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Fernandes JB, Fernandes S, Domingos J, Castro C, Romão A, Graúdo S, Rosa G, Franco T, Ferreira AP, Chambino C, Ferreira B, Courela S, Ferreira MJ, Silva I, Tiago V, Morais MJ, Casal J, Pereira S, Godinho C. Motivational strategies used by health care professionals in stroke survivors in rehabilitation: a scoping review of experimental studies. Front Med (Lausanne) 2024; 11:1384414. [PMID: 38813377 PMCID: PMC11133544 DOI: 10.3389/fmed.2024.1384414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Cognitive and motor impairments are common among stroke survivors. Physical therapy is often used to improve the functional capacity of stroke survivors. However, limited adherence to rehabilitation programs is a challenge. Motivation plays a crucial role in the success of rehabilitation programs as it influences individual adherence to treatment and overall health outcomes. This review aims to identify current trends in motivational strategies used by healthcare professionals for stroke survivor rehabilitation. Methods Following the framework developed by Arksey and O'Malley, a scoping review was conducted. We performed a literature search using MEDLINE, CINAHL, the Cochrane Central Register of Controlled Trials, Nursing & Allied Health, and MedicLatina databases. Results A total of 906 papers were identified. After selecting and analyzing the articles, 17 papers were included in this review. Health professionals use various strategies to motivate stroke survivors. These approaches include establishing a therapeutic alliance, improving patients' health literacy, defining realistic goals, fostering problem-solving skills, personalizing the rehabilitation program, showcasing success stories, utilizing persuasive techniques, offering encouragement and compliments, providing emotional support, and effectively managing symptoms. Conclusion The knowledge gathered in this review can guide healthcare professionals in helping patients overcome barriers to rehabilitation, improve their motivation, and ultimately enhance their recovery outcomes.
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Affiliation(s)
- Júlio Belo Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Sónia Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Josefa Domingos
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
| | - Cidália Castro
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Ana Romão
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Susana Graúdo
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Gonçalo Rosa
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Tânia Franco
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Patrícia Ferreira
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Claudine Chambino
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Bruno Ferreira
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Susana Courela
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Maria José Ferreira
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Isabel Silva
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, Hospital Garcia de Orta, Almada, Portugal
| | - Vera Tiago
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, ACeS Almada-Seixal, UCC Seixal, Seixal, Portugal
| | - Maria João Morais
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, ACeS Almada-Seixal, UCC Seixal, Seixal, Portugal
| | - Joana Casal
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, ACeS Almada-Seixal, UCC Seixal, Seixal, Portugal
| | - Silvia Pereira
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, ACeS Almada-Seixal, UCC Seixal, Seixal, Portugal
| | - Catarina Godinho
- Department of Nursing, Unidade Local de Saúde de Almada-Seixal, ACeS Almada-Seixal, UCC Seixal, Seixal, Portugal
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Nguyen TTN, Liang SY, Liu CY, Nguyen HD. Translation and Psychometric Properties of the Strategies Used by People to Promote a Health Instrument for the Assessment of Self-Care Self-Efficacy among Patients Undergoing Hemodialysis in Vietnam. Healthcare (Basel) 2023; 11:healthcare11111644. [PMID: 37297785 DOI: 10.3390/healthcare11111644] [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: 05/08/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Self-care and self-efficacy play an important role in predicting quality of life among patients undergoing hemodialysis, but there currently is a lack of an instrument in the Vietnamese language for assessing self-care and self-efficacy. This limits the ability of researchers to explore and determine the confidence patients have in their ability to perform relevant self-care activities. The purpose of this investigation was to assess the validity and reliability of the Strategies Used by People to Promote Health questionnaire-Vietnamese version. This cross-sectional study involved translation, validation, and cultural adaptation of the questionnaire into Vietnamese and a trial with 127 patients undergoing hemodialysis in Bach Mai Hospital (Hanoi, Vietnam). The questionnaire was translated by bilingual translators and validated by three experts. Internal consistency and confirmatory factor analysis were applied. This questionnaire demonstrated good content validity and a Cronbach's alpha of 0.95 for the total scale. Confirmatory factor analysis of the three-factor model showed moderate model fit (comparative fit index = 0.84, Tucker-Lewis coefficient = 0.82, root mean square error of approximation = 0.09). Overall, this questionnaire exhibited acceptable validity and reliability for measuring self-care and self-efficacy among patients undergoing hemodialysis.
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Affiliation(s)
- Thi Thuy Nga Nguyen
- Faculty of Nursing and Midwifery, Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi 116177, Vietnam
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Peitou, Taipei 112, Taiwan
| | - Chieh-Yu Liu
- College of Health Technology, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Peitou, Taipei 112, Taiwan
| | - Huu Dung Nguyen
- Nephro-Urology-Dialysis Center, Bach Mai Hospital, No 78, Giai Phong Street, Dong Da District, Hanoi 116177, Vietnam
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Verrienti G, Raccagni C, Lombardozzi G, De Bartolo D, Iosa M. Motivation as a Measurable Outcome in Stroke Rehabilitation: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4187. [PMID: 36901206 PMCID: PMC10001639 DOI: 10.3390/ijerph20054187] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Motivated behaviours are thought to lead to enhanced performances. In the neurorehabilitation field, motivation has been demonstrated to be a link between cognition and motor performance, therefore playing an important role upon rehabilitation outcome determining factors. While motivation-enhancing interventions have been frequently investigated, a common and reliable motivation assessment strategy has not been established yet. This review aims to systematically explore and provide a comparison among the existing motivation assessment tools concerning stroke rehabilitation. For this purpose, a literature search (PubMed and Google Scholar) was performed, using the following Medical Subject Headings terms: "assessment" OR "scale" AND "motivation" AND "stroke" AND "rehabilitation". In all, 31 randomized clinical trials and 15 clinical trials were examined. The existing assessment tools can be grouped into two categories: the first mirroring the trade-off between patients and rehabilitation, the latter reflecting the link between patients and interventions. Furthermore, we presented assessment tools which reflect participation level or apathy, as an indirect index of motivation. In conclusion, we are left to put forth a possible common motivation assessment strategy, which might provide valuable incentive to investigate in future research.
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Affiliation(s)
- Giulio Verrienti
- Department of Neurorehabilitation, Casa di Cura Villa Verde, 73100 Lecce, Italy
| | - Cecilia Raccagni
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 39100 Bolzano, Italy
- Department of Neurology, Innsbruck Medical University, 6030 Innsbruck, Austria
| | | | | | - Marco Iosa
- Smart Lab, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
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Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev 2021; 11:CD001919. [PMID: 34813082 PMCID: PMC8610078 DOI: 10.1002/14651858.cd001919.pub4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety. SEARCH METHODS We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews. SELECTION CRITERIA Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence. MAIN RESULTS We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being. AUTHORS' CONCLUSIONS Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
| | - Peter Knapp
- Department of Health Sciences, University of York and the Hull York Medical School, York, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
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Tamburri LM, Hollender KD, Orzano D. Protecting Patient Safety and Preventing Modifiable Complications After Acute Ischemic Stroke. Crit Care Nurse 2020; 40:56-65. [PMID: 32006035 DOI: 10.4037/ccn2020859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
TOPIC Protecting patient safety and preventing modifiable complications after acute ischemic stroke. CLINICAL RELEVANCE Stroke is a leading cause of death and disability in adults. Stroke survivors often experience a variety of deficits related to mobility, nutrition, immunity, mood, and cognition. These post-stroke complications and residual effects can adversely affect safety, placing the patient at risk for further injury. In order to develop a plan of care that protects patient safety, critical care and progressive care nurses must understand the unique needs of this patient population. PURPOSE To describe selected ischemic stroke-related physiological changes, how these changes contribute to safety risks, and methods of enhancing patient safety. CONTENT COVERED Stroke physiology and stroke-specific interventions that can enable nurses to reduce the risk of falls, dysphagia, malnutrition, dehydration, altered glucose metabolism, device-related infections, aspiration pneumonia, delirium, and depression.
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Affiliation(s)
- Linda M Tamburri
- Linda M. Tamburri is a clinical nurse specialist, Magnet/Quality Department, critical care float pool, and specialty care transport unit, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Kimberly D Hollender
- Kimberly D. Hollender and Devon Orzano are acute care nurse practitioners, stroke neurology and neurocritical care, Robert Wood Johnson University Hospital
| | - Devon Orzano
- Kimberly D. Hollender and Devon Orzano are acute care nurse practitioners, stroke neurology and neurocritical care, Robert Wood Johnson University Hospital
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Scobbie L, Duncan EAS, Brady MC, Thomson K, Wyke S. Facilitators and "deal breakers": a mixed methods study investigating implementation of the Goal setting and action planning (G-AP) framework in community rehabilitation teams. BMC Health Serv Res 2020; 20:791. [PMID: 32843039 PMCID: PMC7447562 DOI: 10.1186/s12913-020-05651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation. METHODS We approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively. RESULTS We recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%, 51/55) participated in G-AP training; of those, 80% (n = 41/51) completed the training questionnaire. Training was rated as 'good' or 'very good' by almost all staff (92%, n = 37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP 'made sense'; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor 'fit' between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records. CONCLUSIONS The interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation "deal breakers". Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.
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Affiliation(s)
- Lesley Scobbie
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - Edward A. S. Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8R2 Scotland
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Brick R, Skidmore E. Optimizing Cancer Rehabilitation through Activity-focused Approaches. Semin Oncol Nurs 2020; 36:150985. [DOI: 10.1016/j.soncn.2019.150985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Zhao FY, Yue YY, Li L, Lang SY, Wang MW, Du XD, Deng YL, Wu AQ, Yuan YG. Clinical practice guidelines for post-stroke depression in China. ACTA ACUST UNITED AC 2018; 40:325-334. [PMID: 29412338 PMCID: PMC6899404 DOI: 10.1590/1516-4446-2017-2343] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
Abstract
Post-stroke depression (PSD) is a very common complication that leads to increased physical disability, poor functional outcome, and higher mortality. Therefore, early detection and treatment are very important. Since there are currently no specific guidelines for this disorder in China, the purpose of this study was to develop PSD guidelines and provide suggestions for clinicians and related workers.
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Affiliation(s)
- Fu-Ying Zhao
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Ying-Ying Yue
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Lei Li
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Sen-Yang Lang
- Department of Psychology, General Hospital of the People's Liberation Army, Beijing, China.,Chinese Society of Psychosomatic Medicine, Beijing, China
| | - Ming-Wei Wang
- Chinese Society of Psychosomatic Medicine, Beijing, China.,Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiang-Dong Du
- Chinese Society of Psychosomatic Medicine, Beijing, China.,Suzhou Psychiatric Hospital (The Affiliated Guangji Hospital of Soochow University), Suzhou, China
| | - Yun-Long Deng
- Chinese Society of Psychosomatic Medicine, Beijing, China.,Institute of Psychosomatic Health of Central South University, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ai-Qin Wu
- Chinese Society of Psychosomatic Medicine, Beijing, China.,Department of Psychosomatics, The Affiliated First Hospital of Soochow University, Suzhou, China
| | - Yong-Gui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China.,Chinese Society of Psychosomatic Medicine, Beijing, China
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Graven C, Brock K, Hill KD, Cotton S, Joubert L. First Year After Stroke: An Integrated Approach Focusing on Participation Goals Aiming to Reduce Depressive Symptoms. Stroke 2016; 47:2820-2827. [PMID: 27738234 DOI: 10.1161/strokeaha.116.013081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Depression is a common issue after stroke. A focus on assisting people to achieve their personal participation goals may reduce levels of depression. The aim of this study was to investigate the effectiveness of a person-centered, integrated approach on facilitating goal achievement in the first year poststroke on depressive symptoms. METHODS This study was a randomized controlled trial that addressed ways to enhance participation in patient-valued activities and intermittently screen for adverse sequelae postdischarge from rehabilitation. Collaborative goal setting was undertaken in both groups at discharge from inpatient rehabilitation. The control group received standard management as determined by the treating team. In addition, the intervention group received a multimodal approach, including telephone contacts, screening for adverse sequelae, written information, home visits, review of goal achievement, and further referral to relevant health services. The main outcome measure was depressed mood, measured by the 15-item Geriatric Depression Scale. RESULTS One hundred ten participants were recruited. No group differences were identified at baseline on any demographic and clinical variables. Using multiple linear regression analysis, there was a significant difference between the 2 groups with respect to the severity of depressive symptoms at 12 months poststroke (R2=0.366; F (6, 89)=8.57; P<0.005), with the intervention group recording lower depressive scores. CONCLUSIONS This model of community-based rehabilitation proved effective in reducing poststroke depressive symptoms. An integrated approach using pursuit of patient-identified activities should form part of routine poststroke management. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN12608000042347.
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Affiliation(s)
- Christine Graven
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia.
| | - Kim Brock
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
| | - Keith D Hill
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
| | - Sue Cotton
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
| | - Lynette Joubert
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
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10
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Fryer CE, Luker JA, McDonnell MN, Hillier SL. Self management programmes for quality of life in people with stroke. Cochrane Database Syst Rev 2016; 2016:CD010442. [PMID: 27545611 PMCID: PMC6450423 DOI: 10.1002/14651858.cd010442.pub2] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Stroke results from an acute lack of blood supply to the brain and becomes a chronic health condition for millions of survivors around the world. Self management can offer stroke survivors a pathway to promote their recovery. Self management programmes for people with stroke can include specific education about the stroke and likely effects but essentially, also focusses on skills training to encourage people to take an active part in their management. Such skills training can include problem-solving, goal-setting, decision-making, and coping skills. OBJECTIVES To assess the effects of self management interventions on the quality of life of adults with stroke who are living in the community, compared with inactive or active (usual care) control interventions. SEARCH METHODS We searched the following databases from inception to April 2016: the Cochrane Stroke Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, Web of Science, OTSeeker, OT Search, PEDro, REHABDATA, and DARE. We also searched the following trial registries: ClinicalTrials.gov, Stroke Trials Registry, Current Controlled Trials, World Health Organization, and Australian New Zealand Clinical Trials Registry. SELECTION CRITERIA We included randomised controlled trials of adults with stroke living in the community who received self management interventions. These interventions included more than one component of self management or targeted more than a single domain of change, or both. Interventions were compared with either an inactive control (waiting list or usual care) or active control (alternate intervention such as education only). Measured outcomes included changes in quality of life, self efficacy, activity or participation levels, impairments, health service usage, health behaviours (such as medication adherence or lifestyle behaviours), cost, participant satisfaction, or adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently extracted prespecified data from all included studies and assessed trial quality and risk of bias. We performed meta-analyses where possible to pool results. MAIN RESULTS We included 14 trials with 1863 participants. Evidence from six studies showed that self management programmes improved quality of life in people with stroke (standardised mean difference (SMD) random effects 0.34, 95% confidence interval (CI) 0.05 to 0.62, P = 0.02; moderate quality evidence) and improved self efficacy (SMD, random effects 0.33, 95% CI 0.04 to 0.61, P = 0.03; low quality evidence) compared with usual care. Individual studies reported benefits for health-related behaviours such as reduced use of health services, smoking, and alcohol intake, as well as improved diet and attitude. However, there was no superior effect for such programmes in the domains of locus of control, activities of daily living, medication adherence, participation, or mood. Statistical heterogeneity was mostly low; however, there was much variation in the types and delivery of programmes. Risk of bias was relatively low for complex intervention clinical trials where participants and personnel could not be blinded. AUTHORS' CONCLUSIONS The current evidence indicates that self management programmes may benefit people with stroke who are living in the community. The benefits of such programmes lie in improved quality of life and self efficacy. These are all well-recognised goals for people after stroke. There is evidence for many modes of delivery and examples of tailoring content to the target group. Leaders were usually professionals but peers (stroke survivors and carers) were also reported - the commonality is being trained and expert in stroke and its consequences. It would be beneficial for further research to be focused on identifying key features of effective self management programmes and assessing their cost-effectiveness.
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Affiliation(s)
- Caroline E Fryer
- University of South Australia (City East)International Centre for Allied Health Evidence, Sansom Institute for Health ResearchNorth TceAdelaideSAAustralia5000
| | - Julie A Luker
- University of South Australia (City East)International Centre for Allied Health Evidence, Sansom Institute for Health ResearchNorth TceAdelaideSAAustralia5000
- Florey Institute of Neuroscience and Mental Health245 Burgundy StreetHeidelbergVictoriaAustralia3081
- NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain RecoveryHeidelberg, VICAustralia
| | - Michelle N McDonnell
- University of South Australia (City East)International Centre for Allied Health Evidence, Sansom Institute for Health ResearchNorth TceAdelaideSAAustralia5000
| | - Susan L Hillier
- University of South Australia (City East)Sansom Institute for Health ResearchNorth TerraceAdelaideSAAustralia5000
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Currin M, Patterson S, McGhee H, Kuipers P. Embedding Socio-Behavioral Frameworks in Community Rehabilitation: Evaluation of a Service Change Program. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2016. [DOI: 10.1080/02703181.2016.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michelle Currin
- Community Adult Rehabilitation Service, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
| | - Sarah Patterson
- Community Adult Rehabilitation Service, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
| | - Hannah McGhee
- Community Adult Rehabilitation Service, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
| | - Pim Kuipers
- Centre for Functioning & Health Research, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Logan, Queensland, Australia
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Abstract
Stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; however, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases suicide risk, especially among women and younger patients. The aim of the current review is to investigate the relationship between suicide and stroke in order to determine which stroke patients are at elevated risk for suicide. Moreover, we review the literature in order to provide pharmacological treatment strategies for stroke patients at high risk of suicide. We performed a careful search to identify articles and book chapters focused on this issue, selecting only English-language articles published from 1990 to 2014 that addressed the issue of suicide after stroke and its pharmacological management. We found 12 clinical trials that explored the relationship between stroke and suicidal ideation and/or suicidal plans and 11 investigating suicide as the cause of death after stroke. We identified stroke as a significant risk factor for both suicide and suicidal ideation, especially among younger adult depressed patients in all articles, providing further support for the association between post-stroke and suicidality. Suicide risk is particularly high in the first 5 years following stroke. Depression, previous mood disorder, prior history of stroke, and cognitive impairment were found to be the most important risk factors for suicide. Selective serotonin reuptake inhibitors (SSRIs) represent the treatment of choice for stroke survivors with suicide risk, and studies in rats have suggested that carbolithium is a promising treatment in these patients. Early identification and treatment of post-stroke depression may significantly reduce suicide risk in stroke patients.
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Pesola F, Williams J, Bird V, Freidl M, Le Boutillier C, Leamy M, Macpherson R, Slade M. Development and evaluation of an Individualized Outcome Measure (IOM) for randomized controlled trials in mental health. Int J Methods Psychiatr Res 2015; 24:257-65. [PMID: 26184686 PMCID: PMC6878370 DOI: 10.1002/mpr.1480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 11/05/2022] Open
Abstract
Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n = 20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalized Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a pre-defined list at baseline, and complete a standardized questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n = 84). IOM was then evaluated in a RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Francesca Pesola
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | - Julie Williams
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | - Victoria Bird
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | - Marion Freidl
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK.,Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Clair Le Boutillier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | - Mary Leamy
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | | | - Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
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Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: A systematic scoping review. Brain Inj 2015; 29:1515-29. [DOI: 10.3109/02699052.2015.1075152] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Levack WMM, Weatherall M, Hay‐Smith EJC, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev 2015; 2015:CD009727. [PMID: 26189709 PMCID: PMC8941379 DOI: 10.1002/14651858.cd009727.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation. OBJECTIVES To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability. DATA COLLECTION AND ANALYSIS Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information. MAIN RESULTS We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation. AUTHORS' CONCLUSIONS There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.
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Affiliation(s)
- William MM Levack
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Mark Weatherall
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - E. Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Sarah G Dean
- University of ExeterUniversity of Exeter Medical SchoolVeysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
| | - Kathryn McPherson
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
| | - Richard J Siegert
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
- Auckland University of TechnologySchool of Public Health and Psychosocial StudiesAucklandNew Zealand
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Mayo NE, Anderson S, Barclay R, Cameron JI, Desrosiers J, Eng JJ, Huijbregts M, Kagan A, MacKay-Lyons M, Moriello C, Richards CL, Salbach NM, Scott SC, Teasell R, Bayley M. Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke. Clin Rehabil 2015; 29:1198-211. [DOI: 10.1177/0269215514565396] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 12/01/2014] [Indexed: 11/15/2022]
Abstract
Objective: To enhance participation post stroke through a structured, community-based program. Design: A controlled trial with random allocation to immediate or four-month delayed entry. Setting: Eleven community sites in seven Canadian cities. Subjects: Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. Interventions: Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. Main measures: Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months. Results: A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97). Conclusions: Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Sharon Anderson
- Department of Human Ecology, University of Alberta, Alberta, Canada
| | - Ruth Barclay
- Department of Physical Therapy, University of Manitoba, Manitoba, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Johanne Desrosiers
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Maria Huijbregts
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Aura Kagan
- Education and Applied Research, Aphasia Institute – The Pat Arato Aphasia Centre, Toronto, ON, Canada
| | | | - Carolina Moriello
- McGill University Health Center (MUHC), MUHC Research Institute, Montreal, QC, Canada
| | - Carol L Richards
- Department of Rehabilitation and Center for Interdisciplinary Research in Rehabilitation and Social Integration, Laval University, Quebec, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Susan C Scott
- Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Robert Teasell
- Department of Physical Medicine and Rehabilitation, Western University, London, UK
| | - Mark Bayley
- Brain and Spinal Cord Rehab Program, UHN-Toronto Rehabilitation Institute, Toronto, ON, Canada
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Affiliation(s)
- Min Kyun Son
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Korea
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18
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Hariohm K, Prakash V. Deep flexion activity training in a patient with stroke using task-oriented exercise: a case report. Physiother Theory Pract 2013; 30:196-201. [PMID: 24188030 DOI: 10.3109/09593985.2013.850564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Many individuals with stroke express desires to resume activities involving deep knee flexion, such as daily living, work-related, and sports activities. However, training methods for improving deep flexion activities have not commonly been reported in the stroke rehabilitation literature. The purpose of this case report is to describe the development of a task-oriented training program and demonstrate its use in improving deep flexion activities in an individual with sub-acute hemiplegia. CASE DESCRIPTION The patient was a 55-year-old shoe salesman diagnosed with ischemic stroke 6 weeks before physical therapy evaluation. His primary concerns were functional activities that required deep flexion, such as the inability to squat and to maintain a squatting position in the Eastern toilet and difficulty in performing work-related activities (e.g. fitting shoes for customers while sitting on a low stool). INTERVENTION We developed a task-oriented training program that specifically targeted deep flexion activities. The first phase of training consisted primarily of practicing sit-to-stand on a low stool and the second phase consisted of practicing squatting. OUTCOMES After 6 weeks of intervention, the patient achieved more than the expected outcome on the Goal Attainment Scale (score = +2) for both primary goals and reported positive changes in social participation, such as visiting his friends and relatives and praying at the temple. DISCUSSION The task-oriented deep flexion activity intervention was associated with positive changes in functional activity and social participation in a patient recovering from stroke.
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Affiliation(s)
- K Hariohm
- MSAJ College of Physiotherapy , Chennai, Tamil Nadu , India and
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19
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Forster A, Brown L, Smith J, House A, Knapp P, Wright JJ, Young J. Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev 2012; 11:CD001919. [PMID: 23152210 PMCID: PMC6544775 DOI: 10.1002/14651858.cd001919.pub3] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES To assess the effectiveness of information provision strategies in improving the outcome for stroke patients or their identified caregivers, or both. SEARCH METHODS For this update we searched the Cochrane Stroke Group Trials Register (June 2012), the Cochrane Central Register of Controlled trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the NHS Economic Evaluation Database (EED), and the Health Technology Assessment (HTA) Database (The Cochrane Library June, 2012), MEDLINE (1966 to June 2012), EMBASE (1980 to June 2012), CINAHL (1982 to June 2012) and PsycINFO (1974 to June 2012). We also searched ongoing trials registers, scanned bibliographies of relevant articles and books and contacted researchers. SELECTION CRITERIA Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood. MAIN RESULTS We have added four new trials to this update. This review now includes 21 trials involving 2289 patient and 1290 carer participants. Nine trials evaluated a passive and 12 trials an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient knowledge (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.12 to 0.46, P < 0.001), carer knowledge (SMD 0.74, 95% CI 0.06 to 1.43, P = 0.03), one aspect of patient satisfaction (odds ratio (OR) 2.07, 95% CI 1.33 to 3.23, P = 0.001), and patient depression scores (mean difference (MD) -0.52, 95% CI -0.93 to -0.10, P = 0.01). There was no significant effect (P > 0.05) on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes. AUTHORS' CONCLUSIONS There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and may not be clinically significant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow-up for clarification and reinforcement have a greater effect on patient mood.
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Affiliation(s)
- Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Tse T, Douglas J, Lentin P, Carey L. Measuring participation after stroke: a review of frequently used tools. Arch Phys Med Rehabil 2012; 94:177-92. [PMID: 22982555 DOI: 10.1016/j.apmr.2012.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify and critique the measures currently used to assess participation in clinical stroke studies. DATA SOURCES Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases. STUDY SELECTION Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included. DATA EXTRACTION The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories. DATA SYNTHESIS Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered. CONCLUSIONS This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.
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Affiliation(s)
- Tamara Tse
- The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia.
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Graven C, Sansonetti D, Moloczij N, Cadilhac D, Joubert L. Stroke survivor and carer perspectives of the concept of recovery: a qualitative study. Disabil Rehabil 2012; 35:578-85. [DOI: 10.3109/09638288.2012.703755] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Depression, strokes and dementia: new biological insights into an unfortunate pathway. Cardiovasc Psychiatry Neurol 2011; 2011:649629. [PMID: 22216404 PMCID: PMC3246693 DOI: 10.1155/2011/649629] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/14/2011] [Accepted: 10/18/2011] [Indexed: 01/12/2023] Open
Abstract
The literature emphasizes the risk of depression after a stroke. Less well known is the fact that depression may be as big a risk factor for strokes as hypertension, particularly in the older age group. This article reviews the risk for stroke and cognitive impairment consequent to depression, and describes the cardiovascular and immunological mechanisms that would appear to link depression to its cerebrovascular consequences. As well, the article refers to the brain imaging signatures that may allow prediction of impending brain injury. Finally, some questions that might be explored by future research are suggested, and some practical means to identify and help those at risk for the development of depression-associated vascular disease of the brain are suggested.
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