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Fry CH, Fluck A, Affley B, Kakar P, Sharma P, Fluck D, Han TS. Urinary incontinence indicates mortality, disability, and infections in hospitalised stroke patients. BJU Int 2024; 133:604-613. [PMID: 38419275 DOI: 10.1111/bju.16320] [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: 03/02/2024]
Abstract
OBJECTIVES To assess the impact of urinary incontinence (UI) on health outcomes over the entire spectrum of acute stroke severity (National Institutes of Health Stroke Scale [NIHSS] scores: 0-42), due to a paucity of data on patients with milder strokes. PATIENTS AND METHODS Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme (1593 men, 1591 women; mean [SD] age 76.8 [13.3] years) admitted to four UK hyperacute stroke units (HASUs). Relationships between variables were assessed by multivariable logistic regression. Data were adjusted for age, sex, comorbidities, pre-stroke disability and intra-cranial haemorrhage, and presented as odds ratios with 95% confidence intervals. RESULTS Amongst patients with no symptoms or a minor stroke (NIHSS scores of 0-4), compared to patients without UI, patients with UI had significantly greater risks of poor outcomes including: in-hospital mortality; disability at discharge; in-hospital pneumonia; urinary tract infection within 7 days of admission; prolonged length of stay on the HASU; palliative care by discharge; activity of daily living (ADL) support, and new discharge to care home. In patients with more moderate stroke (NIHSS score of 5-15) the same outcomes were identified; being at greater risk for patients with UI, except for palliative care by discharge and ADL support. With the highest stroke severity group (NIHSS score of 16-48) all outcomes were identified except in-patient mortality, pneumonia, and ADL support. However, odds ratios diminished as NIHSS scores increased. CONCLUSIONS Urinary incontinence is a useful indicator of poor short-term outcomes in older patients with an acute stroke, but irrespective of stroke severity. This provides valuable information to healthcare professionals to identify at-risk individuals.
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Affiliation(s)
- Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Adam Fluck
- Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
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Evangelista RR, Silva Lopes B, Coutinho D, Moreira E, Silva A, Almeida PL, Ermida V, Caldas J, Gomes A, Carmezim I, Barreira V, Pinheiro-Guedes L. Subacute stroke: new-onset poststroke bladder and bowel dysfunctions and possible associated factors. Disabil Rehabil 2024; 46:1073-1081. [PMID: 36960634 DOI: 10.1080/09638288.2023.2189317] [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: 03/13/2022] [Accepted: 03/04/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Bladder and bowel poststroke dysfunctions negatively impact patients' health. Stroke-related characteristics associated to these dysfunctions are poorly known. This study aims to estimate the prevalence of new-onset poststroke bladder and bowel dysfunctions, characterize their associated factors, and describe the dysfunctions' clinical approach. MATERIALS AND METHODS Cross-sectional study including 157 patients admitted to a single hospital's stroke unit with a first-ever stroke, during 3 months. An 18-item questionnaire was applied to assess dysfunctions pre and poststroke. The McNemar test was used to compare pre and poststroke prevalence. A logistic regression was used to estimate associations (OR, 95% CI) between individual characteristics and new-onset dysfunctions. RESULTS We had 113 (72%) respondents. There was a significant increase in the prevalence of bladder and bowel dysfunctions poststroke (p < 0.001). Higher stroke severity was significantly associated with both new-onset poststroke bladder and bowel dysfunctions (OR = 15.00, 95% CI [4.92,45.76] and OR = 5.87,95%CI [2.14,16.12], respectively). Total anterior circulation strokes, cardioembolic strokes, and lower functionality at discharge were also significantly associated with both dysfunctions. Thirteen patients (11.5%) reported that health professionals addressed these dysfunctions. CONCLUSIONS Poststroke bladder and bowel dysfunctions are highly prevalent. Being aware of their epidemiology helps draw attention to patients at higher risk of developing these dysfunctions, enhancing the rehabilitation process.IMPLICATIONS FOR REHABILITATIONPoststroke bladder and bowel dysfunctions are highly prevalent and under-recognised consequences of stroke.Being aware of their epidemiology and associated factors may help identify patients at higher risk of developing these dysfunctions.It is necessary to raise clinical awareness to ensure a more efficient diagnostic and therapeutic approach, enhancing patients' rehabilitation process, quality of life and lowering collateral societal burden.
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Affiliation(s)
| | - Bruno Silva Lopes
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - David Coutinho
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Elisa Moreira
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Andreia Silva
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Pedro Leonel Almeida
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Vera Ermida
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Jorge Caldas
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ana Gomes
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ilídia Carmezim
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Viviana Barreira
- General Practice and Family Medicine, USF Horizonte, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
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Mankoo A, Roy S, Davies A, Panerai RB, Robinson TG, Brassard P, Beishon LC, Minhas JS. The role of the autonomic nervous system in cerebral blood flow regulation in stroke: A review. Auton Neurosci 2023; 246:103082. [PMID: 36870192 DOI: 10.1016/j.autneu.2023.103082] [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: 12/24/2021] [Revised: 11/22/2022] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
Stroke is a pathophysiological condition which results in alterations in cerebral blood flow (CBF). The mechanism by which the brain maintains adequate CBF in presence of fluctuating cerebral perfusion pressure (CPP) is known as cerebral autoregulation (CA). Disturbances in CA may be influenced by a number of physiological pathways including the autonomic nervous system (ANS). The cerebrovascular system is innervated by adrenergic and cholinergic nerve fibers. The role of the ANS in regulating CBF is widely disputed owing to several factors including the complexity of the ANS and cerebrovascular interactions, limitations to measurements, variation in methods to assess the ANS in relation to CBF as well as experimental approaches that can or cannot provide insight into the sympathetic control of CBF. CA is known to be impaired in stroke however the number of studies investigating the mechanisms by which this occurs are limited. This literature review will focus on highlighting the assessment of the ANS and CBF via indices derived from the analyses of heart rate variability (HRV), and baroreflex sensitivity (BRS), and providing a summary of both clinical and animal model studies investigating the role of the ANS in influencing CA in stroke. Understanding the mechanisms by which the ANS influences CBF in stroke patients may provide the foundation for novel therapeutic approaches to improve functional outcomes in stroke patients.
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Affiliation(s)
- Alex Mankoo
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Sankanika Roy
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.
| | - Aaron Davies
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Ronney B Panerai
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada; Research center of the Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Lucy C Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Jatinder S Minhas
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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4
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Jiang W, Tang W, Song Y, Feng Y, Zhou Y, Li L, Tan B. Effectiveness of repetitive transcranial magnetic stimulation against poststroke urinary incontinence: a study protocol for a randomized controlled trial. Trials 2022; 23:650. [PMID: 35964135 PMCID: PMC9375329 DOI: 10.1186/s13063-022-06535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Poststroke urinary incontinence (PSI) is prevalent in stroke survivors, and high-quality evidence is required to guide clinical practice. Previous studies have demonstrated the curative effect of repetitive transcranial magnetic stimulation (rTMS) for urinary incontinence in individuals with multiple sclerosis (MS), Parkinson’s disease (PD), and spinal cord injury (SCI). Here, we describe the protocol for a randomized controlled trial to evaluate the efficacy and safety of low-frequency rTMS on the contralesional primary motor cortex (M1) for the treatment of PSI. Methods and analysis In this single-centre randomized controlled trial for poststroke urinary incontinence, a total of 140 eligible patients will be randomly allocated into two groups. The rTMS group (n = 70) will receive low-frequency rTMS at the M1 along with routine medical care, while the control group will receive sham rTMS along with routine medical care. All participants will undergo 20 treatment sessions, five times a week for 4 weeks. The primary outcome measures will be the changes in the urodynamic test at baseline versus 4 weeks after intervention. The secondary outcomes include the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), Overactive Bladder Symptom Score (OABSS), and pelvic floor muscle function. Ethics and dissemination The Institutional Review Board and Hospital Research Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University approved this trial, and the approval number is No. 2020-153. All methods will be carried out in accordance with the principles of the Declaration of Helsinki and relevant ethical guidelines covering informed consent, confidentiality, and data storage. After the study had been thoroughly described to the participants by a physician, all participants will provide written informed consent indicating their willingness to participate. The results will be disseminated to most of the population, including participants, researchers, healthcare providers, and sponsors. Trial registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2100042688. Date of Registration: 2021-01-26. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06535-y.
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Affiliation(s)
- Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Wen Tang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Yunling Song
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Yali Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Yuesan Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Lang Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China.
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Minelli C, Bazan R, Pedatella MTA, Neves LDO, Cacho RDO, Magalhães SCSA, Luvizutto GJ, Moro CHC, Lange MC, Modolo GP, Lopes BC, Pinheiro EL, de Souza JT, Rodrigues GR, Fabio SRC, do Prado GF, Carlos K, Teixeira JJM, Barreira CMA, Castro RDS, Quinan TDL, Damasceno E, Almeida KJ, Pontes-Neto OM, Dalio MTRP, Camilo MR, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Carvalho JJF, Martins SCO. Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:634-652. [PMID: 35946713 PMCID: PMC9387194 DOI: 10.1590/0004-282x-anp-2021-0354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/21/2021] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature. The main objective was to guide physicians, physiotherapists, speech therapists, occupational therapists, nurses, nutritionists, and other professionals involved in post-stroke care. Recommendations and levels of evidence were adapted according to the currently available literature. Part I discusses topics on rehabilitation in the acute phase, as well as prevention and management of frequent conditions and comorbidities after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
| | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Geral de Goiânia, Goiania GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia GO, Brazil
| | | | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Carla Heloísa Cabral Moro
- Neurológica Joinville, Joinville SC, Brazil
- Hospital Municipal de Joinville, Joinville SC, Brazil
- Associação Brasil AVC, Joinville SC, Brazil
| | | | | | | | | | - Juli Thomaz de Souza
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
| | - Guilherme Riccioppo Rodrigues
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | | | - Karla Carlos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil
| | | | | | - Rodrigo de Souza Castro
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
| | | | - Eduardo Damasceno
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Geral de Goiânia, Goiania GO, Brazil
- Hospital Orion, Goiania GO, Brazil
| | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Marina Teixeira Ramalho Pereira Dalio
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Centro de Cirurgia de Epilepsia de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Millene Rodrigues Camilo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | | | | | | | - Sheila Cristina Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
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6
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Doyle E, Brettkelly J, Buhler R, Lovett T, O’Neil L, Aldabe D. Reliability and validity of outcome measures used for urinary incontinence in patients with stroke: a narrative review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Emma Doyle
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jake Brettkelly
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Buhler
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Tim Lovett
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Luke O’Neil
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniela Aldabe
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Post-Cerebrovascular Accident Unpredictable Incontinence: A Qualitative Analysis of an Interdisciplinary Rehabilitation Team's Perspective. Rehabil Nurs 2019; 44:69-77. [PMID: 30830882 DOI: 10.1097/rnj.0000000000000097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigates experiences of the interdisciplinary rehabilitation team in the treatment of patients with urinary incontinence after stroke. DESIGN A qualitative approach was chosen. Ten members of an interdisciplinary treatment team were interviewed in a neurological inpatient rehabilitation setting. METHODS Data were obtained via focus groups with nurses, physicians, physiotherapists, and occupational therapists in a rehabilitation clinic. The analysis followed the principles of qualitative content analysis. FINDINGS According to the interdisciplinary treatment team, professionals and patients prioritize incontinence treatment differently. Challenges surrounding collaboration, communication, structural conditions, and the perception of intervention success were identified as barriers to promoting continence. CONCLUSION To overcome this discrepancy in treatment priority, awareness of poststroke urinary incontinence must be improved. CLINICAL RELEVANCE A key component is communication about urinary incontinence with patients and among team members.
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Kohler M, Mayer H, Kesselring J, Saxer S. (Can) Not talk about it - Urinary incontinence from the point of view of stroke survivors: a qualitative study. Scand J Caring Sci 2017; 32:371-379. [PMID: 28544132 DOI: 10.1111/scs.12471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The current study intends to gain an in-depth understanding of stroke survivors' lived experience of urinary incontinence and its treatment in an inpatient rehabilitation clinic. METHODS A qualitative approach was chosen. Semi-structured individual interviews with ten stroke survivors suffering from urinary incontinence were conducted in an inpatient rehabilitation clinic and analysed using qualitative content analysis with an inductive approach. RESULTS '(Can) not talk about it' was identified as the first main category. The affected persons do not talk about urinary incontinence because they are ashamed. At the same time, no one asks them about this issue. Psychological strain is so high that patients feel the need to talk about incontinence, but from their point of view, conversations with nurses - if they indeed occur - are superficial or nurses do not listen. Therefore, patients' needs and concerns are not properly considered. 'Trying to command incontinence' was also identified as a main category. Participants reported that they try to command incontinence and to develop their own strategies in order to hide urinary incontinence and prevent shameful situations. However, this proved mostly unsuccessful and resulted in resignation to their condition. CONCLUSION It is important to raise awareness within the treatment team of urinary incontinence in stroke survivors. Team members should be able to communicate about urinary incontinence in an open and empathic way. Obviously, there is great potential for supporting stroke survivors in dealing with incontinence.
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Affiliation(s)
- Myrta Kohler
- Institute of Applied Nursing Science, University of Applied Sciences St.Gallen, St.Gallen, Switzerland.,Rehabilitation Centre Valens, Valens, Switzerland.,Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Hanna Mayer
- Department of Nursing Science, University of Vienna, Vienna, Austria
| | | | - Susi Saxer
- Institute of Applied Nursing Science, University of Applied Sciences St.Gallen, St.Gallen, Switzerland
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French B, Thomas LH, Harrison J, Burton CR, Forshaw D, Booth J, Britt D, Cheater FM, Roe B, Watkins CL. Implementing a Systematic Voiding Program for Patients With Urinary Incontinence After Stroke. QUALITATIVE HEALTH RESEARCH 2016; 26:1393-1408. [PMID: 26935722 DOI: 10.1177/1049732316630975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We explored health professionals' views of implementing a systematic voiding program (SVP) in a multi-site qualitative process evaluation in stroke services recruited to the intervention arms of a cluster randomized controlled feasibility trial during 2011-2013. We conducted semi-structured group or individual interviews with 38 purposively selected nursing, managerial, and care staff involved in delivering the SVP. Content analysis of transcripts used normalization process theory (NPT) as a pre-specified organization-level exploratory framework. Barriers to implementing the SVP included perceived lack of suitability for some patient groups, patient fear of extending hospital stay, and difficulties with SVP enactment, scheduling, timing, recording, and monitoring. Enablers included the guidance provided by the SVP, patient and relative involvement, extra staff, improved nursing skill and confidence, and experience of success. Three potential mechanisms of consistency, visibility, and individualization linked the SVP process with improvements in outcome, and should be emphasized in SVP implementation.
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Affiliation(s)
| | - Lois H Thomas
- University of Central Lancashire, Preston, United Kingdom
| | | | | | - Denise Forshaw
- University of Central Lancashire, Preston, United Kingdom
| | - Joanne Booth
- Glasgow Caledonian University, Glasgow, United Kingdom
| | - David Britt
- University of Liverpool, Liverpool, United Kingdom
| | | | - Brenda Roe
- Edge Hill University, Ormskirk, United Kingdom
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11
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Effects of Transcutaneous Electrical Nerve Stimulation at Two Frequencies on Urinary Incontinence in Poststroke Patients: A Randomized Controlled Trial. Am J Phys Med Rehabil 2016; 95:183-93. [PMID: 26259053 DOI: 10.1097/phm.0000000000000360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare the effects of two frequencies of transcutaneous electrical nerve stimulation (TENS) on urinary incontinence caused by stroke. METHODS Eighty-one patients with poststroke urinary incontinence were recruited and randomized into the following three groups with a 1:1 ratio: a 20-Hz TENS group, a 75-Hz TENS group, and a no-treatment control group (n = 27 per group). TENS currents were biphasic square waves with pulse durations of 150 μsecs and pulse frequencies of 20 Hz or 75 Hz and were applied for 30 mins once per day for 90 days. The positive electrodes were placed in the region of the second sacral level on opposite sides of the vertebral column; the negative electrodes were placed on the inside of the middle and lower third of the junction between the posterior superior iliac spine and the ischial node. Overactive Bladder Symptom Scores, Barthel Index, urodynamic values, and voiding diary parameters were assessed before and after 90 days. RESULTS The patients treated with 20 Hz had superior Overactive Bladder Symptom Scores, Barthel Index totals, urodynamic values, and voiding diary parameters (P < 0.05). In the 75-Hz group, values were statistically improved compared with the no-treatment group (P < 0.05), but the results were significantly inferior to those of the 20-Hz group (P < 0.05). CONCLUSIONS Twenty-hertz TENS improved incontinence symptoms and promoted activities of daily living better than 75-Hz TENS. These results will aid future research regarding TENS parameters.
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Thomas LH, French B, Sutton CJ, Forshaw D, Leathley MJ, Burton CR, Roe B, Cheater FM, Booth J, McColl E, Carter B, Walker A, Brittain K, Whiteley G, Rodgers H, Barrett J, Watkins CL. Identifying Continence OptioNs after Stroke (ICONS): an evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care. PROGRAMME GRANTS FOR APPLIED RESEARCH 2015. [DOI: 10.3310/pgfar03010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BackgroundUrinary incontinence (UI) following acute stroke is common, affecting between 40% and 60% of people in hospital, but is often poorly managed.AimTo develop, implement and evaluate the preliminary effectiveness and potential cost-effectiveness of a systematic voiding programme (SVP), with or without supported implementation, for the management of UI after stroke in secondary care.DesignStructured in line with the Medical Research Council framework for the evaluation of complex interventions, the programme comprised two phases: Phase I, evidence synthesis of combined approaches to manage UI post stroke, case study of the introduction of the SVP in one stroke service; Phase II, cluster randomised controlled exploratory trial incorporating a process evaluation and testing of health economic data collection methods.SettingOne English stroke service (case study) and 12 stroke services in England and Wales (randomised trial).ParticipantsCase study, 43 patients; randomised trial, 413 patients admitted to hospital with stroke and UI.InterventionsA SVP comprising assessment, individualised conservative interventions and weekly review. In the supported implementation trial arm, facilitation was used as an implementation strategy to support and enable people to change their practice.Main outcome measuresParticipant incontinence (presence/absence) at 12 weeks post stroke. Secondary outcomes were quality of life, frequency and severity of incontinence, urinary symptoms, activities of daily living and death, at discharge, 6, 12 and 52 weeks post stroke.ResultsThere was no suggestion of a beneficial effect on outcome at 12 weeks post stroke [intervention vs. usual care: odds ratio (OR) 1.02, 95% confidence interval (CI) 0.54 to 1.93; supported implementation vs. usual care: OR 1.06, 95% CI 0.54 to 2.09]. There was weak evidence of better outcomes on the Incontinence Impact Questionnaire in supported implementation (OR 1.22, 95% CI 0.72 to 2.08) but the CI is wide and includes both clinically relevant benefit and harm. Both intervention arms had a higher estimated odds of continence for patients with urge incontinence than usual care (intervention: OR 1.58, 95% CI 0.83 to 2.99; supported implementation: OR 1.73, 95% CI 0.88 to 3.43). The process evaluation showed that the SVP increased the visibility of continence management through greater evaluation of patients’ trajectories and outcomes, and closer attention to workload. In-hospital resource use had to be based on estimates provided by staff. The response rates for the postal questionnaires were 73% and 56% of eligible patients at 12 and 52 weeks respectively. Completion of individual data items varied between 67% and 100%.ConclusionsThe trial was exploratory and did not set out to establish effectiveness; however, there are indications the intervention may be effective in patients with urge and stress incontinence. A definitive trial is now warranted.Study registrationThis study is registered as ISRCTN08609907.Funding detailsThe National Institute for Health Research Programme Grants for Applied Research programme. Excess treatment costs and research support costs were funded by participating NHS trusts and health boards, Lancashire and Cumbria and East Anglia Comprehensive Local Research Networks and the Welsh National Institute for Social Care and Health Research.
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Affiliation(s)
- Lois H Thomas
- School of Health, University of Central Lancashire, Preston, UK
| | - Beverley French
- School of Health, University of Central Lancashire, Preston, UK
| | | | - Denise Forshaw
- School of Health, University of Central Lancashire, Preston, UK
| | | | | | - Brenda Roe
- Evidence-Based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Francine M Cheater
- School of Health Science, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Jo Booth
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Andrew Walker
- Robertson Centre for Biostatistics, Glasgow University, Glasgow, UK
| | - Katie Brittain
- Institute of Health and Society and Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Whiteley
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Helen Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - James Barrett
- Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Wirral, Merseyside, UK
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Roe B, Flanagan L, Maden M. Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes. J Adv Nurs 2015; 71:1464-83. [DOI: 10.1111/jan.12613] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Brenda Roe
- Evidence-based Practice Research Centre; Faculty of Health & Social Care; Edge Hill University; Ormskirk UK
- Personal Social Services Research Unit; University of Manchester; UK
| | - Lisa Flanagan
- Countess of Chester Hospital NHS Foundation Trust; UK
| | - Michelle Maden
- Faculty of Health & Social Care; Edge Hill University; Ormksirk UK
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Guo ZF, Liu Y, Hu GH, Liu H, Xu YF. Transcutaneous electrical nerve stimulation in the treatment of patients with poststroke urinary incontinence. Clin Interv Aging 2014; 9:851-6. [PMID: 24904204 PMCID: PMC4041286 DOI: 10.2147/cia.s61084] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate the therapeutic effect of transcutaneous electrical nerve stimulation (TENS) on poststroke urinary incontinence (UI). Patients and methods Sixty-one patients with poststroke UI were enrolled at the Neurology Department in the Shanghai Tenth People’s Hospital of Tongji University between January 2010–January 2011 and were divided into treatment and control groups (n=32 and n=29, respectively). TENS was applied to the treatment group, while the control group received basic therapy. The therapeutic group completed the whole set of TENS therapy with a treatment frequency of 30 minutes once a day for 60 days. The positive electrode was placed on the second lumbar spinous process, and the negative electrodes were inside the middle and lower third of the junction between the posterior superior iliac spine and ischia node. The overactive bladder symptom score, Barthel Index, and urodynamics examination were estimated before and after therapy in both groups. Results The daily micturition, nocturia, urgent urination, and urge UI in the treatment group significantly improved compared to the control group (P<0.05). The patients in the treatment group were superior in the self-care ability of daily living and also had an advantage over the indexes on maximum cystometry volume, flow rate, and the pressure of detrusor in the end of the filling phase. Conclusion TENS improved incontinence symptoms, enhanced the quality of life, and decreased adverse effects; hence, it is recommended in treating poststroke UI.
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Affiliation(s)
- Zhui-feng Guo
- Department of Urology, Tongji University, Shanghai, People's Republic of China
| | - Yi Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China
| | - Guang-hui Hu
- Department of Urology, Tongji University, Shanghai, People's Republic of China
| | - Huan Liu
- Department of Urology, Tongji University, Shanghai, People's Republic of China
| | - Yun-fei Xu
- Department of Urology, Tongji University, Shanghai, People's Republic of China
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Thomas A, Menon A, Boruff J, Rodriguez AM, Ahmed S. Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review. Implement Sci 2014; 9:54. [PMID: 24885925 PMCID: PMC4040365 DOI: 10.1186/1748-5908-9-54] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 05/01/2014] [Indexed: 11/15/2022] Open
Abstract
Background Use of theory is essential for advancing the science of knowledge translation (KT) and for increasing the likelihood that KT interventions will be successful in reducing existing research-practice gaps in health care. As a sociological theory of knowledge, social constructivist theory may be useful for informing the design and evaluation of KT interventions. As such, this scoping review explored the extent to which social constructivist theory has been applied in the KT literature for healthcare professionals. Methods Searches were conducted in six databases: Ovid MEDLINE (1948 – May 16, 2011), Ovid EMBASE, CINAHL, ERIC, PsycInfo, and AMED. Inclusion criteria were: publications from all health professions, research methodologies, as well as conceptual and theoretical papers related to KT. To be included in the review, key words such as constructivism, social constructivism, or social constructivist theories had to be included within the title or abstract. Papers that discussed the use of social constructivist theories in the context of undergraduate learning in academic settings were excluded from the review. An analytical framework of quantitative (numerical) and thematic analysis was used to examine and combine study findings. Results Of the 514 articles screened, 35 papers published between 1992 and 2011 were deemed eligible and included in the review. This review indicated that use of social constructivist theory in the KT literature was limited and haphazard. The lack of justification for the use of theory continues to represent a shortcoming of the papers reviewed. Potential applications and relevance of social constructivist theory in KT in general and in the specific studies were not made explicit in most papers. For the acquisition, expression and application of knowledge in practice, there was emphasis on how the social constructivist theory supports clinicians in expressing this knowledge in their professional interactions. Conclusions This scoping review was the first to examine use of social constructivism in KT studies. While the links between social constructivism and KT have not been fully explored, the Knowledge to Action framework has strong constructivist underpinnings that can be used in moving forward within the broader KT enterprise.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
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White JH, Patterson K, Jordan LA, Magin P, Attia J, Sturm JW. The experience of urinary incontinence in stroke survivors: A follow-up qualitative study. The Canadian Journal of Occupational Therapy 2014; 81:124-34. [DOI: 10.1177/0008417414527257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. No previous qualitative exploration of urinary incontinence (UI) or post-stroke urinary incontinence (PSUI) has been undertaken in an Australian population. Purpose. The purpose of this study is to explore the experiences of community-dwelling stroke survivors who were living with UI/PSUI and understand how context shaped those experiences. Methods. A pragmatic approach using thematic analysis was employed for this study. Findings. Four themes emerged from the data: “I’ve got to go”: onset and daily experience of UI; “No one ever mentioned it”: lack of advice and information from the health system; “You can’t enjoy something if you’ve got to go the toilet”: experience of occupational restrictions; and “It’s just a matter of planning”: management strategies. Implications. UI continued well beyond discharge and was shaped by limited advice, distress, and role loss. Occupational therapists are encouraged to engage in assessment, management, and treatment of UI, including the provision of education that promotes continence, attenuates negative experiences, and enhances community participation.
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Thomas LH, French B, Burton CR, Sutton C, Forshaw D, Dickinson H, Leathley MJ, Britt D, Roe B, Cheater FM, Booth J, Watkins CL. Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase. Int J Nurs Stud 2014; 51:1308-20. [PMID: 24656435 DOI: 10.1016/j.ijnurstu.2014.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urinary incontinence (UI) affects between 40 and 60% of people in hospital after stroke, but is often poorly managed in stroke units. OBJECTIVES To inform an exploratory trial by three methods: identifying the organisational context for embedding the SVP; exploring health professionals' views around embedding the SVP and measuring presence/absence of UI and frequency of UI episodes at baseline and six weeks post-stroke. DESIGN A mixed methods single case study included analysis of organisational context using interviews with clinical leaders analysed with soft systems methodology, a process evaluation using interviews with staff delivering the intervention and analysed with Normalisation Process Theory, and outcome evaluation using data from patients receiving the SVP and analysed using descriptive statistics. SETTING An 18 bed acute stroke unit in a large Foundation Trust (a 'not for profit' privately controlled entity not accountable to the UK Department of Health) serving a population of 370,000. PARTICIPANTS Health professionals and clinical leaders with a role in either delivering the SVP or linking with it in any capacity were recruited following informed consent. Patients were recruited meeting the following inclusion criteria: aged 18 or over with a diagnosis of stroke; urinary incontinence (UI) as defined by the International Continence Society; conscious; medically stable as judged by the clinical team and with incontinence classified as stress, urge, mixed or 'functional'. All patients admitted to the unit during the intervention period were screened for eligibility; informed consent to collect baseline and outcome data was sought from all eligible patients. RESULTS Organisational context: 18 health professionals took part in four group interviews. Findings suggest an environment not conducive to therapeutic continence management and a focus on containment of UI. Embedding the SVP into practice: 21 nursing staff took part in six group interviews. Initial confusion gave way to embedding of processes facilitated by new routines and procedures. Patient outcome: 43 patients were recruited; 28 of these commenced the SVP. Of these, 6/28 (21%) were continent at six weeks post-stroke or discharge. CONCLUSION It was possible to embed the SVP into practice despite an organisational context not conducive to therapeutic continence care. Recommendations are made for introducing the SVP in a trial context.
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Affiliation(s)
- L H Thomas
- School of Health, University of Central Lancashire (UCLan), Preston PR1 2HE, UK.
| | - B French
- School of Health, University of Central Lancashire (UCLan), Preston PR1 2HE, UK
| | - C R Burton
- School of Health Care Sciences, Bangor University, Gwynedd LL57 2EF, UK
| | - C Sutton
- School of Health, University of Central Lancashire (UCLan), Preston PR1 2HE, UK
| | - D Forshaw
- School of Health, University of Central Lancashire (UCLan), Preston PR1 2HE, UK
| | - H Dickinson
- School of Health, University of Central Lancashire (UCLan), Preston PR1 2HE, UK
| | - M J Leathley
- School of Health, University of Central Lancashire (UCLan), Preston PR1 2HE, UK
| | - D Britt
- Division of Primary Care, University of Liverpool, Brownlow Street, Liverpool L69 3GL, UK
| | - B Roe
- Evidence-Based Practice Research Centre, Edge Hill University, St Helens Road, Ormskirk L39 4QP, UK
| | - F M Cheater
- School of Nursing Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - J Booth
- School of Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - C L Watkins
- School of Health, University of Central Lancashire (UCLan), Preston PR1 2HE, UK
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Regat-Bikoï C, Vuagnat H, Morin D. L'incontinence urinaire chez des personnes âgées hospitalisées en unité de gériatrie : est-ce vraiment une priorité pour les infirmières ? Rech Soins Infirm 2013. [DOI: 10.3917/rsi.115.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Yanagawa Y, Yoshihara T, Kato H, Iba T, Tanaka H. Significance of urinary incontinence, age, and consciousness level on arrival among patients with stroke. J Emerg Trauma Shock 2013; 6:83-6. [PMID: 23723615 PMCID: PMC3665076 DOI: 10.4103/0974-2700.110750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/05/2012] [Indexed: 01/23/2023] Open
Abstract
Purpose: We retrospectively investigated prognostic factors including urinary incontinence on arrival among the patients with stroke. Materials and Methods: A medical chart review was retrospectively performed for patients with stoke admitted between January 2010 and December 2010 in Ken-o Tokorozawa Hospital which had stroke care unit. The subjects were divided into a control group (functional outcome with modified Rankin scale (mRS) 0-3 at 3 months) and a poor group (severe disability or death, mRS 4-6). Results: There were 160 cases that had favorable outcome (the Control group) and 77 cases that had poor outcome (the Poor group). There were no significant differences between the two groups concerning the sex ratio, systolic blood pressure, heart rate, temperature, ratio of diabetes mellitus. However, the average age, ratio of hemorrhagic stroke, ratio of patients with a previous stroke, ratio of urinary incontinence upon admission, and duration of hospitalization in the Poor group was significantly higher than in the Control group. The Glasgow Coma Scale upon admission and ratio of hypertension in the Poor group were significantly lower than that in the Control group. Using a multiple logistic regression analysis, urinary incontinence (odds ratio, 3.17; 95% confidence interval, 1.45-6.93; P = 0.002), age (odds ratio, 1.04; 95% confidence interval, 1.01-1.07; P = 0.003) and Glasgow Coma Scale (odds ratio, 0.87; 95% confidence interval, 0.78-0.97; P = 0.01) were found to be factors independently associated with a poor outcome. Conclusion: Among the patients with strokes, the presence of urinary incontinence on arrival, the old age, and the level of consciousness are important prognostic factors. Physicians should therefore check for these factors when evaluating a patient who has experienced a stroke or suspected stroke.
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Affiliation(s)
- Youichi Yanagawa
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
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Fillion B, Rochette A, Girard A. Challenges of being a scholarly clinician as perceived by stroke rehabilitation professionals. Disabil Rehabil 2013; 36:521-8. [PMID: 23721495 DOI: 10.3109/09638288.2013.797516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Stroke rehabilitation clinicians are responsible for offering quality services through evidence-based practices. How is this role fulfilled on a daily basis? OBJECTIVES (1) To explore the perceptions, experiences, and attitudes of rehabilitation professionals regarding their scholar role; (2) To identify factors that facilitate or hinder this role in their practices. METHOD Qualitative design of a phenomenological orientation. Face-to-face interviews conducted with professionals with at least 1 year experience in stroke rehabilitation using a pre-tested interview guide. Transcripts were coded using QDA-Miner software. RESULTS Mean age of the participants was 40.7 years ± 11.2. Participants were mostly women (n = 9/11). The role of scholar emerged as not having great value. Main themes (5) emerging from the analysis are emphasis on tacit knowledge; experience and clinical intuition leading to self-confidence and comfort in clinical practice; dissatisfaction with the lack of knowledge sharing among clinicians; importance of diversifying clinical tasks; and the underdevelopment of reflective practice. Four factors identified as influencing the role of scholar: motivation, critical incident as a main trigger of reflective practice, interns facilitating reflective practice, and lack of time. CONCLUSION From these results emerged questions about measures to encourage the scholar role and facilitate reflective practice in stroke rehabilitation. Implications for Rehabilitation Reflective practice has to be encouraged in professional rehabilitation of stroke. Managers' involvement is crucial to promote and support the role of scholar among professionals in stroke rehabilitation. The updated knowledge and networking from reading scientific paper, participation in trainings and conferences should be systematically disseminated.
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Affiliation(s)
- Barbara Fillion
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal , Québec , Canada
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Girard A, Rochette A, Fillion B. Knowledge translation and improving practices in neurological rehabilitation: managers' viewpoint. J Eval Clin Pract 2013; 19:60-7. [PMID: 22044561 DOI: 10.1111/j.1365-2753.2011.01769.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies in neurological rehabilitation have been undertaken in recent years to improve knowledge transfer. The manager is an important player in the health care system, yet few studies have examined their role in knowledge transfer. The main objective was to explore the importance of knowledge transfer and improving practices from the viewpoint of managers of neurological rehabilitation programs. METHODS An exploratory qualitative research design was used. Three case studies were conducted by way of semi-structured one-on-one interviews with neurological rehabilitation program managers. To be eligible, managers had to give their informed consent and have had responsibilities directly related to the coordination of clinicians working in neurological rehabilitation for at least a year. Data collected were recorded and transcribed. Each interview was synthesized and its content was carefully analysed. RESULTS The three managers' experience in neurology varied from a year to several decades. They believe that knowledge transfer is important but it appears to be less of a priority because of their numerous other responsibilities. Participants said they perceived their role in this process as being a coach, facilitator, motivator, organizer, guide and ambassador. They mentioned reacting to the needs expressed by the clinicians but, when asked, said they would like to be more proactive and structured in their approach. CONCLUSIONS This study points up the lack of organizational structure fostering uniform knowledge translation across all clinicians, although the managers expect it to happen in the near future or would like to see it in an ideal world.
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Affiliation(s)
- Anik Girard
- Clinician, Institut de Réadaptation Gingras-Lindsay de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
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Walker MF, Fisher RJ, Korner-Bitensky N, McCluskey A, Carey LM. From What We Know to What We Do: Translating Stroke Rehabilitation Research into Practice. Int J Stroke 2012; 8:11-7. [DOI: 10.1111/j.1747-4949.2012.00974.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the recent advances in stroke rehabilitation research, the translation of research evidence into practice remains a challenge. The purpose of this article is to communicate practical experience and describe research methodologies used to promote change and implementation of stroke rehabilitation research in three international settings. In England, the development of an evidence-based consensus document, combined with qualitative and quantitative methods, was used to promote practice change in community-based stroke services. The Canadian research program involved synthesis of evidence, creation of user friendly information, and development of multimodal knowledge transfer strategies to promote change at an individual clinician level. Australian researchers followed a multistep process, involving audit and feedback, identification of barriers, and tailored education to improve implementation of one clinical guideline recommendation. Reducing the evidence–practice gap requires the development of active management strategies. This article highlights the importance of close collaboration between stakeholders – both in terms of the transfer of evidence into clinical practice and for optimizing future Phase IV implementation research endeavours.
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Affiliation(s)
- Marion F. Walker
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Rebecca J. Fisher
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | | | - Annie McCluskey
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Leeanne M. Carey
- Florey Neuroscience Institutes and Stroke Division La Trobe University, Melbourne, VIC, Australia
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Daviet JC, Bonan I, Caire J, Colle F, Damamme L, Froger J, Leblond C, Leger A, Muller F, Simon O, Thiebaut M, Yelnik A. Therapeutic patient education for stroke survivors: Non-pharmacological management. A literature review. Ann Phys Rehabil Med 2012; 55:641-56. [DOI: 10.1016/j.rehab.2012.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 11/17/2022]
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David I, Poissant L, Rochette A. Clinicians' expectations of Web 2.0 as a mechanism for knowledge transfer of stroke best practices. J Med Internet Res 2012. [PMID: 23195753 PMCID: PMC3510686 DOI: 10.2196/jmir.2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Health professionals are increasingly encouraged to adopt an evidence-based practice to ensure greater efficiency of their services. To promote this practice, several strategies exist: distribution of educational materials, local consensus processes, educational outreach visits, local opinion leaders, and reminders. Despite these strategies, gaps continue to be observed between practice and scientific evidence. Therefore, it is important to implement innovative knowledge transfer strategies that will change health professionals’ practices. Through its interactive capacities, Web 2.0 applications are worth exploring. As an example, virtual communities of practice have already begun to influence professional practice. Objective This study was initially developed to help design a Web 2.0 platform for health professionals working with stroke patients. The aim was to gain a better understanding of professionals’ perceptions of Web 2.0 before the development of the platform. Methods A qualitative study following a phenomenological approach was chosen. We conducted individual semi-structured interviews with clinicians and managers. Interview transcripts were subjected to a content analysis. Results Twenty-four female clinicians and managers in Quebec, Canada, aged 28-66 participated. Most participants identified knowledge transfer as the most useful outcome of a Web 2.0 platform. Respondents also expressed their need for a user-friendly platform. Accessibility to a computer and the Internet, features of the Web 2.0 platform, user support, technology skills, and previous technological experience were found to influence perceived ease of use and usefulness. Our results show that the perceived lack of time of health professionals has an influence on perceived behavioral intention to use it despite favorable perception of the usefulness of the Web 2.0 platform. Conclusions In conclusion, female health professionals in Quebec believe that Web 2.0 may be a useful mechanism for knowledge transfer. However, lack of time and lack of technological skills may limit their use of a future Web 2.0 platform. Further studies are required with other populations and in other regions to confirm these findings.
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Affiliation(s)
- Isabelle David
- Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, QC, Canada
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Bayley MT, Hurdowar A, Richards CL, Korner-Bitensky N, Wood-Dauphinee S, Eng JJ, McKay-Lyons M, Harrison E, Teasell R, Harrison M, Graham ID. Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project. Disabil Rehabil 2012; 34:1633-8. [PMID: 22631218 DOI: 10.3109/09638288.2012.656790] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the barriers to implementation of evidence-based recommendations (EBRs) for stroke rehabilitation experienced by nurses, occupational therapists, physical therapists, physicians and hospital managers. METHODS The Stroke Canada Optimization of Rehabilitation by Evidence project developed EBRs for arm and leg rehabilitation after stroke. Five Canadian stroke inpatient rehabilitation centers participated in a pilot implementation study. At each site, a clinician was identified as the "local facilitator" to promote the 6-month implementation. A research coordinator observed the process. Focus groups done at completion were analyzed thematically for barriers by two raters. RESULTS A total of 79 rehabilitation professionals (23 occupational therapists, 17 physical therapists, 23 nurses and 16 directors/managers) participated in 21 focus groups of three to six participants each. The most commonly noted barrier to implementation was lack of time followed by staffing issues, training/education, therapy selection and prioritization, equipment availability and team functioning/communication. There was variation in perceptions of barriers across stakeholders. Nurses noted more training and staffing issues and managers perceived fewer barriers than frontline clinicians. CONCLUSIONS Rehabilitation guideline developers should prioritize evidence for implementation and employ user-friendly language. Guideline implementation strategies must be extremely time efficient. Organizational approaches may be required to overcome the barriers. [Box: see text].
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Affiliation(s)
- Mark T Bayley
- Neuro Rehabilitation Program, Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada.
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Tibaek S, Dehlendorff C. Is Barthel index a relevant measure for measuring prevalence of urinary incontinence in stroke patients? Neurourol Urodyn 2011; 31:44-9. [DOI: 10.1002/nau.21203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/06/2011] [Indexed: 01/26/2023]
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Salbach NM, Jaglal SB. Creation and validation of the evidence-based practice confidence scale for health care professionals. J Eval Clin Pract 2011; 17:794-800. [PMID: 20630014 DOI: 10.1111/j.1365-2753.2010.01478.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE Self-efficacy beliefs may provide a means to influence health care professionals' (HCPs) engagement in evidence-based practice (EBP) but no standardized measure of this construct exists. OBJECTIVES To create and evaluate the validity and comprehensibility of a scale measuring belief in ability to implement EBP, known as EBP self-efficacy, among HCPs. METHODS Items describing the steps of EBP outlined in the literature were generated. Fourteen content experts reviewed the scale for face and content validity. A purposive sample of 10 HCPs from medicine, nursing, physical and occupational therapy and speech language pathology provided feedback on the clarity and meaning of scale wording in telephone interviews. RESULTS Progressive refinement yielded an 11-item self-report scale. Each item describes an activity that is part of the process of implementing EBP, such as formulating a question to guide a literature search and asking your patient or client about his/her needs, values and treatment preferences. To complete the scale, HCPs rate their level of confidence on an 11-point scale ranging from 0% (no confidence) to 100% (completely confident) in their ability to perform each activity. Item-level responses are averaged to obtain a summary score that can range from 0% to 100%. CONCLUSION The newly created scale, named the EPIC (evidence-based practice confidence) scale, provides an opportunity to evaluate HCPs' beliefs in their ability to implement EBP and the effects of interventions on these beliefs. Psychometric evaluation of the test-retest reliability and construct validity of the scale is necessary prior to its widespread use.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.
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Divani AA, Majidi S, Barrett AM, Noorbaloochi S, Luft AR. Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008. Stroke 2011; 42:1821-5. [PMID: 21597018 DOI: 10.1161/strokeaha.110.607630] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke. METHODS We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups. RESULTS Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95% CI, 1.16 to 2.24), falls (OR, 1.5; 95% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects. CONCLUSIONS The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.
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Affiliation(s)
- Afshin A Divani
- University of Minnesota, Department of Neurology, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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Menon A, Cafaro T, Loncaric D, Moore J, Vivona A, Wynands E, Korner-Bitensky N. Creation and validation of the PERFECT: a critical incident tool for evaluating change in the practices of health professionals. J Eval Clin Pract 2010; 16:1170-5. [PMID: 20557418 DOI: 10.1111/j.1365-2753.2009.01288.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE The critical incident technique provides a means to better understand the reasons behind clinicians' practices and changes in practice. No standardized tool exists to elicit information using this technique. OBJECTIVES To create and validate a standardized tool that explores change and reasons for change in professional practice. METHOD Item generation was based on expert consultation and a review of the clinical practice and knowledge translation literature. The draft tool was pilot-tested with a convenience sample of 10 rehabilitation clinicians to receive feedback on its content, clarity, optimal cueing, omissions and ease of recall of critical incidents. RESULTS The tool was progressively refined and validated according to feedback from both the clinicians and expert reviewers. The final version of the tool includes 33 questions designed to elicit information on change and reasons for change in four areas: problem identification, assessment, treatment and referral practices. In addition, it elicits information on factors that facilitate or hinder change in practice. Cues are included when necessary to clarify questions and facilitate responses. Regarding ease of recall, all clinicians confirmed that beginning with a 6-month recall of practice change and working back to 1 year was a facilitator. All clinicians mentioned that the tool encouraged them to reflect about changes they made in their practice or lack thereof. CONCLUSION The newly created standardized critical incident tool, named the PERFECT (Professional Evaluation & Reflection on Change Tool) provides an opportunity for widespread applicability to explore change, reasons for change, as well as facilitators and barriers to change in the practices of health professionals.
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Affiliation(s)
- Anita Menon
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Salbach NM, Guilcher SJ, Jaglal SB, Davis DA. Determinants of research use in clinical decision making among physical therapists providing services post-stroke: a cross-sectional study. Implement Sci 2010; 5:77. [PMID: 20946678 PMCID: PMC2964556 DOI: 10.1186/1748-5908-5-77] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 10/14/2010] [Indexed: 11/17/2022] Open
Abstract
Background Despite evidence of the benefits of research use in post-acute stroke rehabilitation where compliance with clinical practice guidelines has been associated with functional recovery and patient satisfaction, the rate of reliance on the research literature in clinical decision making among physical therapists is low. More research examining factors that motivate physical therapists to consider research findings in neurological practice is needed to inform efforts to intervene. The objective of this study was to identify practitioner, organizational, and research characteristics associated with research use among physical therapists providing services post-stroke. Methods A cross-sectional mail survey of physical therapists providing services to people with stroke in Ontario, Canada was conducted. The survey questionnaire contained items to evaluate practitioner and organizational characteristics and perceptions of research considered to influence evidence-based practice (EBP), as well as the frequency of using research evidence in clinical decision making in a typical month. Ordinal regression was used to identify factors associated with research use. Results The percentage of respondents reporting research use in clinical decision making 0 to 1, 2 to 5, or 6+ times in a typical month was 33.8%, 52.9%, and 13.3%, respectively (n = 263). Academic preparation in the principles of EBP, research participation, service as a clinical instructor, self-efficacy to implement EBP, a positive attitude towards research, perceived organizational support of research use, and Internet access to bibliographic databases at work were each associated with research use and placed in the final regression model. In the final model (n = 244), academic preparation in EBP, EBP self-efficacy, agreement that research findings are useful, and research participation each remained significantly associated with research use after adjusting for the effects of the other variables in the model. Conclusions A third of therapists rarely use research evidence in clinical decision making. Education in the principles of EBP, EBP self-efficacy, a positive attitude towards research, and involvement in research at work may promote research use in neurological physical therapy practice. Future research is needed to confirm these findings and to determine the type of research participation that may promote research use.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7 Canada.
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Menon A, Bitensky NK, Straus S. Best practise use in stroke rehabilitation: from trials and tribulations to solutions! Disabil Rehabil 2010; 32:646-9. [PMID: 20205577 DOI: 10.3109/09638280903214640] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article explores the use of best practises among stroke rehabilitation professionals, salient barriers that influence their knowledge uptake/application and effective knowledge translation (KT) strategies that meet the needs of this clinician group. METHOD Relevant literature on evidence-based practise in stroke rehabilitation and the use of KT strategies among rehabilitation professionals is summarised and discussed. RESULTS Although adherence to rehabilitation guidelines translates into improved patient outcomes, best practises are not routinely applied by clinicians when treating individuals with a stroke. Lack of protected work time to search and appraise the research literature is by far the largest organisational barrier to knowledge uptake/application. Personal barriers, such as the lack of confidence and skills to interpret, synthesise and apply research findings, also limit clinicians' uptake of best practises. Studies involving rehabilitation professionals found that active KT strategies were more effective than passive strategies to produce change in their evidence-based knowledge and practise behaviours. As such, interactive e-learning resources are likely to be a relevant KT solution to meet rehabilitation professionals' specific learning needs, guide their clinical decision-making and ultimately increase their best practise behaviours. CONCLUSION We have the knowledge of best practises in stroke rehabilitation, a means to disseminate that knowledge internationally through interactive e-learning resources, and information about effective KT interventions. With these opportunities in place, rehabilitation professionals can expand their capacity by adopting stroke best practises and producing better outcomes for patients.
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Affiliation(s)
- Anita Menon
- Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6 Canada.
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Prevalence of Incontinence During Rehabilitation in Patients Following a Stroke. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Historical Account of Stroke and the Evolution of Nursing Care for Stroke Patients. J Neurosci Nurs 2010; 42:19-27. [DOI: 10.1097/jnn.0b013e3181c1fdad] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Matthews M, Mitchell EA. Causes and rehabilitation of urinary incontinence after stroke: A literature review. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjnn.2010.6.1.46057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE To determine the content and face validity of the Danish Prostate Symptom Score (DAN-PSS-1) questionnaire in stroke patients. MATERIALS AND METHODS Content validity was judged among an expert panel in neuro-urology. The judgement was measured by the content validity index (CVI). Face validity was indicated in a clinical sample of 482 stroke patients in a hospital-based, cross-sectional survey. RESULTS I-CVI was rated >0.78 (range 0.94-1.00) for 75% of symptom and bother items corresponding to adequate content validity. The expert panel rated the entire DAN-PSS-1 questionnaire highly relevant (S-CVI = 1.00). No experts suggested items omitted or improved. The response rate was 84% and face validity had an acceptable level of completed response for each symptom items (96-98%) and bother items (93-96%) indicating that all items were well interpreted. CONCLUSION The DAN-PSS-1 questionnaire appears to be content and face valid for measuring lower urinary tract symptoms after stroke.
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Affiliation(s)
- S Tibaek
- Department of Geriatrics and Rheumatology, Division of Physiotherapy, Copenhagen University Hospital, Glostrup, Denmark.
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Rochette A, Korner-Bitensky N, Thomas A. Changing clinicians' habits: Is this the hidden challenge to increasing best practices? Disabil Rehabil 2009; 31:1790-4. [DOI: 10.1080/09638280902803773] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tibaek S, Gard G, Klarskov P, Iversen HK, Dehlendorff C, Jensen R. Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross-sectional, clinical survey. Neurourol Urodyn 2009; 27:763-71. [PMID: 18551565 DOI: 10.1002/nau.20605] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were primarily to investigate the prevalence, severity and impact on daily life of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and secondly to identify factors associated with LUTS. MATERIALS AND METHODS This was a cross-sectional, hospital based survey whereby stroke patients were invited by letter to complete The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire at least 1 month following their stroke. Subjects were asked to report the frequency and severity of their symptoms (symptom score) and the impact of each symptom on their daily life (bother score) over the previous fortnight. Of 519 stroke patients invited, 482 subjects were eligible. RESULTS The response rate was 84%. The period prevalence of at least one symptom was 94%; the most frequent symptom was nocturia (76%) followed by urgency (70%) and daytime frequency (59%). The most severe symptom was urgency followed by nocturia and daytime frequency. Among respondents who had at least one symptom, the prevalence of bother was 78%. Likewise the most frequent bothersome symptom was nocturia (53%), followed by urgency (48%) and daytime frequency (40%). Paresis in legs, symptoms of urinary incontinence on admission, and use of analgesics were significantly associated with severity, whereas the prevalence and bother of LUTS could not be associated with other patient characteristics. CONCLUSION LUTS are highly prevalent in stroke patients and have a major impact on daily life.
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Affiliation(s)
- Sigrid Tibaek
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
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Lindsay P, Bayley M, McDonald A, Graham ID, Warner G, Phillips S. Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care. CMAJ 2008; 178:1418-25. [PMID: 18490636 DOI: 10.1503/cmaj.071253] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Each year more than 50,000 Canadians experience a stroke and more than 300,000 currently live with its effects. Despite the evidence supporting best practices in stroke care, significant gaps in translating this knowledge into action remains in Canada. An interdisciplinary working group of the Canadian Stroke Strategy was formed to develop best-practice recommendations relevant to Canadian health care. The working group used a rigorous process to develop the guidelines, which included reviewing existing stroke recommendations and research literature, and consulting a national interprofessional consensus panel. The Canadian Best Practice Recommendations for Stroke Care consist of 24 recommendations based on the strongest evidence and address topics that span the full continuum of stroke care. Implementation and dissemination of these recommendations is in progress. Bringing about change will require political will and collaboration throughout the health care system.
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Affiliation(s)
- Lalit Kalra
- King's College London School of Medicine, Bessemer Road, London, United Kingdom.
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