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Carlsson GE, Törnbom K, Nordin Å, Stibrant Sunnerhagen K. Coming home in the context of very early supported discharge after stroke - An interview study of patients' experiences. J Stroke Cerebrovasc Dis 2024; 33:107869. [PMID: 39032718 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/24/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVES To explore patients' experiences of coming home and managing everyday life within the context of very early supported discharge after stroke (VESD). STUDY DESIGN An explorative qualitative study using semi structured interviews. METHOD This study was nested within a randomised controlled trial,; Gothenburg Very Early Supported Discharge (GOTVED), comparing a home rehabilitation intervention given by a coordinated team (VESD) with conventional care. Eleven participants with a median age 70.0 years (range 63-95) of which nine scoring 0-4 on the NIHSS indicating no symptoms or minor stroke were interviewed on average 12 days after discharge. Data was analysed using thematic analysis. RESULTS The diversity of patients' experiences was reflected in the overarching main theme Very Early Supported Discharge after stroke - a multifaceted experience, built upon five themes: "Conditions surrounding the discharge", "Concerns about the condition", "Confronting a new everyday life", "Experiences of the intervention" and the "Role of next of kin". CONCLUSIONS The respondents were largely satisfied with the very early supported discharge which might be expected, given that it was well planned regarding timing, individualisation and content. The patients need to be aware of the purpose of the VESD intervention. Due to the unpredictability of the stroke and its consequences, interventions need to be flexible. Goal setting is important but must be comprehensible. The role and burden of next of kin should be addressed and negotiated, and the ending of the intervention must be planned, with seamless transition to further rehabilitation and social support including the issue of participation in everyday life.
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Affiliation(s)
- Gunnel E Carlsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden.
| | - Karin Törnbom
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden; Faculty of Social Sciences, Department of Social Work, University of Gothenburg, Sweden
| | - Åsa Nordin
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden; Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden; Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
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Warner KN, Poulos RG, Cole AM, Nguyen TA, Un FC, Faux SG, Kohler F, Alexander T, Capell JT, Hilvert DR, O'Connor CMC, Poulos CJ. Re/connecting with "home": a mixed methods study of service provider and patient perspectives to facilitate implementing rehabilitation in the home for reconditioning. Disabil Rehabil 2024:1-11. [PMID: 39105538 DOI: 10.1080/09638288.2024.2386157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE To explore the views of healthcare professionals and patients about the advantages and disadvantages of rehabilitation in the home (RITH) for reconditioning, and identify factors that should contribute to the successful implementation of a consensus-based RITH model for reconditioning. MATERIALS AND METHODS Interviews with 24 healthcare professionals and 21 surveys (comprising Likert scale and free text responses) of inpatients undergoing rehabilitation for reconditioning provided study data. Interpretive thematic analysis was used to analyse interview data; descriptive statistics analysed Likert scale responses; patient written responses assisted with the interpretation of themes developed from the interview data. RESULTS Two major themes were elicited in this study: the home is a physical setting and the home is a lived space. Advantages and disadvantages of RITH for patients, carers and healthcare professionals were identified within these themes. Appropriate patient selection; effective communication with patients and carers, and within RITH teams; adequate patient and carer support; ensuring the safety of patients and staff; and education of patients, carers and healthcare professionals are essential for the satisfactory implementation of RITH. CONCLUSION The concept of home shapes the delivery of RITH. Recognising the advantages and disadvantages of RITH highlights important considerations needed to successfully implement RITH for reconditioning.
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Affiliation(s)
- Kerry N Warner
- HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Roslyn G Poulos
- HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Andrew M Cole
- HammondCare, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Tuan-Anh Nguyen
- South Western Sydney Local Health District, Sydney, Australia
| | | | - Steven G Faux
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- St Vincent's Hospital, Sydney, Australia
| | - Friedbert Kohler
- HammondCare, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Tara Alexander
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Jacquelin T Capell
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | | | - Claire M C O'Connor
- HammondCare, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Christopher J Poulos
- HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Järbrink H, Forsberg A, Erhag HF, Lundälv J, Bjerså K, Engström M. Recovering from physical trauma in late life, a struggle to recapture autonomy: A grounded theory study. J Adv Nurs 2024; 80:2905-2916. [PMID: 38130055 DOI: 10.1111/jan.16035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
AIM The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma. DESIGN A qualitative study with a constructivist grounded theory design. METHODS Fifteen in-depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology. RESULTS The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges. CONCLUSION Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process. IMPACT As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns. REPORTING METHOD Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Hanna Järbrink
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery Sahlgrenska, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Forsberg
- Institute of Health Sciences, Lund university, Lund, Sweden
- Department of Thoracic Surgery, Skåne University Hospital, Malmö, Sweden
| | - Hanna Falk Erhag
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Gothenburg, Sweden
| | - Jörgen Lundälv
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
- Department of Surgical and Perioperative Sciences, Unit of Surgery, Umeå University, Umeå, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Care, Närhälsan Majorna, Region Västra Götaland, Gothenburg, Sweden
| | - My Engström
- Department of Surgery Sahlgrenska, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fors S, Bråndal A, Pessah-Rasmussen H, Lindgren I. Experiences of chain of care and rehabilitation after stroke: a qualitative study of persons discharged to skilled nursing facilities before returning home. J Rehabil Med 2024; 56:jrm35240. [PMID: 38899476 PMCID: PMC11218674 DOI: 10.2340/jrm.v56.35240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To explore how people with stroke, discharged to skilled nursing facilities before returning home, experience the chain of care and rehabilitation. DESIGN Qualitative, semi-structured interview design. METHODS Thirteen stroke survivors discharged from a stroke unit to a skilled nursing facility before returning to independent living participated. Semi-structured telephone interviews were conducted 2-5 months after stroke and analysed with content analysis. RESULTS The analysis resulted in three categories, Organizational processes, critical and complex, Rehabilitation, the right support at the right time and Adaptation to the changed situation, with a total of 9 subcategories. The informants perceived low participation in planning and goalsetting and limited information. Support from the healthcare services was important to proceed with improvements although the amount of supported training varied. Factors hindering and facilitating managing everyday life were described, as well as lingering uncertainty of what the future would be like. CONCLUSION Support and rehabilitation as well as individuals' needs varied, throughout the chain of care. To enable participation in the rehabilitation, assistance in setting goals and repeated information is warranted. Tailored care and rehabilitation throughout the chain of care should be provided, followed up at home, and coordinated for smooth transitions between organizations.
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Affiliation(s)
- Sofie Fors
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Sweden; Department of Health Sciences, Lund University, Sweden.
| | - Anna Bråndal
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Sweden; Department of Clinical Sciences, Lund, Lund University, Sweden
| | - Ingrid Lindgren
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Sweden; Department of Health Sciences, Lund University, Sweden
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Ortiz-Rubio A, Håkansson C, Rasmussen HP, Lexell EM. Occupational balance and stroke impact among community-dwelling stroke survivors 65 years or older: a cross-sectional study. Aust Occup Ther J 2024. [PMID: 38711275 DOI: 10.1111/1440-1630.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 03/28/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Occupational balance has been investigated in different populations but less in stroke survivors. Previous studies have focussed on occupational balance among stroke survivors of working age (15-64 years of age), showing they did not perceive they had occupational balance. There is, therefore, a lack of knowledge of how older stroke survivors perceive their occupational balance. The aims of this study were to describe occupational balance in community-dwelling stroke survivors 65 years or older and to investigate if there were any associations between their perceived stroke impact and occupational balance. METHODS A cross-sectional study was performed with 58 stroke survivors, with a median age of 75 years at stroke onset and a median time since stroke onset of 11 months. The participants were recruited from a local stroke register and answered questionnaires on occupational balance and stroke impact. Data were analysed with descriptive statistics, correlations and logistic regression. RESULTS The participants had a median score of 29 (min 12 to max 33), indicating a very high occupational balance, a low stroke impact, and a good recovery (median 82.5; min 0 to max 100). An association between participation and occupational balance (OR 1.13; 95% CI 1.04-1.23) was found. CONCLUSION The stroke survivors perceived a low stroke impact and a high occupational balance. It is possible that older community-dwelling stroke survivors, of whom many have retired, juggle less occupations leaving them with more time to engage in those occupations they want to, leading to a better occupational balance.
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Affiliation(s)
- Araceli Ortiz-Rubio
- Division of Occupational Therapy, Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Hélène Pessah Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund/Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Eva Månsson Lexell
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund/Malmö, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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Wallis JA, Shepperd S, Makela P, Han JX, Tripp EM, Gearon E, Disher G, Buchbinder R, O'Connor D. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database Syst Rev 2024; 3:CD014765. [PMID: 38438114 PMCID: PMC10911892 DOI: 10.1002/14651858.cd014765.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Worldwide there is an increasing demand for Hospital at Home as an alternative to hospital admission. Although there is a growing evidence base on the effectiveness and cost-effectiveness of Hospital at Home, health service managers, health professionals and policy makers require evidence on how to implement and sustain these services on a wider scale. OBJECTIVES (1) To identify, appraise and synthesise qualitative research evidence on the factors that influence the implementation of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home, from the perspective of multiple stakeholders, including policy makers, health service managers, health professionals, patients and patients' caregivers. (2) To explore how our synthesis findings relate to, and help to explain, the findings of the Cochrane intervention reviews of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home services. SEARCH METHODS We searched MEDLINE, CINAHL, Global Index Medicus and Scopus until 17 November 2022. We also applied reference checking and citation searching to identify additional studies. We searched for studies in any language. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with qualitative data collection and analysis methods examining the implementation of new or existing Hospital at Home services from the perspective of different stakeholders. DATA COLLECTION AND ANALYSIS Two authors independently selected the studies, extracted study characteristics and intervention components, assessed the methodological limitations using the Critical Appraisal Skills Checklist (CASP) and assessed the confidence in the findings using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). We applied thematic synthesis to synthesise the data across studies and identify factors that may influence the implementation of Hospital at Home. MAIN RESULTS From 7535 records identified from database searches and one identified from citation tracking, we included 52 qualitative studies exploring the implementation of Hospital at Home services (31 Early Discharge, 16 Admission Avoidance, 5 combined services), across 13 countries and from the perspectives of 662 service-level staff (clinicians, managers), eight systems-level staff (commissioners, insurers), 900 patients and 417 caregivers. Overall, we judged 40 studies as having minor methodological concerns and we judged 12 studies as having major concerns. Main concerns included data collection methods (e.g. not reporting a topic guide), data analysis methods (e.g. insufficient data to support findings) and not reporting ethical approval. Following synthesis, we identified 12 findings graded as high (n = 10) and moderate (n = 2) confidence and classified them into four themes: (1) development of stakeholder relationships and systems prior to implementation, (2) processes, resources and skills required for safe and effective implementation, (3) acceptability and caregiver impacts, and (4) sustainability of services. AUTHORS' CONCLUSIONS Implementing Admission Avoidance and Early Discharge Hospital at Home services requires early development of policies, stakeholder engagement, efficient admission processes, effective communication and a skilled workforce to safely and effectively implement person-centred Hospital at Home, achieve acceptance by staff who refer patients to these services and ensure sustainability. Future research should focus on lower-income country and rural settings, and the perspectives of systems-level stakeholders, and explore the potential negative impact on caregivers, especially for Admission Avoidance Hospital at Home, as this service may become increasingly utilised to manage rising visits to emergency departments.
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Affiliation(s)
- Jason A Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Cabrini Health, Malvern, Australia
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Petra Makela
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jia Xi Han
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Evie M Tripp
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emma Gearon
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gary Disher
- New South Wales Ministry of Health, St Leonards, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Björkdahl A, Rafsten L, Petersson C, Sunnerhagen KS, Danielsson A. Effect of very early supported discharge versus usual care on activi-ties of daily living ability after mild stroke: a randomized controlled trial. J Rehabil Med 2023; 55:jrm12363. [PMID: 37615492 PMCID: PMC10464824 DOI: 10.2340/jrm.v55.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke. DESIGN A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. Patients: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild. METHODS The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke. RESULTS Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p = 0.039) at 4 weeks post-discharge and 3 and 4.5 (p = 0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p = 0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke. CONCLUSION Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results.
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Affiliation(s)
- Ann Björkdahl
- nstitute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ²Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Rafsten
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cathrine Petersson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Danielsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Eliassen M, Arntzen C, Nikolaisen M, Gramstad A. Rehabilitation models that support transitions from hospital to home for people with acquired brain injury (ABI): a scoping review. BMC Health Serv Res 2023; 23:814. [PMID: 37525270 PMCID: PMC10388520 DOI: 10.1186/s12913-023-09793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/07/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Research shows a lack of continuity in service provision during the transition from hospital to home for people with acquired brain injuries (ABI). There is a need to gather and synthesize knowledge about services that can support strategies for more standardized referral and services supporting this critical transition phase for patients with ABI. We aimed to identify how rehabilitation models that support the transition phase from hospital to home for these patients are described in the research literature and to discuss the content of these models. METHODS We based our review on the "Arksey and O`Malley framework" for scoping reviews. The review considered all study designs, including qualitative and quantitative methodologies. We extracted data of service model descriptions and presented the results in a narrative summary. RESULTS A total of 3975 studies were reviewed, and 73 were included. Five categories were identified: (1) multidisciplinary home-based teams, (2) key coordinators, (3) trained family caregivers or lay health workers, (4) predischarge planning, and (5) self-management programs. In general, the studies lack in-depth professional and contextual descriptions. CONCLUSIONS There is a wide variety of rehabilitation models that support the transition phase from hospital to home for people with ABI. The variety may indicate a lack of consensus of best practices. However, it may also reflect contextual adaptations. This study indicates that health care service research lacks robust and thorough descriptions of contextual features, which may limit the feasibility and transferability to diverse contexts.
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Affiliation(s)
- Marianne Eliassen
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway.
| | - Cathrine Arntzen
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
- Center for Care Sciences, North, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
| | - Morten Nikolaisen
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
- Center for Care Sciences, North, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
| | - Astrid Gramstad
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
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Lavis H, van Vliet P, Tavener M. Stroke survivor, caregiver and therapist experiences of home-based stroke rehabilitation: a thematic synthesis of qualitative studies. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2180710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Heidi Lavis
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Paulette van Vliet
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Meredith Tavener
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
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Poulos RG, Cole AM, Warner KN, Faux SG, Nguyen TA, Kohler F, Un FC, Alexander T, Capell JT, Hilvert DR, O'Connor CM, Poulos CJ. Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia. BMC Health Serv Res 2023; 23:113. [PMID: 36737750 PMCID: PMC9895972 DOI: 10.1186/s12913-023-09068-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Reconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning. METHODS A multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses. RESULTS One-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each. CONCLUSIONS Strong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost-benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.
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Affiliation(s)
- Roslyn G Poulos
- HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | - Andrew M Cole
- HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | - Kerry N Warner
- HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | - Steven G Faux
- School of Population Health, UNSW, Sydney, Australia
- St Vincent's Hospital, Sydney, Australia
| | - Tuan-Anh Nguyen
- South Western Sydney Local Health District, Sydney, Australia
| | - Friedbert Kohler
- HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | | | - Tara Alexander
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Jacquelin T Capell
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | | | - Claire Mc O'Connor
- HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | - Christopher J Poulos
- HammondCare, Sydney, Australia.
- School of Population Health, UNSW, Sydney, Australia.
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Williams S, O’Riordan C, Steed F, Leahy A, Shanahan E, Peters C, O’Connor M, Galvin R, Morrissey AM. Early Supported Discharge for Older Adults Admitted to Hospital with Medical Complaints: A Qualitative Study Exploring the Views of Stakeholders. J Multidiscip Healthc 2022; 15:2861-2870. [PMID: 36561433 PMCID: PMC9766477 DOI: 10.2147/jmdh.s380572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/07/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. Methods Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used. Phone interviews took place following a semi-structured interview guide. Focus groups were moderated by A-MM. Braun and Clarke's approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021). Results Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: 1. Pre-ESD experiences of providing and receiving older adult inpatient care, 2. Navigating discharge procedures from acute hospital services, 3. A vision for more integrated model of care and a medical ESD team. Discussion This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints. Conclusion This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a feasibility trial, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.
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Affiliation(s)
- Susan Williams
- School of Allied Health, University of Limerick, Limerick, Ireland,Correspondence: Susan Williams, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland, Email
| | - Clíona O’Riordan
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Fiona Steed
- Department of Medicine, University Hospital Limerick, Limerick, Ireland
| | - Aoife Leahy
- School of Allied Health, University of Limerick, Limerick, Ireland,Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Catherine Peters
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland
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12
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Mastering health following minor stroke-A qualitative explorative study. J Stroke Cerebrovasc Dis 2022; 31:106607. [PMID: 35753094 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with minor stroke or transient ischemic attack are encouraged to adopt a healthy lifestyle to prevent recurrent stroke. After discharge health behaviour is performed in an individual everyday context and must be properly understood within this context, including which aspects act as facilitators or barriers for healthy behaviour. OBJECTIVES To explore the experience of daily life in patients discharged home after minor stroke or transient ischemic attack, focusing on perceived health and reflection on health behaviour, and how this is associated with their overall experience of returning to their everyday context in relation to potential sequelae of stroke. METHODS Semi-structured qualitative interviews were conducted 3 - 13 months after discharge with sixteen patients discharged home after minor stroke or transient ischemic attack. Inductive thematic analysis was performed to analyse the interviews. RESULTS Participants associated their health and behaviour within a lens of worrying for future life prospect and triggered by perceived intrusive changes in their life condition. Even though some found it possible to resume participation in everyday life within weeks, they became increasingly aware that minor cognitive deficits, difficulties with planning, multi-tasking, memory, and fatigue influenced their health believes and behavioural patterns. The need for social and professional support had to be balanced against a wish for independence. CONCLUSION Patients with minor stroke or transient ischemic attacks experience changes as both being concrete in the form of persisting symptoms and abstract in the form of worries and uncertainty about the future. Perceived health was associated with a new sense of vulnerability due to realisations about the risk of recurrent stroke. Worries were anchored within the individual to handle, but for some they serve as a motivator to regulate their behaviour in order to master health.
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13
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Lindblom S, Tistad M, Flink M, Laska AC, von Koch L, Ytterberg C. Referral-based transition to subsequent rehabilitation at home after stroke: one-year outcomes and use of healthcare services. BMC Health Serv Res 2022; 22:594. [PMID: 35505404 PMCID: PMC9066723 DOI: 10.1186/s12913-022-08000-7] [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: 01/08/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is a lack of knowledge about patients’ journeys across the stroke care continuum, especially regarding the transition from inpatient to outpatient care and rehabilitation. Therefore, the aim of the present study was to explore and describe patterns of healthcare use over a one-year period, health outcomes at 3 and 12 months for patients following a referral-based transition to subsequent rehabilitation in the home, and the caregiver burden on their significant others. A further aim was to explore factors associated with the use of rehabilitation and healthcare after the referral-based transition to continued rehabilitation in the home for people recovering from a stroke. Methods Data regarding healthcare use during the first 12 months post-stroke was collected from the Region Stockholm computerized register. Data on patient characteristics, disease-related data, and functioning were retrieved drawn from medical records and questionnaires. Descriptive statistics were used to present healthcare use, participants’ characteristics, disease-related data, and patient functioning. Multivariable regression models were created to explore associations between the total number of outpatient contacts, total visits with the neurorehabilitation team, and the independent variables. Results The mean age for the 190 participants was 73 years for men and 78 years for women. Twenty-one participants (11%) had an acute rehospitalization within 30 days after discharge, and 41 participants (21%) were re-hospitalized within 90 days. Twenty-two (12%) of the participants had no visits with the neurorehabilitation team, 73 (39%) participants had 1–3 visits, 57 (30%) had 4–16 visits, and 38 (20%) had ≥17 visits. Female sex and length of hospital stay were associated with a higher number of visits with the neurorehabilitation team. Living alone, higher self-rated recovery, and being able to walk independently were associated with a lower number of visits with the neurorehabilitation team. Female sex, having home help services before the stroke, longer length of hospital stay, and more comorbidities were associated with a higher number of outpatient contacts. Conclusions The findings indicate that there is no generic pattern of healthcare use during the first-year post-stroke in patients receiving referral-based transition to continued rehabilitation in the home. The different patterns of healthcare use seemed to mirror the participants’ level of functioning. However, there is a need to further investigate how follow-up and rehabilitation correspond to the needs of patients and their significant others in the short- and long-term perspective. Trial registration ClinicalTrials.gov, registration number: NCT02925871. Date of registration: October 6, 2016.
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Affiliation(s)
- Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. .,Karolinska University Hospital, Stockholm, Sweden.
| | - Malin Tistad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Dalarna University, School of Health and Social Studies, Falun, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Ann Charlotte Laska
- Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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14
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Fisher RJ, Chouliara N, Byrne A, Cameron T, Lewis S, Langhorne P, Robinson T, Waring J, Geue C, Paley L, Rudd A, Walker MF. Large-scale implementation of stroke early supported discharge: the WISE realist mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In England, the provision of early supported discharge is recommended as part of an evidence-based stroke care pathway.
Objectives
To investigate the effectiveness of early supported discharge services when implemented at scale in practice and to understand how the context within which these services operate influences their implementation and effectiveness.
Design
A mixed-methods study using a realist evaluation approach and two interlinking work packages was undertaken. Three programme theories were tested to investigate the adoption of evidence-based core components, differences in urban and rural settings, and communication processes.
Setting and interventions
Early supported discharge services across a large geographical area of England, covering the West and East Midlands, the East of England and the North of England.
Participants
Work package 1: historical prospective patient data from the Sentinel Stroke National Audit Programme collected by early supported discharge and hospital teams. Work package 2: NHS staff (n = 117) and patients (n = 30) from six purposely selected early supported discharge services.
Data and main outcome
Work package 1: a 17-item early supported discharge consensus score measured the adherence to evidence-based core components defined in an international consensus document. The effectiveness of early supported discharge was measured with process and patient outcomes and costs. Work package 2: semistructured interviews and focus groups with NHS staff and patients were undertaken to investigate the contextual determinants of early supported discharge effectiveness.
Results
A variety of early supported discharge service models had been adopted, as reflected by the variability in the early supported discharge consensus score. A one-unit increase in early supported discharge consensus score was significantly associated with a more responsive early supported discharge service and increased treatment intensity. There was no association with stroke survivor outcome. Patients who received early supported discharge in their stroke care pathway spent, on average, 1 day longer in hospital than those who did not receive early supported discharge. The most rural services had the highest service costs per patient. NHS staff identified core evidence-based components (e.g. eligibility criteria, co-ordinated multidisciplinary team and regular weekly multidisciplinary team meetings) as central to the effectiveness of early supported discharge. Mechanisms thought to streamline discharge and help teams to meet their responsiveness targets included having access to a social worker and the quality of communications and transitions across services. The role of rehabilitation assistants and an interdisciplinary approach were facilitators of delivering an intensive service. The rurality of early supported discharge services, especially when coupled with capacity issues and increased travel times to visit patients, could influence the intensity of rehabilitation provision and teams’ flexibility to adjust to patients’ needs. This required organising multidisciplinary teams and meetings around the local geography. Findings also highlighted the importance of good leadership and communication. Early supported discharge staff highlighted the need for collaborative and trusting relationships with patients and carers and stroke unit staff, as well as across the wider stroke care pathway.
Limitations
Work package 1: possible influence of unobserved variables and we were unable to determine the effect of early supported discharge on patient outcomes. Work package 2: the pragmatic approach led to ‘theoretical nuggets’ rather than an overarching higher-level theory.
Conclusions
The realist evaluation methodology allowed us to address the complexity of early supported discharge delivery in real-world settings. The findings highlighted the importance of context and contextual features and mechanisms that need to be either addressed or capitalised on to improve effectiveness.
Trial registration
Current Controlled Trials ISRCTN15568163.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca J Fisher
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Niki Chouliara
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Adrian Byrne
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Trudi Cameron
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Claudia Geue
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lizz Paley
- Sentinel Stroke National Audit Programme, King’s College London, London, UK
| | - Anthony Rudd
- Sentinel Stroke National Audit Programme, King’s College London, London, UK
| | - Marion F Walker
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
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15
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Lafiatoglou P, Ellis-Hill C, Gouva M, Ploumis A, Mantzoukas S. A systematic review of the qualitative literature on older individuals' experiences of care and well-being during physical rehabilitation for acquired brain injury. J Adv Nurs 2021; 78:377-394. [PMID: 34397112 PMCID: PMC9291982 DOI: 10.1111/jan.15016] [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: 02/16/2021] [Revised: 06/24/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
Aims To acquire an in‐depth understanding of how older individuals diagnosed with acquired brain injury (ABI) experience their well‐being and care when undergoing physical rehabilitation. Design Systematic literature review. Data sources The electronic databases of PubMed, CINAHL, APA PsycInfo, ASSIA and SCOPUS were searched from 2005 to 2020. Extensive reference checking was also conducted. Review methods A systematic review was conducted following PRISMA guidelines, including predominantly qualitative studies. Studies’ quality was appraised using the critical apraisal skills programme (CASP) tool. Results Seventeen studies met the inclusion criteria. Following methods of thematic synthesis, four overarching interpretive themes were identified: (a) Rehabilitation processes and their impact on older individuals’ well‐being; (b) Identity and embodiment concerns of older individuals during rehabilitation; (c) Institutional factors affecting older individuals’ care and well‐being experiences; and (d) Older individuals’ participation in creative activities as part of rehabilitation. Conclusion Organizational and structural care deficiencies as well as health disparities can adversely impact older individuals’ autonomous decision‐making and goal‐setting potentials. The discrepancy between older individuals’ expectations and the reality of returning home along with the illusionary wish to return to a perceived normality, can further negatively affect older individuals’ sense of well‐being. Constructive communication, emotional support, family involvement in rehabilitation and creating a stimulating, enriching social environment can humanize and facilitate older individuals’ adjustment to their new reality following ABI. Impact There is a lack of qualitative research on older individuals’ ABI rehabilitation experiences, especially traumatic brain injury incidents. Further study should consider patients’ concerns over their involvement in decision‐making and goal setting about their care. Overall, this review reveals the need to examine further the significance of humanizing care and the factors that affect older individuals’ sense of well‐being.
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Affiliation(s)
| | | | - Mary Gouva
- Department of Nursing, University of Ioannina, Ioannina, Greece
| | - Avraam Ploumis
- Department of Medicine, University of Ioannina, Ioannina, Greece
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16
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Brouwer-Goossensen D, den Hertog HM, Mastenbroek-de Jong MA, van Gemert-Pijnen LJEWC, Taal E. Patient perspectives on health-related behavior change after transient ischemic attack or ischemic stroke. Brain Behav 2021; 11:e01993. [PMID: 33662179 PMCID: PMC8035466 DOI: 10.1002/brb3.1993] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Unhealthy lifestyle is common among patients with ischemic stroke or TIA. Hence, health-related behavior change may be an effective way to reduce stroke recurrence. However, this is often difficult to carry out successfully. We aimed to explore patients' perspectives on health-related behavior change, support in this change, and sustain healthy behavior. METHODS We conducted a descriptive qualitative study with in-depth, semistructured interviews in eighteen patients with recent TIA or ischemic stroke. Interviews addressed barriers, facilitators, knowledge, and support of health-related behavior change framed by the protection motivation theory. All interviews were transcribed and thematically analyzed. RESULTS Patients seem unable to adequately appraise their own health-related behavior. More than half of the patients were satisfied with their lifestyle and felt no urgency to change. Self-efficacy as coping factor was the most important determinant (both barrier and facilitator). Fear as threat factor was named as facilitator for health-related behavior change by half of the patients. Most of the patients did not need support or already received support in changing health behavior. Patients indicated knowledge, guidelines, and social support as most needed to support and preserve a healthy lifestyle. CONCLUSION This study suggests that patients with recent TIA or ischemic stroke often do not have a high intention to change health-related behavior. The results fit well within the framework of the protection motivation theory. As many patients seem unable to adequately appraise their health behaviors, interventions should focus on increasing knowledge of healthy behavior and improving self-efficacy and social support.
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Affiliation(s)
| | | | | | | | - Erik Taal
- University of Twente, Twente, The Netherlands
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17
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van Dongen L, Hafsteinsdóttir TB, Parker E, Bjartmarz I, Hjaltadóttir I, Jónsdóttir H. Stroke survivors' experiences with rebuilding life in the community and exercising at home: A qualitative study. Nurs Open 2021; 8:2567-2577. [PMID: 33690972 PMCID: PMC8363348 DOI: 10.1002/nop2.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 01/27/2023] Open
Abstract
Aim This study aimed to explore how stroke survivors deal with stroke‐related impairments when rebuilding their lives in the community and their experiences of exercising at home. Design An explorative and descriptive qualitative study. Methods A purposive sample of ten stroke survivors residing at home was recruited to explore experiences of rebuilding their lives in the community and exercising at home. One focus group interview was conducted followed by semi‐structured interviews. Data were analysed using thematic analysis. Results Three main themes were identified: “Framing exercise within the context of everyday life” describes how stroke survivors integrate exercise in everyday activities with varying success and the social importance of exercising; “Managing the challenges of physical impairment” describes the taxing undertakings in daily living, loss of concentration and identity; “Long‐term challenges of everyday life” describes how the stroke survivors manage depression and live with a sense of uncertainty.
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Affiliation(s)
- Lisa van Dongen
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ethna Parker
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Ingibjörg Hjaltadóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
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18
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Brouwer-Goossensen D, Lingsma HF, Koudstaal PJ, den Hertog HM. The optimal timing of supporting patients in health-related behavior change after TIA or ischemic stroke: a prospective cohort study to determinants of health-related intention to change over time. Int J Rehabil Res 2021; 44:32-37. [PMID: 33208689 PMCID: PMC7884245 DOI: 10.1097/mrr.0000000000000443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/10/2020] [Indexed: 11/25/2022]
Abstract
The optimal timing of an intervention to support health-related behavior after transient ischemic attack (TIA) or ischemic stroke is unknown. We aimed to assess determinants of patients' health-related intention to change over time. We prospectively studied 100 patients with TIA or minor ischemic stroke. Patients completed questionnaires on fear, response-efficacy (belief that lifestyle change reduces risk of recurrent stroke), and self-efficacy (patients' confidence to carry out lifestyle behavior) for behavior change, at baseline, 6 weeks and at 3 months after their TIA or ischemic stroke. We studied differences between these determinants at each visit by means of Wilcoxon signed-rank tests. Median self-efficacy score at baseline was 4.3 [interquartile range (IQ) 3.9-4.7], median fear 16 (IQ 7-21), and response-efficacy 10 (9-12). Fear was significantly higher at baseline than at 3 months (mean difference 2.0; 95% confidence interval: 0.78-3.9) and started to decrease after 6 weeks. No change in self-efficacy or response-efficacy was found. Since fear significantly decreased over time after TIA or ischemic stroke and self-efficacy and response-efficacy scores remained high, the optimal moment to start an intervention to support patients in health-related behavior change after TIA or ischemic stroke seems directly after the stroke or TIA.
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19
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O Connor E, Dolan E, Horgan F, Robinson K, Galvin R. A protocol for a qualitative synthesis exploring people with stroke, family members, caregivers and healthcare professionals experiences of early supported discharge (ESD) after stroke. HRB Open Res 2020; 3:79. [PMID: 34136748 PMCID: PMC8185577 DOI: 10.12688/hrbopenres.13158.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/20/2022] Open
Abstract
Early supported discharge (ESD) facilitates a person with a stroke to be discharged from the acute hospital environment earlier than conventional care to continue their rehabilitation within the home with members of the multi-disciplinary team. A number of quantitative studies have highlighted benefits of ESD including a reduction in the length of inpatient stay, cost savings, as well as reducing long term dependency. This systematic review and qualitative synthesis explores the perspectives and experiences of those involved in ESD including people with stroke, family members, caregivers as well as the healthcare professionals involved in the delivery of the service. A comprehensive literature search will be completed in the following databases CINAHL, PubMed Central, Embase, Medline, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journals, The Cochrane Library, PsycARTICLES and Scopus. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service will be included. Methodological quality will be appraised using the ten-item Critical Appraisal Skills Programme checklist for qualitative research by two independent reviewers with a third reviewer involved should differences of opinion arise. Findings will be synthesised using thematic synthesis. It is anticipated that the qualitative synthesis will provide a deeper understanding of the experiences of ESD which may serve to inform practice as well as assist in the development of new ESD services. PROSPERO registration: CRD42020135197 - 28/04/2020.
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Affiliation(s)
- Elaine O Connor
- School of Allied Health, University of Limerick, Castletroy, Limerick, Ireland
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Eamon Dolan
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Castletroy, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Castletroy, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
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20
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Liljehult J, Christensen T, Molsted S, Overgaard D, Mesot Liljehult M, Møller T. Effect and efficacy of lifestyle interventions as secondary prevention. Acta Neurol Scand 2020; 142:299-313. [PMID: 32620044 PMCID: PMC7540464 DOI: 10.1111/ane.13308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Improvements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice. AIM In this systematic review and meta-analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes. METHODS PubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta-analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of. RESULTS Twenty-nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; -3.85 mmHg [95%CI -6.43; -1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; -9.83 mmHg [95%CI -16.56; -3.09]). CONCLUSION Modifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.
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Affiliation(s)
- Jacob Liljehult
- Department of NeurologyNordsjællands HospitalHillerødDenmark
- The University Hospitals Centre for Health Research UCSFDepartment 9701 Copenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
- Faculty of Health and TechnologyInstitute of Nursing and NutritionCopenhagen University CollegeCopenhagen NDenmark
| | - Thomas Christensen
- Department of NeurologyNordsjællands HospitalHillerødDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagen NDenmark
| | - Stig Molsted
- Department of Clinical ResearchNordsjællands HospitalHillerødDenmark
| | - Dorthe Overgaard
- Faculty of Health and TechnologyInstitute of Nursing and NutritionCopenhagen University CollegeCopenhagen NDenmark
| | | | - Tom Møller
- The University Hospitals Centre for Health Research UCSFDepartment 9701 Copenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
- Institute of Public HealthUniversity of CopenhagenCopenhagen KDenmark
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21
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Chen L, Xiao LD, Chamberlain D. An integrative review: Challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. J Adv Nurs 2020; 76:2253-2265. [PMID: 32511778 DOI: 10.1111/jan.14446] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. BACKGROUND Due to shortened hospital stays, stroke survivors and caregivers must take responsibility for complex care on discharge from hospital to home. Gaps exist in the literature that synthesizes studies on hospital to home transition care. DESIGN A systematic integrated review. DATA SOURCES Six databases were searched systematically between 18 June 2018 - 31 October 2018 including Medline, CINAHL, Web of Science, ProQuest, Scopus and Science Direct. The search did not have a date limit. REVIEW METHODS Studies that met the selection criteria were critically reviewed. Data were extracted from the studies for analyses. A convergent qualitative synthesis approach using inductive thematic synthesis was applied to the review. RESULTS The analysis of 23 studies identified three major findings. First, health and social care systems influence transition care by either enabling stroke survivors and caregivers to manage transition care via well-coordinated services or preventing them from accessing services. Second, health professionals' partnership with stroke survivors and caregivers largely decides tailored support for them. Successful partnerships and engagements with stroke survivors and caregivers depend on organizational resources. Third, survivors and caregivers are at different levels of readiness to cope with challenges. Individualized support for them to develop resilience is highly regarded. CONCLUSION Stroke survivors and caregivers encounter enormous challenges in self-management of hospital to home transition care. Further research is required to address their expectations of support during transition care. IMPACT There is a lack of synthesis of studies on factors affecting hospital to home transition care for stroke survivors. Health and social care system designs, health professionals' commitment to individualized care and the self-management capability of stroke survivors and their caregivers have a profound influence on the transition care experiences.
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Affiliation(s)
- Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lily D Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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22
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Murie-Fernández M, Laxe S. Neurorrehabilitación del ictus en España, comparativa con Europa. Neurologia 2020; 35:354-355. [DOI: 10.1016/j.nrl.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022] Open
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23
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Murie-Fernández M, Laxe S. Comparison of stroke neurorehabilitation in Spain and in Europe. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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24
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Christensen ER, Golden SL, Gesell SB. Perceived Benefits of Peer Support Groups for Stroke Survivors and Caregivers in Rural North Carolina. N C Med J 2019; 80:143-148. [PMID: 31072940 DOI: 10.18043/ncm.80.3.143] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Significant geographical disparities exist in stroke prevalence among southeastern states, including North Carolina. Additionally, stroke is more prevalent in rural areas. Peer support groups play an important role in stroke recovery by providing tools for effective coping, alleviating psychological stress, and creating an outlet for stroke survivors and caregivers. However, their perceived benefits have not been clearly defined for rural stroke survivors and their families.METHODS This qualitative study describes the experiences of survivors and caregivers in rural North Carolina who have participated in stroke peer support groups. Four focus groups were conducted with 32 participants (average age 67 years, 72% female) in 4 rural North Carolina counties, using a semi-structured discussion guide and an inductive coding approach.RESULTS Thematic analysis revealed that participants in rural support groups seek and receive knowledge from their support groups and feel empowered by providing and receiving this knowledge. Shared experiences cultivate a sense of community, and participants viewed support outside of the support group as necessary to their recovery process.LIMITATIONS This study reflects the views of a small group of predominantly non-Hispanic, white stroke survivors and caregivers who voluntarily participated. We did not conduct separate focus groups with survivors and caregivers.CONCLUSION Peer support groups are a sparse, but critical resource for rural stroke survivors and caregivers because they provide information and community that can assist with recovery to health and independence.
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Affiliation(s)
- Erin R Christensen
- graduate student, Graduate School of Arts and Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Shannon L Golden
- senior research associate, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Sabina B Gesell
- associate professor, Department of Social Sciences and Health Policy and Department of Implementation Science, Division of Public Health Sciences, Wake Forest University Health Science, Winston-Salem, North Carolina
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25
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Bråndal A, Eriksson M, Glader EL, Wester P. Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry. BMC Neurol 2019; 19:40. [PMID: 30866844 PMCID: PMC6417172 DOI: 10.1186/s12883-019-1268-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD. METHODS Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD. RESULTS The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17-2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55-0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17-1.92), toileting (OR: 1.30, 95%CI: 1.05-1.61), and dressing (OR: 1.23, 95%CI: 1.02-1.48). CONCLUSION In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.
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Affiliation(s)
- Anna Bråndal
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden. .,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-901 87, Umeå, Sweden.
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business and Economics Umeå University, S-901 87, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden.,Department of Clinical Sciences, Karolinska Institute, Danderyd hospital, S-182 88, Stockholm, Sweden
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26
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Watanabe Y, Ishikawa S, Nagata H, Kojima M. Determinants Associated with Prolonged Hospital Stays for Patients Aged 65 Years or Older with a Vertebral Compression Fracture in a Rural Hospital in Japan. TOHOKU J EXP MED 2019; 247:27-34. [PMID: 30651405 DOI: 10.1620/tjem.247.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Japan is an aging society, and the incidence of diseases related to aging, such as pneumonia, heart failure, vertebral compression fracture (VCF), is increasing. Prolonged hospital stays are becoming a serious social problem, leading to elevated medical expenses. Thus, shortening the period of hospitalization is important. This study aimed to reveal determinants associated with prolonged hospital stays for patients with VCF. Our institution is the primary hospital in a rural area in the Kanto region of Japan. Altogether, 110 patients with a VCF, aged 65 years or older, including 79 women, were divided into two groups according to the average hospital stay period of 28 days: the long-stay group (mean stay 40.0 ± 11.6 days, n = 39) and the short-stay group (mean stay 20.6 ± 4.4 days, n = 71). Notably, the short-stay group included 55 women. Multivariate logistic regression analyses in male showed no variates significantly associated with prolonged hospitalization. By contrast, multivariate logistic regression analyses in female showed requiring emergency transportation to hospital was significantly associated with prolonged hospitalization [odds ratio 7.69, 95% confidence interval 1.13-52.29, P = 0.04]. In conclusion, this study implies that patients with better levels of activities of daily living are able to walk alone sooner and are easily discharged. Furthermore, the patient requiring emergency transportation might be in a poor social living environment, such as living alone. These results may give us a good opportunity to re-consider fundamental problems surrounding the elderly.
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Affiliation(s)
- Yusuke Watanabe
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital
| | | | - Hiroyuki Nagata
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital
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27
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Duncan PW, Abbott RM, Rushing S, Johnson AM, Condon CN, Lycan SL, Lutz BJ, Cummings DM, Pastva AM, D’Agostino RB, Stafford JM, Amoroso RM, Jones SB, Psioda MA, Gesell SB, Rosamond WD, Prvu-Bettger J, Sissine ME, Boynton MD, Bushnell CD. COMPASS-CP: An Electronic Application to Capture Patient-Reported Outcomes to Develop Actionable Stroke and Transient Ischemic Attack Care Plans. Circ Cardiovasc Qual Outcomes 2018; 11:e004444. [DOI: 10.1161/circoutcomes.117.004444] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Pamela W. Duncan
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Rica M. Abbott
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Scott Rushing
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
| | - Anna M. Johnson
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | | | - Sarah L. Lycan
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Barbara J. Lutz
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill. School of Nursing, University of North Carolina Wilmington (B.J.L.)
| | - Doyle M. Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC (D.M.C.)
| | - Amy M. Pastva
- Division of Physical Therapy, Department of Orthopaedic Surgery (A.M.P.)
| | - Ralph B. D’Agostino
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
| | - Jeanette M. Stafford
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
| | - Robert M. Amoroso
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | - Sara B. Jones
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | | | | | - Wayne D. Rosamond
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | - Janet Prvu-Bettger
- Department of Orthopaedic Surgery (J.P.-B.), Duke University School of Medicine, Durham, NC
| | - Mysha E. Sissine
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Mark D. Boynton
- Sticht Center on Aging, Pain Management and Rehabilitation Advisory Council (M.D.B.)
| | - Cheryl D. Bushnell
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
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28
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Mayo NE. Stroke Rehabilitation at Home: Lessons Learned and Ways Forward. Stroke 2016; 47:1685-91. [PMID: 27143275 DOI: 10.1161/strokeaha.116.011309] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/22/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Nancy E Mayo
- From the Division of Clinical Epidemiology, Department of Medicine, School of Physical and Occupational Therapy, Center for Outcomes Research and Evaluation, McGill University Health Center Research Institute, McGill University, Montreal, Québec, Canada.
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