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Jacobi M, van der Schuur L, Seves BL, Brandenbarg P, Dekker R, Hettinga FJ, Hoekstra F, Krops LA, van der Woude LHV, Hoekstra T. Exploring experiences of people with stroke and health professionals on post-stroke fatigue guidance: getting the right people to the right care at the right time. Disabil Rehabil 2024; 46:4439-4447. [PMID: 37950406 DOI: 10.1080/09638288.2023.2277398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This focus group study aimed to explore experiences and perceptions on post-stroke fatigue guidance in Dutch rehabilitation and follow-up care among people/patients with stroke and health professionals. METHODS Ten persons with stroke and twelve health professionals with different professions within stroke rehabilitation or follow-up care in the Netherlands were purposively sampled and included. Eight online focus group interviews were conducted. We analysed the data using reflexive thematic analysis. RESULTS Three themes were identified. Guidance in fatigue management did not always match the needs of people/patients with stroke. Professionals were positive about the provided fatigue guidance (e.g. advice on activity pacing), but found it could be better tailored to the situation of people/patients with stroke. Professionals believe the right time for post-stroke fatigue guidance is when people/patients with stroke are motivated to change physical activity behaviour to manage fatigue - mostly several months after stroke - while people/patients with stroke preferred information on post-stroke fatigue well before discharge. Follow-up care and suggestions for improvement described that follow-up support after rehabilitation by a stroke coach is not implemented nationwide, while people/patients with stroke and professionals expressed a need for it. CONCLUSIONS The study findings will help guide improvement of fatigue guidance in stroke rehabilitation programmes and stroke follow-up care aiming to improve physical activity, functioning, participation, and health.
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Affiliation(s)
- M Jacobi
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L van der Schuur
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B L Seves
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - F Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - L A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Hoekstra
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Choi H, Song Y. The Development of the Adaptive Behavior Scale for Stroke Survivors. Healthcare (Basel) 2024; 12:1719. [PMID: 39273743 PMCID: PMC11395091 DOI: 10.3390/healthcare12171719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024] Open
Abstract
The adjustment of stroke survivors is self-directed and multi-dimensional. This study developed an adaptive behavior scale for stroke survivors reflecting these characteristics and performed a psychometric evaluation. The item pool was derived based on conceptual attributes and indicators of adaptive behaviors for stroke survivors. Ten experts assessed the content validity. The scale was refined through pilot testing and interviews with 10 stroke survivors. From December 2021 to May 2022, a self-report questionnaire consisting of a five-point Likert scale was administered to 215 stroke survivors visiting a university hospital in S City, South Korea. Item analysis and confirmatory factor analysis were conducted to assess the construct validity; reliability was confirmed using Cronbach's α. The final scale comprised three factors and 16 items: taking an optimistic view, restructuring daily activities to suit oneself, and carrying out one's daily life. The confirmatory factor analysis indicated a good fit for the three-factor model; Cronbach's α coefficient of the scale was 0.90, indicating a very good internal consistency. This easy-to-use, concise self-report scale applies to stroke survivors from subacute to chronic stages, providing healthcare professionals with the basic data needed to assess their adaptation. It may also facilitate individualized intervention program development to improve stroke survivor adaptation.
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Affiliation(s)
- Hyunsuk Choi
- Department of Nursing, Cheongju University, Cheongju 28503, Republic of Korea
| | - Youngshin Song
- Department of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
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Zhou Z, Fang X, Huang Y, Hu J, Zhang K, Jia S. A scoping review of factors associated with self-management in young adults with stroke. PATIENT EDUCATION AND COUNSELING 2024; 125:108308. [PMID: 38705023 DOI: 10.1016/j.pec.2024.108308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To synthesize the available evidence on factors associated with self-management behavior in young stroke patients. METHODS The methodological guidelines for scoping reviews developed by the Joanna Briggs Institute and the PRISMA-scR-checklist for scoping reviews were used. A total of 5586 studies were identified through bibliographic searches of the scientific databases Medline (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO, limited to the period 2000-2023. Studies were independently assessed for inclusion and exclusion criteria by two reviewers. Quantitative observational data and qualitative studies were extracted, mapped, and summarized to provide a descriptive summary of trends and considerations for future research. RESULTS Nine papers were finally selected to answer the research question. Young patients' self-management was mainly influenced by demographic factors (age, gender, income, education, and stroke knowledge), disease-related factors (functionality and independence, duration of stroke diagnosis, cognitive function, and poststroke fatigue), and psychosocial factors (hardiness, spiritual self-care, self-efficacy, and social support). CONCLUSION Further research is needed to determine the trajectory of poststroke self-management over time and its potential predictors, which should lead to the development of specific stroke rehabilitation and stroke self-management support programs for young people (considering factors that influence return to work in young stroke patients' self-management). PRACTICE IMPLICATIONS Healthcare providers can design more efficient interventions to improve the quality of life of young stroke patients after discharge. Gaining an in-depth understanding of the factors that influence self-management can help achieve this.
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Affiliation(s)
- Zifang Zhou
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Xiaoqun Fang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Youhong Huang
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Jiangyu Hu
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Kaibing Zhang
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Shulei Jia
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China.
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Bright L, Wei TZ, Lau SCL, Baum CM. An Exploratory Study of Young Stroke Survivors' Lived Experiences: A Multi-Methods Study Using Developmental Theory. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:405-413. [PMID: 37649450 DOI: 10.1177/15394492231196783] [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] [Indexed: 09/01/2023]
Abstract
Young adults make up 10% of strokes that occur in the United States each year. Little research has shown the developmental and occupational disruption as a result of stroke for this population. The objective of this study was to describe young stroke survivors' perceived disruptions using developmental theory. A multiple methods study was conducted with community-dwelling stroke survivors between the ages of 18 and 40 using Patient-Reported Outcomes Measurement Information System (PROMIS) measures and qualitative interviews. Five themes were reported from the qualitative data: stroke and health, work and school, romantic relationships, parenting, and other social relationships. PROMIS measure results were not significantly different from the normed population despite challenges revealed during qualitative interviews. Qualitative data showed variations in post-stroke deficits and occupational performance that could not be meaningfully captured by the PROMIS measures alone. Occupational therapy practitioners should use developmental theory to guide their understanding of occupational disruptions in young stroke survivors.
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Affiliation(s)
- Lindsay Bright
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Stephen C L Lau
- Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Washington University School of Medicine, St. Louis, MO, USA
- Washington University in St. Louis, MO, USA
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Sathananthan N, Morris E, Gillanders D, das Nair R, Knox L, Wong D. Rebuilding the self through valued action and group connections after acquired brain injury: Participant perspectives of the VaLiANT group intervention. Neuropsychol Rehabil 2024:1-29. [PMID: 38838171 DOI: 10.1080/09602011.2024.2359992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024]
Abstract
Effective interventions that facilitate adjustment following acquired brain injury (ABI) are needed to improve long-term outcomes and meaningful reengagement in life. VaLiANT is an 8-week group intervention that combines cognitive rehabilitation with Acceptance and Commitment therapy to improve valued living, wellbeing, and adjustment. This study explored participant experiences of VaLiANT to optimize its ongoing development. This included characterization of individually meaningful treatment outcomes, mechanisms of action, and intervention acceptability. Qualitative interviews and quantitative ratings were collected from 39 ABI survivors (Mage = 52, SD = 15; 54% stroke) following their participation in VaLiANT. Participants reported diverse outcomes which resulted in three themes being generated following reflexive thematic analysis. "A fuller toolkit for life with brain injury" indicated increased strategy usage and better daily functioning; "The value of connection and belonging" captured the importance of social experiences in shaping recovery; and "Finding the me I can be" represented cognitive, behavioural, and emotional aspects of identity reconstruction post-ABI. The content and delivery of the intervention were rated highly but participants desired greater follow-up and tailoring of the intervention. Overall, VaLiANT appears to facilitate adjustment through several mechanisms, but greater intervention individualization and dosage may be required to enhance the treatment impact.
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Affiliation(s)
- Nick Sathananthan
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - David Gillanders
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Roshan das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Health Division, SINTEF, Trondheim, Norway
| | - Lucy Knox
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Naknoi S, Li J, Ramasoota P, Liu X, Chen L, Phuanukoonnon S, Soonthornworasiri N, Kaewboonchoo O. Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand. BMC Public Health 2023; 23:1910. [PMID: 37789277 PMCID: PMC10548574 DOI: 10.1186/s12889-023-16784-4] [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: 04/21/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
Stroke incidence is increasing among working-age population, but the role of psychosocial stress in the workplace in predicting quality of life (QoL) after stroke onset is understudied. This longitudinal study aimed to investigate the relationship between work stress, measured by the effort-reward imbalance (ERI) model, and QoL over one-year period among 103 Thai workers who had experienced a stroke. The study evaluated the effort (E)-reward (R) ratio and over-commitment, the extrinsic and intrinsic components of the ERI model, before discharge; QoL was repeatedly measured at baseline, six months, and 12 months after discharge, respectively, using the Short Form Version 2 (SF-12v2) indicators of physical and mental health composite scores. Generalized estimating equations were used to examine longitudinal relationships between work stress at baseline and QoL over one year by testing the hypotheses that E-R ratio and over-commitment would have direct effects on QoL, and potential moderating effects of over-commitment on E-R ratio and QoL. The results supported the ERI model partially, as over-commitment was significantly associated with poor mental health (coefficient - 8.50; 95% CI: -13.79, -3.20) after adjusting baseline sociodemographic, behavioral, and clinical characteristics, while the E-R ratio was not significantly associated with physical or mental health; the interaction between the E-R ratio and over-commitment was also not significant. These findings suggest that more attention should be paid to workers' personal coping skills and ability to handle work-related problems and prioritize interventions that address over-commitment to promote long-term mental health among workers with stroke.
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Affiliation(s)
- Siripan Naknoi
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Public health Nursing, Faculty of Public health, Mahidol University, Bangkok, 10400, Thailand
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Pongrama Ramasoota
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Suparat Phuanukoonnon
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Ngamphol Soonthornworasiri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Orawan Kaewboonchoo
- Department of Public health Nursing, Faculty of Public health, Mahidol University, Bangkok, 10400, Thailand.
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Additional therapy promotes a continued pattern of improvement in upper-limb function and independence post-stroke. J Stroke Cerebrovasc Dis 2023; 32:106995. [PMID: 36681009 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/29/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Upper-limb motor impairment after stroke is common and disabling. Growing evidence suggests that rehabilitation is effective in the chronic period. However, there is limited knowledge on the effects of ongoing targeted rehabilitation programs on patient outcomes. OBJECTIVES This study investigated the effects of delivering two programs of dose-matched evidence-based upper-limb rehabilitation to community-dwelling post-acute stroke patients with low, moderate and high motor-function. MATERIALS AND METHODS 12 patients (2 female) aged 50.5±18.2 years and 13.8±10.8 months post-stroke completed 2-weeks of modified-Constraint-Induced Movement Therapy followed by 2-weeks of Wii-based Movement Therapy after a mean interval of 9.6±1.1 months (range 6-19months). Function was assessed at 6 time points (i.e. before and after each therapy program and 6-month follow-up after each program). Primary outcome measures were the Wolf Motor Function Test timed-tasks (WMFT-tt), upper-limb Fugl-Meyer Assessment (F-M) and the Motor Activity Log Quality of Movement Scale (MALQOM). Improvement and maintenance was analyzed using Paired T-Tests and Wilcoxon Signed Rank Tests. RESULTS Upper-limb function significantly improved on all primary outcome measures with the first therapy program (WMFT-tt p=0.008, F-M p=0.007 and MALQOM p<0.0001). All scores continued to improve with the second therapy program with significant improvements in the F-M (p=0.048) and the MALQOM (p=0.001). CONCLUSIONS All patients showed a pattern of continued improvement in upper-limb motor-function and independence in activities of daily living. These improvements demonstrate the benefit of ongoing post-stroke rehabilitation for community-dwelling stroke survivors for individuals of varying baseline functional status.
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Gopaul U, Charalambous M, Thilarajah S, Kwah LK, Chapman S, Bayley M, Demers M. Age-specific information resources to address the needs of young people with stroke: a scoping review protocol. Syst Rev 2022; 11:275. [PMID: 36529833 PMCID: PMC9761956 DOI: 10.1186/s13643-022-02147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIMS Young people with stroke (YPwS) persistently experience challenges with disability, social reintegration, employment, and financial stability to provide for themselves and their families. The aims of this scoping review are to (1) identify and collate information resources for YPwS and evidence-based self-managements programs and (2) identify gaps in age-specific resources available for YPwS after traditional rehabilitation services have ended and/or who are returning to live in the community. METHODS We will include both qualitative and quantitative studies, including all study designs. Participants will be community-dwelling adults aged between 18 and 65 years with a clinical diagnosis of stroke. We will include information resources and evidence-based self-managements programs for YPwS. Search terms will include stroke, young people, and community dwelling. We will search electronic databases such as MEDLINE. The reference lists of included studies, systematic reviews, and stroke guidelines and stroke-specific websites will also be searched. We will also contact Stroke Support Organizations and international/national allied health professional organisations to gather information resources about YPwS. We will also conduct a comprehensive environmental scan of additional resources using the search engine Google. The titles, abstracts, full-text articles, and contents of the resources identified by the search will be assessed against the inclusion and exclusion criteria to identify potentially relevant resources. RESULTS AND CONCLUSIONS Existing resources and self-management programs will be collated and categorized according to the type of needs addressed such as physical, emotions, activities of daily living, information, relationships, and social needs as well as the key gaps identified.
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Affiliation(s)
- U Gopaul
- The KITE Research Institute, Toronto Rehabilitation Institute, Toronto, Canada.
| | - M Charalambous
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Rehabilitation Sciences Department, Cyprus University of Technology, Limassol, Cyprus
| | - S Thilarajah
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore
| | - L K Kwah
- Health and Social Sciences Cluster, Singapore Institute of Technology, Dover, Singapore
| | - S Chapman
- University of Virginia Comprehensive Stroke Center, Charlottesville, USA
| | - M Bayley
- The KITE Research Institute, Toronto Rehabilitation Institute, Toronto, Canada
| | - M Demers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
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Yan HY, Lin HR. Resilience in Stroke Patients: A Concept Analysis. Healthcare (Basel) 2022; 10:2281. [PMID: 36421605 PMCID: PMC9691242 DOI: 10.3390/healthcare10112281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 05/01/2024] Open
Abstract
(1) Background: Resilience enables individuals to develop positive coping strategies when faced with adversity. However, knowledge on resilience in stroke patients remains limited, and resilience assessment methods continue to be debated. (2) Aim: To perform a concept analysis of resilience in stroke patients. (3) Methods: The Walker and Avant approach to concept analysis was adopted. Searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Chinese Electronic Periodical Services (CEPS) databases and grey literature using the keywords "stroke patient", "resilience", and "concept analysis". (4) Results: The defining attributes of resilience in stroke patients were classified into internal personality traits and external environmental support. Antecedents included physical, mental, and familial and social impairments caused by the disease, and the consequences were good adaptation, which included active cooperation with rehabilitation activities, positive thinking, goal setting, and harboring hope for the future. (5) Conclusion: Resilience is of a diverse and complex nature. Optimism and positivity, problem-solving ability, and familial and social support may assist in re-adjusting or restoring the balance between physical and mental health when a stroke patient faces adversity. Key factors affecting resilience in stroke patients should be further investigated in future research to assist in the development of effective interventional treatment measures.
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Affiliation(s)
- Huey-Yeu Yan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
- Department of Nursing, University of Kang Ning, Taipei City 114311, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
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Choi H, Lim A, Song Y. Adaptive behavior in stroke survivors: A concept analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:S1976-1317(22)00034-2. [PMID: 35963571 DOI: 10.1016/j.anr.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 11/02/2022] Open
Abstract
PURPOSE This study aims to explore a clear and evidence-based definition of adaptive behavior in stroke survivors and establish the antecedents, attributes, consequences, and empirical referents of the concept. METHODS The concept analysis was performed using the Walker and Avant methods as a framework. Data from 90 publications were collected using various databases (PubMed, EMBASE, CINAHL, RISS, and KISS) and applied in the analysis. RESULTS Adaptive behavior in stroke survivors was defined according to four attributes: realizing change, taking an optimistic view, restructuring daily activities to suit oneself, and carrying out one's own daily life. The conceptual structure of their adaptive behavior comprised stroke onset, functional changes, and emotional liability as antecedents and autonomy, family equilibrium, and quality of life as consequences. CONCLUSIONS Clarifying the concept of adaptive behavior in stroke survivors provides an understanding of the underlying attributes of this concept. Furthermore, it will facilitate the development of scales to measure the concept and the application of a theory-based intervention program that can improve adaptive behavior.
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Affiliation(s)
- Hyunsuk Choi
- Department of Nursing, College of Nursing, Chungnam National University, Munwharo 266 Junggu, Daejeon, 35015 Republic of Korea
| | - Ancho Lim
- Department of Nursing, College of Nursing, Chungnam National University, Munwharo 266 Junggu, Daejeon, 35015 Republic of Korea.
| | - Youngshin Song
- Department of Nursing, College of Nursing, Chungnam National University, Munwharo 266 Junggu, Daejeon, 35015 Republic of Korea.
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Turner A, De Wet TJ, McMurray J, Wrobel A, Smith H, Clissold B, Mohebbi M, Kneebone I. Feasibility of the community-based Stay at Work Intervention (SAWI) for stroke survivors. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Rates of stroke in people of working age are increasing. Returning to work (RTW) after stroke is a key rehabilitation aspiration for younger stroke survivors. A pilot community-based Stay at Work Initiative (SAWI) was developed and delivered from March 2017 to December 2019. SAWI used a co-ordination based approach, covering rehabilitation and vocational recovery to support RTW in younger stroke survivors. OBJECTIVE: The aim of the study was to conduct a feasibility evaluation of SAWI. METHODS: A mixed methods approach was taken considering quantitative and qualitative data. Quantitative data included employment, mood, anxiety and fatigue outcomes at time of engagement with the service and at 6-months post-stroke. Qualitative data was collected on a sub-sample of SAWI clients who volunteered to participate in a semi-structured interview. RESULTS: Overall, there were 93 referrals to SAWI, with 42 clients completing an initial service meeting. Average working hours pre-stroke were high (mean 46.9, SD 22.0, range 5–100 hours/week). By 6 months post stroke, 71% (n = 29 of 41) of SAWI clients were working. For those with 6-month questionnaire information (n = 19), there was a significant reduction in cognitive fatigue, overall fatigue levels, and perceived impact of stroke on employment (medium effect sizes of r = 0.36, 0.34 and 0.40 respectively). No significant difference was seen on measures of mood or anxiety from pre- to post-intervention. Qualitative interviews with six SAWI participants highlighted the importance of personalised support that addresses individual needs during the RTW journey. CONCLUSIONS: A significant number of eligible participants referred to SAWI can engage with the service. RTW is able to be assessed as are potential predictor variables. Seventy one percent of participants had RTW at 6 months post-stroke. Mood, self-efficacy, adjustment, and fatigue likely impact RTW. Qualitative interviews identified that SAWI’s personalised support, tailored to individual need, was valued.
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Affiliation(s)
- Alyna Turner
- School of Medicine, Institute for Innovation in Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | | | - Jade McMurray
- School of Medicine, Institute for Innovation in Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Anna Wrobel
- School of Medicine, Institute for Innovation in Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Heather Smith
- Acute Neurosciences Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Ben Clissold
- Acute Neurosciences Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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12
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Zhang Y, Mou Y, Zhang Y, Wang J, Kong F. Psychological experience and social reintegration needs of young stroke patients: a systematic review and meta-aggregation of qualitative studies. J Community Health Nurs 2022; 39:150-169. [PMID: 35653793 DOI: 10.1080/07370016.2022.2077074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The visible physical dysfunction and invisible psychological effects after stroke prevent young patients from returning to their pre-stroke roles and social activities. PURPOSE/AIM To comprehensively analyze the psychological experience and social reintegration needs of young stroke patients, which may be beneficial for improving quality of life and social reintegration after stroke. METHODS We conducted a comprehensive literature search of 10 databases. The screening and quality assessment of the included articles were performed by the Qualitative Assessment and Review Instrument (QARI). Meta-aggregation was conducted to synthesize the findings of the included studies. We summarized the certainty of confidence using the Confidence in Evidence from Reviews of Qualitative Research (CERQual) approach. RESULTS A total of 5506 studies were screened, of which 12 were included. Data synthesis suggested two new themes: (a) the self-growth process from denial of stroke to accepting stroke (high CERQual confidence), and (b) desire to regain pre-stroke normality, but having difficulty in the social reintegration process (high CERQual confidence). CONCLUSION Stroke, as a traumatic event, disrupts the life structure of young patients, and their needs of reintegration are not adequately considered. Interventions based on the principle of individuation should focus on this issue to restore continuity in life after stroke.
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Affiliation(s)
- Yongli Zhang
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China.,College of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Yating Mou
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China.,College of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Yunqian Zhang
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Jingmei Wang
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Fanyi Kong
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
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13
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Sapuppo D, Bernhardt J, Carvalho LB, Churilov L, Thijs V. Self-evaluation of personal needs by community-living young stroke survivors using an online English language questionnaire. Disabil Rehabil 2022; 45:1830-1835. [PMID: 35617487 DOI: 10.1080/09638288.2022.2076935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Identifying personal needs of young stroke survivors is crucial for their recovery. PURPOSE Identify factors, burden, and significance of unmet needs of young community-living stroke survivors. MATERIALS AND METHODS We used online advertising and word-of-mouth snowballing to recruit participants for an English language online questionnaire constructed for this purpose. Eligible participants aged 18-55 at time of stroke. Needs were classified into seven domains: Healthcare Experience, Impairments from Stroke, Everyday Activities, Work/Study, Finances, Relationships, and Social Participation. Random-effects logistic regression was used to determine the probability of unmet needs and X2 test to determine significance of distribution across domains. RESULTS Out of 137 responses recorded: 32 did not meet inclusion criteria, 29 duplicates identified were discarded, and 76 eligible participants were analysed. Respondents were median 37 (IQR 32-47) years at time of stroke, and median 3 (1-5) years since stroke. Fifty-eight (76%) females. Modified Rankin Scale median score of 1 (1-3). Of 48 identified potential needs, 25 (IQR 19-30) were rated unmet. Twenty (IQR 15-25) considered of high significance. Unmet needs most frequently occurred in the domains: Impairments from Stroke, Finances, and Social Participation. CONCLUSIONS There is high burden of unmet needs in community-living young stroke survivors which are spread disproportionately across the identified domains.IMPLICATIONS FOR REHABILITATIONIdentifying personal needs of young stroke survivors is crucial for their recovery.Impairments after Stroke, Finances, and Social Participation were often selected as being high burden unmet needs for community-living young people after stroke.Employing a post-stroke checklist to guide exploration of needs in young stroke may better capture which needs are unmet.
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Affiliation(s)
- David Sapuppo
- Neurology Department, Austin Health, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Lilian B Carvalho
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Australia
| | - Vincent Thijs
- Neurology Department, Austin Health, Melbourne, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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14
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Therrien MCS, Madden EB, Bislick L, Wallace SE. Aphasia and Friendship: The Role and Perspectives of Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2228-2240. [PMID: 34310195 DOI: 10.1044/2021_ajslp-20-00370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. Supplemental Material https://doi.org/10.23641/asha.15032217.
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Affiliation(s)
| | - Elizabeth B Madden
- School of Communication Science & Disorders, Florida State University, Tallahassee
| | - Lauren Bislick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Sarah E Wallace
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
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15
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Kodumuri N, Edmunds A, Seidel A, Fleming P, Vezzetti A, Mascari R, Kothari R, Lowe J, Sen S. Development and initial validation of a patient-centered stroke outcome measure in young stroke survivors. Eur J Neurol 2021; 28:4069-4077. [PMID: 34363287 DOI: 10.1111/ene.15052] [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] [Received: 04/26/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE This study was undertaken to develop a patient-centered stroke outcome measure and initial validation of the proposed Young Stroke Questionnaire (YSQ). METHODS This study assessed the reliability and discriminant validity of the YSQ. The initial questionnaire evolved from a focus group comprised of six young stroke survivors and six stroke neurologists centralized around four patient-centered domains. To determine the reliability and discriminant validity of the YSQ, 100 young stroke survivors were recruited and provided consent. Standardized clinical assessments completed included the modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, and Stroke Impact Scale. Additionally, all patients were asked to complete the patient-centered YSQ. RESULTS Of the 100 enrolled patients in the study (mean age ± standard deviation = 49 ± 11.3, 58% females, 53% African American, 44% White), Cronbach alpha for all domains was >0.7. Moreover, Cronbach alpha for entire questionnaire was >0.9, indicating that the scale, with four subdomains, is internally consistent and reproducible. Discriminant validity of the scale was assessed by comparing the means of each subdomain of the YSQ among healthy subjects to the groups of stroke patients as defined by the mRS. The YSQ was able to differentiate subjects with good outcome (mRS = 0-1) from subjects with varying degree of disability as defined by the mRS (p = 0.026). CONCLUSIONS Standardized clinical assessments are not sensitive to disabilities in young stroke survivors. When compared to standardized clinical assessments, the YSQ is significantly capable of differentiating the young survivor perspective of the impact of stroke in all four subdomains.
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Affiliation(s)
- Nishanth Kodumuri
- Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Amy Edmunds
- Costal Carolina University, Conway, South Carolina, USA
| | - Amy Seidel
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Phil Fleming
- Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Alexandra Vezzetti
- Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Rachel Mascari
- Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Ravish Kothari
- Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Justin Lowe
- Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Souvik Sen
- Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
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16
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Jackson SM, Solomon SD, Barker RN. Recovering is about living my life, as it evolves: perspectives of stroke survivors in remote northwest Queensland. Disabil Rehabil 2021; 44:3843-3852. [PMID: 33625948 DOI: 10.1080/09638288.2021.1890242] [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: 10/22/2022]
Abstract
PURPOSE Recovering from stroke in remote Australia has rarely been considered, even though rehabilitation services are generally scarce. The primary purpose of this study was to explore stroke recovery, from the perspective of stroke survivors in remote northwest Queensland (NWQ), to explicate the lens through which they view recovering. The secondary purpose was to explore the role of technology to support stroke survivors in remote locations along their recovery journey. METHODS A qualitative study was undertaken using elements of constructivist grounded theory for data collection and analysis. Semi-structured interviews were conducted with fifteen stroke survivors and two partners living, working or travelling in remote NWQ. RESULTS From the participants' perspective, recovering in a remote area after stroke is about living my life, as it evolves by endeavouring to recover my way and navigating my recovery in my world. Technology was only considered helpful when it supported participants to recover their way in their world. CONCLUSION Recovering from stroke from the perspective of stroke survivors in remote NWQ is about living their life, as they want it to be, and as it unfolds within their own context. Technology only has a place when it can support them to recover their way in their world. These findings reinforce the importance of health professionals listening, learning about, and enabling stroke survivors along their recovery journey, within their remote context and support network.Implications for RehabilitationRecovering from the perspective of stroke survivors is about living their life as it evolves.To support stroke survivors from remote areas, health professionals need to listen to and learn from each stroke survivor about what matters to them, what works for them, and about their world; including the challenges (e.g., switching between services) and enablers (e.g., community support) as the stroke survivor perceives them.Finding ways to utilise the strengths within and around them, may improve the recovery process for the stroke survivor in a remote area, ensuring they can access care that meets their needs in their world.Working together with stroke survivors, health professionals need to consider how technology could help them to live their life, while recovering their way and in their world.
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Affiliation(s)
- Sarah M Jackson
- College of Healthcare Sciences, James Cook University, Townsville, Australia.,Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - S D Solomon
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - R N Barker
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia.,College of Healthcare Sciences, James Cook University, Cairns, Australia
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17
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Guo Y, Zhang Z, Lin B, Mei Y, Liu Q, Zhang L, Wang W, Li Y, Fu Z. The Unmet Needs of Community-Dwelling Stroke Survivors: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2140. [PMID: 33671734 PMCID: PMC7926407 DOI: 10.3390/ijerph18042140] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022]
Abstract
The unmet needs perceived by community-dwelling stroke survivors may truly reflect the needs of patients, which is crucial for pleasant emotional experiences and a better quality of life for community-dwelling survivors not living in institutionalized organizations. The purpose of the study is to identify the scope of unmet needs from the perspectives of stroke patients in the community. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. Six electronic databases were searched from inception to February 2020. A total of 24 articles were involved, providing data on 378 stroke survivors. Eight categories were derived from 63 findings, and then summarized into four synthesized findings based on the framework of ICF: (1) unmet needs regarding with the disease-related information; (2) unmet physical recovery and activity/participation needs; (3) unmet needs for social environmental resources; (4) unmet psycho-emotional support needs. We found the framework of ICF mostly complete, but unmet information needs still remain. The needs that are mainly unsatisfied include physical, psychosocial and informational, as well as the practical support from professional or environment resources. The ever-present unmet needs perceived by community-dwelling stroke survivors who do not live in institutions are discoverable and mitigable. Future studies should focus on quantifying unmet needs comprehensively derived from experiential domains, assessing the rationality of the unmet needs expressed by patients' perspectives and developing flexible strategies for long-term and changing needs.
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Affiliation(s)
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (Y.G.); (B.L.); (Y.M.); (Q.L.); (L.Z.); (W.W.); (Y.L.); (Z.F.)
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18
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Keating J, Borschmann K, Johns H, Churilov L, Bernhardt J. Young Stroke Survivors' Preferred Methods of Meeting Their Unique Needs: Shaping Better Care. Neurology 2021; 96:e1701-e1710. [PMID: 33568545 DOI: 10.1212/wnl.0000000000011647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine how young stroke survivors want their unmet needs to be addressed, we undertook an international online survey of people living with stroke. METHODS Participants self-selected to complete an online survey that included a questionnaire on demographics and stroke-related characteristics, the Young Stroke Needs Screening Tool, and a questionnaire on how they wanted their needs to be met. RESULTS One hundred seventy-one responses were received (68% female respondents, mean age 45 years, interquartile range 36-51 years). Preferences for methods of meeting needs varied depending on the domain of need and participants' demographic and stroke-related characteristics. Face-to-face contact with a health care professional was a popular means of meeting needs, but methods outside of a traditional health care setting such as a succinct list of tips or peer support were widely acceptable and sometimes preferred. CONCLUSION This work provides the impetus for developing alternative methods of meeting young stroke survivors' needs, many of which are not resource intensive or do not require an appointment with a health care professional.
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Affiliation(s)
- Jessica Keating
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Karen Borschmann
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Hannah Johns
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Leonid Churilov
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia
| | - Julie Bernhardt
- From The Florey Institute of Neuroscience and Mental Health (J.K., K.B., H.J., J.B.), University of Melbourne, Heidelberg; St. Vincent's Hospital (K.B.), Melbourne; Austin Health Department of Medicine (L.C.), Heidelberg; Melbourne Brain Center (L.C.), Royal Melbourne Hospital; and Melbourne Medical School (L.C.), University of Melbourne, Australia.
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19
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Meads H, Hunt J, Page A, Withy L, Plowman R, Calder A. Stroke survivors’ experiences of upper limb recovery: a systematic review of qualitative studies. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hayley Meads
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Jamie Hunt
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Alister Page
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Lee Withy
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Rose Plowman
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Allyson Calder
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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20
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Chang FH, Lin YN, Liou TH. Recovery after stroke: perspectives of young stroke survivors in Taiwan. Disabil Rehabil 2020; 44:1976-1983. [PMID: 32931342 DOI: 10.1080/09638288.2020.1817157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To learn about the experiences of stroke recovery among young stroke survivors in Taiwan and to elucidate the beliefs, goals, and facilitators of and barriers to their recovery. METHODS A qualitative approach was used for data collection, and data were obtained from five focus groups consisting of stroke survivors aged 20-64 years (n = 25). Data were transcribed verbatim and analyzed thematically by two independent coders using NVivo version 10. RESULTS "Returning to prestroke status" was a common belief of recovery for stroke survivors; their goals of recovery changed overtime from regaining physical functions, independent living, and participating in work and leisure activities to maintaining functions or returning to normality. Their perceived personal and environmental facilitators of recovery included positive attitude, family and friends, and rehabilitation, whereas barriers to recovery included psychological factors, social stigma, and physical environment. CONCLUSION These findings provide useful insights for rehabilitation clinicians to develop culturally tailored interventions to improve poststroke recovery outcomes in young stroke survivors.Implications for rehabilitationRehabilitation clinicians should understand stroke survivors' beliefs and goals of recovery to provide tailored services.Optimizing the goal-setting process and patient-provider communication may help clinicians and survivors examine and adjust their expectations toward recovery during rehabilitation.Interventions will be needed to address personal and environmental supports and barriers, such as motivation, psychological factors, social support, and the physical environment to help survivors achieve their recovery goals.
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Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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21
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Rimmele DL, Lebherz L, Frese M, Appelbohm H, Bartz HJ, Kriston L, Gerloff C, Härter M, Thomalla G. Health-related quality of life 90 days after stroke assessed by the International Consortium for Health Outcome Measurement standard set. Eur J Neurol 2020; 27:2508-2516. [PMID: 32810906 DOI: 10.1111/ene.14479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Stroke has detrimental effects in multiple health domains not captured by routine scales. The International Consortium for Health Outcome Measurement has developed a standardized set for self-reported assessment to overcome this limitation. The aim was to assess this set in acute stroke care. METHODS Consecutive patients with acute ischaemic stroke, transient ischaemic attack or intracerebral hemorrhage were enrolled. Demographics, living situation and cardiovascular risk factors were collected from medical records and interviews. The Patient-reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) and the Patient Health Questionnaire-4 (PHQ-4) were conducted 90 days after admission. Linear and logistic regression analyses were used to identify predictors of outcome. The study is registered at ClinicalTrials.gov, NCT03795948. RESULTS In all, 1064 patients were enrolled; mean age was 71.6 years, 51% were female, and median National Institutes of Health Stroke Scale (NIHSS) on admission was 3. Diagnosis was acute ischaemic stroke in 74%, transient ischaemic attack in 20% and intracerebral hemorrhage in 6%. 673 patients were available for outcome evaluation at 90 days; of these 90 (13%) had died. In survivors, t scores of PROMIS-10 physical and mental health were 40.3 ± 6.17 and 44.3 ± 8.63, compared to 50 ± 10 in healthy populations. 16% reported symptoms indicating depression or anxiety on the PHQ-4. Higher NIHSS, prior stroke and requiring help pre-stroke predicted lower values in physical and mental health scores. Higher NIHSS and diabetes were associated with anxiety or depression. CONCLUSIONS Integrated in the routine of acute stroke care, systematic assessment of patient-reported outcomes reveals impairments in physical and mental health. Main predictors are severity of stroke symptoms and comorbidities such as hypertension and diabetes.
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Affiliation(s)
- D L Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Frese
- Quality Management and Clinical Process Management, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - H Appelbohm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H-J Bartz
- Quality Management and Clinical Process Management, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - L Kriston
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Call 911: Lower Ambulance Utilization Among Young Adults, Especially Women, with Stroke. Can J Neurol Sci 2020; 47:764-769. [PMID: 32507117 DOI: 10.1017/cjn.2020.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Delayed presentation to the emergency department influences acute stroke care and can result in worse outcomes. Despite public health messaging, many young adults consider stroke as a disease of older people. We determined the differences in ambulance utilization and delays to hospital presentation between women and men as well as younger (18-44 years) versus older (≥45 years) patients with stroke. METHODS We conducted a population-based retrospective study using national administrative health data from the Canadian Institute of Health Information databases and examined data between 2003 and 2016 to compare ambulance utilization and time to hospital presentation across sex and age. RESULTS Young adults account for 3.9% of 463,310 stroke/transient ischemic attack/hemorrhage admissions. They have a higher proportion of hemorrhage (37% vs. 15%) and fewer ischemic events (50% vs. 68%) compared with older patients. Younger patients are less likely to arrive by ambulance (62% vs. 66%, p < 0.001), with younger women least likely to use ambulance services (61%) and older women most likely (68%). Median stroke onset to hospital arrival times were 7 h for older patients and younger men, but 9 h in younger women. There has been no improvement among young women in ambulance utilization since 2003, whereas ambulance use increased in all other groups. CONCLUSIONS Younger adults, especially younger women, are less likely to use ambulance services, take longer to get to hospital, and have not improved in utilization of emergency services for stroke over 13 years. Targeted public health messaging is required to ensure younger adults seek emergency stroke care.
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23
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Kageyama G, Onishi A, Ueda Y, Naka I, Tsuda K, Okano T, Akashi K, Nishimura K, Sendo S, Saegusa J, Morinobu A. Subjective well-being among rheumatoid arthritis patients. Int J Rheum Dis 2019; 22:1863-1870. [PMID: 31599096 DOI: 10.1111/1756-185x.13704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
AIM Subjective well-being (SWB) is a psychological construct that is synonymous with happiness. Many variables including age, sex, income, employment, and marital status are related to SWB. Health is also an important determinant of SWB that can be adversely affected in patients with chronic conditions such as rheumatoid arthritis (RA). In this study, we evaluate the SWB of RA patients and compare it with that of healthy controls. METHODS We obtained the original dataset from the "Quality of Life Survey, 2013", which was conducted by the Economic and Social Research Institute, Cabinet Office, Government of Japan. In this survey, SWB was determined by asking participants to rate their happiness between 0 (very unhappy) and 10 (very happy). The survey also included a 56-point questionnaire regarding well-being-related variables. This questionnaire was administered to RA patients recruited from Kobe University Hospital, and clinical and treatment data were simultaneously collected. RESULTS Multivariate analysis revealed that RA patients with high or moderate disease activity had SWB scores that were similar to those of controls. However, the SWB scores of RA patients in remission or with low disease activity were higher than those of controls (P = .013). SWB was associated with household income, self-assessment of living costs, self-assessment of health, depression/ anxiety, and social connection. CONCLUSIONS For RA patients, achieving the therapeutic target can result in better SWB than that of healthy controls. Financial status, self-assessment of health, psychological stress, and social network are also important determinants for the SWB of RA patients.
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Affiliation(s)
- Goichi Kageyama
- Department of Rheumatology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.,Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Akira Onishi
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Yo Ueda
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Ikuko Naka
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Kosaku Tsuda
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Takaichi Okano
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Kengo Akashi
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | | | - Sho Sendo
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Jun Saegusa
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
| | - Akio Morinobu
- Department of Rheumatology, Kobe University Hospital, Kobe, Japan
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Slade M, Rennick-Egglestone S, Blackie L, Llewellyn-Beardsley J, Franklin D, Hui A, Thornicroft G, McGranahan R, Pollock K, Priebe S, Ramsay A, Roe D, Deakin E. Post-traumatic growth in mental health recovery: qualitative study of narratives. BMJ Open 2019; 9:e029342. [PMID: 31256037 PMCID: PMC6609070 DOI: 10.1136/bmjopen-2019-029342] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/12/2019] [Accepted: 05/31/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Post-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems. DESIGN Qualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery. SETTING England. PARTICIPANTS Participants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British. RESULTS Components of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process. CONCLUSIONS Post-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery. TRIAL REGISTRATION NUMBER ISRCTN11152837.
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Affiliation(s)
- Mike Slade
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | | | - Laura Blackie
- Department of Psychology, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Donna Franklin
- Institute of Mental Health, NEON Lived Experience Advisory Panel, Nottingham, UK
| | - Ada Hui
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stefan Priebe
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Roe
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Emilia Deakin
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
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