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Shiggins C, Ryan B, Dewan F, Bernhardt J, O'Halloran R, Power E, Lindley RI, McGurk G, Rose ML. Inclusion of People With Aphasia in Stroke Trials: A Systematic Search and Review. Arch Phys Med Rehabil 2024; 105:580-592. [PMID: 37394026 DOI: 10.1016/j.apmr.2023.06.010] [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: 08/09/2022] [Revised: 05/23/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Although people with aphasia (PwA) represent 30% of stroke survivors, they are frequently excluded from stroke research, or their inclusion is unclear. Such practice significantly limits the generalizability of stroke research, increases the need to duplicate research in aphasia-specific populations, and raises important ethical and human rights issues. OBJECTIVE To detail the extent and nature of inclusion of PwA in contemporary stroke randomized controlled trials (RCTs). METHODS We conducted a systematic search to identify completed stroke RCTs and RCT protocols published in 2019. Web of Science was searched using terms "stroke" and "randomized controlled trial". These articles were reviewed by extracting rates of PwA inclusion/exclusion, whether "aphasia" or related terms were referred to in the article or supplemental files, eligibility criteria, consent procedures, adaptations made to support the inclusion of PwA, and attrition rates of PwA. Data were summarized, and descriptive statistics applied when appropriate. RESULTS 271 studies comprising 215 completed RCTs and 56 protocols were included. 36.2% of included studies referred to aphasia/dysphasia. Of completed RCTs, only 6.5% explicitly included PwA, 4.7% explicitly excluded PwA, and inclusion was unclear in the remaining 88.8%. Among RCT protocols, 28.6% of studies intended inclusion, 10.7% intended excluding PwA, and in 60.7%, inclusion was unclear. In 45.8% of included studies, sub-groups of PwA were excluded, either explicitly (ie, particular types/severities of aphasia, eg, global aphasia) or implicitly, by way of ambiguous eligibility criteria which could potentially relate to a sub-group of PwA. Little rationale for exclusion was provided. 71.2% of completed RCTs did not report any adaptations that could support the inclusion of PwA, and minimal information was provided about consent procedures. Where it could be determined, attrition of PwA averaged 10% (range 0%-20%). CONCLUSION This paper details the extent of inclusion of PwA in stroke research and highlights opportunities for improvement.
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Affiliation(s)
- Ciara Shiggins
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia; Queensland Aphasia Research Centre, the University of Queensland, Brisbane, Australia; Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia; School of Health Sciences, University of East Anglia, Norwich, UK.
| | - Brooke Ryan
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; University of Technology Sydney, Graduate School of Health, Clinical Psychology, Ultimo, Australia; Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Farhana Dewan
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia
| | - Julie Bernhardt
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Robyn O'Halloran
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia
| | - Emma Power
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; University of Technology Sydney, Graduate School of Health, Speech Pathology, Ultimo, Australia
| | - Richard I Lindley
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gordon McGurk
- Human Research Ethics Committee, Royal Brisbane and Women's Hospital, Brisbane, Australia; Human Research Ethics Committee A, University of Queensland, Brisbane, Australia; Human Research Ethics Committee, Townsville Hospital and Health Service, Townsville, Australia; OmniAdvisory Consulting
| | - Miranda L Rose
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia
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Rafsten L, Sunnerhagen KS. Patient-centered goal setting in very early supported discharge with continued rehabilitation after stroke. Disabil Rehabil 2023; 45:3869-3874. [PMID: 36346073 DOI: 10.1080/09638288.2022.2141357] [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: 01/07/2022] [Revised: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To examine patients' perception of performance and satisfaction with the activities in their set goals before and after very early supported discharge (VESD) with continued rehabilitation. MATERIALS AND METHODS A descriptive cohort study with data extracted from a randomized controlled trial. Sixty-nine patient allocated to the intervention group were eligible. Before discharge, the patients were asked to set rehabilitation goals, and they were asked to rate the performance and satisfaction of their set goals. At discharge from the rehabilitation, the patients were asked to re-evaluate their experience and satisfaction with the goal performance. RESULTS One hundred and forty goals were registered. At 81.5% of the set goals, the patients estimated that they performed the task better at discharge than at enrolment and at 86.5% of the set goals the patients were more satisfied with the performance at discharge than at enrolment. CONCLUSIONS Patients with mild to moderate stroke, undergoing a VESD after stroke, reported high performance level for their set goals and were satisfied with their performance execution. Further research is needed to investigate whether the goal should be set preferably at home or at hospital before discharge.Implications for rehabilitationMany of the patients can formulate achievable goals with their rehabilitation after stroke.Patients ongoing rehabilitation after stroke are satisfied with their performance of the set goals.As part of patient-centered care, stroke patients should be given the opportunity to formulate their own goals with their rehabilitation.Short hospital times and fast planning of goal-meetings, seems to influence patient goal setting in early discharge rehabilitation.
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Affiliation(s)
- Lena Rafsten
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Nelsone L, Rafsten L, Abzhandadze T, Sunnerhagen KS. A cohort study on anxiety and perceived recovery 3 and 12 months after mild to moderate stroke. Front Neurol 2023; 14:1273864. [PMID: 37900595 PMCID: PMC10600446 DOI: 10.3389/fneur.2023.1273864] [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: 08/07/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background Anxiety is a common complication of stroke, affecting one in every three stroke survivors. Stroke recovery is a dynamic process, with most recovery occurring within the first 3 months. However, how anxiety affects this dynamic remains unknown. Therefore, this study aimed to investigate how anxiety affects perceived recovery at 3 and 12 months after stroke. Additionally we also examined the change in perceived stroke recovery from 3 to 12 months and its relationship with anxiety. Methods In this longitudinal study patients with stroke were enrolled at Sahlgrenska University Hospital, Gothenburg, Sweden. The Hospital Anxiety and Depression Scale was used to assess anxiety, and the Stroke Impact Scale was used to assess perceived recovery 3 and 12 months after the stroke. The difference in perceived stroke recovery between the anxiety and no-anxiety groups at 3 and 12 months was analyzed. Changes in perceived stroke recovery were calculated and trichotomized from 3 to 12 months based on clinically significant positive changes (+10 points or more), clinically important negative changes (-10 points or less), or no changes (±9). At 3 and 12 months after the stroke, negative and positive recovery was compared to no change in recovery regarding anxiety scores. Results This study included 99 patients (44.4% female, median age, 77 years). At 3 and 12 months after the stroke, the median recovery score was 80 out of 100. At 3- and 12-months 17.6 and 15.7% of the patients experienced anxiety, respectively. At both time points, there was a significant association between anxiety and lower perceived stroke recovery (at 3 months: p < 0.001; and 12 months p = 0.002). Among participants with anxiety at 3 or 12 months after stroke, a positive change in recovery from 3 to 12 months was identified (3 months, p = 0.004 and 12 months, p = 0.0014). Conclusion Anxiety symptoms following a stroke are associated with lower levels of perceived stroke recovery for at least 1 year after the stroke. Identifying patients with anxiety early after stroke may be beneficial for identifying those at risk of lower recovery.Clinical trial registration:ClinicalTrials.gov, identifier [NCT01622205]. Registered on June 19, 2012 (retrospectively registered).
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Affiliation(s)
- Linda Nelsone
- Faculty of Residency, Riga Stradins University, Riga, Latvia
- Riga East University Hospital, Riga, Latvia
| | - Lena Rafsten
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Rehabilitation Medicine, Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
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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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Preitschopf A, Holstege M, Ligthart A, Groen W, Burchell G, Pol M, Buurman B. Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis. Age Ageing 2023; 52:6972294. [PMID: 36626320 PMCID: PMC9831263 DOI: 10.1093/ageing/afac300] [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: 04/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase. OBJECTIVE To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR. METHODS Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped. RESULTS We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41 days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver. CONCLUSION This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.
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Affiliation(s)
- Astrid Preitschopf
- Address correspondence to: Astrid D. Preitschopf, MSc, Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands. Tel: (+31) 651260776.
| | - Marije Holstege
- Department of Research GRZPLUS; Omring and Zorgcirkel, Hoorn, The Netherlands,Department of Research Omring, Hoorn, The Netherlands,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands
| | - Andrea Ligthart
- Department of Research GRZPLUS; Omring and Zorgcirkel, Hoorn, The Netherlands
| | - Wim Groen
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - George Burchell
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margriet Pol
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands,Research Group Occupational Therapy: Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca Buurman
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
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Ayasrah S, Ahmad M, Basheti I, Abu-Snieneh HM, Al-Hamdan Z. Post-stroke Anxiety Among Patients in Jordan: A Multihospital Study. J Geriatr Psychiatry Neurol 2022; 35:705-716. [PMID: 34933575 DOI: 10.1177/08919887211060015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to assess the prevalence, correlates, and significant associated factors of anxiety among patients with stroke. A cross-sectional, correlation design was utilized. The Hospital Anxiety and Depression scale was used to detect and assess the severity of anxiety and depression among mentally well patients at general hospital settings. Among the 226 patients with stroke, 45.6% had clinically significant levels of anxiety to be considered as a definite case. Having a short duration since the stroke onset, being a definite case of depression, being unable to perform self-care activities, having an insufficient monthly income, and having visual problems due to stroke were the significantly associated factors. The high prevalence of anxiety among patients with stroke highlights the need for interventions of early detection and management to enhance recovery. Patients who have any of the significant traits predicted post-stroke anxiety required special attention.
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Affiliation(s)
| | | | - Iman Basheti
- 59177Applied Science Private University, Amman, Jordan
| | - Hana M Abu-Snieneh
- Faculty of Nursing, 84977Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Zaid Al-Hamdan
- 37251Jordan University of Science and Technology, Irbid, Jordan
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García-Pérez P, Lara JP, Rodríguez-Martínez MDC, de la Cruz-Cosme C. Interventions within the Scope of Occupational Therapy in the Hospital Discharge Process Post-Stroke: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10091645. [PMID: 36141257 PMCID: PMC9498873 DOI: 10.3390/healthcare10091645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke is one of the main causes of disability in adulthood. Its rehabilitation is a complex process that requires a multidisciplinary team of specialised professionals. The main goal of this review was to determine the impact of occupational therapy intervention post-stroke on the home discharge process. A systematic search was carried out of the following databases: Pubmed, Web of Science, PsycINFO, Scopus, Otseeker, and Dialnet. A screening was performed taking into account the type of article, including exclusively RCT, and type of intervention, only including interventions within the scope of occupational therapy that take place during the process of hospital discharge post-stroke. A total of 2285 citations were identified in the search from which 13 articles met the inclusion criteria. Comparisons of the groups indicated that early occupational therapy intervention during the process of hospital discharge can be effective in terms of functional recovery and can lead to the caregiver seeing improvements in self-efficacy and fatigue. In addition, the inclusion of a caregiver in the intervention influences the patient’s adherence to treatment, leading to a reduction in the cost of treatment and rehabilitation.
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Affiliation(s)
- Patricia García-Pérez
- Faculty of Medicine, University of Málaga, Blvr. Louis Pasteur, 32, 29010 Málaga, Spain
- Occupational Therapy Department, Virgen de la Victoria University Hospital, Servicio Andaluz de Salud (SAS), 29010 Málaga, Spain
| | - José Pablo Lara
- Faculty of Medicine, University of Málaga, Blvr. Louis Pasteur, 32, 29010 Málaga, Spain
- Brain Health Unit, CIMES, 29010 Málaga, Spain
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain
- Correspondence: (J.P.L.); (M.C.R.-M.)
| | - María del Carmen Rodríguez-Martínez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/Arquitecto Francisco Peñalosa 3, 29071 Málaga, Spain
- Correspondence: (J.P.L.); (M.C.R.-M.)
| | - Carlos de la Cruz-Cosme
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain
- Neurology Department, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
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Jee S, Jeong M, Paik NJ, Kim WS, Shin YI, Ko SH, Kwon IS, Choi BM, Jung Y, Chang W, Sohn MK. Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:755316. [PMID: 35370909 PMCID: PMC8965290 DOI: 10.3389/fneur.2022.755316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the available evidence on early supported discharge (ESD) and transitional care (TC) delivery service in patients with cerebrovascular disease. Methods A systematic literature search was conducted to collect all available evidence on the use of ESD and TC services. We included cluster-randomized pragmatic trials or randomized controlled trials (RCTs) that recruited patients with stroke or transient ischemic attack to receive either conventional care or any care service intervention that included rehabilitation or support provided by professional medical personnel with the aim of accelerating and supporting home discharge. Relevant data were electronically searched through international databases (Cochrane Library, EMBASE, and PubMed) and incorporated into a summary grid to investigate research outcomes and provide a narrative synthesis. Furthermore, we compared the outcomes in terms of length of hospital stay, patient and caregiver outcomes, and mortality through meta-analysis. Results We identified and included a total of 20 publications of various original randomized studies. There were 18 studies conducted in western countries and 2 in eastern countries. The meta-analysis revealed a tendency that ESD or TC could decrease the length of hospital stay more than the usual care [standardized mean difference (SMD) -0.13; 95% confidence interval (CI) -0.31 to 0.04 days; P = 0.14]. Moreover, there was a tendency that ESD resulted in better activities of daily living (ADL) than usual care (SMD 0.29; 95% CI -0.04 to 0.61; P = 0.08). Patient outcome based on modified Rankin scale (mRS) score (SMD -0.11; 95% CI -0.38 to 0.17; P = 0.45] and mortality (odds ratio 0.80; 95% CI 0.56-1.17; P = 0.25) did not reveal any significant difference. The Caregiver Strain Index revealed no difference. Conclusion We did not find a large effect size for the use of TC and ESD. When implementing the TC and ESD model from western to Asian countries, services should be prepared and implemented in accordance with national medical rehabilitation pathways for cerebrovascular disease.
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Affiliation(s)
- Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
| | - Minah Jeong
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Bo Mi Choi
- Department of Public Health and Medical Services, Chungnam National University Hospital, Daejeon, South Korea
| | - Yunsun Jung
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Wonkee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
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García-Pérez P, Rodríguez-Martínez MDC, Lara JP, de la Cruz-Cosme C. Early Occupational Therapy Intervention in the Hospital Discharge after Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412877. [PMID: 34948486 PMCID: PMC8700854 DOI: 10.3390/ijerph182412877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
Stroke is the leading cause of acquired disability in adults which is a cerebrovascular disease of great impact in health and social terms, not only due to its prevalence and incidence but also because of its significant consequences in terms of patient dependence and its consequent impact on the patient and family lives. The general objective of this study is to determine whether an early occupational therapy intervention at hospital discharge after suffering a stroke has a positive effect on the functional independence of the patient three months after discharge—the patient’s level of independence being the main focus of this research. Data will be collected on readmissions to hospitals, mortality, returns to work and returns to driving, as well as an economic health analysis. This is a prospective, randomized, controlled clinical trial. The sample size will be made up of 60 patients who suffered a stroke and were discharged from the neurology unit of a second-level hospital in west Malaga (Spain), who were then referred to the rehabilitation service by the joint decision of the neurology and rehabilitation department. The patients and caregivers assigned to the experimental group were included in an early occupational therapy intervention program and compared with a control group that receives usual care.
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Affiliation(s)
- Patricia García-Pérez
- Faculty of Medicine, University of Málaga, 29010 Málaga, Spain;
- Occupational Therapy Department, Hospital Marítimo, Servicio Andaluz de Salud (SAS), 29620 Málaga, Spain
| | | | - José Pablo Lara
- Faculty of Medicine, University of Málaga, 29010 Málaga, Spain;
- Brain Health Unit, CIMES, 29010 Málaga, Spain
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain;
- Correspondence: (M.C.R.-M.); (J.P.L.)
| | - Carlos de la Cruz-Cosme
- Malaga Biomedical Research Institute (IBIMA), 29010 Málaga, Spain;
- Neurology Department, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
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Sarkar A, Sarmah D, Datta A, Kaur H, Jagtap P, Raut S, Shah B, Singh U, Baidya F, Bohra M, Kalia K, Borah A, Wang X, Dave KR, Yavagal DR, Bhattacharya P. Post-stroke depression: Chaos to exposition. Brain Res Bull 2020; 168:74-88. [PMID: 33359639 DOI: 10.1016/j.brainresbull.2020.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022]
Abstract
Cerebral ischemia contributes to significant disabilities worldwide, impairing cognitive function and motor coordination in affected individuals. Stroke has severe neuropsychological outcomes, the major one being a stroke. Stroke survivors begin to show symptoms of depression within a few months of the incidence that overtime progresses to become a long-term ailment. As the pathophysiology for the progression of the disease is multifactorial and complex, it limits the understanding of the disease mechanism completely. Meta-analyses and randomized clinical trials have shown that intervening early with tricyclic antidepressants and selective serotonin receptor inhibitors can be effective. However, these pharmacotherapies possess several limitations that have given rise to newer approaches such as brain stimulation, psychotherapy and rehabilitation therapy, which in today's time are gaining attention for their beneficial results in post-stroke depression (PSD). The present review highlights numerous factors like lesion location, inflammatory mediators and genetic abnormalities that play a crucial role in the development of depression in stroke patients. Further, we have also discussed various mechanisms involved in post-stroke depression (PSD) and strategies for early detection and diagnosis using biomarkers that may revolutionize treatment for the affected population. Towards the end, along with the preclinical scenario, we have also discussed the various treatment approaches like pharmacotherapy, traditional medicines, psychotherapy, electrical stimulation and microRNAs being utilized for effectively managing PSD.
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Affiliation(s)
- Ankan Sarkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Aishika Datta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Harpreet Kaur
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Priya Jagtap
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Swapnil Raut
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Birva Shah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Upasna Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Falguni Baidya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Mariya Bohra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam, India
| | - Xin Wang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Kunjan R Dave
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India.
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Rafsten L, Danielsson A, Sunnerhagen KS. Self-perceived postural balance correlates with postural balance and anxiety during the first year after stroke: a part of the randomized controlled GOTVED study. BMC Neurol 2020; 20:410. [PMID: 33167877 PMCID: PMC7650177 DOI: 10.1186/s12883-020-01982-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postural balance is an important rehabilitation outcome, and screening stroke patients for confidence in postural balance during rehabilitation and before hospital discharge is recommended. Early supported discharge could improve postural balance self-confidence. This study aimed to investigate associations between patient self-confidence in postural balance and observer-assessed postural balance and anxiety during the first year after stroke. Whether very early supported discharge (VESD) affects self-confidence in postural balance compared with standard discharge was also evaluated. METHODS A longitudinal trial for with data extracted from a randomized controlled study of 140 adults with confirmed stroke was conducted. The experimental group received VESD. The control group was discharged according to the standard routine. Postural balance was assessed with Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Falls Efficacy Scale. Anxiety was assessed with the Hospital Anxiety and Depression Scale. Spearman's rank correlation coefficient (rho) was used to test associations between independent variables. The Wilcoxon signed-rank test was used to examine differences over time. A single test, according to Eid, Gollwitzer, and Schmidt, was used to test temporal differences in correlation. RESULTS The correlation between self-confidence in postural balance and observer-assessed postural balance was 0.62-0.78 in the first year after stroke. The correlation between self-confidence and anxiety was 0.22-0.41 in the first year after stroke. Correlations did not differ by group affiliation at any time point when the postural balance was assessed with BBS. The intervention group had a significantly higher correlation (r = - 0.709) than the control group (r = - 0.416) when postural balance was assessed with the TUG test 1 month after discharge. There were no significant differences in correlations between confidence in postural balance and anxiety between the two groups at any time point. CONCLUSIONS Patients with mild stroke can accurately assess their confidence in performing daily activities without falling. VESD does not substantially affect the correlation between self-confidence in postural balance and observer assessed postural balance and is safe to use as an alternative to standard discharge. Assessment of self-confidence can provide important information for rehabilitation planning and supporting the physical activity of patients after discharge. TRIAL REGISTRATION Clinical Trials.gov: NCT01622205 . Registered 19 June 2012 (retrospectively registered).
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Affiliation(s)
- Lena Rafsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden. .,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Anna Danielsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Buvarp D, Rafsten L, Sunnerhagen KS. Predicting Longitudinal Progression in Functional Mobility After Stroke: A Prospective Cohort Study. Stroke 2020; 51:2179-2187. [PMID: 32568652 PMCID: PMC7306259 DOI: 10.1161/strokeaha.120.029913] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. A majority of people with stroke remain impaired in their functional mobility. The aim of the study was to determine longitudinal changes in functional mobility after stroke.
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Affiliation(s)
- Dongni Buvarp
- Rehabilitation Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.B., L.R., K.S.S.), University of Gothenburg, Sweden
| | - Lena Rafsten
- Rehabilitation Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.B., L.R., K.S.S.), University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (L.R., K.S.S.)
| | - Katharina S Sunnerhagen
- Rehabilitation Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.B., L.R., K.S.S.), University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (L.R., K.S.S.)
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