and needs, allowing extra time and conducting multidisciplinary sessions are examples of such support. WHAT THIS PAPER ADDS What is already known on this subject? Communication and cognitive impairments are known contributors to negative health outcomes and barriers to shared decision-making generally. The existing literature in decision-making in MND does not address the specific impact of these impairments on personal healthcare involvement for plwMND and their carers. What this paper adds to existing knowledge? This paper reports the findings of a research project that interviewed 19 plwMND and 15 carers on one to three occasions over a 26-month period to obtain their perspectives of the impact of communication on healthcare involvement. Whilst a priori the intention was to look at both communicative and cognitive decline, only the former was achieved. The effort and often 'invisible' activity undertaken to manage or maintain involvement in healthcare is identified. Communication impairment requires support and accommodation, otherwise healthcare involvement can be compromised. Results show participants may associate effective communication with good healthcare. What are the potential or actual clinical implications of the work? Clinicians may wish to use these insights from plwMND and their carers to guide adjustments to their professional practice to maximize healthcare involvement for their patients. Tailored education for different healthcare groups is needed to improve understanding of MND-related communication impairments and supportive strategies so that involvement in healthcare is not compromised.
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Affiliation(s)
- Camille Paynter
- Department of Audiology and Speech PathologyUniversity of MelbourneMelbourneVICAustralia
| | - Susan Mathers
- Calvary Health Care BethlehemMelbourneVICAustralia
- School of Clinical SciencesMonash UniversityMelbourneVICAustralia
| | - Heidi Gregory
- Calvary Health Care BethlehemMelbourneVICAustralia
- Eastern Health Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Adam P. Vogel
- Department of Audiology and Speech PathologyUniversity of MelbourneMelbourneVICAustralia
- RedenlabMelbourneVICAustralia
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Brown SE, Scobbie L, Worrall L, Mc Menamin R, Brady MC. Access G-AP: development of an accessible goal setting and action planning resource for stroke survivors with aphasia. Disabil Rehabil 2022:1-11. [PMID: 35695078 DOI: 10.1080/09638288.2022.2085331] [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: 11/03/2022]
Abstract
PURPOSE Goal setting is key to stroke rehabilitation, but access for people with aphasia is challenging. Based on the Goal setting and Action Planning (G-AP) framework, we developed an accessible goal setting resource (Access G-AP). METHODS Access G-AP was designed using a three-phase, user-centred design process. Phase 1: Access G-AP Draft A was designed using evidence-based recommendations. Phase 2: Draft A was reviewed by stroke survivors with aphasia (focus groups 1&2) and rehabilitation staff (questionnaire). Phase 3: Suggested recommendations informed Access G-AP Draft B, which was further reviewed by stroke survivors with aphasia (focus group 3). The final version of Access G-AP was approved by stroke survivors with aphasia at a debrief meeting. Data were analysed using content analysis. RESULTS Recommended design improvements included reducing text, adding bullet points, and diversifying images. Both participant groups highlighted that Access G-AP should be used collaboratively to support stroke survivor involvement. Staff recommended Access G-AP training and additional resources to support stroke survivors with severe aphasia. CONCLUSIONS Access G-AP was co-developed to support people with aphasia to access and engage in stroke rehabilitation goal setting. Further research is required to establish the feasibility of Access G-AP in clinical practice.IMPLICATIONS FOR REHABILITATIONEvidence-based accessible formatting strategies and an iterative design process can inform the design of accessible goal setting resources.Accessible goal setting materials should be relevant to stroke survivors with aphasia and responsive to their needs.Rehabilitation staff require training and support to use accessible goal setting resources (like Access G-AP) with stroke survivors with aphasia, especially those with severe aphasia.Evaluation of the feasibility of Access G-AP in clinical practice is now required.
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Affiliation(s)
| | - Lesley Scobbie
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | | | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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10
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Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: Perspectives of people with aphasia on receiving information about recovery. Neuropsychol Rehabil 2022; 33:871-902. [PMID: 35297737 DOI: 10.1080/09602011.2022.2051565] [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: 10/18/2022]
Abstract
Many people with aphasia (language impairment post-stroke) want to know their prognosis for recovery, yet current understanding of their experience of receiving prognoses is limited. Such insight is necessary to inform clinical practice in formulating and delivering aphasia prognoses, especially given the psycho-emotional distress and secondary adverse effects on recovery associated with conversations about prognosis. We sought an in-depth understanding of the perspectives of people with aphasia in relation to receiving prognoses post-stroke, with the aim of informing an evidence-based approach to aphasia prognostication in clinical practice. Semi-structured interviews, facilitated by communication support strategies, were conducted one-to-one with eight people with aphasia (ranging from mild to very severe) 3-12 months post-stroke. Reflexive thematic analysis was used to analyse the qualitative data, yielding two over-arching themes: (1) How would you know without knowing me?; (2) I need to know, but I don't want to know. Our findings illustrate issues of mistrust within the patient-clinician relationship, and complex emotions relating to hope and post-stroke adjustment. The present insight into the lived experience of receiving aphasia prognoses highlights the need for focused consideration of personal definitions of normalcy, measures for fostering trust, and the role of prognostic uncertainty.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
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11
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Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in Poststroke Aphasia: Perspectives of Significant Others of People With Aphasia on Receiving Information About Recovery. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:896-911. [PMID: 35050706 DOI: 10.1044/2021_ajslp-21-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Knowing what to expect poststroke is important for many significant others of people with aphasia, yet an understanding of their perceptions and preferences in receiving prognostic information is limited. This knowledge is needed to inform the formulation and delivery of aphasia prognoses as conversations about prognosis can be harmful or helpful depending on their alignment with key stakeholder perspectives. Our preliminary study sought insight into the perspectives of significant others of people with aphasia on receiving prognostic information, with an aim toward informing evidence-based practice in aphasia prognostication. METHOD We interviewed seven significant others of people with aphasia, 3-12 months poststroke. The interviews were semistructured, conducted one-to-one, and analyzed qualitatively using reflexive thematic analysis. RESULTS Five themes were drawn from the interviews: (a) You don't know what you don't know. (b) Having them alive is the best you can ask for. (c) Recovery in the eye of the beholder. (d) Outcomes don't matter unless they help me help them. (e) It's my prognosis too if I'm living with aphasia. CONCLUSIONS A significant other's prognosis-related perceptions and preferences are products of their poststroke reality and may inadvertently shape that of the person with aphasia. In order to facilitate recovery, prognostication practices need to consider the needs of significant others both as providers of care and as requiring care themselves for their first-hand experiences of third-party disability.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
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12
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Fong TCT, Lo TLT, Ho RTH. Indirect effects of social support and hope on quality of life via emotional distress among stroke survivors: A three-wave structural equation model. Front Psychiatry 2022; 13:919078. [PMID: 35966472 PMCID: PMC9365992 DOI: 10.3389/fpsyt.2022.919078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Stroke survivors are prone to functional impairments and reduced quality of life (QoL). This study examined the mediating role of social support and hope in the relationships between functional impairment, emotional distress, and QoL. METHODS A total of 188 stroke survivors in Hong Kong completed assessments on functional impairment, social support, and hope at baseline, with follow-up measurements of emotional distress at 2 months and QoL at 8 months. Structural equation modeling with bootstrapping was used to analyze the direct and indirect effects of functional impairment on emotional distress and QoL via the mediating factors of social support and hope. RESULTS The partial cascading model provided an adequate fit to the data. Functional impairment had significant negative direct effects on hope and physical QoL and social support had significant positive direct effects on hope and physical QoL. Social support had a significant positive indirect effect on physical QoL via hope and perceived stress and on psychosocial QoL via hope and depression. Functional impairment and hope had a significant negative interaction effect on perceived stress. CONCLUSION The findings support a mediating role for hope in the relationship between social support and QoL in stroke survivors. The protective effect of hope on perceived stress was stronger among patients with greater functional impairment.
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Affiliation(s)
- Ted C T Fong
- Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Temmy L T Lo
- Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Rainbow T H Ho
- Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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13
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Abstract
Abstract
Background and Aims:
Engagement is increasingly recognised as important for maximising rehabilitation outcome following stroke. However, engagement can be challenging when neurological impairment impacts a persons’ ability to activate the regulatory processes necessary for engagement and in the context of a changed self. We explored engagement in stroke rehabilitation from the perspective of people with stroke with a primary focus on identifying key processes that appeared important to engagement in stroke rehabilitation.
Design and Methods:
This study drew on Interpretive Description methodology. Maximum variation and theoretical sampling were used to capture diversity in the sample and access a depth and breadth of perspectives. Data collection included semi-structured interviews with people with stroke (n = 19). Data were analysed through a collaborative and iterative process drawing on range of analytical tools including coding, memoing, diagramming and group discussions.
Findings:
Our findings highlight that engagement is a complex, nuanced, responsive, flexible and inherently two-way process. Developing connections appeared central to engagement with connections taking various forms. The most fundamental was the therapeutic connection between the person with stroke and their practitioner as it provided the foundation on which to build other connections. Connection was made possible through five collaborative processes: Knowing, Entrusting, Adapting, Investing and Reciprocating.
Conclusions:
Engagement is a social and relational process enabled through an inherently person-centred approach and active and ongoing reflexivity – highlighting the importance of a humanising approach to care where aspects of self, care and emotion are evident, for both the person with stroke and their practitioner.
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14
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Northcott S, Simpson A, Thomas S, Barnard R, Burns K, Hirani SP, Hilari K. "Now I Am Myself": Exploring How People With Poststroke Aphasia Experienced Solution-Focused Brief Therapy Within the SOFIA Trial. QUALITATIVE HEALTH RESEARCH 2021; 31:2041-2055. [PMID: 34130554 PMCID: PMC8552370 DOI: 10.1177/10497323211020290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Aphasia, a language disability, can profoundly affect a person's mood and identity. The experiences of participants who received Solution-Focused Brief Therapy, a psychological intervention, were explored in the Solution-Focused brief therapy In poststroke Aphasia (SOFIA) Trial. Thirty participants with chronic aphasia, 14 with severe aphasia, participated in in-depth interviews that were analyzed using framework analysis. Two overarching themes emerged: valued therapy components (exploring hopes, noticing achievements, companionship, sharing feelings, and relationship with therapist) and perceptions of progress (mood, identity, communication, relationships, and independence). Participants were categorized into four groups: (a) "changed," where therapy had a meaningful impact on a person's life; (b) "connected," where therapy was valued primarily for companionship; (c) "complemental," where therapy complemented a participant's upward trajectory; and (d) "discordant," where therapy misaligned with participants' preference for impairment-based language work. This study suggests that it is feasible to adapt a psychological therapy for people with aphasia, who perceive it as valuable.
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Affiliation(s)
| | | | | | | | - Kidge Burns
- Expert Independent Practitioner, London, United Kingdom
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15
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Cheng BBY, Ryan B, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: speech pathologists' clinical insights on formulating and delivering information about recovery. Disabil Rehabil 2021; 44:5046-5059. [PMID: 33969776 DOI: 10.1080/09638288.2021.1922514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE For people with post-stroke aphasia, "Will I get better?" is a question often asked, but one that is intellectually and emotionally demanding for speech pathologists to answer. Speech pathologists' formulation and delivery of aphasia prognoses is varied and there is limited evidence for optimising practice. We aimed to understand speech pathologists' clinical experiences, reasoning, and support needs in aphasia prognostication. MATERIALS AND METHODS Twenty-five Australian speech pathologists working with people with aphasia participated in individual, semi-structured interviews. Their age, level of experience, work setting, and location were maximally varied. Interview responses were analysed qualitatively using thematic analysis. RESULTS Five themes were drawn from the interviews: (1) prognostic challenges are shared but not voiced; (2) truth is there's no quick fix; (3) recovery is more than words; (4) the power of words; and, (5) prognostic competence is implicit. CONCLUSIONS Speech pathologists use implicit competencies to formulate and deliver aphasia prognoses. A patient-centred, holistic contextualisation of aphasia recovery may enable realistic, optimistic, and constructive conversations about prognosis. These conversations may have therapeutic potential if prognostic uncertainty, emotional adjustment, and conditional outcomes are carefully addressed. Future research should seek to understand the perceptions and preferences of people with aphasia and their significant others.Implications for RehabilitationAphasia prognostication in clinical practice is complex and nuanced, thus increased clinical and research focus is warranted to ensure key stakeholder needs are met.Conversations about prognosis may be more meaningful to people with aphasia if recovery is conceptualised as encompassing impairment, activity, and participation outcomes.Given the implicit competencies required for prognostication, a structured approach to reflective practice and experience-based training may be beneficial.Conversations about prognosis may have therapeutic value, but further research is needed to explore this potential.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Brooke Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.,University of Queensland Centre for Clinical Research, Herston, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
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16
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Moss B, Northcott S, Behn N, Monnelly K, Marshall J, Thomas S, Simpson A, Goldsmith K, McVicker S, Flood C, Hilari K. 'Emotion is of the essence. … Number one priority': A nested qualitative study exploring psychosocial adjustment to stroke and aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:594-608. [PMID: 33826205 DOI: 10.1111/1460-6984.12616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Stroke and aphasia can have a profound impact on people's lives, and depression is a common, frequently persistent consequence. Social networks also suffer, with poor social support associated with worse recovery. It is essential to support psychosocial well-being post-stroke, and examine which factors facilitate successful adjustment to living with aphasia. AIMS In the context of a feasibility randomized controlled trial of peer-befriending (SUPERB), this qualitative study explores adjustment for people with aphasia in the post-acute phase of recovery, a phase often neglected in previous research. METHODS & PROCEDURES Semi-structured interviews were conducted with 20 people with aphasia and 10 significant others, who were purposively sampled from the wider group of 56 people with aphasia and 48 significant others. Interviews took place in participants' homes; they were analysed using framework analysis. OUTCOMES & RESULTS Participants with aphasia were 10 women and 10 men; their median (interquartile range-IQR) age was 70 (57.5-77.0) years. Twelve participants had mild aphasia, eight moderate-severe aphasia. Significant others were six women and four men with a median (IQR) age of 70.5 (43-79) years. They identified a range of factors that influenced adjustment to aphasia post-stroke. Some were personal resources, including mood and emotions; identity/sense of self; attitude and outlook; faith and spirituality; and moving forward. Significant others also talked about the impact of becoming carers. Other factors were external sources of support, including familial and other relationships; doctors, nurses and hospital communication; life on the ward; therapies and therapists; psychological support, stroke groups; and community and socializing. CONCLUSIONS & IMPLICATIONS To promote adjustment in the acute phase, hospital staff should prioritize the humanizing aspects of care provision. In the post-acute phase, clinicians play an integral role in supporting adjustment and can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. What this paper adds What is already known on the subject Anxiety and depression are common consequences of stroke, with depression rates high at 33% at 1 year post-onset. There is evidence that the psychological needs of people with aphasia are even greater than those of the general stroke population. Social support and social networks are also negatively impacted. Few studies have examined adjustment when people are still in hospital or in the early stages of post-stroke life in the community (< 6 months). Further, many stroke studies exclude people with aphasia. What this paper adds to existing knowledge Adjustment to living with stroke and aphasia begins in the early stages of recovery. While this partly depends on personal resources, many factors depend on external sources of help and support. These include doctors, nurses and hospital communication, their experience of life on the ward, and their therapists' person-centred care. What are the potential or actual clinical implications of this work? Clinicians play an integral role in facilitating people with aphasia to utilize their personal resources and support systems to adjust to life after stroke. They can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy.
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Affiliation(s)
- Becky Moss
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Sarah Northcott
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Behn
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Katie Monnelly
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Shirley Thomas
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care and Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Biostatistics Department, Division of Psychology and Systems Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sally McVicker
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
- Aphasia Re-Connect, London, UK
| | - Chris Flood
- School of Health and Social Care, London South Bank University, London, UK
| | - Katerina Hilari
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
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17
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Bezmez D, Shakespeare T, Lee K. Theorising rehabilitation: Actors and parameters shaping normality, liminality and depersonalisation in a UK hospital. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:713-731. [PMID: 33899271 DOI: 10.1111/1467-9566.13252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Sociological concern for rehabilitation remains limited. This paper aims to contribute to rehabilitation theory. It examines two units of a specialist rehabilitation hospital in the UK (amputee and neurological services) by focusing on the key actors involved - families, patients, staff - and the parameters shaping their relationships. The findings extend previous theoretical understandings of rehabilitation in three themes: normality, liminality and depersonalisation. We argue, first: normality is constantly negotiated amongst the different actors. This complicates existing works' critique of rehabilitation as reproducing the ideology of normality. Second, discourses produced during acute care shape the inpatient rehabilitation experience. This calls attention to the pre-rehabilitation phase and complicates existing works' emphasis on the transition from inpatient stay to the time of discharge. Finally, inpatient rehabilitation is notable in rendering the adverse effects of depersonalisation apparent. It combines the bureaucracy of a regular hospital ward, with institutionalising aspects of long-term care. These findings have a potential to enhance practice as well as knowledge. We call for a deeper sociological attention, combining theory-building with empirical data for a better understanding of inpatient rehabilitation.
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Affiliation(s)
- Dikmen Bezmez
- Department of Sociology, Koç University, Istanbul, Turkey
| | - Tom Shakespeare
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kate Lee
- Norfolk Community Health & Care NHS Trust, London, UK
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18
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Souchon NM, Krüger E, Eccles R, Pillay BS. Perspectives of working-age adults with aphasia regarding social participation. Afr J Disabil 2020; 9:713. [PMID: 33392061 PMCID: PMC7757020 DOI: 10.4102/ajod.v9i0.713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background Working-age adults with aphasia experience difficulties in social participation, specifically fulfilling social roles and reintegrating into communities. Literature regarding social participation of people with aphasia (PWA) is predominantly based on studies conducted in high-income countries (HIC), limiting generalisability of findings. Perspectives of social participation are influenced by person, place and cultural background warranting investigation in heterogeneous low- and middle-income countries (LMICs), like South Africa. Objectives Describe perspectives of working-age adults with aphasia regarding social participation within the first 2 years post-incident. Method Semi-structured interviews gained perspectives of 10 working-age adults (with mild to moderate aphasia) using principles of supported conversation for adults with aphasia. Data were thematically analysed to describe participants' perspectives of social participation. Results Seven themes were identified pertaining to participants' perspectives of social participation. Participants considered rehabilitation services, faith-related activities and returning to work as valued areas of social participation. Previous interests, presence of support and characteristics of communication partners determined their preference and willingness to participate with others. Finally, personal attitudes and feelings continued to influence their perspectives of social participation, as well as their motivation to participate. Conclusion Successful social participation was dependent on the PWA's perceived value of social activities and presence of support from significant others. Speech-language therapists are in the ideal position to facilitate PWA's communication abilities and their experience of successful participation through the implementation of person-centered care and community-led intervention. This study provided a preliminary investigation of social participation in South Africa and further investigation is warranted.
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Affiliation(s)
- Nadia M Souchon
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Renata Eccles
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Bhavani S Pillay
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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19
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Paynter C, Mathers S, Gregory H, Vogel AP, Cruice M. How people living with motor neurone disease and their carers experience healthcare decision making: a qualitative exploration. Disabil Rehabil 2020; 44:3095-3103. [PMID: 33295820 DOI: 10.1080/09638288.2020.1855261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Healthcare decision making in motor neurone disease (MND) focuses on symptom management and quality of life. Decision making may be affected by personal approach to receiving information, decision making style, and disease symptoms. This study explored decision making from the perspectives of people living with motor neurone disease (plwMND). The issues impacting engagement and involvement in healthcare decisions were investigated. METHODS Semi-structured interviews were conducted with 19 plwMND and 15 carers. Interview data was inductively analysed to identify and describe patterns and themes. RESULTS Data analysis identified six overarching themes: Dimensions of decision making; Window of opportunity for choice; Intrinsic influences on decision making; Extrinsic influences impacting decision making; Planning in uncertainty; and, Communication is core. Many participants did not identify a process of "decision-making" except if considering early gastrostomy placement. Information provision requires a balance between ensuring patients are informed but not overwhelmed. Communication impairment impacts involvement. Healthcare professionals' communication style influences engagement in decision making. CONCLUSION PlwMND perceive a lack of clinical decisions to make because disease symptoms and clinical phenotypes dictate necessary interventions. PlwMND describe communication impairment as a barrier to involvement in decision making and extra support is required to ensure they maintain engagement.IMPLICATIONS FOR REHABILITATIONPeople living with MND (plwMND) perceive they have few clinical decisions to make and viewed this process as "accepting a recommendation", rather than "making a decision" although early gastrostomy placement is the exception with considerable deliberation evident.Specialist multidisciplinary clinic advice is especially helpful for plwMND without dysphagia (swallowing problems) when considering early gastrostomy placement.Communication impairment may be a barrier to involvement in healthcare decisions and extra support to remain engaged is required.Some plwMND choose not to involve others in their decisions, and patients/families with medical or scientific backgrounds are more likely to collaborate with each other outside the context of clinic appointments.
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Affiliation(s)
- C Paynter
- Centre for Neuroscience of Speech, University of Melbourne, Parkville, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - S Mathers
- Calvary Health Care Bethlehem, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - H Gregory
- Calvary Health Care Bethlehem, Melbourne, Australia
| | - A P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Parkville, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Germany.,Redenlab, Australia
| | - M Cruice
- Division of Language and Communication Science, City, University of London, London, UK
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Bright FAS, McCann CM, Kayes NM. Recalibrating hope: A longitudinal study of the experiences of people with aphasia after stroke. Scand J Caring Sci 2019; 34:428-435. [PMID: 31487069 PMCID: PMC7432176 DOI: 10.1111/scs.12745] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
Background Hope is a critical resource for people with aphasia after stroke, sustaining people though times of distress and uncertainty and providing motivation. In the first months after stroke, hope is vulnerable to different influences, and people can struggle to identify and work towards hopes for the future. We have little knowledge about how people with aphasia experience hope in the longer term after stroke. Objectives To identify how people with aphasia experience hope 1 year after stroke and how hope may change in the year after stroke. Methods The study used an Interpretive Description methodology. Interviews were conducted with four people with aphasia who had been interviewed 1 year previously. These were analysed using content analysis. Results All people reported a broad sense of hope for the future. They described an active process of recalibrating their early poststroke hopes through a process of reflecting on past progress, current function and what they considered might be possible and desirable in the future. People were able to develop ‘new’ hopes that were meaningful and seemingly achievable when they had a sense of a possible, desirable future. Those who struggled to see a possible future maintained a hope that things will be good. Social supports, a sense of progress, engagement in meaningful activities and interactions appeared crucial in helping people (re)develop hopes for their future. Conclusions Hope and hopes for the future gradually changed after stroke. Hope, identity and social connectedness were closely entwined and could enable people to both dwell in the present and move towards desired futures. This research suggests clinicians should prioritise creating hope‐fostering environments which support people to develop hope for their future.
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Affiliation(s)
- Felicity A S Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Clare M McCann
- School of Psychology (Speech Science), University of Auckland, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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