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Johansson B, Dalhielm E. An online self-study mindfulness-based stress reduction course for people suffering from mental fatigue after an acquired brain injury. Brain Inj 2024; 38:727-733. [PMID: 38676709 DOI: 10.1080/02699052.2024.2347545] [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: 08/21/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE The Mindfulness-Based Stress Reduction (MBSR) program has shown promising results for people suffering from mental fatigue after an acquired brain injury. The aim was to evaluate the feasibility of a MBSR program performed as an online self-study course for this group of people. METHODS Sixty participants who had suffered an acquired brain injury with lasting mental fatigue were randomized to an online MBSR course or to a waitlist control group. They answered self-report questionnaires before start and after the course. RESULTS Sixteen completed the MBSR program. With the repeated ANOVA no significant difference between groups was found, although there was a significant change in time (the repetition factor). The post-hoc paired t-test indicated a significant reduction and a large-to-median effect size in mental fatigue (p = 0.003, d = 0.896), depression (p = 0.038, d = 0.569) and anxiety (p = 0.030, d = 0.598) for the MBSR group. No significant changes were found for the control group. CONCLUSION An online self-study MBSR program for people suffering from mental fatigue after an acquired brain injury can be a feasible option for those suffering from less severe mental fatigue and emotional symptoms, while others may require a program adapted to their needs.
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Affiliation(s)
- Birgitta Johansson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Dalhielm
- Department of Neurology, Skaraborg´s Hospital, Skövde, Sweden
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Lawrence M, Davis B, De Amicis L, Booth J, Dickson S, Dougall N, Grealy M, Jani B, Maxwell M, Parkinson B, Pieri M, Mercer S. The HEADS: UP Development Study: Working with Key Stakeholders to Adapt a Mindfulness-Based Stress Reduction Course for People with Anxiety and Depression after Stroke. Healthcare (Basel) 2023; 11:healthcare11030355. [PMID: 36766930 PMCID: PMC9914141 DOI: 10.3390/healthcare11030355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a standard MBSR course specifically for people affected by stroke. METHODS We recruited stroke survivors and family members with symptoms of anxiety and/or depression to take part in a co-development study comprising two rounds of MBSR 'taster' sessions, followed by focus groups in which views were sought on the practices sampled. Data were collected in October 2017 and May 2018 and were analysed using framework analysis, informed adaptations to mindfulness materials and delivery. RESULTS Twenty-eight stroke survivors and seven family members participated. Nineteen (76%) stroke survivors had anxiety; 15 (60%) had depression. Five (71.4%) family members reported anxiety; n = 4 (57.1%) depression. Thirty participants attended the first round of taster sessions and focus groups; twenty (66%) the second and three (10%) were unable to attend either round. Framework analysis informed adaptations to course delivery, practices, and materials, ultimately resulting in a stroke-specific MBSR course, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). CONCLUSIONS HEADS: UP may provide a feasible, appropriate, and meaningful self-management intervention to help alleviate symptoms of mood disorder.
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Affiliation(s)
- Maggie Lawrence
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
- Correspondence: ; Tel.: +44-(0)141-331-8863
| | - Bridget Davis
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Leyla De Amicis
- School of Education, University of Glasgow, Glasgow G3 6NH, UK
| | - Jo Booth
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Sylvia Dickson
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Nadine Dougall
- Health and Social Care Sciences, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Madeleine Grealy
- Psychological Services and Health, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Bhautesh Jani
- General Practice and Primary Care, School of Health and Wellbeing, MVLS, University of Glasgow, Glasgow G12 9LJ, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Ben Parkinson
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Matilde Pieri
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Stewart Mercer
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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Rhudy LM, Hines EA, Farr EM, Esterov D, Chesak SS. Feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor and their family caregivers. NeuroRehabilitation 2023; 52:123-135. [PMID: 36617758 DOI: 10.3233/nre-220127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Practice guidelines and research results emphasize the need for dyadic interventions targeting psychosocial outcomes such as depression, anxiety, social function, physical function, and health-related quality of life. Resilience interventions have been proposed as one strategy to influence these outcomes. OBJECTIVE The objective of this observational pilot study was to determine the feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor (BT) admitted for comprehensive acute inpatient rehabilitation and/or their family caregivers. A secondary aim was to gather preliminary data to assess the effects of the program on quality of life, stress, anxiety, physical function, sleep disturbance, fatigue, resilience, dyadic coping, and caregiver role overload. METHODS The Resilient Living program is a psychosocial intervention with a focus on building resilience skills. Feasibility and acceptability outcomes were assessed at the end of the study. Quantitative outcome measures were collected at baseline, 12 weeks, and 6 months post the intervention. RESULTS Eight patients and eight caregivers completed the study. The intervention was feasible with this population. Participants found the intervention useful and appreciated the flexibility of an online program; however, finding time to engage in it was challenging. Recruitment of eligible patients with acquired brain disorders and their caregivers as a dyad was challenging. CONCLUSION The study confirms prior research suggesting that interventions targeting resilience are feasible, but larger studies with more rigorous methods are needed to appreciate the influence of resilience interventions in persons with brain disorders and their caregivers. Further research is needed to identify the characteristics of those most likely to benefit from resilience interventions and the optimal timing of such interventions.
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Affiliation(s)
- Lori M Rhudy
- Department of Graduate Nursing, Winona State University, Rochester, Minnesota, USA
| | - Emily A Hines
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ellen M Farr
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Sherry S Chesak
- Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, Minnesota, USA
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4
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Wrapson W, Dorrestein M, Wrapson J, Theadom A, Kayes N, Snell D, Rutherford S, Roche M, Babbage DR, Siegert RJ. Stroke survivors' expectations and post-intervention perceptions of mindfulness training: A qualitative study. Neuropsychol Rehabil 2022; 32:2496-2518. [PMID: 34278952 DOI: 10.1080/09602011.2021.1950777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Depression and anxiety are common sequelae of stroke, occurring in at least one-third of patients. This study evaluated the acceptability and feasibility of providing mindfulness training (MT) to stroke survivors with the aim of reducing depression and anxiety. Following a six-week one-on-one MT course, 17 participants were interviewed. The median age of participants was 71, and 10 participants were male. This paper focuses on participants' expectations of the MT and their views about its impact on their everyday lives. Conventional content analysis was used for coding and analysis. A single theme, Seizing rehabilitation opportunities, was captured in relation to expectations of MT, and four themes provided information relating to participants' perceived impact of the course: Calming the mind, Reduced reactivity, Remedying physical symptoms, and Not quite there yet.Most participants knew little about mindfulness before the MT and did not have specific goals in mind when volunteering to take part. The findings suggest that most participants considered MT beneficial through reducing stress and giving them additional skills to cope with their everyday lives. A tailored mindfulness intervention may be a useful adjunct to other rehabilitation therapies for stroke survivors.
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Affiliation(s)
- Wendy Wrapson
- Auckland University of Technology, Auckland, New Zealand
| | | | - Jill Wrapson
- Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Auckland University of Technology, Auckland, New Zealand
| | - Nicola Kayes
- Auckland University of Technology, Auckland, New Zealand
| | | | | | - Maree Roche
- University of Waikato, Hamilton, New Zealand
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Neate SL, Reece JC, Hassed C, Chambers R, Connaughton S, Nag N. A qualitative analysis of free text comments of participants from a massive open online mindfulness course. Front Public Health 2022; 10:947898. [PMID: 36033817 PMCID: PMC9413085 DOI: 10.3389/fpubh.2022.947898] [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: 05/20/2022] [Accepted: 07/26/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Mindfulness-based interventions are associated with improved health and wellbeing. Online mindfulness interventions offer potential scalability and cost advantages over face-to-face interventions. However, little is known about the experiences of learners, what they identify as being helpful to developing a practice of mindfulness and what outcomes they experience from undertaking an online mindfulness program. Methods The Mindfulness for Wellbeing and Peak Performance Massive Open Online Course is a 4-week mindfulness program which includes psychoeducation, mindfulness meditation, applications and moderated discussion forums. Of the 3,335 participants who completed the March 2020 course, 527 (16%) responded to the final forum which invited participants to describe the highlights of the course. In order to enhance understanding of participant experiences and perceived outcomes of undertaking the course, a qualitative analysis of these free text comments was conducted using reflexive thematic analysis. Results Two overarching themes were identified: (1) internal mechanisms of developing mindfulness (subthemes: paying attention to the present moment, learning to let go and find acceptance, cultivating an attitude of gentleness, and learning through a sense of belonging) and (2) the translation of mindfulness into daily living (subthemes: mindfulness being a support to mental wellbeing, learning to deal with uncertainty and adversity, living a more conscious life, a greater connection with self and others and channeling attention into productivity). Discussion The themes and subthemes provided insights into the mechanisms learners used to develop mindfulness and how they translated mindfulness into their lives in a variety of beneficial ways. This understanding of learners' experiences could inform delivery of future online mindfulness interventions.
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Affiliation(s)
- Sandra L. Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia,*Correspondence: Sandra L. Neate
| | - Jeanette C. Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Craig Hassed
- Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
| | - Richard Chambers
- Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
| | - Sherelle Connaughton
- Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
| | - Nupur Nag
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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El-Helou R, Ryan B, Kneebone I. Development of the "Kalmer" relaxation intervention: co-design with stroke survivors with aphasia. Disabil Rehabil 2022; 45:1517-1529. [PMID: 35549790 DOI: 10.1080/09638288.2022.2069294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Anxiety is common after stroke and more prevalent in survivors with aphasia. Relaxation is an effective first-line therapy. The current study aimed to obtain the perspectives of stroke survivors with aphasia to inform the development of an accessible, technology-based, relaxation intervention. MATERIALS AND METHODS Qualitative co-design methods were used with twelve people with aphasia after stroke. The "Kalmer" Relaxation treatment package materials were iteratively based on participants' experiences and preferences; barriers and facilitators to treatment compliance were explored. Participants were also asked to consider how the intervention might be evaluated in a research trial. RESULTS A thematic analysis highlighted the importance and need for the development of an appropriate and inclusive relaxation product, to be implemented by health professionals early post-stroke. Several behavioural strategies to improve treatment adherence were recommended. Participants had varying perspectives on clinically meaningful treatment outcomes. CONCLUSIONS Overall, a co-designed accessible relaxation product was viewed as a necessary component of usual stroke care. Acceptability and feasibility and preliminary efficacy of the "Kalmer" intervention should be trialled in future studies. IMPLICATIONS FOR REHABILITATIONCo-designing psychological interventions for people with aphasia after stroke is needed to meet the needs of this at-risk population.Technology-based relaxation interventions to manage anxiety after stroke are viewed positively by people with aphasia and deemed acceptable and feasible.Clinical trials of these co-designed relaxation interventions are required before recommending integration into routine practice.
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Affiliation(s)
- Rebecca El-Helou
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Brooke Ryan
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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7
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Demers M, Pagnini F, Phillips D, Chang B, Winstein C, Langer E. Feasibility of an Online Langerian Mindfulness Program for Stroke Survivors and Caregivers. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:228-237. [PMID: 35485301 DOI: 10.1177/15394492221091266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mindfulness is promising for individuals with neurological disorders and their caregivers to improve psychological well-being. The potential application of a Langerian mindfulness intervention, focused on attention to variability, however, is still unknown. The objective of the study was to determine the feasibility (usability, satisfaction, and potential effectiveness on psychological well-being) of an online mindfulness intervention for stroke survivors and caregivers. Using mixed methods, 11 stroke survivors and three caregivers participated in a 3-week, online, Langerian mindfulness intervention. A semi-structured interview assessed the intervention's usability and gathered feedback. Self-reported measures about psychological well-being were documented remotely 3 times (preintervention, postintervention, and 1-month follow-up). Qualitatively, participants were highly satisfied with the intervention and reported subjective benefits, but the usability of the online platform was poor. None of the self-reported measures changed over time. This study provided evidence of feasibility of an online Langerian mindfulness intervention in a new population: stroke survivors and caregivers.
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Affiliation(s)
| | - Francesco Pagnini
- Università Cattolica del Sacro Cuore, Milano, Italy.,Harvard University, Cambridge, MA, USA
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8
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Lau SCL, Drake BF, Sanders-Thompson VL, Baum CM. Racial Variation in the Association Between Domains of Depressive Symptomatology and Functional Recovery in Stroke Survivors. J Racial Ethn Health Disparities 2022; 10:1058-1066. [PMID: 35378721 DOI: 10.1007/s40615-022-01293-8] [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: 12/20/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate the relationships between various domains of depressive symptomatology and functional recovery in Black and White stroke survivors. METHODS Black (n = 181) and White (n = 797) stroke survivors from the Stroke Recovery in Underserved Population database were included. Four domains of depressive symptomatology (depressed affect, positive affect, somatic symptoms, interpersonal difficulties) were measured by the Center for Epidemiologic Studies Depression Scale at discharge; functional recovery was measured by the Functional Independence Measure at discharge and 3-month follow-up. Multivariable linear regression analyses examined the relation between race and functional recovery, and the association between depressive symptomatology and functional recovery by race. RESULTS Three-month functional recovery was greater among White stroke survivors than Black survivors. Affective symptoms of depression predicted poorer functional recovery of White survivors; whereas somatic symptoms predicted poorer functional recovery of Black survivors. CONCLUSIONS Domains of depressive symptomatology were differentially associated with poorer functional recovery in Black and White stroke survivors. Psychosocial interventions aimed at alleviating depressive symptomatology have the potential to improve functional recovery in Black and White stroke survivors and should be addressed in planning rehabilitation post-stroke.
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Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, 600 S. Taylor Ave 00163, St. Louis, MO, 63110, USA
| | - Bettina F Drake
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, 600 S. Taylor Ave 00163, St. Louis, MO, 63110, USA.
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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9
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Simpson R, Simpson S, Wasilewski M, Mercer S, Lawrence M. Mindfulness-based interventions for people with multiple sclerosis: a systematic review and meta-aggregation of qualitative research studies. Disabil Rehabil 2021; 44:6179-6193. [PMID: 34498997 DOI: 10.1080/09638288.2021.1964622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Mindfulness-based interventions (MBIs) are effective treatments for stress, anxiety, and depression in PwMS. However, low adherence and high attrition may limit effectiveness. Qualitative research can provide important insights into MBI acceptability, accessibility, and implementation. This systematic review and meta-aggregation evaluated qualitative research findings on the use of MBIs for PwMS. METHODS Systematic searches were undertaken in six major electronic databases. Studies using qualitative or mixed methods were included. Two reviewers screened, data extracted, and critically appraised studies. Meta-aggregation was performed following the Joanna Briggs Institute approach, extracting findings, developing categories, and synthesizing findings. RESULTS Six eligible papers, including 136 PwMS were included in meta-aggregation. 136 findings were extracted, grouped into 17 categories, with four synthesized findings: (1) "accessing mindfulness," (2) "a sense of belonging," (3) "experiencing mindfulness," and (4) "making mindfulness more relevant and sustainable for PwMS." CONCLUSIONS MBIs for PwMS need to take into consideration disability which can limit accessibility. Online MBIs (synchronous and asynchronous) appear acceptable alternatives to traditional face-to-face courses. However, PwMS benefit from shared (mindful) experiencing and highlight MBI instructors as crucial in helping them understand and practice mindfulness. Involving PwMS in design, delivery, and iterative refinement would make MBIs more relevant to those taking part.IMPLICATIONS FOR REHABILITATIONBoth face-to-face and online Mindfulness-based interventions (MBIs) appear acceptable to PwMS and, ideally, people should be offered a choice in training modality.PwMS derive benefit from undertaking MBIs with their peers, where a sense of camaraderie and belonging develop through shared (mindful) experiences.Instructors delivering MBIs for PwMS should be knowledgeable about the condition; participants describe how the instructor has a key role in helping them practice mindfulness effectively in the context of unpleasant experiences associated with MS.MBIs tailored for PwMS should include a pre-course orientation session, clearly articulate how mindfulness practices can help with MS, provide well-organized course materials in large font size, and deliver individual mindfulness practices flexibly depending on participant need.
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Affiliation(s)
- Robert Simpson
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada.,Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Sharon Simpson
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Marina Wasilewski
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada
| | | | - Maggie Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Scotland, UK
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10
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Ghosh M, Nosaka K, Whitehead L, Nosaka K. Identifying key elements to assess patient's acceptability of neurorehabilitation in stroke survivors - a Delphi method. Disabil Rehabil 2021; 44:6258-6266. [PMID: 34383623 DOI: 10.1080/09638288.2021.1960438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Assessing patient acceptability of treatment is a clinical concern. No guidance exists to determine the best way to measure acceptability in stroke neurorehabilitation. This study identifies key elements to measure patient's acceptance of stroke neurorehabilitation by establishing expert consensus. MATERIALS AND METHODS A four-phase Delphi method with a three-round electronic-based survey was conducted. Experts were considered as stroke survivors or their caregivers and professionals in stroke neurorehabilitation. A twenty-five-item list was sourced from a literature review and discussion with a consumer panel (n = 22). In Round-1 (n = 118) and Round-2 (n = 80), experts ranked the items on a five-point scale. Consensus levels were validated by a Validation group in Round-3 (n = 50). Validity of the results was considered if consensus reached ≥70%, a non-bimodal pattern of response central tendency, SD in Round-2 was lower than that in Round-1, and the agreement scores of responses were similar between all rounds. RESULTS In Round-1&2 and Round-3, 77.5% (n = 62) and 74.0% (n = 37) respectively, of the respondents were professionals, 20.0% (n = 16, n = 10 respectively) were either stroke survivors or caregivers, and 2.57% (n = 2) and 6.0% (n = 3) respectively were professionals who themselves were stroke survivors or caregivers. The key elements which met all priori criteria are: Goal setting, Measurable progress, Functional improvement, Challenging, Motivation, Interactive, Communications with health professionals, Knowledge of treatment, and No risks. CONCLUSIONS Patient's acceptance is crucial to developing the appropriate neurorehabilitation interventions. Future clinical trials should consider these items when measuring patient's acceptance of stroke neurorehabilitation interventions during the development and evaluation phases.Implications for rehabilitationAssessing patient acceptability of treatment is a clinical concern in stroke neurorehabilitation.This study has identified nine key elements to assess patient acceptability of stroke neurorehabilitation. These key elements are: Goal setting, Measurable progress, Functional improvement, Challenging, Motivation, Interactive, Communications with health professionals, Knowledge of treatment, and No risks.Professionals should consider these elements when measuring patient's acceptance of an intervention during the development, piloting, evaluation, and implementation phases.These findings provide a framework in designing neurorehabilitation programs and clinical trials on acceptance of and adherence to treatment in stroke survivors.
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Affiliation(s)
- Manonita Ghosh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Kaoru Nosaka
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Kazunori Nosaka
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Gray LA. Living the Full Catastrophe: A Mindfulness-Based Program to Support Recovery from Stroke. Healthcare (Basel) 2020; 8:healthcare8040498. [PMID: 33228109 PMCID: PMC7711731 DOI: 10.3390/healthcare8040498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/30/2022] Open
Abstract
Decades of research suggest that Mindfulness-Based Stress Reduction (MBSR) training supports a greater capacity to live with chronic medical conditions and contributes to lowering stress levels. This paper introduces a model for a Mindfulness-Based Recovery from Stroke (MBRfS) for promoting stroke recovery, informed by the lived experience of the author (a stroke survivor and certified MBSR instructor), the research literature regarding MBSR training, and the specific challenges of stroke recovery. Four themes emerged from the autoethnographic analysis that informed the proposed model: Readiness to accept the stroke event and the acquired brain injury, navigating uncertainties of stroke recovery with awareness and self-responsibility for outcomes, trusting the inherent wisdom of the body as a stroke recovery "teacher", and increased capacity to integrate complex emotions with self-compassion, and a sense of wholeness. A four-component MBRfS model is offered, which consists of an integration amongst a modified MBSR framework, emergent attitudinal themes, and insights from the autoethnographic vignettes. The MBRfS model offers a path for providing participants with a supportive experience within stroke recovery. Recommendations and suggestions for future studies are offered to support the development of MBRfS for stroke survivors and their caregivers, as well as contributing to healthcare providers.
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Affiliation(s)
- Lori A Gray
- Holistic Health Programs, Western Michigan University, Kalamazoo, MI 49008, USA
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12
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Chen J, Xiao H, Chen Y, Sun H, Chen S, Zheng J. Effect of reminiscence therapy based on positive psychology theory (RTBPPT) on the positive feelings of the spousal caregivers of elderly patients with advanced cancer in China. Eur J Cancer Care (Engl) 2020; 29:e13324. [PMID: 32885518 DOI: 10.1111/ecc.13324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/21/2020] [Accepted: 08/07/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Elderly patients with advanced cancer often experience various symptoms and need a great amount of care. However, their spousal caregivers are prone to negative emotions because of old age, poor health and the heavy burden of care. OBJECTIVE To examine the effect of a reminiscence therapy (RT) intervention on the spousal caregivers of elderly patients with advanced cancer. METHODS This study was a randomised controlled trial. Fifty-six spousal caregivers were randomly assigned to the control group (N = 29) receiving usual care and the experimental group (N = 27) receiving the RT intervention. The caregivers' caregiving burden, positive feelings towards caregiving and hope were measured before and immediately after the intervention. RESULTS The experimental group showed a significant reduction in the burden of spousal care compared to the control group (p < .01). The experimental group also had higher levels of positive feelings and hope than did the control group (p < .01). CONCLUSION RT is an effective approach to reducing the care burden of spouses of elderly patients with advanced cancer and enhancing the spouses' positive feelings and hope.
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Affiliation(s)
- Jingjing Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ying Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Haiyan Sun
- Department of Oncology, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shaohua Chen
- School of Nursing, Capital Medical University, Beijing, China
| | - Jianjing Zheng
- Department of Oncology, Fujian Provincial Hospital, Fuzhou, China
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13
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Merriman NA, Gillan D, Pender N, Williams DJ, Horgan F, Sexton E, Johnston M, Bennett KE, Donnelly NA, Wren MA, Hickey A. The StrokeCog study: development and description of a cognition-focused psychological intervention to address cognitive impairment following stroke. Psychol Health 2020; 36:792-809. [PMID: 32924891 DOI: 10.1080/08870446.2020.1820009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the process of developing a cognitive rehabilitation intervention for patients with post-stroke cognitive impairment (PSCI) and to describe the intervention prior to evaluation in a pilot randomised controlled trial (RCT). Method: The Medical Research Council framework, 'Developing and evaluating complex interventions', was used to develop the cognitive rehabilitation intervention. We conducted a combined analysis of the existing evidence base for PSCI rehabilitation alongside qualitative exploration of the perspectives of stroke survivors, their families, and healthcare professionals providing stroke care, on the necessary components for a cognitive rehabilitation intervention for PSCI. The Template for Intervention Description and Replication checklist was used as a structural framework for the description of the intervention. Results: The intervention comprises a five-week intervention integrating group-based activities, supported by a clinical neuropsychologist, with home-based activities to encourage self-efficacy through the practice of adjustment and compensatory strategies learned in the group format to achieve the patients' identified goals in managing their PSCI. Conclusion: A cognitive rehabilitation intervention for patients with PSCI has been developed and described. We are in the process of developing a structured intervention manual to standardise the content and delivery of the intervention for further testing in a pilot RCT.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Diane Gillan
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Wathugala M, Saldana D, Juliano JM, Chan J, Liew SL. Mindfulness Meditation Effects on Poststroke Spasticity: A Feasibility Study. J Evid Based Integr Med 2019; 24:2515690X19855941. [PMID: 31215234 PMCID: PMC6585237 DOI: 10.1177/2515690x19855941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study examined the feasibility of an adapted 2-week mindfulness meditation protocol for chronic stroke survivors. In addition, preliminary effects of this adapted intervention on spasticity and quality of life in individuals after stroke were explored. Ten chronic stroke survivors with spasticity listened to 2 weeks of short mindfulness meditation recordings, adapted from Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction course, in a pre/post repeated measures design. Measures of spasticity, quality of life, mindfulness, and anxiety, along with qualitative data from participants’ daily journals, were assessed. On average, participants reported meditating 12.5 days of the full 15 days (mean 12.5 days, SD 0.94, range 8-15 days). Seven of the 10 participants wrote comments in their journals. In addition, there were no adverse effects due to the intervention. Exploratory preliminary analyses also showed statistically significant improvements in spasticity in both the elbow (P = .032) and wrist (P = .023) after 2 weeks of meditation, along with improvements in quality of life measures for Energy (P = .013), Personality (P = .026), and Work/Productivity (P = .032). This feasibility study suggests that individuals with spasticity following stroke are able to adhere to a 2-week home-based mindfulness meditation program. In addition, preliminary results also suggest that this adapted, short mindfulness meditation program might be a promising approach for individuals with spasticity following stroke. Future research should expand on these preliminary findings with a larger sample size and control group.
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Affiliation(s)
- Melanie Wathugala
- 1 University of Southern California, Los Angeles, CA, USA.,Both the authors contributed equally to this work
| | - David Saldana
- 1 University of Southern California, Los Angeles, CA, USA.,Both the authors contributed equally to this work
| | | | - Jennifer Chan
- 1 University of Southern California, Los Angeles, CA, USA
| | - Sook-Lei Liew
- 1 University of Southern California, Los Angeles, CA, USA
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15
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Wang X, Smith C, Ashley L, Hyland ME. Tailoring Self-Help Mindfulness and Relaxation Techniques for Stroke Survivors: Examining Preferences, Feasibility and Acceptability. Front Psychol 2019; 10:391. [PMID: 30863349 PMCID: PMC6399145 DOI: 10.3389/fpsyg.2019.00391] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/08/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: Studies on psychological techniques to reduce stroke-related anxiety and/or distress are limited. More scarce is research on tailoring such techniques to suit stroke survivors’ needs, including the needs of those with aphasia. To address this gap, we report two sequential studies. Study 1 explored preferred psychological techniques (i.e., mindfulness and relaxation) and ways to modify them for stroke survivors, including those with communication difficulties. Study 2 examined the feasibility and acceptability of these modified techniques with a new sample of survivors. Design: Mixed-methods using qualitative and quantitative approach in both studies. Participants: All participants were stroke survivors living in the community (Study 1: n = 13, median age = 61 years; Study 2: n = 38, median age = 67 years). Interventions and Procedures: Study 1: seven techniques representing commonly used types of mindfulness and relaxation were filmed on a professionally produced DVD. Participants feedback on how these techniques could be tailored to meet their needs, their preferences for techniques and reasons for likes and dislikes. Study 2: four favored techniques from study 1 were modified and re-filmed into a new DVD. A new group of participants were asked to practice them twice daily, five times a week for at least 4 weeks. They completed questionnaires at the start of the study (T1), returned approximately 4 weeks later completing the same measures (n = 24 at T2). Focus group discussions/interviews were conducted at the end of T2 exploring the feasibility and acceptability of these techniques. Results: Four techniques were favored by participants in Study 1. After adaptation, these techniques were generally perceived as acceptable, user-friendly and beneficial to participants who participated in the focus groups /interviews in Study 2. A ‘once a day’ practice frequency could make practicing more feasible. Participants also preferred having choices- multiple techniques could be more useful than single technique. Conclusion: Tailoring psychological techniques for stroke survivors is beneficial. Tailored techniques in a self-help DVD format seemed feasible and acceptable, however, a less frequent practice would be easier for stroke survivors. Future studies should seek to recruit a more heterogenous sample as well as implementing strategies to increase the retention rate.
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Affiliation(s)
- Xu Wang
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Connie Smith
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Michael E Hyland
- School of Psychology, Plymouth University, Plymouth, United Kingdom
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