1
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Ignacio KHD, Muir RT, Diestro JDB, Singh N, Yu MHLL, Omari OE, Abdalrahman R, Barker-Collo SL, Hackett ML, Dukelow SP, Almekhlafi MA. Prevalence of depression and anxiety symptoms after stroke in young adults: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107732. [PMID: 38657829 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Young adults with stroke have distinct professional and social roles making them vulnerable to symptoms of post-stroke depression (PSD) and post-stroke anxiety (PSA). Prior reviews have examined the prevalence of anxiety and depression in stroke populations. However, there are a lack of studies that have focused on these conditions in young adults. OBJECTIVE We performed a systematic review and meta-analysis of observational studies that reported on symptoms of PSD, PSA and comorbid PSD/PSA in young adults aged 18 to 55 years of age. METHODS MEDLINE, EMBASE, SCOPUS and PsycINFO were searched for studies reporting the prevalence of symptoms of PSD and/or PSA in young adults with stroke from inception until June 23, 2023. We included studies that evaluated depression and/or anxiety symptoms with screening tools or interviews following ischemic or hemorrhagic stroke. Validated methods were employed to evaluate risk of bias. RESULTS 4748 patients from twenty eligible studies were included. Among them, 2420 were also evaluated for symptoms of PSA while 847 participants were evaluated for both PSD and PSA symptoms. Sixteen studies were included in the random effects meta-analysis for PSD symptoms, with a pooled prevalence of 31 % (95 % CI 24-38 %). Pooled PSA symptom prevalence was 39 % (95 % CI 30-48 %) and comorbid PSD with PSA symptom prevalence was 25 % (95 % CI 12-39 %). Varying definitions of 'young adult', combinations of stroke subtypes, and methods to assess PSD and PSA contributed to high heterogeneity amongst studies. CONCLUSIONS We identified high heterogeneity in studies investigating the prevalence of symptoms of PSD and PSA in young adults, emphasizing the importance of standardized approaches in future research to gain insight into the outcomes and prognosis of PSD and PSA symptoms following stroke in young adults. Larger longitudinal epidemiological studies as well as studies on tailored interventions are required to address the mental health needs of this important population. FUNDING None.
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Affiliation(s)
- Katrina Hannah D Ignacio
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada.
| | - Ryan T Muir
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Jose Danilo B Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Nishita Singh
- Neurology division, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | - Maree L Hackett
- University of New South Wales, Sydney, Australia; The School of Nursing and Midwifery, The University of Central Lancashire, Preston, United Kingdom
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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2
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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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3
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Pituch E, Cormier T, Gilbert V, Bottari C. Babycare Assistance Needs of Parents With Physical Disabilities: An Observational Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:25-36. [PMID: 37191385 PMCID: PMC10676028 DOI: 10.1177/15394492231172935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The assistance needs of parents with physical disabilities have been widely underexamined. This qualitative observational study described the assistance needs of parents with physical disabilities during the performance of in-home babycare activities. Thirty-one parents were assessed by trained occupational therapists using the Activities of Daily Living (ADL) Profile adapted for use with parents, an ecological performance-based assessment that considers executive functioning. Descriptive statistics of participants' demographics and parents' independence scores in babycare activities were calculated, and a qualitative content analysis of parents' assistance needs was performed using video recordings. At least one-fourth of parents experienced difficulties in all babycare activities, either affecting activity performance or requiring verbal or physical assistance. Assistance needs were also observed in all activity-related operations of the ADL Profile. It is necessary to develop specialized clinical services to address assistance needs and promote safe and easy parenting in parents with physical disabilities.
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Affiliation(s)
- Evelina Pituch
- Université de Montréal, Québec, Canada
- CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
| | | | | | - Carolina Bottari
- Université de Montréal, Québec, Canada
- CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
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4
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Pusa S, Saveman BI, Sundin K. Family systems nursing conversations: influences on families with stroke. BMC Nurs 2022; 21:108. [PMID: 35524243 PMCID: PMC9078019 DOI: 10.1186/s12912-022-00873-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Since a family member’s stroke affects the entire family, family systems nursing conversations (FSNCs) may be an appropriate intervention to support the family as a whole. The purpose of our study was to illuminate family members’ experiences within their family situations 6 months after participating in FSNCs when a family member under 65 years of age had suffered a stroke. Methods Fourteen semi-structured follow-up interviews were conducted with family members 6 months after they had completed a series of 3 FSNCs. The interview transcripts were subjected to qualitative content analysis. Results Family members experienced that the FSNCs had contributed to greater understanding of each other and greater closeness in the family. The FSNCs had also facilitated a mutual understanding of the family’s situation, which they could better manage and move forward with together. Conclusions FSNCs can support relational aspects and healthy transitions within families. However, long-term follow-up research is needed to generate sound evidence and inform education about FSNCs, as well as to facilitate their implementation. As a result, families may become better able to prevent the negative outcomes of illness in the family.
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Affiliation(s)
- Susanna Pusa
- Department of Nursing, Umeå University, Campus Örnsköldsvik, Box 843, S-891 18, Örnsköldsvik, Sweden.
| | | | - Karin Sundin
- Department of Nursing, Umeå University, Campus Örnsköldsvik, Box 843, S-891 18, Örnsköldsvik, Sweden
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5
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Martinsen R, Kitzmüller G, Mangset M, Kvigne K, Evju AS, Bronken BA, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Nurses' and occupational therapists' experiences of conducting a home-based psychosocial intervention following stroke: a qualitative process evaluation. BMC Health Serv Res 2021; 21:791. [PMID: 34376188 PMCID: PMC8356405 DOI: 10.1186/s12913-021-06857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Persons with stroke are susceptible to psychosocial problems, and express disappointment at how health care professionals fail to meet their psychosocial needs following discharge to home. The responsibility of nurses and occupational therapists in stroke rehabilitation is to assist the persons and their families during the recovery and adjustment process. A home-based dialogical intervention aiming to enhance psychosocial support was therefore developed and tested in a randomized controlled trial. This study is a part of the process evaluation conducted alongside the trial. The aim was to explore the nurses’ and occupational therapists’ experiences of conducting the intervention. Methods Eighteen nurses and four occupational therapists participated in six focus groups to explore their experiences when providing the intervention. The themes discussed in the focus groups were the aspects that facilitated the delivering of the intervention and the challenges they encountered during the study period. The interviews were analysed using qualitative content analysis. Results The analysis generated two themes. The theme Developing a supportive relationship to facilitate the adjustment process following stroke had two subthemes: Getting personally involved and Handling challenges. This theme reveals how the nurses and occupational therapists experienced their relationship with the persons with stroke and potential threats which challenged them while conducting the intervention. The theme Developing professional skills in providing psychosocial support had two subthemes: Becoming confident in conducting dialogues and Integrating psychosocial topics. This theme reveals the aspects that the nurses and occupational therapists perceived as facilitating the development of their professional skills in conducting the dialogues. Conclusion Delivering the psychosocial intervention was perceived as deeply meaningful and increased the nurses’ and occupational therapists’ understanding of how to support stroke survivors to live with the consequences of stroke. However, balancing the professional and the personal relationship was challenging. A basic educational programme, training, supervision and having dedicated time were crucial elements to instil confidence in professionals conducting theme-based dialogues to promote post-stroke psychosocial well-being. Individual clinical experience and knowledge of stroke care were considering important to enable professionals to integrate psychosocial rehabilitation into community health care. Trial registration ClinicalTrials.gov, NCT 02338869, registered 10/04/2014.
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Affiliation(s)
- Randi Martinsen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway.
| | - Gabriele Kitzmüller
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kari Kvigne
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Anne Svelstad Evju
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Berit Arnesveen Bronken
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Line Kildal Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Gabrielsen Hjelle
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Geriatric Medicine and Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
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The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.
Method:
Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.
Results:
While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.
Conclusions:
Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.
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7
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Harris Walker G, Gonzalez-Guarda R, Yang Q, Shah S, Prvu Bettger J. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. J Adv Nurs 2021; 77:2860-2874. [PMID: 33650219 DOI: 10.1111/jan.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022]
Abstract
AIMS Stroke is affecting an increasing number of young and middle-aged adults. Given the substantial diversion from anticipated life trajectories that younger stroke survivors experience as a result of their stroke deficits, their health-related quality of life (HRQOL) is likely to be negatively impacted during the immediate post-acute recovery period. The aim of this study was to generate a comprehensive understanding of the influences on HRQOL and acute recovery during the first three months following stroke for younger adults using a socio-ecological perspective. DESIGN Longitudinal, convergent mixed methods design. METHODS HRQOL survey data, assessed using the Patient Generated Index (N = 31), and qualitative interview data about survivors' recovery experiences (N = 20) were collected. Simple linear regression and effect size results were integrated with themes and sub-themes identified from conventional content analysis using joint data displays. RESULTS Depression and fatigue negatively affected recovery at the individual level. At the family and societal level, family functioning, social support including being married, having insurance, working, adequate income and being unemployed post-stroke all positively impacted recovery. Qualitative findings revealed determination, coping, and accessing healthcare to positively affect recovery though a meta-inference could not be drawn as no quantitative data addressed these concepts. CONCLUSION A variety of factors intersecting across socio-ecological levels were perceived by young stroke survivors to influence acute recovery experiences and outcomes. IMPACT This study identified individual-, family- and societal-level factors in younger adults' environments that may affect the acute stroke recovery experience. Findings underscore the need for research and clinical approaches that consider environmental factors at multiple levels of influence when supporting stroke recovery for younger adults.
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Affiliation(s)
| | | | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Duke University School of Nursing, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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8
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Lo SHS, Chau JPC, Choi KC, Shum EWC, Yeung JHM, Li SH. Promoting community reintegration using narratives and skills building for young adults with stroke: a protocol for a randomised controlled trial. BMC Neurol 2021; 21:3. [PMID: 33397316 PMCID: PMC7783975 DOI: 10.1186/s12883-020-02015-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke in adults aged between 18 and 64 years old is increasing significantly worldwide. Studies have reported that this group of young stroke survivors encounters enormous difficulties reintegrating into their social roles. Individualised discussions with healthcare professionals and learning from other survivors are imperative for them to reconstruct their identities after stroke. There is also great demand for community support during their chronic stage of recovery to help them rebuild life skills to promote reintegration. METHODS/DESIGN This is a randomised controlled trial to investigate the effects of a 24-week Narrative and Skills-building Intervention (NSI) on young stroke survivors' community reintegration and psychosocial outcomes. A total of 208 adults aged 18-64 years old with a first-ever or recurrent ischaemic or haemorrhagic stroke and have been discharged home will be recruited and randomly assigned to receive usual care or usual care with NSI. The NSI is grounded in Narrative Theory and Bandura's principles of Self-efficacy and Outcome Expectation, consisting of successive eight individual sessions over six months delivered by a trained facilitator (a registered nurse). Participants will be facilitated to narrate their survival experiences and rebuild core life skills. Videos of peer young stroke survivors' experiences of recovery will be provided. Outcomes including community reintegration, depressive symptoms, health-related quality of life, self-efficacy, outcome expectation and satisfaction with performance of self-management behaviours will be measured before (T0) and immediately after NSI (T1), then six (T2) and 12 months after NSI (T3). Generalised estimating equations models will be used to compare the differential changes in outcomes across time between the two groups. Focus group interviews will be conducted with the facilitator at T1 and with the participants in the intervention group at T1 and T3. DISCUSSION This study will evaluate the short and long-term effects of a theory-based NSI on young stroke survivors' community reintegration and establish a new model of community reintegration after stroke to inform future research. The results will also provide valuable evidence to develop clinical guidelines for young stroke survivors' community reintegration. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04560140 , registered on 23 September, 2020.
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Affiliation(s)
- Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | | | - Jonas Hon Ming Yeung
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China
| | - Siu Hung Li
- Department of Medicine, North District Hospital, Hospital Authority, Hong Kong SAR, China
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9
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Pituch E, Bindiu AM, Grondin M, Bottari C. Parenting with a physical disability and cognitive impairments: a scoping review of the needs expressed by parents. Disabil Rehabil 2020; 44:3285-3300. [PMID: 33295215 DOI: 10.1080/09638288.2020.1851786] [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: 10/22/2022]
Abstract
PURPOSE Parents, whose daily activities are limited by a disability, account for 6.2% of the American population with minor children. Considering the prevailing knowledge gaps concerning parents with a physical disability and cognitive impairments, there is an urgency to instigate an investigation of their unmet needs. In this study, we will examine the scope of literature relating to the specific needs of parents with a physical disability and cognitive impairments in early child rearing occupations. METHODS A scoping review of peer-reviewed literature was conducted by two independent raters in four databases (CINAHL, EMBASE, Medline, PsycINFO). Data were extracted and analyzed numerically and thematically using the International Classification of Functioning, Disability and Health (ICF). RESULTS Twenty-nine studies were included for review representing the needs of 113 parents. Emerging needs related to 15 ICF categories and three corresponding themes: parents' (1) needs when engaging with their young children, (2) personal needs in and outside the home, and (3) needs navigating the health system. CONCLUSIONS The unmet needs of parents with a physical disability and cognitive impairments legitimize the development of clinical services for this population. Future research should focus on developing assessments and interventions specific to parental needs in child rearing occupations.IMPLICATIONS FOR REHABILITATIONAdults with a physical disability and cognitive impairments who parent young children have unmet needs with regards to engaging in child rearing, meeting their personal needs, and navigating the health system.Studies reporting on the impact of impairments on parenting mostly focus on elucidating physical impairments and less so cognitive impairments.Developing a more comprehensive understanding of parental needs will inform further development of targeted assessments and interventions for parents with a physical disability and cognitive impairments.
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Affiliation(s)
- Evelina Pituch
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Anna Maria Bindiu
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Myrian Grondin
- Bibliothèque Marguerite-d'Youville, Université de Montréal, Montreal, Canada
| | - Carolina Bottari
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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10
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Harris Walker G, Oyesanya TO, Hurley A, Sandhu S, Liu C, Mulla M, Prvu Bettger J. Recovery experiences of younger stroke survivors who are parents: A qualitative content analysis. J Clin Nurs 2020; 30:126-135. [PMID: 33031618 DOI: 10.1111/jocn.15529] [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: 07/09/2020] [Revised: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore the experience of parenting for younger stroke survivors (aged 18 to 64 years at the time of the stroke). BACKGROUND Stroke among younger adults increased 43% between 2000 and 2010. The social, emotional and physical functioning of younger adults affects multiple aspects of their lives including parenting. There is limited research on the experience of parenting after stroke. DESIGN This is a qualitative descriptive study. METHODS We conducted individual semi-structured interviews with 10 younger adults who were actively parenting children under the age of 18 years at the time of stroke. Conventional content analysis was used to analyse the data. We report the methods and results using the COREQ checklist. RESULTS Impairments from stroke disrupted participants' identity, relationships and roles as a parent. The degree to which parenting abilities and behaviours were affected by stroke was contingent upon the type and severity of impairments as well as the children's age. Participants also observed emotional and behavioural changes in their children in response to their stroke. Support from family, friends, healthcare providers and children's school/day care was crucial to participants throughout their stroke recovery. Two major themes emerged: (a) finding a new normal; and (b) support for parenting post-stroke. CONCLUSIONS Findings enable a deeper understanding of the distinct parenting challenges younger stroke survivors face and can inform future research on this population. RELEVANCE FOR CLINICAL PRACTICE Study findings highlight the need for continual and tailored follow-up by nurses and other allied healthcare professionals to decrease the difficulty stroke survivors experience when trying to resume their role as parents.
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Affiliation(s)
| | | | - Alexandria Hurley
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Sahil Sandhu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Chelsea Liu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Maaz Mulla
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Janet Prvu Bettger
- School of Nursing, Duke University, Durham, NC, USA.,School of Medicine, Duke University, Durham, NC, USA
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11
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Rasmus A, Orłowska E. Marriage and Post-stroke Aphasia: The Long-Time Effects of Group Therapy of Fluent and Non-fluent Aphasic Patients and Their Spouses. Front Psychol 2020; 11:1574. [PMID: 32733342 PMCID: PMC7358429 DOI: 10.3389/fpsyg.2020.01574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies of therapy influence on after-aphasia marital relations are lacking. Much needs to be learned about the range of factors associated with couples benefiting from therapy. Understanding these issues is key to facilitating optimal post-aphasia outcomes from the perspective of the patient and his caretaking spouse. This paper reports an evaluation of a group therapy intervention conducted with aphasic people and their life partners. METHODS The intervention comprised of 10 sessions of approximately 90 min duration and included two groups of couples, with fluent and non-fluent aphasic partner. The therapy program consisted of basic communication activities within the group which encouraged sharing of personal experience but mostly relied on psychoeducation, gaining knowledge about after-stroke aphasia. The respondents were interviewed and completed neuropsychological assessment. Quality of marriage was determined using Dyadic Adjustment Scale. Marital adjustment was measured twice, before intervention and after 6 months. Long-time effects of therapy included a significant mean difference in quality of marriage between therapy attendants and controls. Marital relationship decline seems to be worse amongst control subjects, who were not involved in any kind of psychological support. In spite of initial non-distressed relationship they report deterioration of their bond in half a year's time. We also showed changes in dynamics of quality of marriage during this time in all investigated groups. The implications of these findings for counseling services are discussed.
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Affiliation(s)
- Anna Rasmus
- Instytut Psychologii, Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Bydgoszcz, Poland
| | - Edyta Orłowska
- Instytut Psychologii, Uniwersytet Gdański, Gdańsk, Poland
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12
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Martin-Saez MM, James N. The experience of occupational identity disruption post stroke: a systematic review and meta-ethnography. Disabil Rehabil 2019; 43:1044-1055. [PMID: 31373246 DOI: 10.1080/09638288.2019.1645889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE After a stroke, most individuals cannot participate in some of their valued occupations, disrupting their occupational identity. The aim of this interpretive synthesis is to systematically review the existing body of research to develop an understanding of the experience of occupational identity disruption post-stroke. METHODS A systematic review of the literature that included nine electronic databases, reference lists screening and grey literature checking was completed. Ten studies published between January 2012 and October 2018 were included. Meta-ethnography was used for the interpretive synthesis. FINDINGS A three-staged process model was created. Stage 1 illustrates the four factors involved in occupational identity disruption: "A fragmented and externalized body", "losing control, freedom and independence", "changed social and familial interactions", and "occupational participation loss". Stage two explains the experience of occupational identity disruption: "Occupational identity loss", "a de-valued self", and "threat to identity continuity". Stage three shows the individual's coping strategies: "protecting one's self", "social isolation", and "re-inventing one's occupational self". CONCLUSIONS Stroke impacts on an individual's occupational identity, compromising the continuity of a stroke survivor's sense of self. However, occupational identity is fluid; this can be used to support individuals to re-invent the occupational self. A conceptual model was developed to support the application of these results in clinical practice.Implications for rehabilitationOccupational identity disruption impacts on stroke survivors' self-value and sense of self continuity.Health care professionals' understanding of stroke survivors experience of occupational identity disruption could contribute to realign stroke survivors and clinicians' rehabilitation goals.Occupational participation and social interaction should be core aspects of stroke rehabilitation.Occupation-focus rehabilitation could provide opportunities for stroke survivors to pursue their desired occupational identity.
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Affiliation(s)
- Maria M Martin-Saez
- Occupational Therapy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil James
- School of Health Sciences, University of East Anglia, Norwich, UK
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Shipley J, Luker J, Thijs V, Bernhardt J. How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia. Disabil Rehabil 2019; 42:1697-1704. [DOI: 10.1080/09638288.2018.1534278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jessica Shipley
- Royal Melbourne Hospital, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Julie Luker
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Neurology Department, Austin Health, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Pucciarelli G, Ausili D, Galbussera AA, Rebora P, Savini S, Simeone S, Alvaro R, Vellone E. Quality of life, anxiety, depression and burden among stroke caregivers: A longitudinal, observational multicentre study. J Adv Nurs 2018; 74:1875-1887. [PMID: 29700840 DOI: 10.1111/jan.13695] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
AIM To longitudinally describe stroke caregivers' quality of life, anxiety, depression and burden and to identify predictors of stroke caregivers' quality of life, anxiety, depression and burden. BACKGROUND Caregivers have a key role in stroke survivor care and the first year of caregiving is the most challenging. To give tailored interventions, it is important to capture changes and identify predictors of caregiver quality of life, anxiety, depression and burden during the first year. DESIGN A 12-month longitudinal study. Data were collected between June 2013-May 2016. METHODS Changes in stroke caregiver quality of life, anxiety and depression and burden and their predictors were identified using linear mixed-effects models. RESULTS The caregivers (N = 244) were 53 years old and mostly female. Caregiver quality of life did not change significantly over the 12 months, anxiety and depression decreased up to 9 months and caregiver burden decreased from baseline to 3 months, then increased up to 9 months. Higher caregiver quality of life was predicted by caregiver younger age, higher education, living with a stroke survivor, survivor older age and higher physical functioning; higher anxiety and depression were predicted by older caregiver age and younger survivor age; higher burden was predicted by caregiver male gender, the caregiver not living with survivor and survivor lower physical functioning. CONCLUSION The first 9 months of caregiving are particularly problematic for caregivers. The trajectories of the above variables and their predictors may be useful for policy makers, clinicians, investigators and educators to give better care to stroke caregivers and their survivors.
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Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessia Antonella Galbussera
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paola Rebora
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Silvio Simeone
- Department of Cardiology, Policlinico Federico II, Naples, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Hutton L, Ownsworth T. A qualitative investigation of sense of self and continuity in younger adults with stroke. Neuropsychol Rehabil 2017; 29:273-288. [PMID: 28274180 DOI: 10.1080/09602011.2017.1292922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Younger adults are more likely to survive after stroke and their life trajectory is often disrupted. This qualitative study aimed to explore the experience of sense of self and continuity in younger adults after stroke. In-depth semi-structured interviews were conducted with 10 adults (3 male, 7 female) with stroke onset between 18 and 55 years of age. Their interview transcripts were analysed using a phenomenological approach that involved idiographic and nomothetic stages of analysis. Two major themes emerged: (1) centrality of stroke; and (2) impacts of stroke on self. The first theme relates to how central the stroke is in participants' lives. The second theme depicts ways in which stroke influences participants' sense of self. In general, participants who perceived their stroke as having lower centrality also experienced continuity of self, whereas participants who viewed their stroke as higher in centrality experienced interruption of self which often co-existed with growth of self. However, perceptions of stroke centrality and the impacts on self shifted over time and context. These findings extend conceptualisations of post-stroke adjustment by indicating that the impact of stroke on sense of self during early to middle adulthood is linked to how central people perceive their stroke to be within their life story. Younger adults may simultaneously experience their sense of self as continuous, interrupted, and grown after stroke.
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Affiliation(s)
- Lauren Hutton
- a School of Applied Psychology and Menzies Health Institute Queensland , Brisbane , Australia
| | - Tamara Ownsworth
- a School of Applied Psychology and Menzies Health Institute Queensland , Brisbane , Australia
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Northcott S, Moss B, Harrison K, Hilari K. A systematic review of the impact of stroke on social support and social networks: associated factors and patterns of change. Clin Rehabil 2015; 30:811-31. [PMID: 26330297 DOI: 10.1177/0269215515602136] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 08/01/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Identify what factors are associated with functional social support and social network post stroke; explore stroke survivors' perspectives on what changes occur and how they are perceived. DATA SOURCES The following electronic databases were systematically searched up to May 2015: Academic Search Complete; CINAHL Plus; E-journals; Health Policy Reference Centre; MEDLINE; PsycARTICLES; PsycINFO; and SocINDEX. REVIEW METHODS PRISMA guidelines were followed in the conduct and reporting of this review. All included studies were critically appraised using the Critical Appraisal Skills Program tools. Meta-ethnographic techniques were used to integrate findings from the qualitative studies. Given the heterogeneous nature of the quantitative studies, data synthesis was narrative. RESULTS Seventy research reports met the eligibility criteria: 22 qualitative and 48 quantitative reporting on 4,816 stroke survivors. The qualitative studies described a contraction of the social network, with non-kin contact being vulnerable. Although family were more robust network members, significant strain was observed within the family unit. In the quantitative studies, poor functional social support was associated with depression (13/14 studies), reduced quality of life (6/6 studies) and worse physical recovery (2/2 studies). Reduced social network was associated with depression (7/8 studies), severity of disability (2/2 studies) and aphasia (2/2 studies). Although most indicators of social network reduced post stroke (for example, contact with friends, 5/5 studies), the perception of feeling supported remained relatively stable (4/4 studies). CONCLUSION Following a stroke non-kin contact is vulnerable, strain is observed within the family unit, and poor social support is associated with depressive symptoms.
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Affiliation(s)
- Sarah Northcott
- Division of Language and Communication Science, School of Health Sciences, City University London, UK
| | - Becky Moss
- Division of Language and Communication Science, School of Health Sciences, City University London, UK
| | - Kirsty Harrison
- Division of Language and Communication Science, School of Health Sciences, City University London, UK
| | - Katerina Hilari
- Division of Language and Communication Science, School of Health Sciences, City University London, UK
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Martinsen R, Kirkevold M, Bronken BA, Kvigne K. Work-aged stroke survivors' psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study. BMC Nurs 2013; 12:22. [PMID: 24066840 PMCID: PMC3849869 DOI: 10.1186/1472-6955-12-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 09/24/2013] [Indexed: 11/30/2022] Open
Abstract
Background Studies point to the lack of psychosocial support and rehabilitation services that are adjusted to the work-aged stroke survivors’ specific needs in order to promote psychosocial well-being. The aim of the study was to illuminate the psychosocial challenges work-aged participants (i.e. aged 18–67 years) thematised during and after participating a dialogue-based psychosocial intervention during the first year following a stroke. Methods The study was a feasibility study guided by the UK Medical Research Council Framework for developing and evaluating complex interventions. Qualitative data from in-depth interviews with fourteen stroke-survivors aged 33–66 years, researcher field notes and log notes written during the intervention were analysed applying a hermeneutic-phenomenological approach. Results The stroke and its consequences had a substantial impact on family and work life. Their experiences were summarised in the two themes The threat of becoming marginalised in family life and The threat of becoming marginalised in work life. Conclusion Life as a work-aged stroke survivor was experienced as challenging and created a threat of becoming marginalised in family and work life. The study highlights the need to understand the specific psychosocial challenges and needs facing work-aged stroke survivors’ in order to promote their psychosocial well-being. More research is needed concerning specific life-span challenges amongst work-aged stroke survivors in order to further develop appropriate interventions that helps address this issue.
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Affiliation(s)
- Randi Martinsen
- Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, Oslo, Norway.
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