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Zhou Z, Fang X, Huang Y, Hu J, Zhang K, Jia S. A scoping review of factors associated with self-management in young adults with stroke. PATIENT EDUCATION AND COUNSELING 2024; 125:108308. [PMID: 38705023 DOI: 10.1016/j.pec.2024.108308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To synthesize the available evidence on factors associated with self-management behavior in young stroke patients. METHODS The methodological guidelines for scoping reviews developed by the Joanna Briggs Institute and the PRISMA-scR-checklist for scoping reviews were used. A total of 5586 studies were identified through bibliographic searches of the scientific databases Medline (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO, limited to the period 2000-2023. Studies were independently assessed for inclusion and exclusion criteria by two reviewers. Quantitative observational data and qualitative studies were extracted, mapped, and summarized to provide a descriptive summary of trends and considerations for future research. RESULTS Nine papers were finally selected to answer the research question. Young patients' self-management was mainly influenced by demographic factors (age, gender, income, education, and stroke knowledge), disease-related factors (functionality and independence, duration of stroke diagnosis, cognitive function, and poststroke fatigue), and psychosocial factors (hardiness, spiritual self-care, self-efficacy, and social support). CONCLUSION Further research is needed to determine the trajectory of poststroke self-management over time and its potential predictors, which should lead to the development of specific stroke rehabilitation and stroke self-management support programs for young people (considering factors that influence return to work in young stroke patients' self-management). PRACTICE IMPLICATIONS Healthcare providers can design more efficient interventions to improve the quality of life of young stroke patients after discharge. Gaining an in-depth understanding of the factors that influence self-management can help achieve this.
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Affiliation(s)
- Zifang Zhou
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Xiaoqun Fang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Youhong Huang
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Jiangyu Hu
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Kaibing Zhang
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Shulei Jia
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China.
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Gao C, Li X, Li F, Li J, Zhang J. Non-pharmacological interventions on quality of life in stroke survivors: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2024; 21:158-182. [PMID: 38429872 DOI: 10.1111/wvn.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/29/2023] [Accepted: 01/27/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Non-pharmacological interventions have been used in the rehabilitation of stroke survivors, but their effects on stroke survivors' quality of life (QoL) are unknown. AIM This review aimed to summarize the existing evidence regarding non-pharmacological interventions for QoL in stroke survivors and to evaluate the effectiveness of different types of interventions. METHODS We systematically searched databases including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, China Science and Technology Journal Database, and Wanfang data from the earliest available records to March 2023. Randomized controlled trials which explored the effects of non-pharmacological interventions on QoL in stroke patients were included. The meta-analysis was conducted to evaluate the effectiveness of different interventions on QoL. The Review Manager 5.3 was used to conduct the meta-analysis and the revised Cochrane risk-of-bias tool was used to assess the methodological quality of trials. RESULTS A total of 93,245 records were identified, and 34 articles were reviewed and summarized, of which 20 articles were included in the meta-analysis. The summary of the findings of the included studies revealed fitness training, constraint-induced movement therapy (CIMT), physical exercise, music therapy (MT), and art-based interventions may have positive effects on QoL. The fitness training improved total QoL, especially in physical domains including physical functioning (mean difference [MD] = 10.90; 95% CI [7.20, 14.59]), role physical (MD = 10.63; 95% CI [6.71, 14.55]), and global health (MD = 8.76; 95% CI [5.14, 12.38]). The CIMT had a slight effect on general QoL (standardized mean difference [SMD] = 0.48, 95% CI [0.16, 0.80]), whereas significantly improved strength (MD = 8.84; 95% CI [1.31, 16.38]), activities of daily living/instrumental activities of daily living (ADL/IADL; MD = 10.42; 95% CI [2.98, 17.87]), and mobility (MD = 8.02; 95% CI [1.21, 14.83]). MT had a positive effect on the mental health domain (SMD = 0.54; 95% CI [0.14, 0.94]). LINKING EVIDENCE TO ACTION Our findings suggest that fitness training and CIMT have a significant effect on improving physical QoL, while MT has a positive effect on improving psychological QoL. Future studies may use comprehensive and multicomponent interventions to simultaneously improve the patients' physical, psychological, and social QoL.
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Affiliation(s)
- Chang Gao
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fanling Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jin Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jingjun Zhang
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Liljehult J, Molsted S, Møller T, Overgaard D, Christensen T. Lifestyle counselling as secondary prevention in patients with minor stroke or transient ischemic attack: a randomized controlled pilot study. Pilot Feasibility Stud 2024; 10:50. [PMID: 38519983 PMCID: PMC10958836 DOI: 10.1186/s40814-024-01478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Patients with minor stroke or transient ischemic attacks have an increased risk of future strokes. These patients are often discharged home with limited specialized follow-up, although close to half of them experience cognitive deficits. Simple encouragements to avoid smoking, be physically active, and to take preventive medication are often insufficient to ensure adherence and more comprehensive interventions are needed to support the patients in adapting healthy behaviour. The aim of this study was to test the feasibility and potential effect of an early initiated, patient-centred intervention to patients with minor stroke or transient ischemic attacks targeting smoking, physical activity, and medication adherence, in a randomized, controlled pilot trial. METHODS Hospitalized patients were randomized to usual care or an intervention consisting of health behavioural counselling based on the 5A's model, telephone follow-up (4 and 8 weeks), and monitoring of physical activity. Follow-up time was 12 weeks. Feasibility was on the following domains: eligibility, acceptance, demand and practicality, adherence, attrition, and implementation and integration. RESULTS Forty patients of 84 potentially eligible were randomized to the two treatment arms (20 intervention/20 usual care). Thirty-two completed the 12-week follow-up, while 8 were either excluded or lost to follow-up. With few changes, the intervention was feasible and possible to deliver according to the protocol. CONCLUSION It was possible to identify relevant patients who could potentially benefit from a behavioural intervention, recruit and randomize them early after admission and retain most participants in the study until follow-up and derive statistical estimates to guide the design of large-scale randomized controlled trials. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03648957 . Registered 28 August 2018.
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Affiliation(s)
- Jacob Liljehult
- Department of Neurology, Nordsjællands Hospital, Dyrehavevej 29, Hillerød, 3400, Denmark.
- Department 9701, The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark.
- Faculty of Health and Technology, Department of Nursing and Nutrition, Copenhagen University College, Tagensvej 86, Copenhagen N, 2200, Denmark.
| | - Stig Molsted
- Department of Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, Hillerød, 3400, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, Copenhagen N, 2200, Denmark
| | - Tom Møller
- Department 9701, The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Dorthe Overgaard
- Faculty of Health and Technology, Department of Nursing and Nutrition, Copenhagen University College, Tagensvej 86, Copenhagen N, 2200, Denmark
| | - Thomas Christensen
- Department of Neurology, Nordsjællands Hospital, Dyrehavevej 29, Hillerød, 3400, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, Copenhagen N, 2200, Denmark
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Temehy B, Soundy A, Sahely A, Palejwala Y, Heath J, Rosewilliam S. Exploring the needs of stroke patients after discharge from rehabilitation centres in Saudi Arabian communities: An IPA qualitative exploratory study design. PLoS One 2023; 18:e0291263. [PMID: 37682983 PMCID: PMC10490873 DOI: 10.1371/journal.pone.0291263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
There are about 29 strokes per 100,000 people, annually, in the Kingdom of Saudi Arabia (KSA). These patients require long-term rehabilitation services to enhance recovery and independence in the community. Currently there are limited long-term rehabilitation services in KSA and research is needed to establish pathways for provision of community-based rehabilitation (CBR). To develop effective new CBR models, understanding the experiences and needs of stroke patients in KSA who have undergone poststroke care services is essential. This study aims to gain insight into stroke patients' needs after their discharge from rehabilitation centres in Saudi Arabia. An interpretive phenomenological analysis (IPA) study was undertaken using semi-structured interviews. Participants were eligible if they had a stroke, completed their in-hospital rehabilitation sessions and had been discharged within the past three years. Semi-structured interviews were conducted using interview guides. Transcripts were translated and analysed using interpretive phenomenological analysis. Twenty-four (15 males and 9 females) participants were recruited from two hospitals in KSA. The key findings suggested that patients experienced limited community rehabilitation services postdischarge unless they were financially able to pay for private therapy. Coping barriers including Medical, Psychological, Social, and Financial and facilitators including Faith, Recovery, Social support and leisure were identified. Participants suggested strategies to improve services within hospital and community for rehabilitation, needs of staff, access to services and ongoing care. Further work is required to develop, implement and evaluate a community rehabilitation intervention that includes education, and self-management elements to support stroke survivors in the community in KSA.
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Affiliation(s)
- Basema Temehy
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrew Soundy
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ahmad Sahely
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Yasmin Palejwala
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Heath
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sheeba Rosewilliam
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Krawcyk RS, Christoffersen LC, Danielsen AK, Kruuse C. Motivators for physical activity in patients with minor stroke: a qualitative study. Disabil Rehabil 2023; 45:277-285. [PMID: 35119324 DOI: 10.1080/09638288.2022.2032409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Physical inactivity is a major risk factor for stroke. However, to encourage physical activity after stroke, it is important to know what motivates the patients. We aimed to explore possible motivators and barriers for physical activity in patients discharged after minor stroke or transient ischemic attack (TIA). METHODS A qualitative study including 35 patients (21 men) with minor stroke or TIA (median age; 69 years, range 47-90) in semi-structured focus group interviews. Audio recordings were transcribed to text verbatim and analyzed with qualitative content analysis. RESULTS Six interviews of 60 min. revealed five categories; the patients had a positive attitude towards physical activity, and they preferred to exercise locally under supervision of health professionals. Physical activity with others was motivating and obligating, and if possible as a weekly habit. Some experienced physical- and mental sequelae, which kept them from exercising. CONCLUSION This study provides valuable knowledge of what motivates and prevents patients with minor stroke or TIA to be physically active after hospital discharge, and what to consider when designing future exercise studies. Consequently, it is recommended that patients with minor stroke or TIA are offered supervised physical activity to prevent worsening of cardiovascular disease and recurrent cardiovascular event.Implications for rehabilitationParticipants were positive towards physical activity after minor stroke or transient ischemic attack (TIA).Physical activity with others was perceived as both motivating and obligating.Post-stroke fatigue, lack of energy, and overview should be considered when designing secondary prevention programs.Participants call for exercise opportunities arranged locally and as group exercise supervised by health professionals with knowledge of stroke.
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Affiliation(s)
- Rikke Steen Krawcyk
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Laura Cathrine Christoffersen
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Anne Kjaergaard Danielsen
- Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Temehy B, Rosewilliam S, Alvey G, Soundy A. Exploring Stroke Patients' Needs after Discharge from Rehabilitation Centres: Meta-Ethnography. Behav Sci (Basel) 2022; 12:404. [PMID: 36285973 PMCID: PMC9598696 DOI: 10.3390/bs12100404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
Healthcare providers must consider stroke survivors needs in order to enable a good quality of life after stroke. This review aimed to investigate the perceived needs of the stroke survivors across various domains of care following their discharge from hospital. A meta-ethnographic review of qualitative studies that reported needs of stroke patients after discharge from rehabilitation services was conducted. Main searches were conducted on the following electronic databases: Ovid Medline (1946 to 2021), CINAHL plus (EBSCO), AMED (EBSCO), PsycINFO (1967 to 2021), the Cochrane Library, and PubMed in June 2022. Main outcomes were related to stroke survivors' views, experiences, and preferences on physical, psychological, social, rehabilitation needs, and other identified needs. Twenty-seven studies were included in the final analysis. The findings show that existing rehabilitation provision for stroke survivors does not address the long-term needs of stroke survivors. Two main issues were revealed concerning the unmet needs of stroke survivors: (1) a lack of information availability and suitability and (2) inadequacy of care and services. It is crucial to further investigate the needs of patients in Asian countries and the Middle East as there is very limited understanding of patients' needs in the community in these regions.
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Affiliation(s)
- Basema Temehy
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2SA, UK
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7
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Mastering health following minor stroke-A qualitative explorative study. J Stroke Cerebrovasc Dis 2022; 31:106607. [PMID: 35753094 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with minor stroke or transient ischemic attack are encouraged to adopt a healthy lifestyle to prevent recurrent stroke. After discharge health behaviour is performed in an individual everyday context and must be properly understood within this context, including which aspects act as facilitators or barriers for healthy behaviour. OBJECTIVES To explore the experience of daily life in patients discharged home after minor stroke or transient ischemic attack, focusing on perceived health and reflection on health behaviour, and how this is associated with their overall experience of returning to their everyday context in relation to potential sequelae of stroke. METHODS Semi-structured qualitative interviews were conducted 3 - 13 months after discharge with sixteen patients discharged home after minor stroke or transient ischemic attack. Inductive thematic analysis was performed to analyse the interviews. RESULTS Participants associated their health and behaviour within a lens of worrying for future life prospect and triggered by perceived intrusive changes in their life condition. Even though some found it possible to resume participation in everyday life within weeks, they became increasingly aware that minor cognitive deficits, difficulties with planning, multi-tasking, memory, and fatigue influenced their health believes and behavioural patterns. The need for social and professional support had to be balanced against a wish for independence. CONCLUSION Patients with minor stroke or transient ischemic attacks experience changes as both being concrete in the form of persisting symptoms and abstract in the form of worries and uncertainty about the future. Perceived health was associated with a new sense of vulnerability due to realisations about the risk of recurrent stroke. Worries were anchored within the individual to handle, but for some they serve as a motivator to regulate their behaviour in order to master health.
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Pérez‐de la Cruz S. Perceptions of recovery and rehabilitation in people with brain injury in Spain. A qualitative study. Health Expect 2022; 25:1168-1175. [PMID: 35289029 PMCID: PMC9122431 DOI: 10.1111/hex.13471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Acquired brain injury (ABI) is a condition that severely impairs the personal, family, social and professional lives of the individuals who experience it. The aim of this study was to gain insight into ABI patients' perceptions of their condition and rehabilitation process so that physiotherapists can approach their treatment in a more comprehensive, satisfactory manner. METHODS A qualitative study was carried out with individual interviews, and focus group sessions (semi-structured interviews) were held with 33 individuals from various associations. RESULTS Four themes emerged in this study: physiotherapy treatment, changes in lifestyle, patients' feelings about their condition and aspirations for the future. The participants reported that their condition had led to multiple changes in their personal and family lives that were not always positive. CONCLUSIONS These findings may be useful for identifying ways to increase acceptance of their condition and design a comprehensive rehabilitation programme for these patients and their families. The psychosocial needs of ABI patients could be optimized by providing good physical care through effective communication within the rehabilitation environment where communication between professionals and patients prevails, to meet their real needs and expectations. PATIENT OR PUBLIC CONTRIBUTION This study was conducted based on interviews with adult ABI patients regarding their experiences concerning their rehabilitation process and daily life.
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Evans N, Connelly DM, Hay ME. The process of commitment to exercise among stroke survivors in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e706-e716. [PMID: 34041792 DOI: 10.1111/hsc.13441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
The objective of this research was to understand the process of commitment to exercise participation for functional recovery among community-living survivors of stroke following discharge from formal rehabilitation. Participants were recruited from a mid-sized city in south-western Ontario, Canada. Between September 2017 and March 2018, 10 individuals living in the community with the effects of stroke, who continued to engage in regular exercise post-stroke, were recruited for participation. Constructivist grounded theory methodology was employed, utilising in-depth individual interviews and theoretical sampling, whereby data collection and analysis occurred simultaneously. Analysis involved constant comparison between data and codes to reduce knowledge gaps and formulate the proposed theory. The process of commitment to exercise involved four phases. Initiation of the process followed a significant interaction with a healthcare provider who advocated for participants to learn the foundations of exercise. Through planned exercise, maintenance of a positive attitude and comparisons with their pre-stroke selves and peers, participants identified future goals and imparted the desire to get back to life before stroke. Over time individuals navigated exercise opportunities-trialling different types and environments-to learn what works. Finally, participants developed a commitment to exercise as a way of life, supported by social connections and reinforced with pride in successes-mastering self-care skills, improved mobility and meaningful function. The process of commitment to exercise among survivors of stroke required early interactions with healthcare providers to initiate exercise participation for long-term engagement, and navigation through various exercise elements fuelled by a desire to reconnect with their pre-stroke selves.
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Affiliation(s)
- Nicole Evans
- Health and Rehabilitation Sciences Program, Western University, London, ON, USA
| | - Denise M Connelly
- Graduate and Postdoctoral Studies, Faculty of Health Sciences, Western University, London, ON, USA
- Interprofessional Education and Practice (IPEP) Office, Western University, London, ON, USA
- School of Physical Therapy, Western University, London, ON, USA
| | - Melissa E Hay
- Health and Rehabilitation Sciences Program, Western University, London, ON, USA
- Graduate and Postdoctoral Studies, Faculty of Health Sciences, Western University, London, ON, USA
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Evaluating and Characterizing an Individually-Tailored Community Exercise Program for Older Adults With Chronic Neurological Conditions: A Mixed-Methods Study. J Aging Phys Act 2022; 30:1047-1060. [PMID: 35294924 DOI: 10.1123/japa.2021-0292] [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: 07/28/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
Abstract
A mixed-methods approach was used to study an individually-tailored community exercise program for people with a range of chronic neurological conditions (e.g., stroke, spinal cord injury, brain injury, multiple sclerosis, Parkinson's disease) and abilities. The program was delivered to older adults (mean age: 62 ± 9 years) with chronic neurological conditions across a 12-week and an 8-week term. Participants attended 88% of sessions and completed 89% of prescribed exercises in those sessions. There were no adverse events. Clinically important improvements were achieved by all evaluated participants (n = 8) in at least one testing domain (grip strength, lower-extremity strength, aerobic endurance, and balance). Interviews with participants identified key program elements as support through supervision, social connection, individualized programming, and experiential learning. Findings provide insight into elements that enable a community exercise program to meet the needs of a complex and varied group. Further study will support positive long-term outcomes for people aging with neurological conditions.
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English K, Daley B, Cahill L, Liu E, Lannin NA, Baker A. Characteristics and Outcomes of a Community Upper Limb Rehabilitation Group for Adult Stroke Survivors in Australia: A Pre-Post Cohort Study. Occup Ther Health Care 2021; 36:440-458. [PMID: 34878364 DOI: 10.1080/07380577.2021.2012734] [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: 10/19/2022]
Abstract
This study investigated outcomes of a community-based upper limb rehabilitation group for adult stroke survivors in metropolitan Australia. Pre-post data were extracted from medical records. Participants (n = 27) were predominantly men (n = 22, 81%); mean age 61 years (SD 17) and median time 109 days post stroke. Participants improved on upper limb outcomes, with statistically significant changes on several of the items on the Motor Assessment Scale (item seven mean improvement 0.93 (95% CI 0.48-2.19), p = .016; item eight mean improvement 1.4 (95% CI 0.38-2.42), p = .016) and grip strength (mean improvement 4.5 kg/9 pounds, 14.73 ounces (95% CI 1.5-7.6), p = .006). These results guide occupational therapists implementing community-based upper limb rehabilitation groups.
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Affiliation(s)
- Kylie English
- Australian Catholic University, School of Allied Health, Melbourne, Australia; Eastern Health, Department of Occupational Therapy, Melbourne, Australia
| | - Bella Daley
- Alfred Health, Melbourne, Australia; St. Vincent's Hospital, Melbourne, Australia
| | - Liana Cahill
- Australian Catholic University, School of Allied Health, Melbourne, Australia
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia.,Allied Health (Occupational Therapy), Alfred Health, Melbourne, Australia
| | - Anne Baker
- Federation University, School of Health, Gippsland, Australia
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Sharpe A, Boyes V, Lee C, Murtha C, Mah J, Yoshida K, Marzolini S, Inness EL. Cardiopulmonary Exercise Testing in Stroke Rehabilitation: Benefits and Clinical Utility Perceived by Physiotherapists and Individuals with Stroke. Physiother Can 2021; 73:110-117. [PMID: 34456420 DOI: 10.3138/ptc-2019-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this study was to understand the perceived benefits and clinical utility of cardiopulmonary exercise testing (CPET) from the perspectives of physiotherapists and patients and to explore the factors that influence adopting CPET in a stroke rehabilitation setting. Method: A qualitative descriptive study was conducted. Physiotherapists (n = 6) participated in a focus group to discuss the use of CPET in practice. Patients (n = 8) who had completed CPET during stroke rehabilitation participated in a semi-structured interview to explore their experiences. Thematic analysis was performed. Results: CPET increased the physiotherapists' confidence in prescribing exercise, especially for medically complex patients. Ongoing medical management early post-stroke was a barrier to referral. Physiotherapists expressed decreased confidence in interpreting test results. Consultation with local experts facilitated the use of CPET. Patients described how CPET increased their confidence to participate in exercise. They desired more information before and after CPET to better understand the purpose and results and their relation to their rehabilitation goals. Conclusions: Both physiotherapists and patients described the benefit of having CPET available to support them as they participated in exercise in a stroke rehabilitation setting. Physiotherapists would benefit from having educational tools to support their interpretation and application of test results, and patients would benefit from improved communication and education to support their understanding of the relevance of CPET to their rehabilitation goals. Future research should explore these findings in other stroke rehabilitation settings.
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Affiliation(s)
| | - Valerie Boyes
- Department of Physical Therapy, University of Toronto
| | - Calvin Lee
- Department of Physical Therapy, University of Toronto
| | | | - Justin Mah
- Department of Physical Therapy, University of Toronto
| | - Karen Yoshida
- Department of Physical Therapy, University of Toronto
| | - Susan Marzolini
- Department of Physical Therapy, University of Toronto.,Cardiovascular Prevention and Rehabilitation Program.,The KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ont
| | - Elizabeth L Inness
- Department of Physical Therapy, University of Toronto.,Brain & Spinal Cord Rehabilitation Program.,The KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ont
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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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Homayouni TS, Ruth A, Abbott-Tate Z, Burger H, Rahim S, Murray C, Wannamaker R, Chan Carusone S, O'Brien KK. Experiences engaging in a group-based physiotherapist-led exercise programme for adults living with HIV and complex multimorbidity: a qualitative study. BMJ Open 2021; 11:e045158. [PMID: 34315789 PMCID: PMC8317082 DOI: 10.1136/bmjopen-2020-045158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore experiences participating in a group-based physiotherapist (PT)-led exercise programme among people living with HIV and complex multimorbidity. DESIGN We conducted a qualitative descriptive study using semistructured interviews. RECRUITMENT AND SETTING We recruited community-dwelling adults living with HIV who engaged in a group-based PT-led exercise programme within an HIV-specialty hospital in Toronto, Canada. Interviews were conducted in-person or by telephone. PARTICIPANTS Eight men and two women with a median age of 58 years and median of six concurrent conditions in addition to HIV, who had attended ≥2 classes of the exercise programme. DATA COLLECTION Interviews explored (1) reasons for engaging in the programme, (2) experiences with exercise prior to and after joining the programme, (3) facilitators and barriers to engagement and (4) perceived impacts of participation on health and disability. We administered the HIV Disability Questionnaire and a demographic questionnaire. RESULTS Experiences spanned perspectives prior to, during and after the PT-led exercise programme. Reasons for engaging in the programme included addressing health-related goals. Participants identified accessibility, the flexible schedule, interprofessional staff and the HIV-specific, group-based environment as facilitators to engagement. Participants reported high attendance rates, but identified episodic health challenges and overcrowded space as potential barriers to attending exercise classes. Perceived impacts on health and disability outcomes included improved physical, mental, social and cognitive health, and activities of daily living. Anticipated or actual experiences transitioning to independent exercise included facilitators (supportive programme leaders) and barriers (challenges motivatiing self to exercise alone). CONCLUSIONS Features of the programme that facilitated engagement included the interprofessional, group-based environment that offered tailored exercise in an HIV-specific facility, whereby participants perceived benefits in domains of health and disability. However, challenges transitioning to independent exercise remain. Group-based PT-led exercise programmes may facilitate engagement in exercise among adults living with HIV and complex multimorbidity.
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Affiliation(s)
- Tina S Homayouni
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alex Ruth
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Abbott-Tate
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Burger
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaera Rahim
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada
- Department of Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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15
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"Just Going to a Spin Class": Participant Experiences of Inclusion Within an Integrated Indoor Cycling Program. Adapt Phys Activ Q 2021; 38:359-376. [PMID: 33785662 DOI: 10.1123/apaq.2020-0107] [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: 06/03/2020] [Revised: 08/08/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Justifications for access to physical activity for people who experience disability tend to focus on the health benefits associated with a medical model of disability. The result is often programs that are segregated and impairment-focused, with limited access to integrated settings that are also potentially inclusive. In this instrumental case study, the authors engaged 20 participants with and without impairment from an adult integrated indoor cycling program to explore what contributed to meaningful and inclusive experiences in this setting. Data were generated through semistructured interviews and reflective notes. Thematic analysis led to three themes: (a) "just going to a spin class" (b) "seamless"? and (c) "deliberate community." Using a relational ethics framework, the findings are discussed with regard to their potential to inform the development of integrated and inclusive physical activity programs, with emphasis on program structure and instructor reflexivity and training.
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Koh JSG, Hill AM, Hill KD, Etherton-Beer C, Francis-Coad J, Bell E, Bainbridge L, de Jong LD. Evaluating a Novel Multifactorial Falls Prevention Activity Programme for Community-Dwelling Older People After Stroke: A Mixed-Method Feasibility Study. Clin Interv Aging 2020; 15:1099-1112. [PMID: 32764897 PMCID: PMC7360420 DOI: 10.2147/cia.s251516] [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: 03/15/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The overall purpose of this study was to explore participants’ and physiotherapists’ experiences regarding the acceptability, implementation, and practicality of a novel group-based multifactorial falls prevention activity programme for community-dwelling older people after stroke. Specifically, the purpose was to explore if and how participating could impact on the participants’ health-related quality of life (HRQoL) in terms of their daily lived experience regarding physical, mental, emotional and social well-being. A secondary purpose was to explore whether participating in the programme could positively influence participants’ balance, strength, falls efficacy, mobility and motor impairment of the trunk. Materials and Methods This was an exploratory mixed-method Phase I feasibility study. A convenience sample of five older community-dwelling people after stroke participated in a novel eight-week multifactorial activity programme which included falls education, a mix of individually tailored and group-based strength and balance exercises, exploring limits of stability and safe landing techniques and a social element. Qualitative data from post-intervention interview transcripts with the participants and the physiotherapists who delivered the programme were thematically analysed using both deductive and inductive approaches to explore the participants’ and therapists’ experiences with the programme. Quantitative outcomes included balance, strength, falls efficacy, mobility and motor impairment of the trunk. Results The programme was deemed feasible in terms of acceptability, implementation and practicality by the participants as well as the physiotherapists delivering the programme. The overarching theme regarding HRQoL identified that participating in the programme was perceived to empower the participants living with stroke and positively influenced their daily physical, mental, emotional and social well-being. Participant outcomes showed a change in the direction of improvements in balance, strength, mobility, motor impairment of the trunk and reduced concerns about falling. Subjectively, participants only reported perceived improvements in balance and strength. Conclusion Running a novel multifactorial falls prevention activity programme for older community-dwelling people after stroke was feasible. Participating in the programme helped participants to perceive improved balance, strength and empower them to make meaningful changes, improving their daily lived experiences. A future fully powered study could build on these results to investigate physical improvements, prevention of falls and improvements to domains of HRQoOL.
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Affiliation(s)
- Jun Sheng Gary Koh
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia.,Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine and Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Elizabeth Bell
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Liz Bainbridge
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Lex D de Jong
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
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17
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The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
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18
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Kokorelias KM, Lu FKT, Santos JR, Xu Y, Leung R, Cameron JI. "Caregiving is a full-time job" impacting stroke caregivers' health and well-being: A qualitative meta-synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:325-340. [PMID: 31769128 DOI: 10.1111/hsc.12895] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
Family caregivers contribute to the sustainability of healthcare systems. Stroke is a leading cause of adult disability and many people with stroke rely on caregiver support to return home and remain in the community. Research has demonstrated the importance of caregivers, but suggests that caregiving can have adverse consequences. Despite the body of qualitative stroke literature, there is little clarity about how to incorporate these findings into clinical practice. This review aimed to characterise stroke caregivers' experiences and the impact of these experiences on their health and well-being. We conducted a qualitative meta-synthesis. Four electronic databases were searched to identify original qualitative research examining stroke caregivers' experiences. In total, 4,481 citations were found, with 39 studies remaining after removing duplicates and applying inclusion and exclusions criteria. Articles were appraised for quality using the Critical Appraisal Skills Programme (CASP), coded using NVivo software, and analysed through thematic synthesis. One overarching theme, 'caregiving is a full-time job' was identified, encompassing four sub-themes: (a) restructured life, (b) altered relationships, (c) physical challenges, and (d) psychosocial challenges. Community and institution-based clinicians should be aware of the physical and psychosocial consequences of caregiving and provide appropriate supports, such as education and respite, to optimise caregiver health and well-being. Future research may build upon this study to identify caregivers in most need of support and the types of support needed across a broad range of health conditions.
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Affiliation(s)
- Kristina M Kokorelias
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Fiana K T Lu
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer R Santos
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Yi Xu
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Robin Leung
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Gregor S, Vaughan-Graham J, Wallace A, Walsh H, Patterson KK. Structuring community-based adapted dance programs for persons post-stroke: a qualitative study. Disabil Rehabil 2020; 43:2621-2631. [PMID: 31905043 DOI: 10.1080/09638288.2019.1708978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Dance improves physical, psychosocial, and cognitive function, while increasing community participation among community-dwelling individuals post-stroke. Yet little is known about how to structure community-based dance classes to optimize benefits and participation. This study aims to gain stakeholders' perspectives about how to optimally structure community-based dance classes for individuals with chronic stroke. METHODS A qualitative descriptive approach utilizing focus group methods was implemented. Two focus groups were undertaken with each of three stakeholder groups: persons post-stroke (n = 9), rehabilitation therapists (n = 6), and dance instructors (n = 8). Focus groups were audio-recorded and transcribed verbatim, providing the raw data. Analysis of the focus group transcripts were completed using the DEPICT model of collaborative qualitative analysis. RESULTS This study identified three main themes/topics requiring consideration when structuring community-based dance programs: the environment, flow of the class, and qualities of the dance instructor. The study findings highlight that the pedagogical skills and teaching philosophy of the dance instructor are integral for a successful dance program, as the dance instructor directly mediates both the environment and flow of classes. CONCLUSION Recommendations generated from our study can inform the development of community-based dance programs that are practical, optimize health benefits, and meet the needs and interests of people post-stroke.IMPLICATIONS FOR REHABILITATIONDance is an effective way to improve physical, psychosocial, and cognitive function for persons post-stroke while also promoting meaningful social relationships within the community.A dance instructor who is a skilled communicator and is willing to adapt to the needs of the class, is the most important factor for a successful dance class.Creating a safe and inviting environment for a dance program, includes both the physical and emotional aspects of environment facilitating individuals to create connections with others and feel more confident in themselves.The structure of a dance class, based on the abilities, interests, and goals of dancers, should include elements of predictability and variability to keep dancers progressing and motivated, and be two times a week for 3 months lasting 1-2 h.
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Affiliation(s)
- Sarah Gregor
- KITE Research Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Julie Vaughan-Graham
- KITE Research Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Aaron Wallace
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Hilary Walsh
- Department of Occupational Sciences & Occupational, Therapy - University of Toronto, Toronto, Canada
| | - Kara K Patterson
- KITE Research Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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20
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Sørensen KE, Dreyer P, Rasmussen M, Simonsen CZ, Andersen G. Experiences and needs of patients on the endovascular therapy pathway after acute ischaemic stroke: Being helpless and next to yourself. Nurs Open 2020; 7:299-306. [PMID: 31871714 PMCID: PMC6917975 DOI: 10.1002/nop2.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 11/08/2022] Open
Abstract
Aims To explore the experiences and needs of patients on the endovascular therapy pathway. Design A qualitative design using a phenomenological-hermeneutic approach. Methods Semi-structured interviews and participant observations were carried out. Data were collected from April 2016-January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline. Results The findings of this study show that the impact of stroke goes far beyond physical disability. During the structural analysis, four themes were identified: (1) Acute admission to a stroke unit - an overwhelming and blurred experience. (2) Being helpless and next to yourself. (3) The important care when you worry about dying. (4) Poststroke feelings of loneliness and uncertainty.
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Affiliation(s)
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | - Mads Rasmussen
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | | | - Grethe Andersen
- Department of NeurologyAarhus University HospitalAarhus NDenmark
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21
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Simpson DB, Bird ML, English C, Gall SL, Breslin M, Smith S, Schmidt M, Callisaya ML. "Connecting patients and therapists remotely using technology is feasible and facilitates exercise adherence after stroke". Top Stroke Rehabil 2019; 27:93-102. [PMID: 31762412 DOI: 10.1080/10749357.2019.1690779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Repetitive task practice after stroke is important to improve function, yet adherence to exercise is low. The aim of this study was to determine whether using the internet, a tablet application, and a chair sensor that connected to a therapist was feasible in monitoring adherence and progressing a functional exercise at home.Methods: Ten participants with stroke completed a 4-week sit-to-stand exercise using the technology at home (ACTRN12616000051448). A therapist remotely monitored exercise adherence, progressed goals, and provided feedback via the app. Measures of feasibility (design, recruitment/withdrawals, adherence, safety, participant satisfaction and estimates of effect on function) were collected.Results: Participants' mean age was 73.6 years [SD 9.9 years]. The system was feasible to deliver and monitor exercise remotely. All participants completed the study performing a mean 125% of prescribed sessions and 104% of prescribed repetitions. Participants rated the system usability (78%), enjoyment (70%) and system benefit (80%) as high. No adverse events were reported. The mean pre- and post-intervention difference in the total short performance physical battery score was 1.4 (95% CI 0.79, 2.00).Conclusions: It was feasible and safe to prescribe and monitor exercises using an app and sensor-based system. A definitive trial will determine whether such technology could facilitate greater exercise participation after stroke.
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Affiliation(s)
- Dawn B Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Marie-Louise Bird
- GF Strong Rehabilitation Research Laboratory, University of British Colombia, Vancouver, Canada
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Stuart Smith
- Division of Research, Southern Cross University, Coffs Harbour, Australia
| | - Matthew Schmidt
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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22
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Xiao L, Gao Y, Zeng K, Zhang L. Perceived participation and its determinants among young and middle-aged stroke survivors following acute care one month after discharge. Disabil Rehabil 2019; 43:648-656. [PMID: 31437066 DOI: 10.1080/09638288.2019.1636314] [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: 10/26/2022]
Abstract
PURPOSE To describe the perceived participation and assess its determinants among young and middle-aged stroke patients following acute care one month after discharge in mainland China. METHODS Two hundred and twenty-three patients were consecutively recruited from two tertiary hospitals and were followed up 1 month after discharge in the outpatient department or their communities to assess their participation by using the Impact on Participation and Autonomy Questionnaire, with 23 patients lost to follow-up. Determinants (i.e., sociodemographic, diseased-related, physical, psychological, and social factors) of participation were identified in four domains: indoor autonomy; outdoor autonomy; family role; and social life. RESULTS The overall perceived participation of our respondents was good to fair. Forty-six (23.0%), 32 (16.0%), 13 (6.5%), and 19 (9.5%) perceived their participation as "very good" in the domains of indoor autonomy, family role, outdoor autonomy and social life, respectively. Stroke severity, depressive symptoms, and social support were the common determinants of participation for all the domains, with stroke severity being the strongest correlate. Activities of daily living was associated with indoor autonomy, family role, and outdoor autonomy, but not associated with social life. CONCLUSIONS The perceived participation of our respondents is relatively optimistic. Physical health along with mental and social status can affect participation. Tailored strategies should be implemented early in the rehabilitation phase to promote stoke survivors' participation in all the domains.Implications for rehabilitationAlthough the overall perceived participation of young and middle-aged stroke patients was fair to good, attention should be paid to their family roles.The strategies should be mainly focused on reducing the stroke severity to improve patients' participation.Improving patients' depressive symptom and social support can also be helpful for improving their participation.
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Affiliation(s)
- Lin Xiao
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yulin Gao
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Kai Zeng
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- School of Nursing, Southern Medical University, Guangzhou, China
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Young RE, Broom D, Sage K, Crossland K, Smith C. Experiences of venue based exercise interventions for people with stroke in the UK: a systematic review and thematic synthesis of qualitative research. Physiotherapy 2019; 110:5-14. [PMID: 31492446 DOI: 10.1016/j.physio.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND The physical benefits of exercise following stroke are research evidenced and the UK stroke population is increasingly encouraged to engage with exercise interventions. A synthesis of qualitative research is required to further understand the perceived experience and psychosocial effect of exercise for people with stroke. OBJECTIVES To provide a systematic search and synthesis of evidence about the experiences and reported impact of participation in venue based exercise following stroke in the UK. DATA SOURCES Eligible studies were identified through a rigorous search of Medline, Cinahl, AMED, PsycINFO, SportDiscus, Proquest and ETHOS from January 2000 until December 2017. STUDY ELIGIBILITY CRITERIA Full text qualitative studies or service evaluations conducted in the UK which explored the reported experience of venue based exercise amongst people with stroke. STUDY SYNTHESIS AND APPRAISAL Included studies were evaluated through application of the Consolidated Criteria for Reporting Qualitative Research. Data synthesis using a thematic approach generated descriptive and analytical themes. RESULTS Six research studies and one service evaluation met the inclusion criteria; methodological quality was variable. These studies highlighted that people with stroke gain confidence and renewed identity through exercise participation. Perceived improvements in physical function were reported and participants enjoyed stroke specific exercise programmes in de-medicalised venues. LIMITATIONS The studies only accessed people who had completed the exercise programmes; non-completers were not represented. CONCLUSION Venue based exercise programmes have a positive effect on perceived wellbeing following stroke. Further research into the reasons for discontinuation of exercise participation following stroke is required. Systematic Review Registration Number PROSPERO 2017:CRD42017072483.
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Affiliation(s)
- Rachel E Young
- Sheffield Neuro Physiotherapy, Mayfield Farm, Mayfield Road, Fulwood, Sheffield, S10 4PR, United Kingdom.
| | - David Broom
- Faculty of Health and Wellbeing, Collegiate Hall, Sheffield Hallam University, S10 2BP, United Kingdom
| | - Karen Sage
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Robert Winston Building, Sheffield Hallam University, S10 2BP, United Kingdom
| | - Kay Crossland
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom
| | - Christine Smith
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Robert Winston Building, Sheffield Hallam University, S10 2BP, United Kingdom
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24
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Bucki B, Spitz E, Baumann M. Emotional and social repercussions of stroke on patient-family caregiver dyads: Analysis of diverging attitudes and profiles of the differing dyads. PLoS One 2019; 14:e0215425. [PMID: 31013289 PMCID: PMC6478282 DOI: 10.1371/journal.pone.0215425] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
Abstract
For patients, the social and emotional repercussions of stroke include shame, personality changes, and upheavals experienced by the couple (i.e. patient and main family caregiver). These impacts on the couple 'patient/family caregiver' are scarcely documented. Focusing on the perceptions of the patients and the family caregivers living at home, two years after a stroke occurrence, the aims of the study were to analyse the concordance of attitudes towards the emotional and social repercussions of stroke and to determine the profiles of the differing dyads. Two researchers conducted separate face-to-face structured interviews with stroke survivors and their family caregivers. Eleven items, identified through a content analysis of interviews and after a qualitative process of generating questionnaire items, assessed the commonly experienced impact of stroke on the family, the social repercussions of stroke, and its emotional effects on the stroke survivors. The kappa concordance coefficient was used to determine the response convergence between patients and family caregivers. Four items, selected by a panel of experts, were included in logistic regressions (i.e., demographic characteristics and patients' impaired functions) to identify the differing dyadic profiles. Family caregivers' and patients' attitudes towards the social repercussions of stroke were similar. Patients with motor deficiencies tended to underestimate the upheaval brought to their couple by stroke, whereas caregivers of language-impaired patients tended to underestimate their feelings of shame and demeaning. Communication disturbances, but also residual physical disabilities in stroke survivors, may affect the understanding of each other's attitudes within dyads. In order to avoid dysfunctional relationships between family caregivers and patients, healthcare professionals need to pay special attention to this issue, especially in cases of aphasia and motor deficiencies.
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Affiliation(s)
- Barbara Bucki
- Institute for Research on Socio-Economy and health Inequalities (IRSEI), Unit INSIDE, University of Luxembourg, Luxembourg city, Grand-Duchy of Luxembourg
- Department of Psychology, EA4360 APEMAC, University of Lorraine, Paris Descartes University, Metz, France
| | - Elisabeth Spitz
- Department of Psychology, EA4360 APEMAC, University of Lorraine, Paris Descartes University, Metz, France
| | - Michèle Baumann
- Institute for Research on Socio-Economy and health Inequalities (IRSEI), Unit INSIDE, University of Luxembourg, Luxembourg city, Grand-Duchy of Luxembourg
- * E-mail:
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25
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Beaudry L, Fortin S, Rochette A. Adapted dance used in subacute rehabilitation post-stroke: impacts perceived by patients, relatives and rehabilitation therapists. Disabil Rehabil 2019; 42:2997-3006. [PMID: 30907140 DOI: 10.1080/09638288.2019.1581845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To examine the perceived impacts of an adapted-dance group intervention when added to intensive functional rehabilitation post-stroke.Method: In this exploratory qualitative case study, semi-structured interviews were analyzed using a deliberative inductive logic and referring to the International Classification of Functioning, Disability and Health. Participants were patients in rehabilitation post-stroke (≤25 days) (n = 6), relatives (n = 4) and rehabilitation therapists (n = 12). Selection was on a voluntary basis. The intervention added to the patients' rehabilitation program consisted of 55-minute bi-weekly sessions for 10 weeks.Results: Three categories of perceived positive impacts emerged from the data: (1) mobility, (2) mental functions and personal factors (emotional functions, motivation and self-efficacy) and (3) interpersonal interactions and social life. A fourth category of perceived impacts involving exercise tolerance was both positive, in terms of general physical endurance, and negative, in terms of a feeling of increased fatigue.Conclusion: Such an adapted-dance intervention holds promise in subacute rehabilitation post-stroke. Its main strength lies in its perceived positive impact on mental functions, personal factors, and interpersonal and social interactions.Implications for rehabilitationAn adapted-dance group intervention could offer an innovative means of contributing to intensive functional rehabilitation post-stroke by potentially generating positive perceived impacts on emotional functions, motivation and self-efficacy, as well as on interpersonal and social interactions.Adapted dance could be added to inpatients' rehabilitation with only minor impacts on fatigue.
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Affiliation(s)
- Lucie Beaudry
- Department of Dance, Université du Québec à Montréal, Montréal,Canada.,Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, Montréal,Canada
| | - Sylvie Fortin
- Department of Dance, Université du Québec à Montréal, Montréal,Canada
| | - Annie Rochette
- Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, Montréal,Canada.,School of Rehabilitation, Université de Montréal, Montréal,Canada
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Bird ML, Mortenson BW, Chu F, Acerra N, Bagnall E, Wright A, Hayley K, Yao J, Eng JJ. Building a Bridge to the Community: An Integrated Knowledge Translation Approach to Improving Participation in Community-Based Exercise for People After Stroke. Phys Ther 2019; 99:286-296. [PMID: 30698783 PMCID: PMC6383711 DOI: 10.1093/ptj/pzy146] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/05/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND People who have had a stroke and are living in the community have low levels of physical activity, which reduces their functional capacity and increases risks of developing secondary comorbid conditions. Exercise delivered in community centers can address these low levels of physical activity; however, implementing evidence-based programs to meet the needs of all community stakeholders is challenging. OBJECTIVES The objective of this study was to determine implementation factors to facilitate participation in relevant exercise and physical activity for people with chronic health conditions, like stroke. DESIGN The design consisted of a qualitative observational study using an integrated knowledge translation approach. METHODS Supported by an integrated knowledge translation approach, a series of focus groups-with stakeholder group representation that included people who had had a stroke and care partners, community organizations (ie, support groups, community center staff), health care providers, and exercise deliverers-was conducted. During the focus groups, participants provided perspectives on factors that could influence implementation effectiveness. Focus groups were recorded, transcribed, and thematically analyzed. RESULTS Forty-eight stakeholders participated. Based on the themes, a new implementation model that describes the importance of relationships between community centers, clinicians, and people who have had a stroke is proposed. The development of partnerships facilitates the implementation and delivery of exercise programs for people with ongoing health needs. These partnerships address unmet needs articulated in the focus groups and could fill a gap in the continuity of care. CONCLUSIONS Data from this study support the need for the community sector to offer a continuing service in partnership with the health system and people with chronic health needs. It indicates the potential of clinicians to partner with people with chronic health conditions and empower them to improve participation in relevant health behaviors, like community-based exercise.
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Affiliation(s)
- Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - B William Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia
| | - Francis Chu
- Vancouver Coastal Health Authority, Community, Vancouver, British Columbia, Canada
| | - Nicole Acerra
- Vancouver Coastal Health Authority, Division of Physical Therapy
| | - Eric Bagnall
- West Vancouver Community Centre, Health and Wellness, Vancouver, British Columbia, Canada
| | | | | | - Jennifer Yao
- Vancouver Coastal Health Authority, Division of Physical Medicine and Rehabilitation
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, 212-2177 Westbrook Mall, Vancouver, BC, V6T 1Z3 Canada,Address all correspondence to Dr Eng at:
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Skrastins O, Tsotsos S, Aqeel H, Qiang A, Renton J, Howe JA, Tee A, Moller J, Salbach NM. Fitness coordinators' and fitness instructors' perspectives on implementing a task-oriented community exercise program within a healthcare-recreation partnership for people with balance and mobility limitations: a qualitative study. Disabil Rehabil 2019; 42:2687-2695. [PMID: 30739500 DOI: 10.1080/09638288.2019.1570357] [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: 12/12/2022]
Abstract
Background: Healthcare organizations are partnering with recreation organizations to support the delivery of community-based exercise programs for people with balance and mobility limitations. The value and impact of support strategies provided by healthcare organizations, however, have not been examined.Objective: Study objectives were to explore fitness coordinators' and fitness instructors' experiences with implementing a task-oriented community-based exercise program for people with balance and mobility limitations within the context of a healthcare-recreation partnership.Methods: A qualitative descriptive study was conducted. Fitness coordinators and instructors involved with delivering a licensed, group, task-oriented community-based exercise program for people with balance and mobility limitations supported by a healthcare-recreation partnership were interviewed by telephone. Interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed.Results: Eight fitness coordinators and 8 fitness instructors from 14 recreation centres were interviewed. Findings showed that healthcare-recreation partnerships help to optimize exercise program quality and safety through multiple strategies. Fitness coordinators and instructors still face challenges with program implementation at start-up and over time. Recommendations to address these challenges included increased training content related to adjusting exercises to accommodate participant abilities, 1-2 visits from a healthcare professional each program after initial program implementation, suggestions to increase exercise variety, and ongoing education.Conclusions: Findings clarify the role of healthcare organizations, ongoing challenges, and directions for improvement in this program delivery model.Implications for rehabilitationCommunity recreation centres can provide task-oriented exercise programs to help people with balance and mobility limitations safely engage in regular exerciseHealthcare organizations should provide specific supports to help increase the safety and quality of task-oriented exercise programs in recreation centresSupports include providing clear exercise guidelines, and a healthcare professional who trains fitness instructors, visits the program, answers questions between visits, promotes collaboration and information exchange between recreation centres, and provides ongoing education.
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Affiliation(s)
- Olivia Skrastins
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Tsotsos
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hammad Aqeel
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anthony Qiang
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica Renton
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Alda Tee
- Royal Victoria Regional Health Centre, Ontario Central East Stroke Network, Barrie, ON, Canada
| | - Jason Moller
- British Columbia Fraser Health Authority, Chilliwack, BC, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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Merali S, Cameron JI, Barclay R, Salbach NM. Experiences of people with stroke and multiple sclerosis and caregivers of a community exercise programme involving a healthcare-recreation partnership. Disabil Rehabil 2019; 42:1220-1226. [PMID: 30668173 DOI: 10.1080/09638288.2018.1519042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore perceptions of people with neurological conditions and their caregivers of the health benefits of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership.Materials and methods: Descriptive qualitative study. Individuals with balance and mobility deficits from a neurological condition, and their caregivers, were interviewed on completion of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership. A thematic analysis was performed.Results: Nine people post-stroke, and four people with multiple sclerosis (MS) (n = 13; 54% male) and 12 caregivers (83% spouses) participated. Two themes emerged. One theme indicated that the programme fosters diverse, interrelated health benefits. Participants described experiences of improved balance, strength, and confidence that translated to improved everyday functioning and social participation. Benefits were reinforced through repeated programme registration. A second theme indicated that caregivers experience challenges and diverse benefits related to the programme. Transportation and programme cost were primary challenges. Caregivers described emotional health benefits from assisting participants during classes and observing participants improvement over time.Conclusions: Group, task-oriented community-based exercise programmes incorporating a healthcare-recreation partnership may yield health benefits for exercise participants and caregivers. Results can guide programme evaluation, the nature and timing of education about such programmes, and efforts to address cost and transportation issues.Implications of rehabilitationStroke and multiple sclerosis commonly cause balance and mobility limitations that can result in physical inactivity and further deterioration in health.Group, task-oriented community-based exercise programmes in which rehabilitation professionals train and support fitness instructors to deliver the exercise programme in community centres may increase access to exercise participation for this group.Study results suggest by improving balance and mobility, these programmes help increase independence in activities of daily living and social and leisure participation, while improving caregiver mental health and decreasing the need for caregiver assistance.Rehabilitation professionals can use findings to inform patient education, and support programme implementation and referral.
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Affiliation(s)
- Saira Merali
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Ruth Barclay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Xie G, Rao T, Lin L, Lin Z, Xiao T, Yang M, Xu Y, Fan J, Lin S, Wu J, Feng X, Li L, Tao J, Chen L. Effects of Tai Chi Yunshou exercise on community-based stroke patients: a cluster randomized controlled trial. Eur Rev Aging Phys Act 2018; 15:17. [PMID: 30564291 PMCID: PMC6292054 DOI: 10.1186/s11556-018-0206-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 11/28/2018] [Indexed: 02/03/2023] Open
Abstract
Backgroud Tai Chi Chuan was used for stroke survivors with balance impairments. However, even a short-form of Tai Chi Chuan includes forms that make the exercise challenging for the stroke survivors. Tai Chi Yunshou (wave hands in the cloud) is the “mother” form and the fundamental form of all Tai Chi Chuan styles, which is considered more suitable and feasible for stroke survivors with balance impairments. So this study was designed to evaluate the effects of Tai Chi Yunshou exercise on community-based stroke patients with balance dysfunctions. Methods A total of 250 participants from 10 community health centers (5 per arm) were selected and randomly allocated into Tai Chi Yunshou exercise group (TC group) or a balance rehabilitation training group (control group) in an equal ratio. Participants in the TC group were received Tai Chi Yunshou exercise training five times per week for 12 weeks and those in control group were received balance rehabilitation training five times per week for 12 weeks. Outcome assessments including Berg Balance Scale (BBS), Time up to go test (TUGT), Modified Barthel Index (MBI) were measured at baseline, 4 weeks, 8 weeks, 12 weeks and followed-up 6 weeks (18 weeks), 12 weeks (24 weeks). Intention-to-treat analysis was performed. Analysis of variance of repeated measures was used to assess between-group differences. Results A total of 244 participants, 120 in the TC group and 124 in the rehabilitation group, were included in final analysis. There was no siginificant difference in Tai Chi Yunshou and balance rehabilitation training on the improvement of balance ability and mobility (P = 0.531 and P = 0.839, respectively) after adjustment for baseline. However, there was significant difference between two groups on improvement of motor funtion (P = 0.022), fear of falling (P < 0.001) and depression (P = 0.035) for the post stroke patients. No adverse events were reported during the study. Conclusion Tai Chi Yunshou and balance rehabilitation training led to improved balance ability and functional mobility, and both are suitable community-based programs that may benefit for stroke recovery and community reintegration. Our data demonstrated that a 12-week Tai Chi Yunshou intervention was more effective in motor function, fear of falling and depression than balance rehabilitation training. Future studies examining the effectiveness of Tai Chi Yunahou as a balance ability improvement strategy for community-dwelling survivors of stroke are recommended. Trial registration Chinese Clinical Trail Registry: ChiCRT-TRC-13003641. Registration date: 22 August, 2013.
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Affiliation(s)
- Guanli Xie
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, People's Republic of China
| | - Ting Rao
- 2Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lili Lin
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
| | - Zhengkun Lin
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
| | - Tianshen Xiao
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China
| | - Ming'ge Yang
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China
| | - Ying Xu
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, People's Republic of China
| | - Jinmei Fan
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
| | - Shufang Lin
- 2Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jinsong Wu
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Xiaodong Feng
- 6The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Li Li
- 7The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jing Tao
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Lidian Chen
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, People's Republic of China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China
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30
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Munford D, Gunn H. What are the perceptions and experiences of falls amongst people with stroke who live in the community? Disabil Rehabil 2018; 42:722-729. [DOI: 10.1080/09638288.2018.1510047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Danielle Munford
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Hilary Gunn
- School of Health Professions, University of Plymouth, Plymouth, UK
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31
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Moore SA, Hrisos N, Flynn D, Errington L, Price C, Avery L. How should long-term free-living physical activity be targeted after stroke? A systematic review and narrative synthesis. Int J Behav Nutr Phys Act 2018; 15:100. [PMID: 30333027 PMCID: PMC6192196 DOI: 10.1186/s12966-018-0730-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing physical activity (PA) levels (regular movement such as walking and activities of daily living) and reducing time spent sedentary improves cardiovascular health and reduces morbidity and mortality. Fewer than 30% of independently mobile stroke survivors undertake recommended levels of PA. Sedentary behaviour is also high in this population. We aimed to systematically review the study characteristics and the promise of interventions targeting free-living PA and/or sedentary behaviour in adult stroke survivors. METHODS Seven electronic databases were searched to identify randomised controlled trials (≥3-months follow-up) targeting PA and/or sedentary behaviour in adults with first or recurrent stroke or transient ischaemic attack. The quality assessment framework for RCTs was used to assess risk of bias within and across studies. Interventions were rated as "very", "quite" or "non-promising" based on within- or between-group outcome differences. Intervention descriptions were captured using the TIDieR (Template for Intervention Description and Replication) Checklist. Behaviour change techniques (BCTs) within interventions were coded using the BCT Taxonomy v1, and compared between studies by calculating a promise ratio. RESULTS Nine studies fulfilled the review criteria (N = 717 randomised stroke patients) with a high or unclear risk of bias. None of the studies targeted sedentary behaviour. Six studies were very/quite promising (reported increases in PA post-intervention). Studies were heterogeneous in their reporting of participant age, time since stroke, stroke type, and stroke location. Sub-optimal intervention descriptions, treatment fidelity and a lack of standardisation of outcome measures were identified. Face to face and telephone-based self-management programmes were identified as having promise to engage stroke survivors in PA behaviour change. Optimal intensity of contact, interventionist type and time after stroke to deliver interventions was unclear. Nine promising BCTs (ratios ≥2) were identified: information about health consequences; information about social and environmental consequences; goal setting-behaviour; problem-solving; action planning; feedback on behaviour; biofeedback; social support unspecified; and credible source. CONCLUSIONS Future research would benefit from establishing stroke survivor preferences for mode of delivery, setting and intensity, including measurement of physical activity. Interventions need to justify and utilise a theory/model of behaviour change and explore the optimal combination of promising BCTs within interventions.
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Affiliation(s)
- Sarah A. Moore
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Nina Hrisos
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastlee Upon Tyne, NE2 4AX UK
| | - Linda Errington
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - Christopher Price
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- School of Health & Social Care, Centuria Building, Teesside University, Middlesbrough, TS1 3BX UK
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Norris M, Poltawski L, Calitri R, Shepherd AI, Dean SG. Acceptability and experience of a functional training programme (ReTrain) in community-dwelling stroke survivors in South West England: a qualitative study. BMJ Open 2018; 8:e022175. [PMID: 30049699 PMCID: PMC6067351 DOI: 10.1136/bmjopen-2018-022175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
Rehabilitation Training (ReTrain) is a group-based approach to functional training post stroke. ReTrain has recently been evaluated through a pilot randomised controlled trial. OBJECTIVE This article reports on the acceptability of the intervention as described by trial participants. DESIGN A qualitative approach was undertaken. Of the 45 participants recruited into the trial, 23 were randomised to receive ReTrain. Following a sampling strategy, 10 participants undertook 1:1 semistructured audio-recorded interviews. Transcripts were analysed following a modified Framework Approach. RESULTS Six themes were developed including exploration of: the physical and psychological impacts of training,the perceived mechanisms of change, the interaction of the group and approach of the trainer. A further theme considered the reported longer term impact of participation. Overall, the results indicated the acceptability of the intervention, but also key areas for potential modification in the definitive trial. These include a need to consider potential impact on both physical and psychological function, careful consideration of dosing and fatigue and the interpersonal factors that facilitate appropriate level of delivery, the trainer to participant ratio, and enhancing features that support continuation of activity postintervention. CONCLUSION Overall, this study supports the acceptability of ReTrain and the development of a definitive trial evaluation of this intervention to full. TRIAL REGISTRATION NUMBER NCT02429180.
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Affiliation(s)
| | | | | | - Anthony I Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
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Smith R, Burgess C, Sorinola I. The effect of a dysfunctional upper limb on community-dwelling stroke survivors and their carers: An interpretative phenomenological analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1726. [PMID: 29984436 DOI: 10.1002/pri.1726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/25/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The poststroke upper limb continues to pose a myriad of physical and psychological challenges for patients and caregivers. To optimize existing services, this study firstly aimed to explore the experiences of both stroke survivors and caregivers and secondly identify their ongoing needs. METHODS A qualitative approach was utilized for this study. Six participants (three stroke survivors and three caregivers) were purposively sampled from community stroke groups. Semi structured interviews were utilized to collect experiential data, which were analysed using an interpretative phenomenological approach. RESULTS Three master themes emerged from data analysis: "Finding a way forwards from a poor start," "The battle with the upper-limb," and "Relationships with self and society." All participants, seemingly affected by disappointing services, expressed negative views of rehabilitation. Misplaced or persistent hope, losses in control, and reduced autonomy may have contributed to poor functional outcomes and perceptions of rehabilitation services. The complex physical and psychological impact of the experience of the dysfunctional upper limb was also associated with ongoing and unmet support needs for stroke survivors and carers. CONCLUSIONS Healthcare professionals may consider the varying impact of the dysfunctional upper limb during decision-making and treatment planning, particularly during acute rehabilitation. Future research could explore therapists' perceptions and experiences of upper-limb rehabilitation during this period.
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Affiliation(s)
| | - Caroline Burgess
- Primary Care and Public Health Sciences, King's College London, London, UK
| | - Isaac Sorinola
- Primary Care and Public Health Sciences, King's College London, London, UK
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Lloyd M, Skelton DA, Mead GE, Williams B, van Wijck F. Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis. Brain Behav 2018; 8:e01000. [PMID: 29920979 PMCID: PMC6043697 DOI: 10.1002/brb3.1000] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors. METHODS Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework. RESULTS Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%. CONCLUSIONS Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings.
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Affiliation(s)
- Megan Lloyd
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Dawn A. Skelton
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Gillian E. Mead
- Geriatric MedicineDivision of Health SciencesCentre for Clinical Brain SciencesThe University of Edinburgh, and the Royal InfirmaryEdinburghUK
| | - Brian Williams
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
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35
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Salbach NM, Howe JA, Baldry D, Merali S, Munce SEP. Considerations for expanding community exercise programs incorporating a healthcare-recreation partnership for people with balance and mobility limitations: a mixed methods evaluation. BMC Res Notes 2018; 11:214. [PMID: 29609662 PMCID: PMC5879753 DOI: 10.1186/s13104-018-3313-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/21/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To increase access to safe and appropriate exercise for people with balance and mobility limitations, community organizations have partnered with healthcare providers to deliver an evidence-based, task-oriented group exercise program in community centers in Canada. We aimed to understand challenges and solutions to implementing this program model to inform plans for expansion. RESULTS At a 1-day meeting, 53 stakeholders (healthcare/recreation personnel, program participants/caregivers, researchers) identified challenges to program implementation that were captured by seven themes: Resources to deliver the exercise class (e.g., difficulty finding instructors with the skills to work with people with mobility limitations); Program marketing (e.g., to foster healthcare referrals); Transportation (e.g., particularly from rural areas); Program access (e.g., program full); Maintaining program integrity; Sustaining partnerships (i.e., with healthcare partners); and Funding (e.g., to deliver program or register). Stakeholders prioritized solutions to form an action plan. A survey of individuals supervising 28 programs revealed that people with stroke, acquired brain injury, multiple sclerosis, and Parkinson's disease register at 95-100% of centers. The most prevalent issues with program fidelity across centers were not requiring a minimum level of walking ability (32%), class sizes exceeding 12 (21%), and instructor-to-participant ratios exceeding 1:4 (19%). Findings provide considerations for program expansion.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Diem Baldry
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Saira Merali
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Sarah E P Munce
- University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
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36
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Condon M, Guidon M. A survey of exercise professionals' barriers and facilitators to working with stroke survivors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:250-258. [PMID: 29143386 DOI: 10.1111/hsc.12517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
Stroke survivors (SSs) are largely inactive despite the benefits of exercise. Exercise professionals (EPs), skilled in exercise prescription and motivation, may have a role in promoting exercise among SSs. However, the number of EPs working with SSs is estimated to be low. This study aimed to investigate EPs' opinions on working with SSs by rating their agreement of barriers and facilitators to working with SSs. The study also investigated EPs skills, interest and experience working with SSs and the relationship between EPs' barriers and facilitators with their training on stroke. A descriptive cross-sectional study was conducted using a researcher-designed online survey between October and December 2015. Purposive sampling was used to survey EPs on the Register of Exercise Professionals in Ireland (n = 277). The response rate was 31% (87/277). Only 22% (19/86) of EPs had experience working with SSs. The primary barriers rated by EPs included insufficient training on psychological problems post-stroke (84%; 61/73), unsuitable equipment for SSs (69%; 50/73) and the level of supervision SSs require (56%; 41/73). The primary facilitators rated included access to suitable equipment (97%; 69/71), practical (100%; 71/71) and theoretical training (93%; 66/71) on stroke. Respondents with no training on stroke were significantly more likely to agree that insufficient training on psychological problems post-stroke and lack of experience were barriers. Seventy-six per cent of EPs (58/76) were interested in one-to-one exercise sessions with SSs but only 53% (40/76) were interested in group sessions. Eighty-two per cent of EPs (62/76) rated their motivational skills as good or very good but 42% (32/76) indicated having only acceptable skills dealing with psychological problems. Results indicate that EPs are interested in working with SSs despite limited experience and practical barriers. Training opportunities on stroke need to be developed; taking into account EPs' barriers, facilitators and skills along with access to suitable equipment.
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Affiliation(s)
- Marie Condon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Guidon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, Mant J. Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography. PLoS One 2018; 13:e0192533. [PMID: 29466383 PMCID: PMC5821463 DOI: 10.1371/journal.pone.0192533] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/25/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services. Design Systematic review and meta-ethnography. Data sources Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015). Eligibility criteria Primary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services. Data synthesis A set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria. Results 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke. Limitations Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems. Conclusions Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services. Systematic review registration number PROSPERO 2015:CRD42015026602
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Affiliation(s)
- Dominika M. Pindus
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ricky Mullis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Lisa Lim
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - A. Viona Rundell
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Noor Azah Abd Aziz
- Department of Family Medicine, National University of Malaysia, Bandar Tun Razak Cheras, Kuala Lumpur, Malaysia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
- * E-mail:
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Mansfield A, Brooks D, Tang A, Taylor D, Inness EL, Kiss A, Middleton L, Biasin L, Fleck R, French E, LeBlanc K, Aqui A, Danells C. Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity-study protocol for a stepped-wedge randomised trial. BMJ Open 2017; 7:e015843. [PMID: 28667222 PMCID: PMC5726051 DOI: 10.1136/bmjopen-2017-015843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/07/2017] [Accepted: 04/25/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Physical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation. This study aims to evaluate the effect of PROPEL on long-term participation in exercise after discharge from stroke rehabilitation. We hypothesise that individuals who complete PROPEL will be more likely to meet recommended frequency, duration and intensity of exercise compared with individuals who do not complete the programme up to 6 months post discharge from stroke rehabilitation. METHODS AND ANALYSIS Individuals undergoing outpatient stroke rehabilitation at one of six hospitals will be recruited (target n=192 total). A stepped-wedge design will be employed; that is, the PROPEL intervention (group exercise plus self-management) will be 'rolled out' to each site at a random time within the study period. Prior to roll-out of the PROPEL intervention, sites will complete the control intervention (group aerobic exercise only). Participation in physical activity for 6 months post discharge will be measured via activity and heart rate monitors, and standardised physical activity questionnaire. Adherence to exercise guidelines will be evaluated by (1) number of 'active minutes' per week (from the activity monitor), (2) amount of time per week when heart rate is within a target range (ie, 55%-80% of age-predicted maximum) and (3) amount of time per week completing 'moderate' or 'strenuous' physical activities (from the questionnaire). We will compare the proportion of active and inactive individuals at 6 months post intervention using mixed-model logistic regression, with fixed effects of time and phase and random effect of cluster (site). ETHICS AND DISSEMINATION To date, research ethics approval has been received from five of the six sites, with conditional approval granted by the sixth site. Results will be disseminated directly to study participants at the end of the trial, and to other stake holders via publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02951338; Pre-results.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Denise Taylor
- St Joseph’s Care Group, Thunder Bay, Ontario, Canada
- Northern Ontario School of Medicine, West Campus, Thunder Bay, Ontario, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Laura Middleton
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Louis Biasin
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Fleck
- Regional Rehabilitation Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Esmé French
- Northwestern Ontario Regional Stroke Network, Thunder Bay, Ontario, Canada
| | - Kathryn LeBlanc
- Regional Rehabilitation Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Anthony Aqui
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Lund A, Melhus M, Sveen U. Enjoyable company in sharing stroke experiences; - lifestyle groups after stroke. Scand J Occup Ther 2017. [PMID: 28625085 DOI: 10.1080/11038128.2017.1341958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Even people with mild to moderate stroke will experience changes in their abilities to perform everyday occupations. Group interventions may be appropriate in late-stage rehabilitation. The aim of this study was to explore how the participants involved themselves in person-centered lifestyle groups after stroke in Norway. METHOD Semi-structured interviews were performed with six older adults with mild-to-moderate stroke who had participated in lifestyle groups over a period of nine months. The interviews were analyzed using qualitative content analysis. RESULTS The participants involved themselves in the lifestyle groups in a variety of ways by creating enjoyable company in sharing stroke experiences, sharing knowledgeable interest, pushing and forcing each other forward and reflecting on self-worth. Through doing group activities together, they created various ways of being, belonging and becoming, addressing development of strategies for regaining self-belief and a sense of autonomy, and for adapting to everyday life post-stroke. CONCLUSION The participants were active contributors in the groups and pushed each other and themselves regarding involvement in meaningful occupations. This active participation seemed to bring the participants' resources into focus and contrasted with the frequent negative perceptions of people post-stroke as 'victims'.
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Affiliation(s)
- Anne Lund
- a Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics , Oslo and Akershus University College of Applied Sciences (HiOA) , Oslo , Norway
| | - Mali Melhus
- a Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics , Oslo and Akershus University College of Applied Sciences (HiOA) , Oslo , Norway
| | - Unni Sveen
- a Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics , Oslo and Akershus University College of Applied Sciences (HiOA) , Oslo , Norway
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Montgomery CA, Henning KJ, Kantarzhi SR, Kideckel TB, Yang CFM, O'Brien KK. Experiences participating in a community-based exercise programme from the perspective of people living with HIV: a qualitative study. BMJ Open 2017; 7:e015861. [PMID: 28377397 PMCID: PMC5387963 DOI: 10.1136/bmjopen-2017-015861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Our aim was to explore the experiences of engaging in a community-based exercise programme (CBEP) from the perspective of people living with HIV (PLWH). DESIGN We conducted a descriptive qualitative study using semistructured interviews. SETTING We recruited adults living with HIV who participated in a 16-week CBEP in Toronto, Canada. PARTICIPANTS 11 participants, the majority men (64%), with a median age of 52 years, and living with a median of 5 concurrent health conditions in addition to HIV participated in the study. OUTCOME MEASURES We asked participants about their overall experiences: strengths, limitations and perceived benefits of the CBEP; factors influencing participation and current level of exercise after completion of the CBEP. We administered a self-reported demographic questionnaire followed by the Rapid Assessment of Physical Activity (RAPA) questionnaire. We analysed interview data using thematic analysis. RESULTS We developed a framework that describes the experiences before, during and after the CBEP; and the perceived impact of the CBEP on health, which influenced the intent to, engagement in and sustainability of exercise among PLWH. Participants described the positive impact of the CBEP on their physical, mental and social health. Interviews were completed at a median of 6 months after the CBEP, when 9 participants reported ongoing engagement in exercise, but to a lesser extent than during the CBEP. Intrinsic and extrinsic factors facilitated or hindered engagement in exercise throughout all phases of the CBEP. The episodic nature of HIV and multimorbidity influenced engagement in exercise and posed challenges to re-engagement after periods of inactivity. CONCLUSIONS CBEPs provide an opportunity to enhance physical activity, perceived health outcomes and knowledge about exercise for PLWH. Community-based exercise is a strategy that may be used by health providers to promote engagement in sustained physical activity for PLWH.
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Affiliation(s)
| | - Katherine J Henning
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah R Kantarzhi
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tamar B Kideckel
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl F M Yang
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
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Vloothuis JDM, Mulder M, Veerbeek JM, Konijnenbelt M, Visser‐Meily JMA, Ket JCF, Kwakkel G, van Wegen EEH. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev 2016; 12:CD011058. [PMID: 28002636 PMCID: PMC6463929 DOI: 10.1002/14651858.cd011058.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced. OBJECTIVES To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, Issue 10), MEDLINE (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field. SELECTION CRITERIA Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. One review author extracted data, and assessed quality and risk of bias, and a second review author cross-checked these data and assessed quality. We determined the quality of the evidence using GRADE. The small number of included studies limited the pre-planned analyses. MAIN RESULTS We included nine trials about CME, of which six trials with 333 patient-caregiver couples were included in the meta-analysis. The small number of studies, participants, and a variety of outcome measures rendered summarising and combining of data in meta-analysis difficult. In addition, in some studies, CME was the only intervention (CME-core), whereas in other studies, caregivers provided another, existing intervention, such as constraint-induced movement therapy. For trials in the latter category, it was difficult to separate the effects of CME from the effects of the other intervention.We found no significant effect of CME on basic ADL when pooling all trial data post intervention (4 studies; standardised mean difference (SMD) 0.21, 95% confidence interval (CI) -0.02 to 0.44; P = 0.07; moderate-quality evidence) or at follow-up (2 studies; mean difference (MD) 2.69, 95% CI -8.18 to 13.55; P = 0.63; low-quality evidence). In addition, we found no significant effects of CME on extended ADL at post intervention (two studies; SMD 0.07, 95% CI -0.21 to 0.35; P = 0.64; low-quality evidence) or at follow-up (2 studies; SMD 0.11, 95% CI -0.17 to 0.39; P = 0.45; low-quality evidence).Caregiver burden did not increase at the end of the intervention (2 studies; SMD -0.04, 95% CI -0.45 to 0.37; P = 0.86; moderate-quality evidence) or at follow-up (1 study; MD 0.60, 95% CI -0.71 to 1.91; P = 0.37; very low-quality evidence).At the end of intervention, CME significantly improved the secondary outcomes of standing balance (3 studies; SMD 0.53, 95% CI 0.19 to 0.87; P = 0.002; low-quality evidence) and quality of life (1 study; physical functioning: MD 12.40, 95% CI 1.67 to 23.13; P = 0.02; mobility: MD 18.20, 95% CI 7.54 to 28.86; P = 0.0008; general recovery: MD 15.10, 95% CI 8.44 to 21.76; P < 0.00001; very low-quality evidence). At follow-up, we found a significant effect in favour of CME for Six-Minute Walking Test distance (1 study; MD 109.50 m, 95% CI 17.12 to 201.88; P = 0.02; very low-quality evidence). We also found a significant effect in favour of the control group at the end of intervention, regarding performance time on the Wolf Motor Function test (2 studies; MD -1.72, 95% CI -2.23 to -1.21; P < 0.00001; low-quality evidence). We found no significant effects for the other secondary outcomes (i.e. PATIENT motor impairment, upper limb function, mood, fatigue, length of stay and adverse events; caregiver: mood and quality of life).In contrast to the primary analysis, sensitivity analysis of CME-core showed a significant effect of CME on basic ADL post intervention (2 studies; MD 9.45, 95% CI 2.11 to 16.78; P = 0.01; moderate-quality evidence).The methodological quality of the included trials and variability in interventions (e.g. content, timing, and duration), affected the validity and generalisability of these observed results. AUTHORS' CONCLUSIONS There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.
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Affiliation(s)
- Judith DM Vloothuis
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Marijn Mulder
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
| | - Janne M Veerbeek
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
- VU University Medical CenterDepartment of Rehabilitation Medicine, Physical TherapyDe Boelelaan 1118AmsterdamNoor‐HollandNetherlands1007 MB
| | - Manin Konijnenbelt
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Johanna MA Visser‐Meily
- University Medical Center Utrecht and De HoogstraatBrain Center Rudolf MagnusHeidelberglaan 100PO Box 85500UtrechtNetherlands3508 GA
| | - Johannes CF Ket
- Vrije Universiteit AmsterdamMedical LibraryDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam NeurosciencesDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- Amsterdam Neurosciences, VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamPO Box 7057AmsterdamNetherlands1007 MB
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Merali S, Cameron JI, Barclay R, Salbach NM. Characterising community exercise programmes delivered by fitness instructors for people with neurological conditions: a scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e101-e116. [PMID: 26445890 DOI: 10.1111/hsc.12282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 06/05/2023]
Abstract
A scoping review was conducted to characterise evaluations of community-based exercise programmes (CBEPs) delivered by fitness instructors to people with neurological conditions. Literature published from 1946 to April 2014 in MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and the grey literature were searched. Search terms included community, programme, exercise, adult, brain disease and spinal cord disease. Two reviewers independently screened titles and abstracts for inclusion. One author reviewed full-text articles to evaluate eligibility. Studies were included if the study objective was to evaluate an exercise programme, the programme was community-based and delivered by fitness instructors, exercise participants were ≥18 years of age and had a neurological condition, and a full-text article was available and written in English. After reviewing 1785 titles and abstracts, 18 (1.01%) articles describing 15 studies were included in the review. One author completed data abstraction from the included studies. A second reviewer independently verified the extracted data for accuracy. Exercise programmes most commonly included people with stroke (47%) and Parkinson's disease (40%), incorporated a stand-alone (80%), multi-component (20%), group (67%), individual (20%) and combined format (13%), strength training (40%) and functional/task-oriented training (40%), reported a minimum walking requirement (67%), and involved a healthcare professional (HCP) with various roles (53%), including training (27%), advising and supporting (33%). The most commonly examined participant outcomes were health-related quality of life (60%) and functional balance (47%). More research is needed to develop CBEPs targeting individuals with low ambulatory function and multiple neurological conditions, to develop recommendations for the involvement of HCPs in CBEPs and document their involvement, and to evaluate system-level outcomes such as cost, healthcare utilisation and impact on caregivers. The findings support a number of considerations to guide future research into CBEPs delivered by fitness instructors for individuals with neurological conditions.
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Affiliation(s)
- Saira Merali
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Barclay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
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Crowe C, Coen RF, Kidd N, Hevey D, Cooney J, Harbison J. A qualitative study of the experience of psychological distress post-stroke. J Health Psychol 2016; 21:2572-2579. [DOI: 10.1177/1359105315581067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is little qualitative data on the emotional effect of stroke upon which to base hypotheses for psychological interventions. We used Interpretative Phenomenological Analysis of semi-structured interviews with 10 individuals in the clinical range for psychological distress on the Hospital Anxiety and Depression Scale to explore their experiences of psychological distress. Three super-ordinate themes (the fear of stroke, loss of self and sense of isolation and aloneness) emerged. Processes involving a lack of acceptance and self-compassion underlined these themes. Internal isolation was found as a great problem. These themes may indicate targets for directed psychological interventions in people following stroke.
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Yu S, Muhunthan J, Lindley R, Glozier N, Jan S, Anderson C, Li Q, Hackett ML. Driving in stroke survivors aged 18–65 years: The Psychosocial Outcomes In StrokE (POISE) Cohort Study. Int J Stroke 2016; 11:799-806. [DOI: 10.1177/1747493016641952] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/21/2015] [Indexed: 11/15/2022]
Abstract
Background There is limited information regarding return to driving after stroke. Aims To determine the frequency and predictors of return to driving within 1 month of acute stroke in younger (age 18–65 years) adults. Methods POISE (Psychosocial Outcomes In StrokE) was a cohort study conducted in Australia between October 2008 and June 2010. Consecutive patients (age 18–65 years) with a recent (≤28 days) acute stroke were recruited. Validated demographic, clinical, mental health, cognitive, and disability measures including return to driving were obtained. Multivariable logistic regression was used to determine factors associated with return to driving within 1 month of stroke. Results Among 359 participants who were legally able to drive before stroke, 96 (26.7%) returned to driving within 1 month. Compared to those without an early return to driving ( n = 263), drivers were more often male, the main income earner, in paid work before stroke and without symptoms of depression or fatigue. Independence in activities of daily living (odds ratio (OR) 30.05, 95% confidence interval (CI) 3.85–234.45), not recalling receiving advice on driving cessation (OR 5.55, 95% CI 2.86–11.11), and having returned to paid work (OR 3.93, 95% CI 1.94–7.96) were associated with early return to driving. Conclusions One in four young adults resumed driving within a month, contrary to guideline recommendations. These data reinforce the importance of deciding who is responsible for determining fitness to drive after stroke, when, and whether it is reasonable to enforce driving restrictions on those with minimal disability who are fit to return to work. Registration Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325.
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Affiliation(s)
- Sungwook Yu
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
- The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Janani Muhunthan
- The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Richard Lindley
- The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Nick Glozier
- Psychological Medicine, Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Craig Anderson
- The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Qiang Li
- The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
- School of Health, The University of Central Lancashire, Preston, UK
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Maratos M, Huynh L, Tan J, Lui J, Jarus T. Picture This: Exploring the Lived Experience of High-Functioning Stroke Survivors Using Photovoice. QUALITATIVE HEALTH RESEARCH 2016; 26:1055-1066. [PMID: 27194645 DOI: 10.1177/1049732316648114] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An increasing number of high-functioning stroke survivors are present with minimal functional impairments and are often discharged with reduced access to community reintegration. Our objectives were to explore the lived experience of high-functioning stroke survivors and to identify gaps in community and rehabilitation services. Photovoice was used with five high-functioning stroke survivors to photo-document their experiences. A modified inductive thematic analysis was used, and meanings behind the photographs were elicited through four focus group sessions followed by photography exhibitions. Five themes emerged: lack of understanding and consideration for persons with disability, emotional and behavioral impacts after stroke, self-reliance and dependence on others, importance of appropriate and accessible services, and financial determinants of quality of life. By including service users' voices; investing in adapted, community-based programs; and providing educational programs for creating attitudinal change among service providers, the polarization between who can and cannot access services will be reduced.
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Affiliation(s)
- Marie Maratos
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Linh Huynh
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Tan
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordon Lui
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tal Jarus
- The University of British Columbia, Vancouver, British Columbia, Canada
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Shook R, Stanton S. Patients' and caregivers' self-perceived stroke education needs in inpatient rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.6.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Shook
- Clinical specialist, Neurological Rehabilitation, Providence Health Care Clinical Instructor, University of British Columbia, Vancouver, BC, Canada
| | - Sue Stanton
- Director, Rehabilitation Science Online Programs and Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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Promoting Optimal Physical Exercise for Life: An Exercise and Self-Management Program to Encourage Participation in Physical Activity after Discharge from Stroke Rehabilitation-A Feasibility Study. Stroke Res Treat 2016; 2016:9476541. [PMID: 27313948 PMCID: PMC4904109 DOI: 10.1155/2016/9476541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/13/2016] [Accepted: 04/20/2016] [Indexed: 02/03/2023] Open
Abstract
People with stroke do not achieve adequate levels of physical exercise following discharge from rehabilitation. We developed a group exercise and self-management program (PROPEL), delivered during stroke rehabilitation, to promote uptake of physical activity after discharge. This study aimed to establish the feasibility of a larger study to evaluate the effect of this program on participation in self-directed physical activity. Participants with subacute stroke were recruited at discharge from one of three rehabilitation hospitals; one hospital offered the PROPEL program whereas the other two did not (comparison group; COMP). A high proportion (11/16) of eligible PROPEL program participants consented to the study. Fifteen COMP participants were also recruited. Compliance with wearing an accelerometer for 6 weeks continuously and completing physical activity questionnaires was high (>80%), whereas only 34% of daily heart rate data were available. Individuals who completed the PROPEL program seemed to have higher outcome expectations for exercise, fewer barriers to physical activity, and higher participation in physical activity than COMP participants (Hedge's g ≥ 0.5). The PROPEL program delivered during stroke rehabilitation shows promise for reducing barriers to exercise and increasing participation in physical activity after discharge. This study supports feasibility of a larger randomized trial to evaluate this program.
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Prout EC, Mansfield A, McIlroy WE, Brooks D. Patients’ perspectives on aerobic exercise early after stroke. Disabil Rehabil 2016; 39:684-690. [DOI: 10.3109/09638288.2016.1161833] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erik C. Prout
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
| | - Avril Mansfield
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - William E. McIlroy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
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49
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Body, Person and Environment: Why Promoting Physical Activity (PA) with Stroke Survivors Requires Holistic Thinking. BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The role of physical activity (PA) after stroke is increasingly recognised as important for function, fitness and wellbeing. Current evidence shows that targeted PA after stroke improves cardiovascular fitness, walking ability and muscle strength and may ameliorate depression and improve quality of life. Secondary stroke prevention and management of cardiovascular risk factors are further health benefits. Despite increasing emphasis on organised exercise classes for stroke, PA levels remain low and effects of organised exercise interventions are not maintained once programmes have finished. Barriers to PA after stroke are complex and innovative approaches to maintaining and promoting long-term engagement in activity are required. This commentary proposes that using the International Classification of Disability and Functioning (ICF) to guide thinking about PA after stroke may help us develop and apply comprehensive solutions that increase PA levels. This approach considers stroke survivors’ PA engagement in terms of Body – the physical impairments imposed by stroke; Person – the role of identity, and psychological factors on PA; and Environment – the physical and social environments that influence PA engagement. The commentary discusses how innovative solutions addressing these issues may enable stroke survivors to be better supported to lead active lifestyles.
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Reunanen MAT, Järvikoski A, Talvitie U, Pyöriä O, Härkäpää K. Individualised home-based rehabilitation after stroke in eastern Finland--the client's perspective. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:77-85. [PMID: 25676161 DOI: 10.1111/hsc.12190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
Reintegration into society is one of the main purposes of post-stroke rehabilitation. The experiences of clients returning home after a stroke have been studied before. There is, however, little knowledge about activities carried out during home-based rehabilitation interventions and about the involvement of clients in the process. This study focused on clients' experiences of a 3-month individualised, home-based rehabilitation programme supervised by a multidisciplinary team. The data were collected in 2009-2010, and it was based on interviews with 14 clients (48-83 years of age) conducted approximately 7 months after stroke. In the thematic analysis, five main topics describing the goals and functions of the home-based rehabilitation were identified as follows: (i) learning strategies for solving problems in daily activities at home and in the community; (ii) receiving exercise coaching; (iii) exploring community services and facilities; (iv) having a dialogue with professionals; and (v) engaging in activities aimed at returning to work. Implementing rehabilitation activities in the home environment seemed to enhance the participants' active involvement and their ability to evaluate themselves and to set goals for their recovery. Work was an important goal for clients of working age, but work-related tasks were not sufficiently integrated with home-based rehabilitation. A challenge for local communities is to provide health promotion and recreation services that are also suitable for persons with limited functioning.
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Affiliation(s)
- Merja A T Reunanen
- Department of Health Care, Mikkeli University of Applied Sciences, Savonlinna, Finland
| | - Aila Järvikoski
- Faculty of Social Sciences, University of Lapland, Rovaniemi, Finland
| | - Ulla Talvitie
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Outi Pyöriä
- Department of Health Care, Mikkeli University of Applied Sciences, Savonlinna, Finland
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