1
|
Wade DT. A general theory of rehabilitation: Rehabilitation catalyses and assists adaptation to illness. Clin Rehabil 2024; 38:429-442. [PMID: 37885405 PMCID: PMC10898207 DOI: 10.1177/02692155231210151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND There is no general theory of rehabilitation, only definitions and descriptions, with the biopsychosocial model of illness as a structure. OBJECTIVE To develop a general theory of rehabilitation that explains how healthcare rehabilitation changes outcomes and to evaluate its validity. NEED A general rehabilitation theory would help research, improve services, increase understanding, modify resource allocation and explain some anomalies, such as how rehabilitation helps when no natural recovery occurs. BUILDING BLOCKS People adapt to change throughout their lives. Illness is a change, and people adapt to their illness. Adaptation's purpose is to maintain an equilibrium in a person's life. The balanced components are related to Maslow's five needs: basic, safety, affiliation, status and self-fulfilment. The general theory of behaviour suggests that a person's behaviours change to maintain balance, regulated by a central homeostatic mechanism. THE THEORY Rehabilitation aids adaptation to changes associated with illness through accurate diagnosis and formulation, catalysing adaptation, optimising the environment and assisting the person in making necessary changes by safely practising activities and teaching self-management. IMPLICATIONS The theory makes the person the central active agent, emphasises the importance of the environment in facilitating adaptation, explains why all conditions may benefit, including progressive and static conditions, suggests that health can be equated to someone maintaining their equilibrium and explains why a small dose may be very effective. CONCLUSION The general theory of rehabilitation emphasises the catalytic effects of rehabilitation in facilitating and guiding adaptation and suggests areas for research and improvement.
Collapse
Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Oxford Brookes University, Oxford, UK
| |
Collapse
|
2
|
de Miranda L, Levi R, Divanoglou A. Tapping into the unimpossible: Philosophical health in lives with spinal cord injury. J Eval Clin Pract 2023; 29:1203-1210. [PMID: 37265003 DOI: 10.1111/jep.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND We investigated the personal philosophies of eight persons with a tetraplegic condition (four male, four female), all living in Sweden with a chronic spinal cord injury (SCI) and all reporting a good life. Our purpose was to discover if there is a philosophical mindset that may play a role in living a good life with a traumatic SCI. METHODS Two rounds of in-depth qualitative interviews were performed by the same interviewer, a philosophical practitioner by training (de Miranda). The second round systematically covered the following elements: bodily sense, sense of self, sense of belonging, sense of the possible, sense of purpose and philosophical sense. This six-step method developed by de Miranda is called SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. RESULTS All the interviewees, as a consequence of their trauma, reported having gone through a reinvention of themselves which implied questioning the meaning and purpose of their life in particular and life in general. A philosophical rather than realistic sense of the possible was abstracted toward teleological growth. All interviewees developed a sense of purpose based on self-interested altruism and solidarity with disabled peers. CONCLUSIONS To reinvent a good life with SCI, in addition to physical training and willpower, one needs to consider philosophical questions about the self and life, what Kant called the cosmic interests of reason: What may I hope? What must I do? What can I know? Our results indicate that we should, in the future, explore what the philosophical health approach may bring to rehabilitation processes in the months or years that follow the trauma.
Collapse
Affiliation(s)
- Luis de Miranda
- Center for Medical Humanities, Uppsala University, Uppsala, Sweden
| | - Richard Levi
- Department of Rehabilitation Medicine, Linköping University Hospital, Linkoping, Sweden
| | - Anestis Divanoglou
- Department of Rehabilitation Medicine, Linköping University Hospital, Linkoping, Sweden
| |
Collapse
|
3
|
Wade DT. Moving on. A farewell from the last Editor-in-Chief who says: 'Rehabilitation is a way of thinking, not a way of doing'. Clin Rehabil 2023; 37:287-293. [PMID: 36203369 DOI: 10.1177/02692155221131248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
What is rehabilitation? From 1994 to 2021, while I was privileged to be Editor of Clinical Rehabilitation, I explored this in editorials. I also encouraged and selected submissions that considered, in one way or another, the central features of rehabilitation. Why? Because when I started in rehabilitation, the general attitude among doctors and other healthcare professionals was that rehabilitation was pleasant but with no evidence of effectiveness. Further, they did not think a doctor had a role to play and did not think there was anything special for rehabilitation experts to know or have skills in. In this editorial, I discuss how, as editor, I used my position to support and encourage the publication of articles that produced evidence, considered the conceptual and scientific basis of rehabilitation, and ultimately answered the above question. I illustrate this with a few specific papers published in Clinical Rehabilitation. After 30 years, I have concluded that the essential feature characterising rehabilitation is its way of thinking about the patient's problems and how to solve them. Rehabilitation is holistic, person-centred, and concerned about social integration rather than disease or disability. Moreover, there is a mass of evidence showing it benefits patients.
Collapse
Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), 6395Oxford Brookes University, Oxford, UK
| |
Collapse
|
4
|
Elemo AS, Kara E, Rostamzadeh M. The fear of COVID-19 and flourishing: the mediating role of search for meaning and presence of meaning. CURRENT PSYCHOLOGY 2022:1-10. [PMID: 36406850 PMCID: PMC9641694 DOI: 10.1007/s12144-022-03872-8] [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] [Accepted: 10/10/2022] [Indexed: 11/10/2022]
Abstract
Past researches have found that sense of control and meaning in life can act as a protective factor against fear of COVID-19 pandemic. The current study examined whether the search for meaning and the presence of meaning could mediate the link between fear of COVID-19 and flourishing. A total of 312 Iranians who were identified by snowball sampling were recruited as the subjects of the cross-sectional study. The participants gave their consent to complete the Meaning in Life Scale, Flourishing Scale, and Fear of COVID-19 Scale. The findings demonstrated that fear of COVID-19 had a significant direct effect on flourishing. The presence meaning was positively and significantly connected with flourishing and the search for meaning. Both the search for - and the presence - of meaning were negatively and significantly linked with fear of COVID-19. Mediation analysis demonstrated that a presence of meaning is a protective factor for flourishing, but the search for meaning can be detrimental to flourishing. As a result, it may be worthwhile to conduct longitudinal research to track how the effects of the presence of meaning and the search for meaning vary over time. The study calls on mental health providers to take into account how the presence of meaning might lessen the negative impacts of fear in crisis situations and promote flourishing.
Collapse
Affiliation(s)
- Aman Sado Elemo
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Ergün Kara
- Department of Educational Sciences, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | | |
Collapse
|
5
|
Nielsen IH, Poulsen I, Larsen K, Larsen NS. Life goals as a driving force in traumatic brain injury rehabilitation: a longitudinal dyadic perspective. Brain Inj 2022; 36:1158-1166. [PMID: 36047479 DOI: 10.1080/02699052.2022.2109748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Traumatic brain injury significantly impacts survivors and their families. Rehabilitation following traumatic brain injury is often complex due to the physical, psychological, and socio-economic problems survivors face. Life goals are considered a motivational factor in rehabilitation. OBJECTIVE The aim was to explore expectations, problems, and strategies for goal setting in survivors of traumatic brain injury and their family caregivers for one-year during rehabilitation. METHODS A longitudinal qualitative study using dyadic interviews with survivors and family caregivers was carried out at three time points during the first year following traumatic brain injury. Data was analyzed according to Braun and Clarke's thematic analysis. RESULTS Eight survivors of traumatic brain injury and their family caregivers completed 24 interviews. Three themes and one sub-theme were identified: 1) life goals as a driving force (subtheme: dyadic discrepancies and conflicts); 2) conflicts between specific, measurable, achievable, realistic, and timed (SMART) goals and life goals; and 3) changing perceptions of the impact of impairments. CONCLUSIONS Life goals are important motivation in the rehabilitation process. Health care professionals must integrate life goals and rehabilitation goals (i.e. SMART goals) to decrease barriers and survivor ambivalence about rehabilitation. Involving both survivors and family caregivers in goal setting increases rehabilitation success.
Collapse
Affiliation(s)
- Iben Husted Nielsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Hvidovre, Denmark.,Department of Nursing and Health Care, Aarhus University, Aarhus C, Denmark
| | - Kristian Larsen
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark.,Copenhagen University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital - Rigshospitalet, Copenhagen N, Denmark.,Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Niels Sandholm Larsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Karhula M, Saukkonen S, Xiong E, Kinnunen A, Heiskanen T, Anttila H. ICF Personal Factors Strengthen Commitment to Person-Centered Rehabilitation – A Scoping Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:709682. [PMID: 36188794 PMCID: PMC9397796 DOI: 10.3389/fresc.2021.709682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 12/03/2022]
Abstract
Background: The International Classification of Functioning, Disability and Health (ICF) classification is a biopsychosocial frame of reference that contributes to a holistic understanding of the functioning of a client and the factors involved. Personal factors (PFs) are not currently classified in the ICF due to large societal and cultural diversity and lack of clarity in the scope of such factors. Aims: To ascertain which factors in the ICF classification have been defined as PFs in different studies and what conclusions have been drawn on their role in the ICF classification. Methods: The study was a scoping review. A systematic search for articles published in 2010–2020 was performed on the Cinahl, Pubmed, ScienceDirect, and Sport Discus databases. The PFs specified in the articles were classified according to the seven categories proposed by Geyh et al. socio-demographic factors; position in the immediate social and physical context; personal history and biography; feelings; thoughts and beliefs; motives; and general patterns of experience and behavior. Results: The search yielded 1,988 studies, of which 226 met the inclusion criteria. The studies had addressed a wide variety of PFs that were linked to all seven categories defined by Geyh et al. Some studies had also defined PFs that were linkable to other components of the ICF or that did not describe functioning. Approximately 22% (51) of the studies discussed the role of PFs in rehabilitation. Conclusions: The range of PFs in the ICF classification addressed in the reviewed studies is wide. PFs play an important role in rehabilitation. However, according to the reviewed studies, a more precise coding of PFs is not yet warranted.
Collapse
Affiliation(s)
- Maarit Karhula
- Sustainable Well-being, Research and Development Department, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
- Kela Research, Social Insurance Institution of Finland, Helsinki, Finland
- *Correspondence: Maarit Karhula
| | - Sari Saukkonen
- Sustainable Well-being, Research and Development Department, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
| | - Essi Xiong
- Social Services and Health Care, Oulu University of Applied Sciences, Oulu, Finland
| | - Anu Kinnunen
- Social Services and Health Care, Savonia University of Applied Sciences, Kuopio, Finland
| | - Tuija Heiskanen
- Kela Research, Social Insurance Institution of Finland, Helsinki, Finland
| | - Heidi Anttila
- Public Health and Welfare Department, Knowledge Management and Co-Creation Unit, Functioning and Service Needs Team, Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
7
|
MacDonald C, Theurer JA, Doyle PC. "Cured" but not "healed": The application of principles of palliative care to cancer survivorship. Soc Sci Med 2021; 275:113802. [PMID: 33714794 DOI: 10.1016/j.socscimed.2021.113802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
Application of principles of palliative care to the concept of survivorship may serve to establish an interdisciplinary approach to guide those treated for cancer through the experience of being "cured" but not "healed". Valuable lessons may be garnered from palliative care if its principles are considered within the context of survivorship. This work aims to define key terms including cured, healed, survivorship, and quality of life (QoL) and delineate the central tenets of palliative care and disease-modifying care. Since pursuit of a cure tends to dominate provision of oncological care, Western society's prevailing death denying attitudes often equate to the prioritization of advanced medial treatment to postpone death. Accordingly, the "modern paradox" of medicine (Cassell, 2004) is examined in consideration of the suffering that often results from advanced medical treatment that is intended to alleviate the cause of suffering and ultimately, "deny" death. However, owing to the profound consequences of advanced medical treatment and the associated losses of function concomitant with cancer, there is an apparent need for a framework of care that attends to these survivorship issues. When the experience of being cured but not healed is articulated through a theoretical discussion of liminality and the "remission society" (Frank, 1995), the applicability of palliative care to survivorship care becomes apparent. By embracing principles of palliative care, survivorship care may be guided by a theoretical foundation that provides cancer survivors with care that supports increased QoL, biopsychosocial symptom management, and a holistic perspective of the illness experience. Accordingly, application of palliative care to survivorship may establish congruence between notions of cured and healed.
Collapse
Affiliation(s)
- Chelsea MacDonald
- Laboratory for Well-Being and Quality of Life in Oncology, Rehabilitation Sciences, Western University, London, ON, N6G 1H1, Canada.
| | - Julie A Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, N6G 1H1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, ON, N6A 5W9, Canada
| | - Philip C Doyle
- Laboratory for Well-Being and Quality of Life in Oncology, Rehabilitation Sciences, Western University, London, ON, N6G 1H1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, ON, N6A 5W9, Canada; Department of Otolaryngology - Head and Neck Surgery Stanford University School of Medicine, Stanford, CA, 94305, USA
| |
Collapse
|
8
|
Dekker J, de Groot V, Ter Steeg AM, Vloothuis J, Holla J, Collette E, Satink T, Post L, Doodeman S, Littooij E. Setting meaningful goals in rehabilitation: rationale and practical tool. Clin Rehabil 2019; 34:3-12. [PMID: 31530186 DOI: 10.1177/0269215519876299] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Goal-setting is a key characteristic of modern rehabilitation. However, goals need to be meaningful and of importance to the client. AXIOMS Both theories and empirical evidence support the importance of a hierarchy of goals: one or more overall goals that clients find personally meaningful and specific goals that are related to the overall goals. We posit that the client's fundamental beliefs, goals and attitudes ("global meaning") need to be explored before setting any rehabilitation goal. A chaplain or other person with similar skills can be involved in doing so in an open-ended way. The client's fundamental beliefs, goals and attitudes serve as a point of departure for setting rehabilitation goals. SETTING GOALS We set out a three-stage process to set goals: (1) exploring the client's global meaning (i.e. fundamental beliefs, goals and attitudes), (2) deriving a meaningful overall rehabilitation goal from the client's global meaning and (3) setting specific rehabilitation goals that serve to achieve the meaningful overall rehabilitation goal. CONCLUSION This is an extension of current practice in many rehabilitation teams, which may help counter the drive toward exclusively functional goals based around independence.
Collapse
Affiliation(s)
- Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Jasmijn Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Emma Collette
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ton Satink
- Department of Occupational Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Lenneke Post
- Department of Spiritual Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Faculty of Religion and Theology, VU University, Amsterdam, The Netherlands
| | - Suzan Doodeman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Elsbeth Littooij
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Effect of a 30-Month Health-Promoting Program on the Prevalence of Cardiovascular Risk Factors in Patients With First Episode Schizophrenia. Am J Ther 2019; 27:e439-e449. [PMID: 30677004 DOI: 10.1097/mjt.0000000000000708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lifestyle interventions aimed at reducing cardiovascular risk factors in patients with first-episode schizophrenia (FES) have shown modest efficacy, probably owing to a short observation period and the presumption of linear trajectories of cardiovascular risk factors. STUDY QUESTION How prevalent are abnormal cardiovascular values in patients with FES and how do cardiovascular risk factors develop during a 30-month program? STUDY DESIGN A 30-month naturalistic longitudinal study of 136 consecutively referred patients with FES from 2 outpatient clinics. The health-promoting program consisted of individual guidance, group sessions, and normal treatment and care. MEASURES AND OUTCOMES The prevalence of abnormal cardiovascular risk factors (body mass index, waist circumference (WC), body fat percentage, systolic and diastolic blood pressure, pulse, total cholesterol, high- and low-density lipoproteins, triglycerides, mean glucose, and visceral adiposity index) was estimated at index. The cardiovascular risk factor trajectories were analyzed with longitudinal mixed-effect models. RESULTS The patient with FES showed elevated cardiovascular risk factors at index. Thus, 56.8% of the patients were overweight in different grades and 50.4% had increased WC. A total of 81.8% had high level of body fat and hypertension prevalence with only 20% with normal blood pressure. Important changes during the intervention period were that the risk factors weight and WC were increasing the first 581 and 646 days, after which they decreased. Almost all cardiovascular risk factors worsened initially, improving after 1-2 years. CONCLUSIONS Patients with FES show increases in cardiovascular risk factors at index. Short observation periods and the presumption of linear trajectories may indicate that the effect of health-promoting programs is ineffective, as the effects are curvilinear and improvements appear only after 1 year. The implication clinically is the importance of a long intervention period regarding lifestyle modifications to ascertain improvement among patients with FES.
Collapse
|
10
|
Freeman J, Gorst T, Gunn H, Robens S. "A non-person to the rest of the world": experiences of social isolation amongst severely impaired people with multiple sclerosis. Disabil Rehabil 2019; 42:2295-2303. [PMID: 30657717 DOI: 10.1080/09638288.2018.1557267] [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: 01/13/2023]
Abstract
Purpose: To gain insight into the experiences of, and potential solutions to, social isolation amongst severely impaired people with multiple sclerosis.Methods: A phenomenological research approach using face-to-face, in-depth semi-structured, audio-recorded interviews. Data were transcribed and analyzed thematically.Results: Sixteen severely impaired people with multiple sclerosis were interviewed (Expanded Disability Status Scale >6.5); aged 38-72 years, nine female, time since diagnosis ranged 3-30 years). Four key themes were generated in line with the study objectives, each with further sub-themes. The themes were (1) Definitions of isolation (2) Causes of isolation (3) Impact of isolation, and (4) Potential eases of isolation.Conclusions: Data portrayed social isolation as complex and multi-factorial in its definitions, its causes, and its impact. Isolation is not just about being lonely or left on one's own, but represents a spiral of impacts. Physical deterioration can lead to reduced choice and control regarding access to, and interaction with others and society, affecting personal identity. Sometimes this leads to further self-isolation. Personalised psychosocial support, with improved ease of access, focused on helping people with severe multiple sclerosis regain a sense of self and their place in the world may ease social isolation.Implications for rehabilitationPeople with severe multiple sclerosis can experience a sense of powerlessness, a lack of choice and control over daily life, leading to changes in self-identity and social isolation.Peoples' experiences are very personal, and any approach to help deal with social isolation needs to be based in considering how to think positively about how life can be lived and how to make that work.Multiple sclerosis support groups should not be assumed to alleviate feelings of social isolation.Interventions should focus on personalized psychosocial input aimed at helping the person with multiple sclerosis regain a sense of self and their place in the world.
Collapse
Affiliation(s)
- Jennifer Freeman
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Terry Gorst
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Hilary Gunn
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Sarah Robens
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| |
Collapse
|
11
|
Barker RN, Hayward KS, Carson RG, Lloyd D, Brauer SG. SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:1005-1016. [DOI: 10.1177/1545968317744276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining. Results. All groups demonstrated a statistically ( P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P = .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57). Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.
Collapse
Affiliation(s)
| | - Kathryn S. Hayward
- The University of Queensland, Brisbane, Queensland, Australia
- James Cook University, Mount Isa, Queensland, Australia
| | - Richard G. Carson
- The University of Queensland, Brisbane, Queensland, Australia
- Trinity College Dublin, Dublin, Ireland
- Queen’s University Belfast, Belfast, UK
| | - David Lloyd
- The University of Queensland, Brisbane, Queensland, Australia
| | | |
Collapse
|
12
|
Chow EO. The role of meaning in life: mediating the effects of perceived knowledge of stroke on depression and life satisfaction among stroke survivors. Clin Rehabil 2017; 31:1664-1673. [PMID: 28516810 PMCID: PMC5697566 DOI: 10.1177/0269215517708604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: Meaning-making is a way of coping when facing adverse events. A paucity of literature suggests other possible factors (e.g. delivery of knowledge) can influence how chronic illness survivors (i.e. stroke survivors in rehabilitation) cope with illness. This article explores the importance and significance of meaning in life as a mediator between perceived stroke knowledge and psychological wellbeing among stroke survivors and how such processes can be applied in practice to promote their psychological wellbeing. Methods: A sample of N = 192 elderly aged 60 or above who experienced a recent stroke completed a survey to assess their levels of cognitive ability, physical function, perceived knowledge of stroke, meaning in life, life satisfaction, and depression. Correlation and mediation analyses using the Sobel test were conducted to clarify the role of meaning in life among stroke survivors. Results: Both perceived knowledge of stroke (r = 0.35, P < 0.001) and meaning in life had positive correlations with life satisfaction (r = 0.37, P < 0.001) and a negative correlation with depression. Analyses revealed that meaning in life is a significant mediator between perceived knowledge of stroke and depression (z = −3.71, P < 0.001) and between perceived knowledge of stroke and life satisfaction (z = 3.97, P < 0.001) in two separate models. Conclusion: The role of meaning in life is clear and can affect the dynamics between knowledge of stroke and one’s psychological wellbeing.
Collapse
Affiliation(s)
- Esther Ow Chow
- Department of Applied Social Studies, City University of Hong Kong, Kowloon, Hong Kong SAR
| |
Collapse
|