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Brycke S, Bråndal A, Brogårdh C. Implementation of evidence-based interventions according to the Swedish National Guidelines for Strokecare: a nationwide survey among physiotherapists. J Rehabil Med 2024; 56:jrm18444. [PMID: 38501731 DOI: 10.2340/jrm.v56.18444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To investigate (i) to what extent physiotherapists (PTs) working in stroke rehabilitation in various parts of the stroke care chain have implemented interventions according to the national guidelines for stroke (NGS), (ii) facilitating and hindering factors for the implementation, and (iii) differences between various care settings. DESIGN A cross-sectional study. SUBJECTS 148 PTs working in stroke rehabilitation in various parts of the care chain in Sweden. METHODS Data were collected by a web-based survey. RESULTS Task-specific training for walking (80-98%), impaired motor function (64-100%) and fall prevention (73-92%) were most implemented. Factors that facilitated implementation were: important to comply with the NGS, that PTs had confidence to perform the interventions, and that interventions were clearly described. Limited time, lack of resources, no clear goals or routines at the workplace hindered the implementation. Significant differences (p < 0.05) between the settings existed. Municipal and primary care reported most challenges in implementing the NGS and providing evidence-based interventions. CONCLUSION Most interventions, with high priority according to NGS, are provided by PTs working in stroke rehabilitation, although differences in various parts of the care chain exist. Knowledge, time, education and supportive management are important factors when implementing evidence-based interventions.
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Affiliation(s)
- Sara Brycke
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Anna Bråndal
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Christina Brogårdh
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
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Temehy B, Rosewilliam S, Alvey G, Soundy A. Exploring Stroke Patients’ Needs after Discharge from Rehabilitation Centres: Meta-Ethnography. Behav Sci (Basel) 2022; 12:bs12100404. [PMID: 36285973 PMCID: PMC9598696 DOI: 10.3390/bs12100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
Healthcare providers must consider stroke survivors needs in order to enable a good quality of life after stroke. This review aimed to investigate the perceived needs of the stroke survivors across various domains of care following their discharge from hospital. A meta-ethnographic review of qualitative studies that reported needs of stroke patients after discharge from rehabilitation services was conducted. Main searches were conducted on the following electronic databases: Ovid Medline (1946 to 2021), CINAHL plus (EBSCO), AMED (EBSCO), PsycINFO (1967 to 2021), the Cochrane Library, and PubMed in June 2022. Main outcomes were related to stroke survivors’ views, experiences, and preferences on physical, psychological, social, rehabilitation needs, and other identified needs. Twenty-seven studies were included in the final analysis. The findings show that existing rehabilitation provision for stroke survivors does not address the long-term needs of stroke survivors. Two main issues were revealed concerning the unmet needs of stroke survivors: (1) a lack of information availability and suitability and (2) inadequacy of care and services. It is crucial to further investigate the needs of patients in Asian countries and the Middle East as there is very limited understanding of patients’ needs in the community in these regions.
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Olaleye OA, Zaki DA, Hamzat TK. Expectations of individuals with neurological conditions from rehabilitation: A mixed-method study of needs. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1498. [PMID: 33604478 PMCID: PMC7876967 DOI: 10.4102/sajp.v77i1.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/08/2020] [Indexed: 11/01/2022] Open
Abstract
Background Knowledge of the specific expectations of patients with neurological conditions (NCs) from rehabilitation helps in setting attainable goals. Such expectations may vary from situation to situation. There are no studies investigating rehabilitation expectations amongst individuals with NCs in Nigeria. Objectives The aim of our study was to explore the rehabilitation expectations of individuals with NCs. Method This convergent mixed-methods study comprised a cross-sectional survey of 105 individuals with NCs and two sessions of Focus Group Discussions (FGDS) amongst eight individuals with NCs. The modified Needs Assessment Questionnaire was used to assess rehabilitation needs as a proxy for rehabilitation expectations, whilst disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Quantitative data were summarised using descriptive statistics and analysed using inferential statistics at p < 0.05. Thematic analysis was conducted on the qualitative data. Results Sixty-one (58.1%) stroke survivors, 33 (31.4%) individuals with spinal cord injury (SCI) and 11 (10.5%) with traumatic brain injury (TBI) aged 46.48 ± 15.91 were surveyed. The need for social/recreational activity was the most expressed need (100%) amongst the participants. Mobility was reported as an important need constituting a barrier to enjoying life by 93 (88.6%) participants. Individuals with SCI expressed the greatest needs compared with the other two groups. Needs were significantly correlated with severity of disability (p < 0.05). Four overarching themes (physical health, financial, healthcare services/rehabilitation and emotional/social) representing major areas of needs emerged from the FGD data. Conclusion Individuals with NCs in Nigeria have specified expectations of rehabilitation. Disability was a major driver of these expectations, irrespective of NC subtype. Clinical implications Rehabilitation programmes for individuals with NCs should target expressed needs or expectations of each patient cohort and minimise disabilities associated with these conditions.
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Affiliation(s)
- Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Desmond A Zaki
- Department of Physiotherapy, Benue State University Teaching Hospital, Markurdi, Nigeria
| | - Talhatu K Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
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The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
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Schindel D, Schneider A, Grittner U, Jöbges M, Schenk L. Quality of life after stroke rehabilitation discharge: a 12-month longitudinal study. Disabil Rehabil 2019; 43:2332-2341. [PMID: 31846594 DOI: 10.1080/09638288.2019.1699173] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To analyse trends in quality of life (QoL) development among older stroke patients within the first year after rehabilitation discharge, and to investigate the impact of including proxy interviews in research and practice. METHODS A prospective cohort study with follow-up at 3, 6, and 12 months with 411 patients and proxy respondents was conducted. The EUROHIS-QOL 8-item index was used to assess QoL. By performing descriptive analyses, QoL development over time was compared among subgroups. Linear mixed models were calculated to estimate mean changes from baseline to 12-month follow-up. The effects of patient characteristics and time on QoL were investigated using comprehensive mixed models. RESULTS One year after rehabilitation discharge, the majority of patients had neither maintained nor regained their initial QoL. Proxy respondents reported significantly lower QoL (22.6-29.5 points, p < 0.001). Characteristics associated with lower QoL were stroke severity, depression, and pain. Having a small social network was negatively associated with QoL (-1.66 points, 95%CI: -2.84/-0.48, p = 0.006). CONCLUSIONS Quality of life scores reported at the time of rehabilitation discharge are often not lasting. Including severely impaired patients via proxies reduces the risk of overestimating QoL outcomes. Outpatient's characteristics should be taken into account when planning therapy strategies to maintain previously achieved health goals. Regular re-assessments are required.Implications for rehabilitationThere should be an awareness that improvements in quality of life (QoL) achieved during rehabilitation are not sustainable.Regularly re-assessing pain status, psychological burden, and social network size could help clinicians to determine treatment strategies for maintaining and improving rehabilitation achievements.Conducting proxy interviews is required to assess disease burden of patients with severe stroke (e.g., non-linguistic patients).
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Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Michael Jöbges
- Department of Neurology, Brandenburg Klinik, Bernau, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Obembe AO, Simpson LA, Sakakibara BM, Eng JJ. Healthcare utilization after stroke in Canada- a population based study. BMC Health Serv Res 2019; 19:192. [PMID: 30917828 PMCID: PMC6438024 DOI: 10.1186/s12913-019-4020-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/18/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND More people are surviving stroke but are living with functional limitations that pose increasing demands on their families and the healthcare system. The aim of this study was to determine the extent to which stroke survivors use healthcare services on a population level compared to people without a stroke. METHODS This was a cross-sectional population-based survey that collected information related to health status, healthcare utilization and health determinants using the 2014 Canadian Community Health Survey. Healthcare utilization was assessed by a computer-assisted personal interview asking about visits to healthcare professionals in the last 12 months. Negative binomial regression was used to estimate the incidence rate ratios (IRR) and 95% confidence intervals (CI) for the number of health professional visits between stroke survivors and people without a stroke. The regression models were adjusted for demographics, as well as for mobility, mood/anxiety disorder and cardiometabolic comorbid conditions. RESULTS The study sample included 35,759 respondents (948 stroke, 34,811 non-stroke) and equate to 12,396,641 (286,783 stroke; 12,109,858 non-stroke) when sampling weights were applied. Stroke survivors visited their family doctor the most, and stroke was significantly associated with more visits to most healthcare professionals [e.g., family doctor IRR 1.6 (CI 1.4-1.8); nurse IRR 3.0 (CI 1.8-4.8); physiotherapist IRR 1.8 (CI 1.1-1.9); psychologist IRR 4.0 (CI 1.1-5.7)] except the dental practitioner, which was less [IRR 0.7 (CI 0.6-0.9)]. Mood/anxiety condition, but not cardiometabolic comorbid condition increased the probability of visiting a family doctor or social worker/ counsellor among people with stroke. CONCLUSION Stroke survivors visited healthcare professionals more often than people without stroke, and were approximately twice as likely to visit with those who manage problems that may arise after a stroke (e.g., family doctor, nurse, psychologist, physiotherapist). The effects of a stroke include mobility impairment and mood/ anxiety disorders. Therefore, adequate access to stroke-related healthcare services should be provided for stroke survivors, as this may improve functional outcome and reduce future healthcare costs.
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Affiliation(s)
- Adebimpe O. Obembe
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Lisa A. Simpson
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, Canada
| | - Brodie M. Sakakibara
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Janice J. Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Abdul Aziz AF, Ali MF, Yusof MF, Che' Man Z, Sulong S, Aljunid SM. Profile and outcome of post stroke patients managed at selected public primary care health centres in Peninsular Malaysia: A retrospective observational study. Sci Rep 2018; 8:17965. [PMID: 30568180 PMCID: PMC6299288 DOI: 10.1038/s41598-018-36154-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/15/2018] [Indexed: 11/09/2022] Open
Abstract
Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients' characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p < 0.05). Post stroke care at public primary care healthcentres showed benefits in stroke risk factors control (i.e. hypertension and dyslipidaemia) but deterioration in renal function. A more structured coordination is needed to optimise post stroke care beyond acute phase management for patients who reside at home in the community.
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Affiliation(s)
- Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Mohd Fairuz Ali
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohammad Fhaisol Yusof
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Medicine, Hospital Tawau, Ministry of Health Malaysia, Tawau, Sabah, Malaysia
| | - Zuraidah Che' Man
- Research Support Unit, Department of Emergency Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Saperi Sulong
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Hawally, Kuwait
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Lamontagne ME, Richards C, Azzaria L, Rosa-Goulet M, Clément L, Pelletier F. Perspective of patients and caregivers about stroke rehabilitation: the Quebec experience. Top Stroke Rehabil 2018; 26:39-48. [PMID: 30320537 DOI: 10.1080/10749357.2018.1534453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The unique perspectives of patients and caregivers on their experiences as users of rehabilitation services help identify areas for improvement for the continuum from acute care to community integration. OBJECTIVE This study reports perceptions of persons with stroke and their caregivers in an existing continuum of stroke care, social services, and rehabilitation in the Province of Quebec. METHODS A total of 10 focus groups were held, 5 with persons with stroke (n = 37, mean age 59.6 years (SD = 11.6); 21 men) and 5 others with caregivers (n = 31; mean age 58.8 years (SD = 15.1); 8 men). Discussions were transcribed and were the object of thematic content analysis using Nvivo. RESULTS Participants expressed their general satisfaction toward the care received in inpatient, hospital, and rehabilitation settings. The information received about acute care, however, was deemed insufficient and fragmented, and access of rehabilitation services was often perceived to be difficult. In the community integration phase of the continuum, most participants stated that they had experienced poor accessibility to services of any kind. CONCLUSIONS Persons with stroke and their relatives' perspectives about the services that they obtained throughout the rehabilitation continuum vary importantly according to the services examined. Adopting a continuum perspective is helpful to target priorities for improvement.
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Affiliation(s)
- Marie-Eve Lamontagne
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | - Carol Richards
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | - Leila Azzaria
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | | | - Louise Clément
- c Ministère de la santé et des services sociaux du Québec , Québec , QC , Canada
| | - France Pelletier
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
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Crowley D, Andrews L. The longitudinal relationship between acceptance and anxiety and depression in people who have had a stroke. Aging Ment Health 2018; 22:1321-1328. [PMID: 28727485 DOI: 10.1080/13607863.2017.1348478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The role that acceptance may play in anxiety and depression has received little attention in stroke, unlike other chronic conditions. This study aimed to clarify whether acceptance of a stroke is related to anxiety and depression post-stroke when controlling for social support. DESIGN A longitudinal design was employed with 35 participants completing measures at two time points: three-month and nine-month post-stroke. METHODS Forty-one stroke patients, who were three-month post-stroke, were recruited from a stroke service register. Participants completed measures of anxiety, depression, social support and acceptance at two time points, six months apart. RESULTS Acceptance was moderately and negatively correlated with anxiety and depression at three- and nine-month post-stroke. Acceptance showed a moderate and positive correlation with emotional and practical social support at Time 1 but not at Time 2. Acceptance at Time 1 was a stronger predictor of both anxiety and depression at Time 2 than emotional or practical social support. CONCLUSIONS Acceptance is an important area to consider in relation to rehabilitation and adjustment following a stroke.
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Affiliation(s)
- Dominic Crowley
- a Clinical Health Psychology Service , Walsall Healthcare National Health Service Trust , West Midlands , UK
| | - Leanne Andrews
- b School of Health and Human Sciences, University of Essex , Colchester , UK
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Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, Mant J. Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography. PLoS One 2018; 13:e0192533. [PMID: 29466383 PMCID: PMC5821463 DOI: 10.1371/journal.pone.0192533] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/25/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services. Design Systematic review and meta-ethnography. Data sources Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015). Eligibility criteria Primary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services. Data synthesis A set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria. Results 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke. Limitations Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems. Conclusions Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services. Systematic review registration number PROSPERO 2015:CRD42015026602
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Affiliation(s)
- Dominika M. Pindus
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ricky Mullis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Lisa Lim
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - A. Viona Rundell
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Noor Azah Abd Aziz
- Department of Family Medicine, National University of Malaysia, Bandar Tun Razak Cheras, Kuala Lumpur, Malaysia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
- * E-mail:
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Sinu E, Nirmala BP, Reddy K, Thomas P. Needs of Persons with Neurological Disorders. INDIAN JOURNAL OF PSYCHIATRIC SOCIAL WORK 2018; 9:29-37. [PMID: 35027785 PMCID: PMC8754389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In India, many persons with neurological disorder (PwND) get discharged from several hospitals with significant unmet needs. AIM To assess the needs of persons with neurological disorders in a tertiary care hospital, Bangalore, India. METHOD AND MATERIALS It was a cross-sectional descriptive study where thirty PwND availing the in-patient services at NIMHANS, Bangalore were selected through purposive sampling. Camberwell Assessment of Need - Research version was used. RESULTS Large majority (90%) of the respondents have unmet needs in daytime activities, psychological distress, information about illness and sex. Majority (70%) have unmet needs in job, self-care, medicines, mobility, child care. Half (50%) of the respondents have unmet need in accommodation, intimate and social relationships, finance. Three-fourth revealed that their need for food, safety and social welfare needs have been met. CONCLUSION Patients from lower economic, educational status and urban domicile have more service needs. Present study attempts a systematic need assessment which has implication in addressing the unmet needs of PwND to improve their quality of life.
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Affiliation(s)
- E Sinu
- Department of Psychiatric Social Work, National Institute of Mental Health & Neuro Sciences, Bangalore, India
| | - B P Nirmala
- Department of Psychiatric Social Work, National Institute of Mental Health & Neuro Sciences, Bangalore, India
| | - Krishna Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health & Neuro Sciences, Bangalore, India
| | - Priya Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health & Neuro Sciences, Bangalore, India
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Desrochers P, Kairy D, Pan S, Corriveau H, Tousignant M. Tai chi for upper limb rehabilitation in stroke patients: the patient's perspective. Disabil Rehabil 2016; 39:1313-1319. [PMID: 27347600 DOI: 10.1080/09638288.2016.1194900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed at exploring the perceived benefits and drawbacks of practicing tai chi, an alternative therapy that can be implemented in the community, as part of upper-limb rehabilitation following stroke. METHODOLOGY Semistructured interviews were carried out with participants with chronic stroke (>6 months). The participants took part in 16 tai chi sessions over 8 weeks. Interviews were conducted in person using an interview guide based on the theory of planned behavior (TPB), and a thematic analysis was conducted. RESULTS Eight interviews were carried out with participants at various stages of motor recovery. Participants perceived a number of physical, functional, and psychological benefits. They found tai chi to be a global exercise, including both physical and mental aspects, and suggested that it can be included as part of rehabilitation for stroke patients. Many participants expressed a desire to continue practicing tai chi after completion of the study because it exceeded their expectations, among other reasons. CONCLUSION This study can serve to guide future tai chi interventions and research on tai chi for rehabilitation in terms of the characteristics of the intervention and the various areas to assess in order to measure the overall benefits. IMPLICATIONS FOR REHABILITATION Tai chi was perceived as a good way of integrating various skills learned during rehabilitation. Despite having different functional abilities, all the participants noted various physical, functional, and psychological benefits from participating in the tai chi sessions. Tai chi seems to be a form of exercise that stroke patients would perform more long-term since all the participants in this study expressed the desire to continue practicing tai chi.
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Affiliation(s)
- Pascal Desrochers
- a School of Rehabilitation, Université de Montréal , Montreal , Quebec , Canada
| | - Dahlia Kairy
- a School of Rehabilitation, Université de Montréal , Montreal , Quebec , Canada.,b Center for Interdisciplinary Research in Rehabilitation of Greater Montreal - IRGLM Site , Montreal , Quebec , Canada
| | - Shujuan Pan
- a School of Rehabilitation, Université de Montréal , Montreal , Quebec , Canada
| | - Hélène Corriveau
- c School of Rehabilitation, Université de Sherbrooke , Sherbrooke , QC , Canada.,d Research Center on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke , QC , Canada
| | - Michel Tousignant
- c School of Rehabilitation, Université de Sherbrooke , Sherbrooke , QC , Canada.,d Research Center on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke , QC , Canada
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The Importance of Patient Involvement in Stroke Rehabilitation. PLoS One 2016; 11:e0157149. [PMID: 27285997 PMCID: PMC4902299 DOI: 10.1371/journal.pone.0157149] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. RESULTS The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. CONCLUSIONS The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.
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Takashima R, Murata W, Saeki K. Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study. Disabil Rehabil 2016; 38:1578-91. [DOI: 10.3109/09638288.2015.1107629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Turcotte PL, Larivière N, Desrosiers J, Voyer P, Champoux N, Carbonneau H, Carrier A, Levasseur M. Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities. BMC Geriatr 2015; 15:95. [PMID: 26231354 PMCID: PMC4522124 DOI: 10.1186/s12877-015-0077-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/23/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. METHODS A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. RESULTS Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. CONCLUSIONS This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.
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Affiliation(s)
- Pier-Luc Turcotte
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Nadine Larivière
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Johanne Desrosiers
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Philippe Voyer
- Faculty of Nursing Sciences, Université Laval, Québec City, Québec, Canada.
- Québec Centre for Excellence in Aging, Québec City, Québec, Canada.
| | - Nathalie Champoux
- Department of Family Medicine, Université de Montréal, Montréal, Québec, Canada.
- Research Centre of the University Institute of Geriatrics of Montreal, Montréal, Québec, Canada.
| | - Hélène Carbonneau
- Department of Leisure, Culture and Tourism Studies, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Annie Carrier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
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[Home after a stroke; 'that's when it really begins'. A qualitative study into the needs for aftercare of stroke patients after being discharged home]. Tijdschr Gerontol Geriatr 2015; 46:196-203. [PMID: 26319670 DOI: 10.1007/s12439-015-0139-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Indexed: 10/23/2022]
Abstract
AIM To explore stroke patients needs of care after discharge from hospital or rehabilitation facility. METHOD Semi-structured interviews with twenty stroke patients and their partners in the region Midden-Kennemerland in the Netherlands. RESULTS 'That's when it really begins'; at home it becomes clear what the real consequences of the stroke are on daily life. After returning home patients would have liked to (1) have had more information/support and they have a need for support for a long time after their stroke; (2) have had the possibility to get support later on (after having said 'no' in the first place). On the other hand there are (3) patients who are inclined to search for solutions by themselves. CONCLUSION Only after returning home stroke patients and their partners can really assess what their need for care is. Therefore the need for care of stroke patients should be assessed after a period of time after the patients return home. The care should be available for a long time after the stroke. Because patients don't realize that they can get help for the neuropsychological consequences, it is important that the initiative to organize the care lies in the hands of the caregivers.
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Hiragami F, Nonaka T, Saitoh K, Suzuki Y. The utility of a care model to individualize rehabilitation in adults aged over 80 years. Top Stroke Rehabil 2015; 22:102-15. [PMID: 25936542 DOI: 10.1179/1074935714z.0000000029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objectives of the present study were to assess the complexity and multidimensionality of rehabilitation needs of very old stroke patients aged ≥ 80 years and report how rehabilitation interventions are customized to meet the complex needs of patients at a hospital with a majority of old patients. METHODS The complex problems faced by 18 post-stroke patients (age, range: 80-92 years) were characterized in terms of the following multiple dimensions: (1) clinical features, (2) functional (motor/cognitive) impairment features, (3) psychological aspects, and (4) environmental aspects. We then evaluated the rehabilitation interventions designed to address the problems identified in these different dimensions in detail. RESULTS The needs of very old stroke patients were extremely complex and unique. To cope with this complexity, rehabilitation interventions were customized in a flexible manner, considering the different dimensions of the needs of these patients. Although the interventions were customized, the complex problems experienced by patients could be divided into stroke conditions on the basis of some invariant patterns in rehabilitation intervention. CONCLUSIONS We obtained empirical data that illustrated the necessity of considering not only clinical features, but also multiple dimensions of problems faced by very old stroke patients during rehabilitation interventions.
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Müller C, Glässel A, Marotzki U, Voigt-Radloff S. [Potential analyses for research on occupational therapy-led training of activities of daily living in stroke patients]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108 Suppl 1:S36-44. [PMID: 25458397 DOI: 10.1016/j.zefq.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 11/26/2022]
Abstract
HEALTH PROBLEM Every year about 200,000 people in Germany suffer from a first stroke and 65,000 persons from a recurrent stroke. Stroke is one of the major causes of acquired life-long disability. It is associated with multiple limitations in functioning, activities of daily living and social participation. People with stroke must develop and apply considerable coping and adaptation strategies to manage the consequences of disabilities in daily life. Insufficient adaptations may result in social isolation, depressive disorders, need for medical and nursing care and subsequently lead to increasing costs for care. Thus occupational therapy-led treatment addressing social participation as well as skills training, adaptation strategies and assistive technology for activities of daily living is essential for stroke patients after hospital discharge. CORPUS OF EVIDENCE Based on nine randomised comparisons, a Cochrane review from 2006 revealed that occupational therapy-led training after stroke had positive effects on personal activities of daily living (8 studies; 961 participants; 0.18 SMD; 95 % CI [0.04 to 0.32]), on extended activities of daily living (6 studies; 847 participants; 0.21 SMD; 95 % CI [0.03 to 0.39]), and on poor outcome (7 studies; 1,065 participants; odds ratio 0.67; 95 % CI [0.51 to 0.87]). However, direct implementation into the German healthcare context is not recommendable due to (1) different settings and heterogeneity within the primary studies, (2) lack of manualisation of treatment programmes and (3) insufficient evaluation of client-oriented outcomes. IMPLICATION FOR RESEARCH It is recommended to manualise client-centred standardised modules of a stage-specific occupational therapy-led training of activities of daily living and to pilot-test this intervention programme in a feasibility study. If this trial results in a set of reliable and valid client-oriented outcome measurements applicable within the German care context and in a feasible treatment programme well accepted by stroke patients and their treating occupational therapists, a large-scaled randomised clinical trial in terms of comparative effectiveness research may follow.
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Affiliation(s)
- Christian Müller
- Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland; Berufsakademie für Gesundheits- und Sozialwesen Saarland, Saarbrücken, Deutschland.
| | - Andrea Glässel
- Swiss Paraplegic Research, Human Functioning Sciences, Nottwil, Schweiz
| | - Ulrike Marotzki
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Deutschland
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Depaul VG, Moreland JD, Dehueck AL. Physiotherapy needs assessment of people with stroke following discharge from hospital, stratified by acute functional independence measure score. Physiother Can 2014; 65:204-14. [PMID: 24403687 DOI: 10.3138/ptc.2012-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the physiotherapy-related needs of people with stroke at discharge, 6 months after discharge, and 1 year after discharge from hospital, and to examine the results stratified by participants' acute Functional Independence Measure (FIM) scores. METHODS A total of 241 adults with recent stroke were recruited into this longitudinal cohort study. As well as participating in a semi-structured interview that included questions about mobility needs and barriers, participants were asked to complete and return a closed-ended needs-assessment survey. RESULTS During the interview, participants reported needs and barriers related to motor control, walking, stairs, fatigue, prevention of falls, and access to physiotherapy services. The survey identified many more needs, including transfers, wheelchair use, higher-level balance and mobility skills, and access to physiotherapy and suitable exercise facilities. Frequencies of needs and barriers tended to be lower among participants with higher acute FIM scores. There was no consistent trend for needs and barriers to decrease over time. CONCLUSIONS Over the first year after discharge from hospital, people with stroke report a large and varied number of persistent mobility-related needs. Physiotherapists have a role to play in advocating for adequate follow-up services and informing health policy with respect to the needs of their patients with stroke.
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Affiliation(s)
- Vincent G Depaul
- Physiotherapy Department, St. Joseph's Healthcare Hamilton ; School of Rehabilitation Science, McMaster University, Hamilton
| | - Julie D Moreland
- Physiotherapy Department, St. Joseph's Healthcare Hamilton ; School of Rehabilitation Science, McMaster University, Hamilton
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Duxbury S, Depaul V, Alderson M, Moreland J, Wilkins S. Individuals with stroke reporting unmet need for occupational therapy following discharge from hospital. Occup Ther Health Care 2013; 26:16-32. [PMID: 23899105 DOI: 10.3109/07380577.2011.621514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT The purpose of this study was to identify the characteristics and needs of individuals with stroke who report an unmet need for occupational therapy following discharge from hospital. Needs were assessed using a semi-structured interview and a survey in a sample of 209 adults hospitalized with a stroke. Participants were divided into three groups-those needing occupational therapy; those receiving occupational therapy, and those neither needing nor receiving occupational therapy. Thirteen percent (n = 28) reported an unmet need for occupational therapy and were more dependent in activities of daily living (ADL) before and after their stroke and had lower acute functional independence measure (FIM) scores than the comparison groups (p < .05). Participants with unmet needs for occupational therapy were more likely to report unmet needs related to upper extremity function, basic and instrumental ADL, leisure, assistive devices, and the resumption of social roles.
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Affiliation(s)
- Shari Duxbury
- 1Department of Occupational Therapy, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Tistad M, von Koch L, Sjöstrand C, Tham K, Ytterberg C. What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke--amount, place, operator or timing? Health Expect 2013; 16:e24-35. [PMID: 23796012 PMCID: PMC3883089 DOI: 10.1111/hex.12095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 12/22/2022] Open
Abstract
Background and Objective To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self‐reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. Methods The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self‐reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home‐based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. Results Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd–4th quarters of the first year (OR 8.36, CI 1.40–49.88 P = 0.020) were more likely to report met rehabilitation needs. Conclusion For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self‐reported met needs for rehabilitation.
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Affiliation(s)
- Malin Tistad
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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McAdam JJ, Leathley MJ, Crichton MS, Dickens J, Jack CIA, Watkins CL. Evaluation of a rehabilitation support service after acute stroke: Feasibility and patient/carer benefit. Health (London) 2013. [DOI: 10.4236/health.2013.57152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Patient-centered integrated motor imagery delivered in the home with telerehabilitation to improve walking after stroke. Phys Ther 2012; 92:1065-77. [PMID: 22499891 PMCID: PMC3409405 DOI: 10.2522/ptj.20110277] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE This case report describes the clinical reasoning process used to examine a person after stroke and intervene with a novel integrated motor imagery treatment designed for the rehabilitation of walking and delivered in the home through telerehabilitation. The integrated motor imagery treatment consisted of patient-centered goal setting and physical practice combined with motor and motivational imagery. CASE DESCRIPTION The patient was a 38-year-old woman who had had a diffuse left subarachnoid hemorrhagic stroke 10 years earlier. She lived independently in an assisted living complex and carried a straight cane during long walks or in unfamiliar environments. Examination revealed a slow gait speed, reduced walking endurance, and decreased balance confidence. Although she was in the chronic phase, patient-centered integrated motor imagery was predicted to improve her community mobility. Treatment sessions of 45 to 60 minutes were held 3 times per week for 4 weeks. The practiced tasks included transitioning from sitting to standing, obstacle clearance, and navigation in interior and exterior environments; these tasks were first executed and then imagined at ratios of 1:5. Task execution allowed the creation of a scene based on movement observation. Imagery scenarios were customized to address the patient's goals and observed movement problems. Motivational elements of arousal, problem solving, and reward were embedded in the imagery scenarios. Half of the sessions were provided on site, and the remaining sessions were delivered remotely. Seven sessions were delivered by the clinician in the home, and 5 sessions were delivered using telerehabilitation. OUTCOMES Improvements in motor imagery ability, gait parameters, and balance were observed after training. Most gains were retained at the 3-month follow-up. Compared with on-site delivery, the telerehabilitation sessions resulted in less therapist travel time and cost, as well as shorter therapy sessions. DISCUSSION The delivery of integrated motor imagery practice for walking recovery was feasible both on site and remotely.
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Tistad M, Tham K, von Koch L, Ytterberg C. Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke: an explorative observational study. BMC Neurol 2012; 12:40. [PMID: 22708545 PMCID: PMC3477008 DOI: 10.1186/1471-2377-12-40] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 06/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke. Methods The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables “unfulfilled needs for rehabilitation” and “dissatisfaction with care” were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses. Results Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08). Conclusions Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients’ needs and aid peoples’ reorientation; this would apply particularly to those with poor coping capacity.
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Affiliation(s)
- Malin Tistad
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Fack 23 200, S 141 83, Huddinge, Sweden.
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Sumathipala K, Radcliffe E, Sadler E, Wolfe CDA, McKevitt C. Identifying the long-term needs of stroke survivors using the International Classification of Functioning, Disability and Health. Chronic Illn 2012; 8:31-44. [PMID: 22025770 DOI: 10.1177/1742395311423848] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate how contextual factors, as described by the World Health Organisation's International Classification of Functioning, Disability and Health (ICF), impact on stroke survivors' functioning and how needs are perceived in the long term after stroke. METHODS Semi-structured interviews were conducted with 35 participants between 1 and 11 years after stroke. Data were analysed thematically using the ICF conceptual framework. RESULTS Long-term needs related to activities of daily living, social participation, mobility aids, home adaptations, housing, financial support, rehabilitation, information and transport. Participants identified a range of ICF environmental and personal factors including 'support and relationships,' 'products and technology,' 'services, systems and policies,' 'attitudes,' life experiences, social position and personal attitudes. Interactions between these contextual factors shaped functioning and how long-term needs were perceived. Social support from family and friends was a key facilitator of functioning for most participants, buffering the impact of disabilities and mediating perceived needs. Needs were not always stroke specific as many participants experienced other health problems. DISCUSSION The ICF framework was useful to investigate how contextual factors shaped functioning and mediated perceived long-term needs. Development of services to meet long-term needs among stroke survivors should consider the range of environmental and personal factors affecting how needs are perceived.
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Poor concurrence between disabilities as described by patients and established assessment tools three months after stroke: A mixed methods approach. J Neurol Sci 2012; 313:160-6. [DOI: 10.1016/j.jns.2011.08.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/24/2011] [Accepted: 08/26/2011] [Indexed: 11/30/2022]
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Kwok T, Pan JH, Lo R, Song X. The influence of participation on health-related quality of life in stroke patients. Disabil Rehabil 2011; 33:1990-6. [DOI: 10.3109/09638288.2011.553709] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Content validity of the Extended ICF Core Set for stroke: an international Delphi survey of physical therapists. Phys Ther 2011; 91:1211-22. [PMID: 21659466 DOI: 10.2522/ptj.20100262] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The "Extended ICF Core Set for stroke" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of people with stroke. OBJECTIVE The objective of this study was to validate this ICF Core Set from the perspective of physical therapists. DESIGN AND METHODS Physical therapists experienced in stroke intervention were asked about their patients' problems and resources and about aspects of the environment that physical therapists treat in people with stroke in a 3-round electronic-mail survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated using the kappa statistic. RESULTS One hundred twenty-five physical therapists from 24 countries named 4,793 problems treated by physical therapists in people with stroke. They identified 10 second-level ICF categories that currently are not represented in the Extended ICF Core Set for stroke. Twelve responses of the participants were linked to the ICF component personal factors, and 15 responses were not covered by the current version of the classification. The kappa coefficient for the linking agreement was 0.39 (95% bootstrapped confidence interval=0.34-0.41). LIMITATIONS Two World Health Organization regions were not represented in the sample of physical therapists. CONCLUSIONS According to the physical therapists, the current version of the Extended ICF Core Set for stroke largely covers the types of problems that their interventions address. However, some aspects of functioning emerged that are not yet covered and may need further investigation.
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Glässel A, Kirchberger I, Linseisen E, Stamm T, Cieza A, Stucki G. Content validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for stroke: the perspective of occupational therapists. The Canadian Journal of Occupational Therapy 2011; 77:289-302. [PMID: 21268511 DOI: 10.2182/cjot.2010.77.5.5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The "ICF Core Set for stroke" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in the functioning of patients with stroke. PURPOSE The objective of this study was to validate this ICF Core Set from the perspective of occupational therapists. METHODS In a three-round electronic mail survey using the Delphi technique, occupational therapists experienced in stroke treatment were asked about patients'problems, patients' resources, and aspects of environment they take care of. Two health professionals linked responses to the ICF. FINDINGS Sixty-nine occupational therapists in 21 countries named 1,747 concepts that occupational therapists treat in patients with stroke. These concepts were linked to 347 different ICF categories. Twenty-three concepts were linked to the ICF component Personal Factors. CONCLUSION The content validity of the "ICF Core Set for stroke" was largely supported by occupational therapists.
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Affiliation(s)
- Andrea Glässel
- Swiss Paraplegic Research (SPF), Gido A. Zaech Str.4, 6207 Nottwil, Switzerland
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Bergström AL, Eriksson G, von Koch L, Tham K. Combined life satisfaction of persons with stroke and their caregivers: associations with caregiver burden and the impact of stroke. Health Qual Life Outcomes 2011; 9:1. [PMID: 21223594 PMCID: PMC3024212 DOI: 10.1186/1477-7525-9-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 01/11/2011] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the life satisfaction of the person with stroke combined with their caregiver, i.e. the dyad, despite the fact that life satisfaction is an important rehabilitation outcome. The aim of this study was to describe the dyads combined life satisfaction and to understand this in relationship to the perceived impact of stroke in everyday life and caregiver burden. Methods In this cross-sectional study, the life satisfaction of persons and their informal caregivers was measured in 81 dyads one year post stroke. Their global life satisfaction, measured with LiSat-11, was combined to a dyad score and the dyads were then categorized as satisfied, dissatisfied or discordant. The groups were compared and analyzed regarding levels of caregiver burden, measured with the Caregiver Burden scale, and the perceived impact of stroke in everyday life, measured with the Stroke Impact Scale (SIS). Results The satisfied dyads comprised 40%, dissatisfied 26% and those that were discordant 34%. The satisfied dyads reported a significantly lower impact of the stroke in everyday life compared with the dyads that were not satisfied. As expected, dyads that were not satisfied reported a significantly greater caregiver burden compared with the satisfied dyads. The discordant group was further broken down into a group of dissatisfied and satisfied caregivers. The caregivers that were not satisfied in the discordant group perceived a significantly greater level of caregiver burden compared with the satisfied group. Even caregivers who were satisfied with life but whose care recipients were not satisfied reported caregiver burden. Conclusions Measuring combined life satisfaction provides a unique focus and appears to be a feasible way of attaining the dyads' perspective. The findings suggest that those dyads with a discordant life satisfaction could be vulnerable because of the caregivers' reported caregiver burden. These findings support the importance of a dyadic perspective and add to the understanding of the reciprocal influences between the caregiver and recipient. This knowledge has clinical implications and contributes to the identification of possible vulnerable dyads in need of tailored support.
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Affiliation(s)
- Aileen L Bergström
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Provision of rehabilitation services in Québec following stroke: a comparative survey conducted by postal questionnaire. Can J Aging 2010; 29:193-203. [PMID: 20465861 DOI: 10.1017/s0714980810000127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a survey to document the rehabilitation services available to clients aged 65 years and older who had suffered a stroke. In all, respondents - gleaned from 295 resources located in three health regions in the province of Québec - completed a postal questionnaire describing the services that they offer, in terms of type of intervention (related to nine capabilities and seven areas of social participation) and type of services (evaluation, rehabilitation, and support). The results show that most rehabilitation services offered to older people with stroke address motor skills and mobility. Somewhat unexpectedly, for four capability-related interventions and two social-participation-related interventions, there appear to be more active rehabilitation services offered in regions with rural areas than in metropolitan regions.
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White DK, Jette AM, Felson DT, Lavalley MP, Lewis CE, Torner JC, Nevitt MC, Keysor JJ. Are features of the neighborhood environment associated with disability in older adults? Disabil Rehabil 2010; 32:639-45. [PMID: 20205576 DOI: 10.3109/09638280903254547] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore the association of features of a person's neighborhood environment with disability in daily activities. METHOD We recruited 436 people aged 65 years and over (mean 70.4 years (SD = 3.9)) with functional limitations from the Multicenter Osteoarthritis Study (MOST). Features of the neighborhood environment were assessed using the Home and Community Environment (HACE) survey. The Late-Life Disability Instrument (LLDI) was used to assess disability in daily activities. We used logistic regression to examine the association of individual environmental features with disability. RESULTS. Older adults whose neighborhoods did not have parks and walking areas less frequently engaged in a regular fitness program (OR = 0.4, 95% CI (0.2, 0.7)), and in social activities (OR = 0.5, 95% CI (0.3, 1.0)). Those whose neighborhoods had adequate handicap parking had 1.5-1.8 higher odds of engagement in several social and work role activities. The presence of public transportation was associated with 1.5-2.9 higher odds of not feeling limited in social, leisure, and work role activities, and instrumental activities of daily living. CONCLUSION Our exploratory study suggests that parks and walking areas, adequate handicap parking, and public transportation are associated with disability in older adults.
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Affiliation(s)
- Daniel K White
- Clinical Epidemiology Research and Training Unit, Boston University Medical Center, Boston, Massachusetts, USA.
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Mirelman A, Bonato P, Deutsch JE. Effects of Training With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke. Stroke 2009; 40:169-74. [DOI: 10.1161/strokeaha.108.516328] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Purpose—
Training of the lower extremity (LE) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion. The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone.
Methods—
A single, blind, randomized clinical trial was conducted. Eighteen individuals poststroke participated in a 4-week training protocol. One group trained with the robot virtual reality (VR) system and the other group trained with the robot alone. Outcome measures were temporal features of gait measured in a laboratory setting and the community.
Results—
Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone. Similarly, significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR. These differences were maintained at 3 months’ follow-up.
Conclusions—
The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone.
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Affiliation(s)
- Anat Mirelman
- From RiVERS Lab (A.M., J.E.D.), Doctoral Program in Physical Therapy, Department of Rehabilitation and Movement Science, University of Medicine and Dentistry of New Jersey, NJ; Department of Physical Medicine and Rehabilitation (A.M., P.B.), Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Mass; The Harvard-MIT Division of Health Sciences and Technology (P.B.), Boston, Mass
| | - Paolo Bonato
- From RiVERS Lab (A.M., J.E.D.), Doctoral Program in Physical Therapy, Department of Rehabilitation and Movement Science, University of Medicine and Dentistry of New Jersey, NJ; Department of Physical Medicine and Rehabilitation (A.M., P.B.), Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Mass; The Harvard-MIT Division of Health Sciences and Technology (P.B.), Boston, Mass
| | - Judith E. Deutsch
- From RiVERS Lab (A.M., J.E.D.), Doctoral Program in Physical Therapy, Department of Rehabilitation and Movement Science, University of Medicine and Dentistry of New Jersey, NJ; Department of Physical Medicine and Rehabilitation (A.M., P.B.), Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Mass; The Harvard-MIT Division of Health Sciences and Technology (P.B.), Boston, Mass
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Vincent C, Deaudelin I, Robichaud L, Rousseau J, Viscogliosi C, Talbot LR, Desrosiers J. Rehabilitation needs for older adults with stroke living at home: perceptions of four populations. BMC Geriatr 2007; 7:20. [PMID: 17697322 PMCID: PMC1994951 DOI: 10.1186/1471-2318-7-20] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 08/13/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases utilization of health services, number of hospitalizations and early institutionalization, leading to a significant psychological and financial burden on the patients, their families and the health care system. The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke and who live in the community. The emphasis was put on needs that act as obstacles to social participation in terms of personal factors, environmental factors and life habits, from the point of view of four target populations. METHODS Using the focus group technique, we met four types of experts living in three geographic areas of the province of Québec (Canada): older people with stroke, caregivers, health professionals and health care managers, for a total of 12 groups and 72 participants. The audio recordings of the meetings were transcribed and NVivo software was used to manage the data. The process of reducing, categorizing and analyzing the data was conducted using themes from the Disability Creation Process model. RESULTS Rehabilitation needs persist for nine capabilities (e.g. related to behaviour or motor activities), nine factors related to the environment (e.g. type of teaching, adaptation and rehabilitation) and 11 life habits (e.g. nutrition, interpersonal relationships). The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation. Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources. CONCLUSION Better knowledge of partially met or unmet rehabilitation needs expressed by the different types of people involved should lead to increased attention being paid to education for caregivers, orientation of caregivers towards resources in the community, and follow-up of patients' needs in terms of adjustment and rehabilitation, whether for improving their skills or for carrying out their activities of daily living.
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Affiliation(s)
- Claude Vincent
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, 525, Wilfrid-Hamel Blvd East, Québec (Québec), G1M 2S8, Canada
- Département de réadaptation, Université Laval, Pavillon Ferdinand-Vandry, Québec (Québec), G1K 7P4, Canada
| | - Isabelle Deaudelin
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, 525, Wilfrid-Hamel Blvd East, Québec (Québec), G1M 2S8, Canada
| | - Line Robichaud
- Département de réadaptation, Université Laval, Pavillon Ferdinand-Vandry, Québec (Québec), G1K 7P4, Canada
| | - Jacqueline Rousseau
- École de réadaptation, Université de Montréal, Pavillon Marguerite D'Youville, c.p. 6128, succursale Centre-ville, Montréal (Québec), H3C 3J7, Canada
- Research Center on Aging, University Institute of Geriatrics of Montreal, 4564 Queen Mary Road, Montréal (Québec), H3W 1W5, Canada
| | - Chantal Viscogliosi
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvédère South, Sherbrooke (Québec), J1H 4C4, Canada
| | - Lise R Talbot
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvédère South, Sherbrooke (Québec), J1H 4C4, Canada
- Department of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 1Avenue, Sherbrooke (Québec), Canada
| | - Johanne Desrosiers
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvédère South, Sherbrooke (Québec), J1H 4C4, Canada
- Department of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12Avenue, Sherbrooke (Québec), Canada
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Dunsky A, Dickstein R, Ariav C, Deutsch J, Marcovitz E. Motor imagery practice in gait rehabilitation of chronic post-stroke hemiparesis: four case studies. Int J Rehabil Res 2006; 29:351-6. [PMID: 17106356 DOI: 10.1097/mrr.0b013e328010f559] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this series of pilot case studies was to examine the feasibility of enhancing the walking of individuals with post-stroke hemiparesis through the imagery practice of gait activities at home. Four persons with chronic hemiparesis received imagery gait practice, 3 days a week for 6 weeks. The intervention addressed gait impairments of the affected lower limb and task-specific gait training. Pre-intervention, mid-term, post-intervention and follow-up evaluations were performed. At 6 weeks from the beginning of treatment, the participants increased walking speed, stride length, cadence and single-support time on the affected lower limb, while decreasing double-support time. The findings appear to justify the institution of a larger-scale study in order to better delineate the contribution of motor imagery practice to gait performance in individuals with post-stroke hemiparesis.
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Affiliation(s)
- Ayelet Dunsky
- Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
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