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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Zhang Q, Chen S, Zhang Y, Ni J, Huang J, Wu Y, Li M. Interventions targeting psychosocial adaptation in people with stroke: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 113:107751. [PMID: 37116222 DOI: 10.1016/j.pec.2023.107751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This scoping review aimed to describe and map interventions targeting psychosocial adaptation in people with stroke. METHODS A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. We included original studies with interventions targeting psychosocial adaptation (concept) on people with stroke (population) in any setting (context). We searched five online electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Cochrane Central Registry of Controlled Trials). We described interventions in terms of design characteristics, theoretical basis, details of interventions, and quantitative outcomes indicated in psychosocial adaptation. RESULTS Forty-three studies were identified. Five intervention categories were identified to describe the interventions targeting psychosocial adaptation. Quantitative outcomes indicated psychosocial adaptation in our review were grouped into four domains: global adaptation, psychological adaptation, social adaptation, and others. CONCLUSIONS The mapping and description brought to light the large heterogeneity of interventions targeting psychosocial adaptation in people with stroke. PRACTICE IMPLICATIONS Deepening understanding of psychosocial adaptation can help health professionals further develop effective interventions aiming at promoting psychosocial adaptation and reducing negative health sequelae, such as risk of reduced psychosomatic recovery post stroke.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Shanshan Chen
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Jieqing Ni
- School of Social Sciences in Applied Psychology, Lingnan University, Hong Kong, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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Kum C, Miller EL, Jones H, Kean EB, Kreitzer N, Bakas T. Theoretically Based Factors Affecting Stroke Family Caregiver Health: An Integrative Review. West J Nurs Res 2021; 44:338-351. [PMID: 34636275 DOI: 10.1177/01939459211050955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke family caregivers often neglect their own health while providing care. Rigorous reviews have focused on stroke caregiver needs and outcomes; however, a comprehensive review of stroke caregiver health is lacking. The purpose of this integrative review was to determine factors associated with stroke family caregiver health. Using a PRISMA flow diagram and Rayyan software, 41 studies were identified published from January 2000 to December 2020. Databases included Cochrane Reviews, Cochrane Trials, PsycINFO, Ovid MEDLINE, PubMed, EBSCOhost MEDLINE, Embase, and CINAHL. Rigorous guidelines were used to critique the 41 articles. Health measures were global in nature, lacking details regarding health promotion activities important to stroke family caregiver health. Common factors associated with caregiver health were depressive symptoms and burden. Further research is needed to design more situation-specific instruments to measure stroke family caregiver health, as well as interventions to reduce depressive symptoms and burden while promoting caregiver health.
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Affiliation(s)
- Cleopatra Kum
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Elaine L Miller
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Holly Jones
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Emily B Kean
- University of Cincinnati, Health Sciences Library, Cincinnati, OH, USA
| | - Natalie Kreitzer
- University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH, USA
| | - Tamilyn Bakas
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
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Douglas SL, Plow M, Packer T, Lipson AR, Lehman MJ. Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial. JMIR Res Protoc 2021; 10:e30617. [PMID: 34435971 PMCID: PMC8430872 DOI: 10.2196/30617] [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: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Of the approximately 1 million people living with multiple sclerosis in the United States, more than half receive informal, unpaid care or support from family or friends (caregivers). These caregivers report high levels of stress, anxiety, and negative emotions. Few researchers have conducted psychoeducational interventions for these caregivers. Objective This paper presents a protocol for a randomized clinical trial that aims to test the efficacy of two interventions for improving stress, anxiety, depression, and negative emotions for caregivers of persons with multiple sclerosis. Methods Participants included any self-identified family or friend caregiver of a person with multiple sclerosis. Data collection began in April 2021 and is expected to continue until November 2021. Participants will be randomized to receive either a website-only or a website-coaching intervention delivered for 6 weeks. Data will be collected at baseline, 6 weeks after baseline (after delivery of intervention), and 6 weeks later. Results The protocol was approved by the institutional review board of the Case Western Reserve University on January 21, 2021 (protocol 20201484). As of May 2021, 66 participants were enrolled. Conclusions Our findings will have implications for identifying the efficacy of two types of interventions developed for caregivers of persons with multiple sclerosis to reduce negative psychological outcomes associated with caregiving. Trial Registration ClinicalTrials.gov NCT04662008; http://clinicaltrials.gov/ct2/show/NCT04662008 International Registered Report Identifier (IRRID) DERR1-10.2196/30617
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Affiliation(s)
- Sara L Douglas
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Matthew Plow
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Tanya Packer
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada.,School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Amy R Lipson
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Michelle J Lehman
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev 2021; 6:CD012996. [PMID: 34184251 PMCID: PMC8238669 DOI: 10.1002/14651858.cd012996.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Affiliation(s)
- David H Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Karianne Backx
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
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Effects of Self RehAbilitation Video Exercises (SAVE) on Functional Restorations in Patients with Subacute Stroke. Healthcare (Basel) 2021; 9:healthcare9050565. [PMID: 34064979 PMCID: PMC8150768 DOI: 10.3390/healthcare9050565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Additional exercise therapy has been shown to positively affect acute stroke rehabilitation, which requires an effective method to deliver increased exercise. In this study, we designed a 4-week caregiver-supervised self-exercise program with videos, named “Self rehAbilitation Video Exercises (SAVE)”, to improve the functional outcomes and facilitate early recovery by increasing the continuity of rehabilitation therapy after acute stroke. Methods: This study is a non-randomized trial. Eighty-eight patients were included in an intervention group (SAVE group), who received conventional rehabilitation therapies and an additional self-rehabilitation session by watching bedside exercise videos and continued their own exercises in their rooms for 60 min every day for 4 weeks. Ninety-six patients were included in a control group, who received only conventional rehabilitation therapies. After 4 weeks of hospitalization, both groups assessed several outcome measurements, including the Berg Balance Scale (BBS), Modified Barthel Index (MBI), physical component summary (PCS) and the mental component summary of the Short-Form Survey 36 (SF-36), Mini-Mental State Examination, and Beck Depression Inventory. Results: Differences in BBS, MBI, and PCS components in SF-36 were more statistically significant in the SAVE group than that in the control group (p < 0.05). Patients in the SAVE group showed more significant improvement in BBS, MBI, and PCS components in SF-36 as compared to that in the control group. Conclusions: This evidence-based SAVE intervention can optimize patient recovery after a subacute stroke while keeping the available resources in mind.
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Lin S, Xiao LD, Chamberlain D, Newman P, Xie S, Tan JY. The effect of transition care interventions incorporating health coaching strategies for stroke survivors: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:2039-2060. [PMID: 32532632 DOI: 10.1016/j.pec.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To systematically analyse health coaching strategies in transition care and synthesise the effect of these strategies on health care outcomes for stroke survivors. METHODS A systematic search of nine databases in two languages was conducted. Meta-analysis was conducted when data were available. RESULTS Twenty-five randomised controlled trials met the inclusion criteria. The meta-analysis revealed that health coaching strategies in transition care interventions significantly improve quality of life (QoL) (p < 0.001), activities of daily living (ADL) (p = 0.002) and reduce depression (p = 0.001) for stroke survivors at 3 months. Further subgroup analysis demonstrated that transition care interventions with a greater number of health coaching strategies are associated with a larger effect size on QoL (SMD=1.15) and ADL (SMD=1.177) at 3 months, and a medium effect size (SMD=0.674) on depression reduction. However, the effects of health coaching strategies on readmission, mortality and falls in stroke survivors remain inconclusive. CONCLUSIONS This review provides evidence that incorporating health coaching strategies in transitional care improves health outcomes of stroke survivors. PRACTICE IMPLICATION More trials of health coaching interventions to improve transition care with a rigorous study design are much needed to address the lack of support for stroke survivors and their caregivers in this crucial care period.
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Affiliation(s)
- Shuanglan Lin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Shiqi Xie
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, NT, Australia
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The effect of family-centered empowerment program on the family caregiver burden and the activities of daily living of Iranian patients with stroke: a randomized controlled trial study. Aging Clin Exp Res 2020; 32:1343-1352. [PMID: 31473982 DOI: 10.1007/s40520-019-01321-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023]
Abstract
Dependence of stroke survivors regarding the ability to perform activities of daily living imposes a burden on family caregivers. The study evaluated the effect of the family-centered empowerment program on the ability of Iranian patients with stroke to perform activities of daily living, as well as on family caregiver burden. In this randomized controlled trial study, a total of 90 pairs of patients with stroke and their family caregivers was selected and randomly assigned to the intervention or control groups. Patients and their family caregivers participated in four family-centered empowerment program sessions over four consecutive days while the patient was hospitalized. The difference in the ability of patients with stroke in the intervention and control groups to perform activities of daily living was not significant 2 weeks after the intervention. However, the ability of patients with stroke in the intervention group to perform activities of daily living increased significantly 2 months after the intervention compared with the control group: 66 ± 35.95 and 51.31 ± 36.28, respectively (p = 0.047). Two weeks after the intervention, the family caregiver burden significantly decreased in the intervention group (29.55 ± 15.38) compared with the control group (38.77 ± 18.53 and p = 0.012). The burden in the intervention group also decreased 2 months after the intervention compared with the control group: 22.95 ± 15.68 and 36.11 ± 18.88, respectively (p < 0.001). Nurses can use the family-centered empowerment program to improve the quality of life of patients with stroke, and to reduce the burden of family caregivers.
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Olafsdottir SA, Jonsdottir H, Bjartmarz I, Magnusson C, Caltenco H, Kytö M, Maye L, McGookin D, Arnadottir SA, Hjaltadottir I, Hafsteinsdottir TB. Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study. BMC Health Serv Res 2020; 20:562. [PMID: 32571316 PMCID: PMC7310069 DOI: 10.1186/s12913-020-05432-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality. Methods A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings. Results Ten stroke survivors aged 55–79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (− 4.2) and 5xSST (− 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying − 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES. Conclusions ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.
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Affiliation(s)
- Steinunn A Olafsdottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland.
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ingibjörg Bjartmarz
- Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Mikko Kytö
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland.,Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Laura Maye
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - David McGookin
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - Solveig Asa Arnadottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thora B Hafsteinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Cox V, Mulder M, Nijland R, Schepers V, Van Wegen E, Van Heugten C, Kwakkel G, Visser-Meily J. Agreement and differences regarding family functioning between patients with acquired brain injury and their partners. Brain Inj 2020; 34:489-495. [PMID: 32064947 DOI: 10.1080/02699052.2020.1725978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PRIMARY OBJECTIVE To investigate the level of agreement and differences regarding the perception of family functioning between patients with acquired brain injury and their partners. Our hypothesis was that patients would report better family functioning than their partners. RESEARCH DESIGN Cross-sectional studyMethods and Procedures: Baseline data were used from 77 patient-partner dyads (87.0% stroke) who were participating in the ongoing CARE4Patient and CARE4Carer trials. Family functioning was assessed using the General Functioning subscale of the McMaster Family Assessment Device (FAD-GF). Agreement was assessed with intraclass correlation coefficient, a Bland-Altman plot, percentages absolute agreement and weighted kappa values. Differences were tested with Wilcoxon signed-rank tests. MAIN OUTCOMES AND RESULTS Patients and their partners differed in their perception of family functioning. Within-dyad agreement was poor regarding the overall FAD-GF scores with partners reporting significantly poorer family functioning compared to the patients (32.5% versus 18.2%). Agreement regarding the individual items ranged from slight to moderate. CONCLUSIONS Health care professionals should assess family functioning after stroke in both patients and their partners, and any discrepancies should be discussed with both members of the patient-partner dyad.
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Affiliation(s)
- Vincent Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Rinske Nijland
- Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Vera Schepers
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Amsterdam, The Netherlands
| | - Erwin Van Wegen
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Caroline Van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands.,Limburg Center for Brain Injury, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Johanna Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Amsterdam, The Netherlands
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11
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Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2020; 3:CD003316. [PMID: 32196635 PMCID: PMC7083515 DOI: 10.1002/14651858.cd003316.pub7] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function. OBJECTIVES The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function. SEARCH METHODS In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons. AUTHORS' CONCLUSIONS Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
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Affiliation(s)
- David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Daniel D Carter
- University of LimerickSchool of Allied Health, Faculty of Education and Health SciencesLimerickIreland
| | - Hannah Jarvis
- Manchester Metropolitan UniversityResearch Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and EngineeringJohn Dalton BuildingChester StreetManchesterUKM1 5GD
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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12
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Lin S, Xiao LD, Chamberlain D. A nurse-led health coaching intervention for stroke survivors and their family caregivers in hospital to home transition care in Chongqing, China: a study protocol for a randomized controlled trial. Trials 2020; 21:240. [PMID: 32131876 PMCID: PMC7057579 DOI: 10.1186/s13063-020-4156-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital to home transition care is a most stressful period for stroke survivors and their caregivers to learn self-management of stroke-related health conditions and to engage in rehabilitation. Health coaching has been identified as a strategy to enhance self-management of poststroke care at home. However, interventions in this field that are informed by a health coaching framework are scarce. This study will address a gap in research by testing the hypothesis that a nurse-led health coaching intervention can improve health outcomes for stroke survivors and their family caregivers in hospital to home transition care. METHODS This is a single-blind, two-arm parallel randomized controlled trial of a nurse-led health coaching program versus routine care situated in two tertiary hospitals in Chongqing, China. Stroke survivors and their primary family caregivers will be recruited together as "participant dyads", and the estimated sample size is 140 (70 in each group). The intervention includes a 12-week nurse-led health coaching program in hospital to home transition care commencing at discharge from the hospital. The primary outcome is changes in self-efficacy of stroke survivors at 12 weeks from the baseline. The secondary outcomes are changes in stroke survivors' and quality of life, functional ability, stroke-related knowledge, the number of adverse events, and unplanned hospital admissions, and caregivers' self-efficacy and caregiver-related burden at 12 weeks from the baseline. The outcomes will be measured at 12 weeks and 24 weeks from the baseline. DISCUSSION This study will examine the effect of nurse-led health coaching on hospital to home transition care for stroke survivors and their caregivers. It is anticipated that findings from this trial will provide research evidence to inform policy, and resource and practice development to improve hospital to home transition care for stroke survivors and their caregivers. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000321145. Registered on 1 March 2019.
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Affiliation(s)
- Shuanglan Lin
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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13
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Vloothuis JDM, Mulder M, Nijland RHM, Goedhart QS, Konijnenbelt M, Mulder H, Hertogh CMPM, van Tulder M, van Wegen EEH, Kwakkel G. Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): A randomized controlled trial. PLoS One 2019; 14:e0214241. [PMID: 30958833 PMCID: PMC6453481 DOI: 10.1371/journal.pone.0214241] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE We designed an 8-week caregiver-mediated exercise program with e-health support after stroke (CARE4STROKE) in addition to usual care with the aim to improve functional outcome and to facilitate early supported discharge by increasing the intensity of task specific training. METHODS An observer-blinded randomized controlled trial in which 66 stroke patient-caregiver couples were included during inpatient rehabilitation. Patients allocated to the CARE4STROKE program trained an additional amount of 150 minutes a week with a caregiver and were compared to a control group that received usual care alone. Primary outcomes: self-reported mobility domain of the Stroke Impact Scale 3.0 (SIS) and length of stay (LOS). Secondary outcomes: motor impairment, strength, walking ability, balance, mobility and (Extended) Activities of Daily Living of patients, caregiver strain of caregivers, and mood, self-efficacy, fatigue and quality of life of both patients and caregivers. Outcomes were assessed at baseline, 8 and 12 weeks after randomization. RESULTS No significant between-group differences were found regarding SIS-mobility after 8 (β 6.21, SD 5.16; P = 0.229) and 12 weeks (β 0.14, SD 2.87; P = 0.961), and LOS (P = 0.818). Significant effects in favor of the intervention group were found for patient's anxiety (β 2.01, SD 0.88; P = 0.023) and caregiver's depression (β 2.33, SD 0.77; P = 0.003) post intervention. Decreased anxiety in patients remained significant at the 12-week follow-up (β 1.01, SD 0.40; P = 0.009). CONCLUSIONS This proof-of concept trial did not find significant effects on both primary outcomes mobility and LOS as well as the secondary functional outcomes. Treatment contrast in terms of total exercise time may have been insufficient to achieve these effects. However, caregiver-mediated exercises showed a favorable impact on secondary outcome measures of mood for both patient and caregiver. CLINICAL TRIAL REGISTRATION NTR4300, URL- http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4300.
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Affiliation(s)
- Judith D. M. Vloothuis
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Quirine S. Goedhart
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Manin Konijnenbelt
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | | | - Cees M. P. M. Hertogh
- Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maurits van Tulder
- Department of Health Sciences & Amsterdam Movement Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands
- Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Erwin E. H. van Wegen
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, United States of America
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14
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Abstract
Telerehabilitation refers to the virtual delivery of rehabilitation services into the patient's home. This methodology has shown to be advantageous when used to enhance or replace conventional therapy to overcome geographic, physical, and cognitive barriers. The exponential growth of technology has led to the development of new applications that enable health care providers to monitor, educate, treat, and support patients in their own environment. Best practices and well-designed Telerehabilitation studies are needed to build and sustain a strong Telerehabilitation system that is integrated in the current health care structure and is cost-effective.
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15
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Vloothuis J, Depla M, Hertogh C, Kwakkel G, van Wegen E. Experiences of patients with stroke and their caregivers with caregiver-mediated exercises during the CARE4STROKE trial. Disabil Rehabil 2018; 42:698-704. [PMID: 30384780 DOI: 10.1080/09638288.2018.1507048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: Caregiver-mediated exercises are a novel way of delivering augmented exercise therapy for patients with stroke, in which patients do additional therapeutic exercises together with a caregiver. This explorative qualitative study is part of the CARE4STROKE trial and focused on how participants manage these exercises together. The research questions were: (1) how do the patient-caregiver couples exercise together? and (2) what does exercising together bring about, besides more hours of practice?Methods: Semi-structured interviews were conducted with patients and caregivers who participated in the CARE4STROKE intervention. Inductive thematic data analysis was applied.Results: Seven patients and seven caregivers were interviewed. Three different role-dynamics were found during caregiver-mediated exercises: (1) patient in control, (2) in concert, and (3) the caregiver as informal carer. In addition, three themes were identified about what exercising together brings about: (a) tailor-made exercises through active involvement, (b) preparation for the home situation, and (c) opportunity to be involved.Conclusion: Different role-dynamics are at play in caregiver-mediated exercises, and it is important for participating staff to be aware of their possible effects on the strain of patient or caregiver. Caregiver-mediated exercises were found to enhance individualization of the treatment plan and preparation for home discharge.Implications for rehabilitationCaregiver-mediated exercises, in which a caregiver does exercises with a patient, are currently under investigation as a new form of augmented exercise delivery after strokeDoing exercises together seems to make patient and caregivers actively involved in rehabilitation, which they appreciate, and which seems to help them prepare for the home situationCaregiver selection and monitoring role-dynamics during exercising is an important task of the rehabilitation team.
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Affiliation(s)
- Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Marja Depla
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
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16
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Lee MJ, Yoon S, Kang JJ, Kim J, Kim JM, Han JY. Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation. Ann Rehabil Med 2018; 42:406-415. [PMID: 29961738 PMCID: PMC6058591 DOI: 10.5535/arm.2018.42.3.406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/04/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy. Methods Acute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures. Results There were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p<0.0001). There were no significant (p=0.0755) differences in changes in TIS-S scores at 4 weeks from baseline between the two groups. MBI, FAC, BBS, and TIS scores showed significantly inverse correlations with FES-I scores in patients receiving CME. There were no TEAEs in our series. Conclusion CME was effective and safe in improving the degree of independence, ambulation status, dynamic and static balance, trunk function, and concerns about post-stroke falls in stroke survivors.
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Affiliation(s)
- Min Jun Lee
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Seihee Yoon
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jung Joong Kang
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jun Young Han
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
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17
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Vloothuis J, de Bruin J, Mulder M, Nijland R, Kwakkel G, van Wegen EEH. Description of the CARE4STROKE programme: A caregiver-mediated exercises intervention with e-health support for stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1719. [PMID: 29797740 PMCID: PMC6055845 DOI: 10.1002/pri.1719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/09/2018] [Accepted: 04/27/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Julya de Bruin
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Rinske Nijland
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
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Abstract
BACKGROUND People with stroke conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed that offer people in hospital an early discharge with rehabilitation at home (early supported discharge: ESD). OBJECTIVES To establish if, in comparison with conventional care, services that offer people in hospital with stroke a policy of early discharge with rehabilitation provided in the community (ESD) can: 1) accelerate return home, 2) provide equivalent or better patient and carer outcomes, 3) be acceptable satisfactory to patients and carers, and 4) have justifiable resource implications use. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (January 2017), Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1) in the Cochrane Library (searched January 2017), MEDLINE in Ovid (searched January 2017), Embase in Ovid (searched January 2017), CINAHL in EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to December 2016), and Web of Science (to January 2017). In an effort to identify further published, unpublished, and ongoing trials we searched six trial registries (March 2017). We also performed citation tracking of included studies, checked reference lists of relevant articles, and contacted trialists. SELECTION CRITERIA Randomised controlled trials (RCTs) recruiting stroke patients in hospital to receive either conventional care or any service intervention that has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. DATA COLLECTION AND ANALYSIS The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow-up. Two review authors scrutinised trials, categorised them on their eligibility and extracted data. Where possible we sought standardised data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not. We assessed risk of bias for the included trials and used GRADE to assess the quality of the body of evidence. MAIN RESULTS We included 17 trials, recruiting 2422 participants, for which outcome data are currently available. Participants tended to be a selected elderly group of stroke survivors with moderate disability. The ESD group showed reductions in the length of hospital stay equivalent to approximately six days (mean difference (MD) -5.5; 95% confidence interval (CI) -3 to -8 days; P < 0.0001; moderate-grade evidence). The primary outcome was available for 16 trials (2359 participants). Overall, the odds ratios (OR) for the outcome of death or dependency at the end of scheduled follow-up (median 6 months; range 3 to 12) was OR 0.80 (95% CI 0.67 to 0.95, P = 0.01, moderate-grade evidence) which equates to five fewer adverse outcomes per 100 patients receiving ESD. The results for death (16 trials; 2116 participants) and death or requiring institutional care (12 trials; 1664 participants) were OR 1.04 (95% CI 0.77 to 1.40, P = 0.81, moderate-grade evidence) and OR 0.75 (95% CI 0.59 to 0.96, P = 0.02, moderate-grade evidence), respectively. Small improvements were also seen in participants' extended activities of daily living scores (standardised mean difference (SMD) 0.14, 95% CI 0.03 to 0.25, P = 0.01, low-grade evidence) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02, low-grade evidence). We saw no clear differences in participants' activities of daily living scores, patients subjective health status or mood, or the subjective health status, mood or satisfaction with services of carers. We found low-quality evidence that the risk of readmission to hospital was similar in the ESD and conventional care group (OR 1.09, 95% CI 0.79 to 1.51, P = 0.59, low-grade evidence). The evidence for the apparent benefits were weaker at one- and five-year follow-up. Estimated costs from six individual trials ranged from 23% lower to 15% greater for the ESD group in comparison to usual care.In a series of pre-planned analyses, the greatest reductions in death or dependency were seen in the trials evaluating a co-ordinated ESD team with a suggestion of poorer results in those services without a co-ordinated team (subgroup interaction at P = 0.06). Stroke patients with mild to moderate disability at baseline showed greater reductions in death or dependency than those with more severe stroke (subgroup interaction at P = 0.04). AUTHORS' CONCLUSIONS Appropriately resourced ESD services with co-ordinated multidisciplinary team input provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. Results are inconclusive for services without co-ordinated multidisciplinary team input. We observed no adverse impact on the mood or subjective health status of patients or carers, nor on readmission to hospital.
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Affiliation(s)
- Peter Langhorne
- ICAMS, University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Satu Baylan
- Queen Elizabeth University HospitalInstitute of Health and Wellbeing, College of Medical, Veterinary and Life SciencesGlasgowUKG51 4TF
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Opara J, Błaszczyszyn M, Mehlich K, Kucio C. Where is the idea of Early Supported Discharge after stroke going? REHABILITACJA MEDYCZNA 2017. [DOI: 10.5604/01.3001.0009.7395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2009 and in 2012 we published two articles in “Medical Rehabilitation” regarding the development of idea of Early Home Supported Discharge in stroke rehabilitation. Today, omitting the word “Home”, the abbreviation ESD is more popular. The aim of this article is to present the latest developments around the idea of continuing rehabilitation after early discharge from the hospital in a home setting. We primarily focus on the most recent reports, particularly systematic reviews. Each country has its own eligibility criteria which are different for early hospital discharge and follow-up rehabilitation in the place of residence, and sometimes the rehabilitation team staff also differs. So far, studies have shown that the optimal role of the rehabilitation team is coordination and delivery of rehabilitation in a home setting. It is also clear that the ESD model brings tangible economic benefits, mainly by shortening hospital stays. Specific organizational solutions used in different countries depend on cultural traditions, capabilities and financial sources.
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Affiliation(s)
- Józef Opara
- Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach / Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | | | - Krzysztof Mehlich
- Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach / Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | - Cezary Kucio
- Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach / Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
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Vloothuis JDM, Mulder M, Veerbeek JM, Konijnenbelt M, Visser‐Meily JMA, Ket JCF, Kwakkel G, van Wegen EEH. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev 2016; 12:CD011058. [PMID: 28002636 PMCID: PMC6463929 DOI: 10.1002/14651858.cd011058.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced. OBJECTIVES To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, Issue 10), MEDLINE (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field. SELECTION CRITERIA Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. One review author extracted data, and assessed quality and risk of bias, and a second review author cross-checked these data and assessed quality. We determined the quality of the evidence using GRADE. The small number of included studies limited the pre-planned analyses. MAIN RESULTS We included nine trials about CME, of which six trials with 333 patient-caregiver couples were included in the meta-analysis. The small number of studies, participants, and a variety of outcome measures rendered summarising and combining of data in meta-analysis difficult. In addition, in some studies, CME was the only intervention (CME-core), whereas in other studies, caregivers provided another, existing intervention, such as constraint-induced movement therapy. For trials in the latter category, it was difficult to separate the effects of CME from the effects of the other intervention.We found no significant effect of CME on basic ADL when pooling all trial data post intervention (4 studies; standardised mean difference (SMD) 0.21, 95% confidence interval (CI) -0.02 to 0.44; P = 0.07; moderate-quality evidence) or at follow-up (2 studies; mean difference (MD) 2.69, 95% CI -8.18 to 13.55; P = 0.63; low-quality evidence). In addition, we found no significant effects of CME on extended ADL at post intervention (two studies; SMD 0.07, 95% CI -0.21 to 0.35; P = 0.64; low-quality evidence) or at follow-up (2 studies; SMD 0.11, 95% CI -0.17 to 0.39; P = 0.45; low-quality evidence).Caregiver burden did not increase at the end of the intervention (2 studies; SMD -0.04, 95% CI -0.45 to 0.37; P = 0.86; moderate-quality evidence) or at follow-up (1 study; MD 0.60, 95% CI -0.71 to 1.91; P = 0.37; very low-quality evidence).At the end of intervention, CME significantly improved the secondary outcomes of standing balance (3 studies; SMD 0.53, 95% CI 0.19 to 0.87; P = 0.002; low-quality evidence) and quality of life (1 study; physical functioning: MD 12.40, 95% CI 1.67 to 23.13; P = 0.02; mobility: MD 18.20, 95% CI 7.54 to 28.86; P = 0.0008; general recovery: MD 15.10, 95% CI 8.44 to 21.76; P < 0.00001; very low-quality evidence). At follow-up, we found a significant effect in favour of CME for Six-Minute Walking Test distance (1 study; MD 109.50 m, 95% CI 17.12 to 201.88; P = 0.02; very low-quality evidence). We also found a significant effect in favour of the control group at the end of intervention, regarding performance time on the Wolf Motor Function test (2 studies; MD -1.72, 95% CI -2.23 to -1.21; P < 0.00001; low-quality evidence). We found no significant effects for the other secondary outcomes (i.e. PATIENT motor impairment, upper limb function, mood, fatigue, length of stay and adverse events; caregiver: mood and quality of life).In contrast to the primary analysis, sensitivity analysis of CME-core showed a significant effect of CME on basic ADL post intervention (2 studies; MD 9.45, 95% CI 2.11 to 16.78; P = 0.01; moderate-quality evidence).The methodological quality of the included trials and variability in interventions (e.g. content, timing, and duration), affected the validity and generalisability of these observed results. AUTHORS' CONCLUSIONS There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.
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Affiliation(s)
- Judith DM Vloothuis
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Marijn Mulder
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
| | - Janne M Veerbeek
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
- VU University Medical CenterDepartment of Rehabilitation Medicine, Physical TherapyDe Boelelaan 1118AmsterdamNoor‐HollandNetherlands1007 MB
| | - Manin Konijnenbelt
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Johanna MA Visser‐Meily
- University Medical Center Utrecht and De HoogstraatBrain Center Rudolf MagnusHeidelberglaan 100PO Box 85500UtrechtNetherlands3508 GA
| | - Johannes CF Ket
- Vrije Universiteit AmsterdamMedical LibraryDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam NeurosciencesDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- Amsterdam Neurosciences, VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamPO Box 7057AmsterdamNetherlands1007 MB
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Pérez-Miralles JA, Marqués-Sulé E, Espí-López GV. Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke. Top Stroke Rehabil 2016; 24:183-193. [DOI: 10.1080/10749357.2016.1245395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Luz Sánchez-Sánchez
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
| | | | - José-Antonio Pérez-Miralles
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
- Nueva Opción – Brain Damage Association, Valencia, Spain
| | - Elena Marqués-Sulé
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Gemma-Victoria Espí-López
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
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van den Berg M, Crotty M, Liu E, Killington M, Kwakkel G, van Wegen E. Early Supported Discharge by Caregiver-Mediated Exercises and e-Health Support After Stroke: A Proof-of-Concept Trial. Stroke 2016; 47:1885-92. [PMID: 27301941 DOI: 10.1161/strokeaha.116.013431] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This proof-of-concept trial investigated the effects of an 8-week program of caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden. METHODS Sixty-three hospitalized stroke patients (mean age 68.7, 64% female) were randomly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care. Primary outcome was the Stroke Impact Scale mobility domain. Secondary outcomes included length of stay, other Stroke Impact Scale domains, readmissions, motor impairment, strength, walking ability, balance, mobility, (extended) activities of daily living, psychosocial functioning, self-efficacy, quality of life, and fatigue. Additionally, caregiver's self-reported fatigue, symptoms of anxiety, self-efficacy, and strain were assessed. Assessments were completed at baseline and at 8 and 12 weeks. RESULTS Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility (P=0.6); however, carers reported less fatigue (4.6, confidence interval [CI] 95% 0.3-8.8; P=0.04) and higher self-efficacy (-3.3, CI 95% -5.7 to -0.9; P=0.01) at week 12. Per-protocol analysis, examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility (-9.8, CI 95% -20.1 to 0.4; P=0.06), significantly improved extended activities of daily living scores at week 8 (-3.6, CI 95% -6.3 to -0.8; P=0.01) and week 12 (3.0, CI 95% -5.8 to -0.3; P=0.03), a 9-day shorter length of stay (P=0.046), and fewer readmissions over 12 months (P<0.05). CONCLUSIONS Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice, resulting in improved patient-extended activities of daily living, reduced length of stay with fewer readmissions post stroke, and reduced levels of caregiver fatigue with increased feelings of self-efficacy. The current findings justify a larger definite phase III randomized controlled trial. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN12613000779774.
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Affiliation(s)
- Maayken van den Berg
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.).
| | - Maria Crotty
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Enwu Liu
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Maggie Killington
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Gert Kwakkel
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Erwin van Wegen
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
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Knols RH, Vanderhenst T, Verra ML, de Bruin ED. Exergames for Patients in Acute Care Settings: Systematic Review of the Reporting of Methodological Quality, FITT Components, and Program Intervention Details. Games Health J 2016; 5:224-35. [PMID: 27096922 DOI: 10.1089/g4h.2015.0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was designed to summarize (1) the evidence from studies investigating the use of exergames in acute care settings, (2) the methodological quality of these studies, (3) the reporting of frequency, intensity, time, and type (FITT) of exergaming components and adherence, and (4) reporting of intervention details enabling study replication. MATERIALS AND METHODS Medline-Ovid, EMBASE, CINAHL, PsychInfo, and the Cochrane Library were consulted. Two authors independently selected and systematically reviewed the included reports. Study quality was scored for each study. RESULTS Of the nine reports representing five randomized clinical trials, one controlled clinical trial, and three single-group studies, the methodological quality was rather low, and the majority of the reports appeared to have a high risk of bias. Altogether, 365 patients were included in the selected articles. Energy expenditure, 6-Minute Walking Test, Timed Up and Go Test, Modified Berg Balance Scale, level of enjoyment, Transitional Dyspnea Index, upper limb activity, cognitive performance, and length of hospital stay favored exergaming. Three studies considered 70 percent or more of methodological quality items. Two studies reported all four FITT components. No studies reported adherence. Three studies each included descriptions of six intervention details. CONCLUSIONS The included studies suggest that patients in acute care settings may benefit from exergaming. The relationship between exergaming and patient outcomes requires, however, further exploration. Future adequately powered studies with low risk of bias and with acute care populations that are followed over extended time periods should be performed to substantiate or refute the advantageous effect of exergaming in acute care settings. Future studies should pay attention to the description of FITT components and adherence to the intervention. Attention to include details of the used exergaming intervention is important for replication purposes.
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Affiliation(s)
- Ruud H Knols
- 1 Directorate of Research and Education, Physiotherapy and Occupational Therapy Research Center, University Hospital Zurich , Zurich, Switzerland
| | - Tom Vanderhenst
- 2 Nursing and Allied Health Professions Office, Physiotherapy Occupational Therapy, University Hospital Zurich , Zurich, Switzerland
| | - Martin L Verra
- 3 Department of Physiotherapy, Berne University Hospital , Berne, Switzerland
| | - Eling D de Bruin
- 4 Institute of Human Movement Sciences and Sport , Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- 5 Centre for Evidence Based Physiotherapy, Maastricht University , Maastricht, The Netherlands
- 6 Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
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