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Chaudhry MT, McCambridge AB, Rivera EII, William S, Stubbs P, Verhagen A, Ferguson C. A Qualitative Exploration of Stroke Survivors' Experiences of Using a Stroke Helpline. Health Expect 2024; 27:e14141. [PMID: 38990166 PMCID: PMC11238573 DOI: 10.1111/hex.14141] [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: 10/24/2023] [Revised: 04/10/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND StrokeLine is a stroke-specific helpline used by stroke survivors and their families in Australia to access professional support. There has been little research exploring stroke survivors' experiences of using helplines and their perceived impact on their stroke recovery. AIM The aim of this study is to explore the reasons prompting stroke survivors to call StrokeLine and their experiences and to describe the perceived impact of calling StrokeLine on their recovery. METHODS An exploratory descriptive qualitative study was undertaken using thematic analysis of data collected through semi-structured interviews of stroke survivors between December 2020 and May 2022. Participants were recruited using purposive sampling. Interviews were conducted via audio-recorded Zoom conference calling and transcribed verbatim for thematic analysis. RESULTS A total of eight callers (four men and women women) participated, with the time since stroke ranging from 3.5 months to 5 years. Four major themes were identified, including 17 sub-themes. Key themes included (1) factors prompting use of StrokeLine; (2) experience of using StrokeLine; (3) perceived impact of using StrokeLine; and (4) conceptualising StrokeLine service provision. CONCLUSIONS Participants perceived their experience of contacting StrokeLine as having a positive impact on their stroke recovery, leaving them feeling empowered and motivated to self-manage their condition. PATIENT OR PUBLIC CONTRIBUTION Stroke survivors with lived experience influenced the conceptualisation of this study through conversations with consumers and the Stroke Foundation. Eight stroke survivors were involved as participants in the research study.
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Affiliation(s)
- Muneeba T Chaudhry
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alana B McCambridge
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Esminio I I Rivera
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Scott William
- Centre for Chronic & Complex Care Research, School of Nursing, Blacktown Hospital, University of Wollongong & Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Stubbs
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caleb Ferguson
- Centre for Chronic & Complex Care Research, School of Nursing, Blacktown Hospital, University of Wollongong & Western Sydney Local Health District, Sydney, New South Wales, Australia
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Bailey RR, Waddoups S. Performance of Dietary Behaviors in Chronic Community-Dwelling Stroke Survivors: A Mixed-Methods Study. Occup Ther Health Care 2024; 38:214-235. [PMID: 36622304 PMCID: PMC10329724 DOI: 10.1080/07380577.2022.2139444] [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: 05/19/2022] [Accepted: 10/19/2022] [Indexed: 01/10/2023]
Abstract
In order to gain a better understanding of post-stroke dietary behaviors (e.g., selecting, accessing, and preparing healthy foods) among chronic, community-dwelling stroke survivors, we conducted a mixed-methods study consisting of a quantitative online survey (n = 63) and follow-up focus groups with a subset of participants (n = 7). Perceived performance, assistance required, adaptive equipment and compensatory strategies used, and sources of education and training were examined. Results demonstrated (1) diminished post-stroke performance for most dietary behaviors (e.g., grocery shopping, meal preparation), (2) an increased desire to eat healthily to prevent recurrent stroke, (3) variable use of adaptive equipment and compensatory strategies, and (4) limited healthcare-based dietary behavior education and training. These results suggest that stroke survivors could benefit from increased dietary behavior intervention to improve dietary behavior performance. Findings can be used to guide clinical intervention and design future research studies.
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Affiliation(s)
- Ryan R Bailey
- Department of Occupational and Recreational Therapies, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Sarah Waddoups
- Department of Occupational and Recreational Therapies, College of Health, University of Utah, Salt Lake City, UT, USA
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3
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Reistetter T, Hreha K, Dean JM, Pappadis MR, Deer RR, Li CY, Hong I, Na A, Nowakowski S, Shaltoni HM, Bhavnani SK. The Pre-Adaptation of a Stroke-Specific Self-Management Program Among Older Adults. J Aging Health 2023; 35:632-642. [PMID: 36719035 PMCID: PMC10387498 DOI: 10.1177/08982643231152520] [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] [Indexed: 02/01/2023]
Abstract
Objectives: Managing multimorbidity as aging stroke patients is complex; standard self-management programs necessitate adaptations. We used visual analytics to examine complex relationships among aging stroke survivors' comorbidities. These findings informed pre-adaptation of a component of the Chronic Disease Self-Management Program. Methods: Secondary analysis of 2013-2014 Medicare claims with stroke as an index condition, hospital readmission within 90 days (n = 42,938), and 72 comorbidities. Visual analytics identified patient subgroups and co-occurring comorbidities. Guided by the framework for reporting adaptations and modifications to evidence-based interventions, an interdisciplinary team developed vignettes that highlighted multimorbidity to customize the self-management program. Results: There were five significant subgroups (z = 6.19, p < .001) of comorbidities such as obesity and cancer. We constructed 6 vignettes based on the 5 subgroups. Discussion: Aging stroke patients often face substantial disease-management hurdles. We used visual analytics to inform pre-adaptation of a self-management program to fit the needs of older adult stroke survivors.
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Affiliation(s)
- Timothy Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900
| | - Kimberly Hreha
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC 27710
| | - Julianna M. Dean
- Department of Clinical, Health, and Applied Sciences, College of Human Sciences and Humanities, University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX 77058
| | - Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Rachel R. Deer
- Department of Nutrition, Metabolism and Rehabilitation Sciences, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, 135 Backun Hall, Yonsei Univroad 1, Wonju, Gangwon-do, Republic of Korea, 26493
| | - Annalisa Na
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102
| | - Sara Nowakowski
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Hashem M. Shaltoni
- Department of Neurology, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Suresh K. Bhavnani
- Department of Population Health and Health Disparities, School of Public and Population Health, 300 University Blvd, Galveston, TX 77555
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Shafer JS, Haley KL, Jacks A. Barriers to Informational Support for Care Partners of People With Aphasia After Stroke. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2211-2231. [PMID: 37566895 DOI: 10.1044/2023_ajslp-22-00391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Care partners of people with aphasia after stroke need various informational supports, such as aphasia education and resources for psychosocial support. However, informational support may vary across clinicians, and access to these supports remains a persistent unmet need. Using implementation science frameworks can help to assess the gap between what is known about an issue and what is occurring in practice. AIM The aim was to identify barriers to providing informational support for care partners of people with aphasia after stroke. METHOD AND PROCEDURE We performed a secondary analysis of qualitative data collected from two of our previous studies. New themes were identified by comparing feedback from both speech-language pathologists and care partners, and previously assigned codes were interpreted relative to the Knowledge to Action (KTA) framework. OUTCOMES AND RESULTS We identified four implementation themes that were specifically related to the action cycle of the KTA framework: (a) Aphasia rehabilitation tends to exclude care partners, (b) aphasia rehabilitation can be hard to understand, (c) structure is lacking for care partner check-ins, and (d) care partner informational support rarely extends beyond the acute phases of recovery. CONCLUSION The results suggest that changes are needed at both systemic and care provider levels to ensure that tailored information is provided to care partners of people with aphasia.
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Affiliation(s)
- Jennifer S Shafer
- Program on Integrative Medicine, The University of North Carolina at Chapel Hill
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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Muijsenberg AJL, Houben-Wilke S, Zeng Y, Spruit MA, Janssen DJA. Methods to assess adults' learning styles and factors affecting learning in health education: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 107:107588. [PMID: 36502561 DOI: 10.1016/j.pec.2022.107588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To develop learner-centered education, knowledge about learning styles and factors that affect the ability to learn in patients and their significant others are essential. The present scoping review aims to identify current evidence on 1) how learning styles are assessed within health education, for adult patients as well as their significant others and 2) factors affecting learning in adult patients and their significant others who receive health education. METHODS Systematic literature searches were performed in ERIC, PubMed, Web of Science and PsycINFO. INCLUSION CRITERIA 1) participants ≥ 18 years; 2) participants were patients or significant others; 3) assessment of learning style and/or factors affecting learning; and 4) health education as context. RESULTS 45 articles were included. Learning style within health education can be assessed with multiple choice questions, qualitative methods and a validated questionnaire. Health literacy was the most reported factor affecting learning, followed by anxiety and illness condition. CONCLUSIONS Prior to the development of learner-centered education for patients and significant others, learning styles as well as factors affecting learning should be assessed in both patients and significant others. PRACTICE IMPLICATIONS The process of learning is complex, and it is a shared responsibility of both the learner and the educator.
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Affiliation(s)
| | | | - Yuqin Zeng
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Calder A, Sole G, Mulligan H. Co-Design of an Educational Resource with Female Partners of Male Stroke Survivors to Support Physical Activity Participation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16856. [PMID: 36554747 PMCID: PMC9779113 DOI: 10.3390/ijerph192416856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Many male stroke survivors find it challenging to meet the recommended physical activity (PA) guidelines for health benefits. The spouse/partner is an important source of self-management for stroke survivor PA participation; however, they feel unsupported by health professionals. This study aimed to co-design an educational resource prototype to guide and empower female partners in supporting male stroke survivors' participation in PA. We used a participatory action research (PAR) methodology. Thirteen support persons of male stroke survivors from Canterbury, New Zealand participated in four PAR cycles. The data were collected using individual interviews and focus groups and analyzed inductively using the general inductive approach. Three themes were reflected in the data and informed the prototype content: (1) managing an unwanted and challenging new life, (2) inconsistent access to meaningful information, and (3) considerations for successful stroke survivor PA participation. If partners are to be an essential source in supporting stroke survivors' self-management of PA, they require resources that are meaningful and credible to enhance their confidence and self-efficacy. Further research is needed to explore the acceptability and usability of the educational resource with a wider audience and evaluate the co-design process. An inclusive and collaborative approach where support persons were valued for their expertise was essential in co-designing a meaningful resource intended to support stroke survivors and support persons' self-management of their PA.
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Temehy B, Rosewilliam S, Alvey G, Soundy A. Exploring Stroke Patients’ Needs after Discharge from Rehabilitation Centres: Meta-Ethnography. Behav Sci (Basel) 2022; 12:bs12100404. [PMID: 36285973 PMCID: PMC9598696 DOI: 10.3390/bs12100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
Healthcare providers must consider stroke survivors needs in order to enable a good quality of life after stroke. This review aimed to investigate the perceived needs of the stroke survivors across various domains of care following their discharge from hospital. A meta-ethnographic review of qualitative studies that reported needs of stroke patients after discharge from rehabilitation services was conducted. Main searches were conducted on the following electronic databases: Ovid Medline (1946 to 2021), CINAHL plus (EBSCO), AMED (EBSCO), PsycINFO (1967 to 2021), the Cochrane Library, and PubMed in June 2022. Main outcomes were related to stroke survivors’ views, experiences, and preferences on physical, psychological, social, rehabilitation needs, and other identified needs. Twenty-seven studies were included in the final analysis. The findings show that existing rehabilitation provision for stroke survivors does not address the long-term needs of stroke survivors. Two main issues were revealed concerning the unmet needs of stroke survivors: (1) a lack of information availability and suitability and (2) inadequacy of care and services. It is crucial to further investigate the needs of patients in Asian countries and the Middle East as there is very limited understanding of patients’ needs in the community in these regions.
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van de Graaf DL, Vlooswijk C, Bol N, Krahmer EJ, Bijlsma R, Kaal S, Sleeman SHE, van der Graaf WTA, Husson O, van Eenbergen MC. AYAs' online information and eHealth needs: A comparison with healthcare professionals' perceptions. Cancer Med 2022; 12:2016-2026. [PMID: 35879825 PMCID: PMC9883566 DOI: 10.1002/cam4.5048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/15/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) diagnosed with cancer fulfill their cancer-related information needs often via the Internet. Healthcare professionals (HCPs) have a crucial role in guiding patients in finding appropriate online information and eHealth sources, a role that is often overlooked. Misperceptions of AYAs' needs by HCPs may lead to suboptimal guidance. We aimed to examine the extent to which AYAs' online information and eHealth needs corresponded with HCPs' perceptions of these needs. METHODS Two cross-sectional online surveys (AYAs, n = 299; HCP, n = 80) on online information and eHealth needs were conducted. HCPs provided indications of their perceptions of AYA's needs. RESULTS AYAs reported significantly more online information needs compared with HCPs' perceptions regarding: survival rates (AYA = 69%, HCP = 35%, p < 0.001), treatment guidelines (AYA = 65%, HCP = 41%, p < 0.001), return of cancer (AYA = 76%, HCP = 59%, p = 0.004), "what can I do myself" (AYA = 68%, HCP = 54%, p = 0.029), and metastases (AYA = 64%, HCP = 50%, p = 0.040). Significantly more unmet eHealth needs were reported by AYAs compared with HCPs relating to access to own test results (AYA = 25, HCP = 0%, p < 0.001), request tests (AYA = 30%, HCP = 7%, p < 0.001), medical information (AYA = 22%, HCP = 0%, p = 0.001), e-consult with nurses (AYA = 30%, HCP = 10%, p < 0.001), e-consult with physicians (AYA = 38%, HCP = 13%, p = 0.001), and request prescriptions (AYA = 33%, HCP = 21%, p = 0.009). CONCLUSION AYAs' online information and eHealth needs are partially discrepant with the impression HCPs have, which could result in insufficient guidance related to AYAs' needs. AYAs and HCPs should get guidance regarding where to find optimal information in a language they understand. This may contribute to AYAs' access, understanding, and satisfaction regarding online information and eHealth.
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Affiliation(s)
- Daniëlle L. van de Graaf
- CoRPS ‐ Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands,Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
| | - Carla Vlooswijk
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
| | - Nadine Bol
- Tilburg Center for Cognition and Communication (TiCC)Tilburg UniversityTilburgThe Netherlands
| | - Emiel J. Krahmer
- Tilburg Center for Cognition and Communication (TiCC)Tilburg UniversityTilburgThe Netherlands
| | - Rhodé Bijlsma
- Department of Medical OncologyUniversity Medical CenterUtrechtThe Netherlands
| | - Suzanne Kaal
- Department of Medical OncologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Winette T. A. van der Graaf
- Department of Surgical OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands,Department of Medical OncologyErasmus MC Cancer Institute, Erasmus MCRotterdamThe Netherlands
| | - Olga Husson
- Division of Psychosocial Research and EpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands,Department of Surgical OncologyErasmus MC Cancer Institute, Erasmus MCRotterdamThe Netherlands,Division of Clinical StudiesInstitute of Cancer ResearchLondonUK
| | - Mies C. van Eenbergen
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands,Tilburg Center for Cognition and Communication (TiCC)Tilburg UniversityTilburgThe Netherlands
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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Formal Health and Social Services That Directly and Indirectly Benefit Stroke Caregivers: A Scoping Review of Access and Use. Can J Nurs Res 2022; 54:211-233. [PMID: 35130749 PMCID: PMC9109593 DOI: 10.1177/08445621211019261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Stroke can be a life altering event that necessitates considerable amounts of
formal and informal care. The impacts of stroke often persist over time
requiring ongoing support for stroke survivors. Family members provide the
majority of care and experience many life changes as a result of their
caregiving role including social, financial, employment and health impacts.
Formal supports such as counselling, respite, and health promotion initiatives
that directly benefit caregivers or benefit them indirectly through supporting
the stroke survivor, are well-placed to help caregivers manage their caregiving
role. However, to date little is known about formal service use by stroke
caregivers and the factors that influence their service use. This scoping review
provides a critique and synthesis of what is known about stroke caregivers’
access and use of formal services intended to support them. Findings suggest
that while services are available, caregivers’ ability to use them are impacted
by both facilitators and barriers. Facilitators included: sex, age, and having a
higher household income (depending on services used). Barriers included: high
cost, poor service quality and deficient knowledge/communication regarding
service availability. This review highlights a significant gap in our knowledge
of caregivers’ experience in accessing and using formal services.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Merati-Fashi F, Dalvandi A, Yekta ZP. Health Information Seeking and Its Achievements in Patients With Chronic Disease. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Velez JA, Keene JR, Corwin M, Elko S, Potter RF. A Visual Interactive Narrative Intervention (VINI) for aphasia education: Can digital applications administer augmented input to educate stroke survivors with aphasia? PATIENT EDUCATION AND COUNSELING 2021; 104:2536-2543. [PMID: 33810913 DOI: 10.1016/j.pec.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Persons with aphasia (PWA) face additional barriers to proper healthcare due to inadequate patient education by health professionals unequipped to use augmentative and alternative communication (AAC). The current study examines a digital application that evokes and sustains health information processing through AAC specifically aimed at increasing comprehension with augmented input (AI). METHODS A digital application designed to educate PWA about their health condition was compared to a video-recorded doctor providing oral-only education. Sixteen PWA received both education interventions in a crossover manner. Health information processing was assessed through heart rate (HR) and skin conductance levels (SCL), which were collected continually during each administration of education interventions. RESULTS PWA demonstrated greater cognitive processing of health information via HR and SCL indices during the digital application compared to the typical oral-only education intervention. The oral-only intervention led PWA to disengage with health information. CONCLUSION By combining visuographic materials and adapted language into a customizable narrative structure, digital applications can utilize AI to educate PWA about basic health information (i.e., diagnosis and prognosis). PRACTICE IMPLICATIONS The current study's AAC requires minimal training and can be used as an aided support in conjunction with other techniques that increase PWA's access to health information.
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Affiliation(s)
- John A Velez
- Communication Science Unit, The Media School, College of Arts + Sciences, Indiana University, Bloomington, USA.
| | - Justin Robert Keene
- Department of Journalism and Creative Media Industries, College of Media and Communication, Texas Tech University, Lubbock, USA
| | - Melinda Corwin
- Department of Speech, Language, and Hearing Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Stacy Elko
- School of Art, J.T. & Margaret Talkington College of Visual & Performing Arts, Texas Tech University, Lubbock, USA
| | - Robert F Potter
- Communication Science Unit, The Media School, College of Arts + Sciences, Indiana University, Bloomington, USA
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Girardi G, Farnese ML, Scarponi F, De Tanti A, Bartolo M, Intiso D, Formisano R, Antonucci G. User-centered practices in the eyes of informal caregivers of in-patients with severe acquired brain injury: needs, caring experience, and satisfaction. Brain Inj 2021; 35:1402-1412. [PMID: 34487469 DOI: 10.1080/02699052.2021.1972338] [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
OBJECTIVE This study examines the perceived needs, experience, and satisfaction of informal caregivers (ICGs) in in-hospital settings, related to their involvement in the design and delivery of services together with hospital staff, namely co-production. DESIGN To obtain a picture of current ICG-staff relationship, a multicenter observational study was carried out. Participants were 75 ICGs recruited in five dedicated in-patient neurorehabilitation wards. Participants answered a self-report questionnaire tapping perceived information/communication needs, emotional/social needs, and their satisfaction; family-centered practices implemented by the staff (namely involving practices and cooperative communication); and ICGs' satisfaction with the service. RESULTS Need satisfaction related positively to staff practices aimed at involving IGCs in treatment and training, but not in decision-making. Involving practices concerning treatment also related positively to ICGs' information/communication needs. In addition, the more the staff involved ICGs in decision-making and promoted cooperative communication regarding treatment, the more ICGs felt that their collaboration in the healthcare process was valuable. Finally, all involvement practices and cooperative communication were positively related to ICGs' overall satisfaction with the service. CONCLUSION The results of the study help to identify gaps in meeting ICGs' needs and to promote strategies to implement family participation toward co-production in in-hospital settings.
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Affiliation(s)
- Giovanna Girardi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Antonio De Tanti
- Istituto S. Stefano Riabilitazione, Centro Cardinal Ferrari, Fontanellato, PR, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA Zingonia, Bergamo, Italy
| | - Domenico Intiso
- UOC di Medicina Fisica e Riabilitativa, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCSS Santa Lucia Foundation, Rome, Italy
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Kristensson L, Björkdahl A. Experience of Information Provision at the Stroke Unit From the Perspective of Relatives to Stroke Survivors. Rehabil Process Outcome 2021; 9:1179572720947086. [PMID: 34497469 PMCID: PMC8282136 DOI: 10.1177/1179572720947086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/11/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Stroke not only affects the stroke survivor, it also significantly affects their families. Given the important supportive role that relatives of stroke survivor have, they should receive information that helps them plan and cope with the new situation. The objective of the study was to explore how relatives to stroke survivors perceived the information provided by the stroke unit. Methods: This qualitative study was based on extensive semi-structured interviews with an inductive approach. A heterogeneous convenience sample of relatives to stroke survivor (n=14) was selected. Qualitative content analysis served to analyze the transcribed interview texts. Results: The content analysis yielded four categories, each with 2–3 subcategories. The overall theme was “to be acknowledged or not”: it encompassed the underlying meaning and the relationships between the categories. The four categories were as follows: shifting information needs; striving for information; lacking of continuity and structure; and taking part and being acknowledged. Conclusions: The study highlighted that the relatives of stroke survivors have a strong need for information and showed that the relatives experienced that they did not always feel satisfactorily informed and supported by the healthcare professionals in the stroke unit. A challenge for the healthcare professionals was to be able to give the right information at the right time and in the appropriate way. The study also showed that when the relatives were acknowledged and invited to participate in the rehabilitation process, they were less anxious of the discharge.
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Affiliation(s)
- Linda Kristensson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg.,Institute of Neuroscience and Physiology, Department of Occupational Therapy, Sahlgrenska Academy, University of Gothenburg
| | - Ann Björkdahl
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg.,Institute of Social Science, Ersta Sköndal Bräcke University Collage, Campus Bräcke, Gothenburg
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Sharpe A, Boyes V, Lee C, Murtha C, Mah J, Yoshida K, Marzolini S, Inness EL. Cardiopulmonary Exercise Testing in Stroke Rehabilitation: Benefits and Clinical Utility Perceived by Physiotherapists and Individuals with Stroke. Physiother Can 2021; 73:110-117. [PMID: 34456420 DOI: 10.3138/ptc-2019-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this study was to understand the perceived benefits and clinical utility of cardiopulmonary exercise testing (CPET) from the perspectives of physiotherapists and patients and to explore the factors that influence adopting CPET in a stroke rehabilitation setting. Method: A qualitative descriptive study was conducted. Physiotherapists (n = 6) participated in a focus group to discuss the use of CPET in practice. Patients (n = 8) who had completed CPET during stroke rehabilitation participated in a semi-structured interview to explore their experiences. Thematic analysis was performed. Results: CPET increased the physiotherapists' confidence in prescribing exercise, especially for medically complex patients. Ongoing medical management early post-stroke was a barrier to referral. Physiotherapists expressed decreased confidence in interpreting test results. Consultation with local experts facilitated the use of CPET. Patients described how CPET increased their confidence to participate in exercise. They desired more information before and after CPET to better understand the purpose and results and their relation to their rehabilitation goals. Conclusions: Both physiotherapists and patients described the benefit of having CPET available to support them as they participated in exercise in a stroke rehabilitation setting. Physiotherapists would benefit from having educational tools to support their interpretation and application of test results, and patients would benefit from improved communication and education to support their understanding of the relevance of CPET to their rehabilitation goals. Future research should explore these findings in other stroke rehabilitation settings.
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Affiliation(s)
| | - Valerie Boyes
- Department of Physical Therapy, University of Toronto
| | - Calvin Lee
- Department of Physical Therapy, University of Toronto
| | | | - Justin Mah
- Department of Physical Therapy, University of Toronto
| | - Karen Yoshida
- Department of Physical Therapy, University of Toronto
| | - Susan Marzolini
- Department of Physical Therapy, University of Toronto.,Cardiovascular Prevention and Rehabilitation Program.,The KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ont
| | - Elizabeth L Inness
- Department of Physical Therapy, University of Toronto.,Brain & Spinal Cord Rehabilitation Program.,The KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ont
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15
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Jayasree-Krishnan V, Ghosh S, Palumbo A, Kapila V, Raghavan P. Developing a Framework for Designing and Deploying Technology-Assisted Rehabilitation After Stroke: A Qualitative Study. Am J Phys Med Rehabil 2021; 100:774-779. [PMID: 33141773 DOI: 10.1097/phm.0000000000001634] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Many unmet rehabilitation needs of patients with stroke can be addressed effectively using technology. However, technological solutions have not yet been seamlessly incorporated into clinical care. The purpose of this pilot study was to examine how to bridge the gaps between the recovery process, technology, and clinical practice to impact stroke rehabilitation meaningfully. DESIGN Semistructured interviews were performed using a grounded theory approach with purposive sampling of 17 diverse expert providers in acute care, inpatient, and outpatient stroke rehabilitation settings. Common themes were identified from qualitative analyses of the transcribed conversations to develop a guiding framework from the emerging concepts. RESULTS Four core themes emerged that addressed major barriers in stroke rehabilitation and technology-assisted solutions to overcome these barriers: (1) accessibility to quality rehabilitation, (2) adaptability to patient differences, (3) accountability or compliance with rehabilitation, and (4) engagement with rehabilitation. CONCLUSIONS The results suggest a four-pronged framework, the A3E framework that stands for Accessibility, Adaptability, Accountability, and Engagement, to comprehensively address existing barriers in providing rehabilitation services. This framework can guide technology developers and clinicians in designing and deploying technology-assisted rehabilitation solutions for poststroke rehabilitation, particularly using telerehabilitation.
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Affiliation(s)
- Veena Jayasree-Krishnan
- From the Department of Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, Brooklyn, New York (VJ-K, SG, VK); Department of Rehabilitation Science, NYU Steinhardt School of Culture, Education, and Human Development, New York, New York (AP); and Rusk Rehabilitation, New York University School of Medicine, New York, New York (PR)
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16
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Suddick KM, Cross V, Vuoskoski P, Stew G, Galvin KT. Holding space and transitional space: stroke survivors' lived experience of being on an acute stroke unit. A hermeneutic phenomenological study. Scand J Caring Sci 2021; 35:104-114. [PMID: 32065418 PMCID: PMC7984029 DOI: 10.1111/scs.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/01/2022]
Abstract
Despite substantial reorganisation of stroke unit provision in the United Kingdom, limited qualitative research has explored how stroke survivors experience the acute stroke unit. This hermeneutic phenomenological study used accounts from four stroke survivors who experienced one of two acute stroke units. Through detailed analysis, the acute stroke unit emerged as a meaningful space, in two distinct but interconnected forms. As holding space, the unit was understood to offer protection and safe haven, as the stroke survivors looked to cope and respond to the temporal, bodily, biographical disruption and significant vulnerability brought about by stroke and by being in hospital. Holding was fulfilled by different people (including their fellow stroke survivors) and reflected a human response to human need and existential vulnerability. This space, and the practices within it, functioned to hold them intimately but also at a distance from their prestroke lifeworld. As such, the acute stroke unit holding space was intertwined with how it supported, encouraged or provoked transition. In the transitional space of the acute stroke unit, stroke survivors described how they survived the hospital-healthcare space, stroke unit and poststroke space. This paper articulates how transition was meaningfully signified through its absence or presence, as they transformed, relinquished or re-asserted their 'self', and in one case, recovered whilst 'in there'. The findings of this study provide phenomenological insight into stroke survivors' lived experience, the meaningful holding and transitional contribution of the unit, and how these spatial forms were intertwined. These insights are discussed in relation to the existing evidence base and stroke unit provision.
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Affiliation(s)
| | - Vinette Cross
- School of Health SciencesUniversity of BrightonEastbourneUK
- Centre for Health and Social Care ImprovementSchool of Health and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Pirjo Vuoskoski
- School of Health SciencesUniversity of BrightonEastbourneUK
- Present address:
Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Graham Stew
- School of Health SciencesUniversity of BrightonEastbourneUK
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17
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Sauvé-Schenk K, Duong P, Savard J, Durand F. A systematic review of social service and community resource interventions following stroke. Disabil Rehabil 2020; 44:2948-2957. [PMID: 33280453 DOI: 10.1080/09638288.2020.1851780] [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: 10/22/2022]
Abstract
PURPOSE Finding and accessing social services and community resources are a challenge for stroke survivors and care partners. The purpose of this systematic review was to identify and review interventions that aimed to increase access and use of such services and resources post stroke. METHOD A systematic review of the published literature was performed using MEDLINE, CINAHL, PsycINFO, and ProQuest Nursing and Allied Health (January 2008 to May 2020). Studies were included if they were quantitative designs and reported on outcomes of interventions addressing post-stroke access to social services or community resources. Results were synthesised narratively. RESULTS 3566 titles and abstracts were reviewed. Ten articles met the inclusion criteria. The interventions included in this review varied in terms of target group, timing, and type of support provided (passive or active tailored information provision, referral service, navigation assistance). Outcome measures, for social service and community resource access, included discharge preparedness measures, service counts, observations, satisfaction evaluations, interviews, and open-ended questions. CONCLUSION Overall, interventions demonstrated some improvements in information received and access to social services and community resources following stroke. Future research should focus on carrying out high quality studies that examine the effectiveness of various social service and community resource interventions, and on setting valid and reliable outcome measures.IMPLICATIONS FOR REHABILITATIONStroke survivors and care partners have unmet social service and community resource needs.Stroke survivors and care partners can benefit from interventions that provide information, referrals, and ongoing support to access services and resources.Clearly identifying social service and community resource needs is important for tailoring interventions to individual situations.Interventions should ideally be provided throughout the hospital stay, in acute care and rehabilitation, and continue on in the community.
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Affiliation(s)
- Katrine Sauvé-Schenk
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Patrick Duong
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Jacinthe Savard
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - François Durand
- Institut du Savoir Montfort, Ottawa, Canada.,Telfer School of Management, University of Ottawa, Ottawa, Canada
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18
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D'Cruz K, Meikle L, White M, Herrmann A, McCallum C, Romero L. Tailoring education of adults with cognitive impairment in the inpatient hospital setting: A scoping review. Aust Occup Ther J 2020; 68:90-102. [PMID: 33029784 DOI: 10.1111/1440-1630.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Education seeks to empower clients to attain and maintain knowledge and skills, and in the context of occupational therapy, to enable occupational participation. While education is routinely provided in the inpatient hospital setting, little is known about how education is best adapted to meet the needs of clients with cognitive impairment. The purpose of this scoping review was to determine what is currently known about approaches to educating adults with cognitive impairment in the inpatient hospital setting. METHODS Five databases were systematically searched to find studies that reported on the use of education in the inpatient hospital setting with adults with cognitive impairment. RESULTS Ten articles were retrieved from the search with duplication of authors across the articles, indicating a small group of research and researchers. Cognitive impairment was not well assessed across all the studies and none included participants with severe cognitive impairment. A number of barriers to education were identified, including time constraints, uncertainty around who should be providing education, a shortage of resources, and client-related barriers such as cognitive deficits. From the retrieved studies it was found that education should occur at multiple time points, be individually tailored, and utilise mixed modal approaches such as verbal and written methods. There was also a preference for less use of jargon, and engagement with carers and clients where possible. CONCLUSION This scoping review highlights factors impacting the provision of education tailored to the needs of clients with cognitive impairment in the inpatient setting. The findings also call to attention the need for better assessment of cognition to guide provision of tailored education, as well as future studies exploring how to best educate clients with not only mild/moderate cognitive impairment but also more severe impairments.
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Affiliation(s)
- Kate D'Cruz
- Discipline of Occupational Therapy, La Trobe University, Melbourne, Vic, Australia
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19
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Physiotherapists' and occupational therapists' perspectives on information and communication technology in stroke rehabilitation. PLoS One 2020; 15:e0236831. [PMID: 32857781 PMCID: PMC7454973 DOI: 10.1371/journal.pone.0236831] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/14/2020] [Indexed: 01/21/2023] Open
Abstract
Aim The aim of this study was to explore the current and potential use of information and communication technology (ICT) to enhance coherent person-centred rehabilitation after stroke, from the perspectives of physiotherapists and occupational therapists. Method Five occupational therapists and four physiotherapists from different phases of the Danish stroke rehabilitation process were included and two focus group interviews were carried out. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. Results Three subcategories were identified from the analysis of interviews with participants: 1) ICT and apps as meaningful and supportive in the rehabilitation process, 2) ICT as a tool in communication and documentation and 3) Barriers to the integration of ICT and apps in the rehabilitation process. From these categories one core category emerged: The potential of a personalized app solution to facilitate coherent person-centred rehabilitation. Conclusion ICT was perceived as important to integrate in stroke rehabilitation both for assessment, training and to compensate for remaining deficits. The development of a personalized app solution could accommodate stroke survivors’ and significant others’ need for insight into and overview over the rehabilitation process as well as access to relevant information, which would thereby empower them. Furthermore, a personalized app solution could also facilitate follow-up after discharge and was perceived to ease the communication and documentation within and between sectors, as well as communication with both stroke survivors and significant others.
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20
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Hersh D, Armstrong E. Information, communication, advocacy, and complaint: how the spouse of a man with aphasia managed his discharge from hospital. APHASIOLOGY 2020; 35:1067-1083. [PMID: 34456417 PMCID: PMC8389356 DOI: 10.1080/02687038.2020.1765304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/03/2020] [Indexed: 06/13/2023]
Abstract
Background: The impact of stroke and aphasia has been recognised as a family problem for many years with studies highlighting spouses' need for information at different times along the recovery journey, for practical and emotional support, recognition, and respite. In particular, the decision-making around discharge from hospital, or planning for rehabilitation, is not always collaborative even though family involvement assists family members to plan and adjust to their new caring role. Aims: This study aims to explore how the wife of a man with aphasia managed his discharge from hospital in the acute phase post-stroke. It provides an opportunity for health professional learning and sensitisation through the detailed analysis of a de-identified but a real case that happened to reflect key issues reported by families in previous research: lack of information, poor communication with healthcare professionals, and the need for advocacy. Methods and procedures: The data for this paper are drawn from two sources: a single in-depth interview with the wife collected as part of an earlier large multi-site study that included interviews with 48 family members of people with aphasia after stroke; and two complaint letters she wrote to the hospital and two letters received back. This study uses a narrative analysis of the interview, and a systemic functional linguistics (SFL) analysis of the letters in order to shed light on the key issues of information, communication, and advocacy. Outcomes and results: The narrative analysis of the interview and the SFL analysis of the letters together help to unpack the reasons why the wife felt motivated to write a complaint letter to the hospital where her husband had been admitted post-stroke. The letters themselves demonstrate careful choices of language for both parties, with the hospital discounting the wife's concerns and closing down the exchange. They also reflect a profound misunderstanding by the hospital about the functional consequences of aphasia and its impact on the family. Conclusions: It is important that family members, taking on a caring role for people with aphasia after stroke, are supported with clear information and good communication in acute settings. This may enable them to be engaged in the recovery process as partners with healthcare teams and more effectively support adjustments to post-stroke life in the longer term.
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Affiliation(s)
- Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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21
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Manola M, Petropoulou K, Calogero F. Gap in stroke patients' and carers' education. J Frailty Sarcopenia Falls 2020; 4:26-28. [PMID: 32300713 PMCID: PMC7155370 DOI: 10.22540/jfsf-04-026] [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] [Accepted: 03/08/2019] [Indexed: 11/03/2022] Open
Abstract
Stroke is a multidimensional illness as it affects various aspects in a person's quality of life. The rehabilitation team focuses mainly on complications but there seems to be a gap in the education of the patients and their carers in skills relevant to the competencies required for community, aged care, health, housing and disability support services. Stroke patients' and carers' education-training, as well as their satisfaction has not been studied adequately. The current article presents important studies in the field about the association of patients' and carers' satisfaction and based on authors' opinion suggests appropriate interventions in order to improve the health of the patients.
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Affiliation(s)
- Margialena Manola
- 2 Rehabilitation Department, National Rehabilitation Center, Athens, Greece
| | | | - Foti Calogero
- Physical and Rehabilitation Medicine Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
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22
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Rose TA, Wallace SJ, Leow S. Family members' experiences and preferences for receiving aphasia information during early phases in the continuum of care. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:470-482. [PMID: 31429322 DOI: 10.1080/17549507.2019.1651396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: This study aimed to explore family members' experiences and preferences for receiving aphasia information during the early phases of post-stroke care. Method: Sixty-five family members completed an online survey structured according to five phases for caregiver support. The majority of participants were female (73.8%, n = 48) and spouses/partners (81.5%, n = 53) to a family member with aphasia. The quantitative data were analysed using descriptive statistics. The qualitative data were analysed using inductive content analysis. Result: Experiences: The majority of family members (≥50%) did not recall receiving aphasia information in four of the five phases and were not completely satisfied with information received in any phase. Preferences: Only three family members (4.6%) reported not wanting aphasia information and this pertained to the first days of care. Family members considered it useful to receive aphasia information in a written modality and via conversations with health professionals across all five phases. Family members identified difficulties obtaining aphasia information, including health professionals providing limited or inadequate information, not being aware of the term aphasia, and difficulties accessing services across care phases. Conclusion: Findings provide insight into how health professionals can better support the information needs of family members living with aphasia.
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Affiliation(s)
- Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Sibin Leow
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
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23
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Shafer JS, Shafer PR, Haley KL. Caregivers navigating rehabilitative care for people with aphasia after stroke: a multi-lens perspective. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:634-644. [PMID: 30884057 PMCID: PMC6609487 DOI: 10.1111/1460-6984.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/04/2019] [Accepted: 02/19/2019] [Indexed: 05/08/2023]
Abstract
BACKGROUND Up to 40% of stroke survivors acquire aphasia and require long-term caregiver assistance after discharge from the hospital. Caregivers assume multiple roles as they help people with aphasia to access outpatient rehabilitative care in an increasingly person-centred model of care. Examining caregiver roles and how different stakeholders in the rehabilitative journey perceive these roles may be the first step in providing more tailored support to caregivers and improving outcomes for both caregivers and people with aphasia. AIMS To characterize the roles caregivers assume while navigating outpatient rehabilitative care for people with aphasia after stroke from the perspective of different stakeholders in the rehabilitative process. METHODS & PROCEDURES Thirty-six people participated in the study, including seven caregivers, 22 stroke survivors with aphasia and seven healthcare providers. Focus groups were conducted, and an iterative thematic analysis was used to identify themes. OUTCOMES & RESULTS Results indicate that caregivers are perceived differently by varying stakeholders, and that caregivers adopt diverse roles as advocates, therapists, motivators and guardians. They assume these roles in order to fill gaps in services or otherwise to facilitate the recovery journey for the person with aphasia. CONCLUSIONS & IMPLICATIONS This study provides a valuable glimpse into how varying stakeholders view the role of the caregiver during rehabilitation for people with aphasia after stroke. Providing caregivers with the training and support they need throughout the recovery journey by treating them as partners in the process may mitigate the perception of caregivers as feeling compelled to adopt multiple roles.
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Affiliation(s)
- Jennifer S. Shafer
- Division of Speech and Hearing Sciences, University of North Carolina, Chapel Hill, North Carolina, U.S
| | - Paul R. Shafer
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina, U.S
| | - Katarina L. Haley
- Division of Speech and Hearing Sciences, University of North Carolina, Chapel Hill, North Carolina, U.S
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24
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Mairami FF, Warren N, Allotey PA, Reidpath DD. Contextual factors that shape recovery after stroke in Malaysia. Disabil Rehabil 2019; 42:3189-3198. [PMID: 30950658 DOI: 10.1080/09638288.2019.1588399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose: A stroke is a sudden event which may leave individuals and their families ill-prepared to deal with the resultant disability. Several contextual factors can influence the recovery process. These factors, internal and external, exist interactively in the lived experiences of the survivors. The limited availability of rehabilitation centres that are located in urban centres meant that recovery predominately occurred outside of the biomedical health and instead relied upon the resources available to individuals and their families.Methods: A qualitative approach with data from in-depth interviews and observations were used to identify contextual factors that shaped recovery following stroke in a community. Twenty-seven individuals with stroke were drawn from a health and demographic surveillance system in Malaysia.Results: Hope and optimism, coping strategies, motivation and support from family and friends, and the use of alternative and complementary medicine shaped the process of recovery within a context where infrastructure is extremely limited.Conclusion: The identification of factors that facilitate the recovery process provides a background in which health care providers can utilise to improve their understanding of the stroke experience. Such understanding could be instrumental in aiding health professionals to offer the most effective help to their clients.Implications for rehabilitationIdentification of contextual factors provides a background for the understanding of the stroke experience.Incorporation of religion into rehabilitation could support and maintain hope in recovery for the survivors and aid acceptance.A collaboration of healthcare professionals with traditional medicine therapists may prove beneficial for the rehabilitation of stroke survivors in Malaysia.
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Affiliation(s)
- Fatima Fanna Mairami
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Narelle Warren
- School of Social Sciences, Monash University, Clayton Campus, Melbourne, Australia
| | - Pascale A Allotey
- UN University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.,South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
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Klint K, Sjöland H, Axelsson ÅB. Revealed by degrees: Patients' experience of receiving information after in-hospital cardiac arrest. J Clin Nurs 2018; 28:1517-1527. [PMID: 30589946 DOI: 10.1111/jocn.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/16/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experience of receiving information about the event after having a cardiac arrest in hospital. BACKGROUND In Sweden, approximately 2,600 people per year experience cardiac arrest in hospital. After a cardiac arrest, the patient is entitled to receive information about what has occurred. This information must be provided in a way that does not do the patient more harm than good. In order to provide information to patients in a satisfactory manner for them, knowledge about how patients react to information in this situation is valuable. DESIGN We used a qualitative approach with interviews and content analysis. METHODS Twenty patients participated in face-to-face interviews analysed by content analysis. Consolidated criteria for reporting qualitative studies were used. RESULTS The analysis resulted in three categories: Getting the information gradually, Understanding information received and Seeking clarity. The subcategories that emerged were as follows: Indirect information, Short and direct information, Explanatory information, Lack of information, Unsatisfactory information, Hard-to-understand information, Insight, Unanswered questions, Hard-to-formulate questions, Requesting information and Searching independently for knowledge. CONCLUSIONS The patients needed gradual and repeated information during their hospitalisation, and repeated information was continually required after their discharge from hospital. Whether or how the information was given varied. The patients' experience was that they sometimes lacked opportunities for conversation and asking questions, while they also found it hard to formulate questions. Patients who have a cardiac arrest in hospital appear to have similar information needs to patients whose cardiac arrest takes place outside the hospital context. RELEVANCE TO CLINICAL PRACTICE Information on the patient's cardiac arrest should be given in gradual stages, according to the patient's needs. The information needs to be repeated during the hospital stay and after discharge. Healthcare professional should gain insight into patients' responses and create information that is adapted to the individual.
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Affiliation(s)
- Kjell Klint
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Helen Sjöland
- Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Åsa B Axelsson
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pascual KJ, Vlasova E, Lockett KJ, Richardson J, Yochelson M. Evaluating the Impact of Personalized Stroke Management Tool Kits on Patient Experience and Stroke Recovery. J Patient Exp 2018; 5:244-249. [PMID: 30574543 PMCID: PMC6295809 DOI: 10.1177/2374373517750416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hallmarks of the difficult period of transition from hospital to home following stroke include stroke survivor and caregiver uncertainty about actionable steps toward recovery and prevention and unfamiliarity with related resources. Current research shows that interdisciplinary interventions focusing on patient experience and patient education enable health-care providers to activate and empower patients, potentially leading to better clinical outcomes. Tool kit approaches have been successfully used to aid patients through ongoing education after hospital discharge and to improve patient experience. In this article, we describe our efforts to iteratively develop and test personalized stroke management tool kits aimed at connecting stroke survivors and their caregivers to empowering resources, while soliciting feedback from patients and family members.
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Wallengren C, Rosengren K, Sawatzky R, Ohlen J. Challenges When Translating and Culturally Adapting a Measurement Instrument: The Suitability and Comprehensibility of Materials (SAM+CAM). Glob Qual Nurs Res 2018; 5:2333393618807380. [PMID: 30450366 PMCID: PMC6236476 DOI: 10.1177/2333393618807380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 01/04/2023] Open
Abstract
There is evidence that low suitability and comprehensibility of printed education
materials (PEMs) affects patients’ and relatives’ ability to read and comprehend
information. However, few instruments measure the suitability of written
information, and none exist in the Swedish language. The aim was to describe the
translation and adaptation of the Suitability and Comprehensibility of Materials
(SAM+CAM) instrument into the Swedish language and health care context and to
explore challenges related to this process. The SAM+CAM instrument was
translated and culturally adapted in five steps: forward translation, synthesis,
back translation, expert review, and pretests. Differences were found when
translating and culturally adapting the SAM+CAM instrument in the areas of
semantic, idiomatic, and experiences. Participants revealed several clarity
inconsistencies between items. They also identified linguistic differences and
unfamiliar wording; they found that the instrument was perplexing to use and
lacked knowledge regarding the specific health care areas in the examined PEMs.
The cultural perspective is a significant factor that influences the usability
of PEMs. Therefore, expert groups of participants are useful when adapting
instruments to different cultures. The Swedish SAM+CAM instrument requires
experienced and highly qualified raters.
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Affiliation(s)
- Catarina Wallengren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person Centred Care (GPCC), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kristina Rosengren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person Centred Care (GPCC), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Joakim Ohlen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person Centred Care (GPCC), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Wang MD, Wang Y, Mao L, Xia YP, He QW, Lu ZX, Yin XX, Hu B. Acute stroke patients' knowledge of stroke at discharge in China: a cross-sectional study. Trop Med Int Health 2018; 23:1200-1206. [PMID: 30178470 DOI: 10.1111/tmi.13148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES A good mastery of stroke-related knowledge can be of great benefit in developing healthy behaviours. This study surveyed the knowledge about stroke and influencing factors among patients with acute ischaemic stroke (AIS) at discharge in a Chinese province. METHODS A cross-section study was conducted from November 1, 2014 to January 31, 2015. A total of 1531 AIS patients in Hubei Province completed a questionnaire at discharge. Multivariate linear regression was used to identify the influencing factors of their knowledge of stroke. RESULTS About 31.2% of the respondents did not know that stroke is caused by blockage or rupture of cerebral blood vessels and 20.3% did not realise they need immediate medical attention after onset. Approximately 50% did not know that sudden blurred vision, dizziness, headache and unconsciousness are the warning signs of stroke. Over 40% were not aware of the risk factors of the condition, such as hypertension, hyperlipidaemia, diabetes mellitus, smoking and obesity. Over 20% had no idea that they need long-term medication and strict control of blood pressure, blood lipids and blood sugar. Their knowledge levels were correlated with regions of residence (P < 0.0001), socioeconomic status (P < 0.05), physical condition (P < 0.01), previous stroke (P < 0.0001) and family members and friends having had a stroke (P < 0.01). CONCLUSIONS Most AIS patients in Hubei Province, China, had little knowledge of stroke at discharge. Further efforts should be devoted to strengthening the in-hospital education of stroke patients, especially those with a low income and those from rural areas.
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Affiliation(s)
- Meng-Die Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuan-Peng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Quan-Wei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zu-Xun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Xv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,The Stroke Quality Control Center of Hubei Province, Wuhan, China
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Baliki MN, Babbitt EM, Cherney LR. Brain network topology influences response to intensive comprehensive aphasia treatment. NeuroRehabilitation 2018; 43:63-76. [DOI: 10.3233/nre-182428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Marwan N. Baliki
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Edna M. Babbitt
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Leora R. Cherney
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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Jones KM, Bhattacharjee R, Krishnamurthi R, Blanton S, Barker-Collo S, Theadom A, Thrift AG, Wolf SL, Venketasubramanian N, Parmar P, Maujean A, Ranta A, Cadilhac D, Sanya EO, MacKay-Lyons M, Pandian JD, Arora D, Obiako RO, Saposnik G, Balalla S, Bornstein NM, Langhorne P, Norrving B, Brown N, Brainin M, Taylor D, Feigin VL. Determining the feasibility and preliminary efficacy of a stroke instructional and educational DVD in a multinational context: a randomized controlled pilot study. Clin Rehabil 2018; 32:1086-1097. [PMID: 29843517 DOI: 10.1177/0269215518777565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the feasibility of conducting a randomized controlled trial of an instructional and educational stroke DVD and determine the feasibility and preliminary efficacy of this intervention in a multinational context. DESIGN Non-funded, pilot randomized controlled trial of intervention versus usual care. SETTING International, multicentre, community-based. PARTICIPANTS Community-living adults up to three years post stroke with moderate to severe disability and their nominated informal caregivers. INTERVENTIONS Intervention patients viewed and practised rehabilitation techniques demonstrated in the DVD over six weeks. MAIN MEASURES Trial feasibility by number of active recruitment sites, recruitment efficiency, randomization and follow-up. Intervention feasibility by patient and caregiver impressions. Preliminary efficacy by the quality of life - 5-level EuroQol-5D (EQ-5D) health status measure, General Health Questionnaire and Centre for Epidemiological Studies-Depression at two months. RESULTS In total, 14 recruitment sites were established across eight countries. Recruitment was achieved at nine (64%) sites. Over 16 months, 66 participants were recruited (mean (SD) age = 63.5 (12.47) years) and randomized to intervention ( n = 34) and control ( n = 32) groups. In total, 54 (82%) completed a follow-up assessment. Patient and/or caregiver comments about the benefits and barriers to accessing the intervention were mixed. There were no significant between-group differences in outcomes at two months ( P > 0.05). CONCLUSION Conducting a multinational trial of a stroke DVD requires full funding. The intervention was acceptable to some patients and their caregivers, yet a generalized education approach did not fully meet their needs and/or expectations. A more individualized method may be required to meet peoples' changing needs during stroke recovery.
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Affiliation(s)
- Kelly M Jones
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Rohit Bhattacharjee
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Sarah Blanton
- 2 Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Alice Theadom
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Amanda G Thrift
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Steven L Wolf
- 2 Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Priya Parmar
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Annick Maujean
- 6 RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Annemarei Ranta
- 7 Department of Neurology, Wellington Regional Hospital, University of Otago, Wellington, New Zealand
| | - Dominique Cadilhac
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Emmanuel O Sanya
- 8 Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Jeyaraj D Pandian
- 10 Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India
| | - Deepti Arora
- 10 Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India
| | - Reginald O Obiako
- 11 Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika Zaria, Nigeria
| | - Gustavo Saposnik
- 12 Stroke Outcomes Research Center, Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shivanthi Balalla
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.,13 School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Natan M Bornstein
- 14 Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Peter Langhorne
- 15 Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Bo Norrving
- 16 Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - Nita Brown
- 17 Stroke Foundation of New Zealand, Wellington, New Zealand
| | - Michael Brainin
- 18 Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria.,19 Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Denise Taylor
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.,20 Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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Dale J, Loew J, Nanton V, Grason Smith G. Coproduction of a Theory-Based Digital Resource for Unpaid Carers (The Care Companion): Mixed-Methods Study. JMIR Aging 2018; 1:e1. [PMID: 31518238 PMCID: PMC6716079 DOI: 10.2196/aging.9025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers' well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers' coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person. OBJECTIVE This study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype. METHODS The study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach. RESULTS Four behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need. Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value. CONCLUSIONS The person-based approach allowed an in-depth understanding of the biopsychosocial context of caring to inform the production of an engaging, relevant, applicable, and feasible Web-based intervention. User acceptance and feasibility testing is currently underway.
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Affiliation(s)
- Jeremy Dale
- Academic Primary Care Unit, Division of Health Sciences, Warwick Medical School, Coventry, United Kingdom
| | - Joelle Loew
- Academic Primary Care Unit, Division of Health Sciences, Warwick Medical School, Coventry, United Kingdom
| | - Veronica Nanton
- Academic Primary Care Unit, Division of Health Sciences, Warwick Medical School, Coventry, United Kingdom
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Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand. Neurol Res Int 2017; 2017:8215726. [PMID: 29130000 PMCID: PMC5654286 DOI: 10.1155/2017/8215726] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/11/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022] Open
Abstract
Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack) have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6 ± 11.3 years [mean ± SD], 62 females). Using an open-ended questionnaire, nearly one-third of patients (31.4%) could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%), dyslipidemia (28.6%), and diabetes (22.9%). Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%), sudden trouble with speaking (25.7%), and sudden trouble with walking, loss of balance, or dizziness (21.4%). Nineteen patients (13.6%) could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.
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Tang EYH, Price C, Stephan BCM, Robinson L, Exley C. Gaps in care for patients with memory deficits after stroke: views of healthcare providers. BMC Health Serv Res 2017; 17:634. [PMID: 28886738 PMCID: PMC5591549 DOI: 10.1186/s12913-017-2569-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/25/2017] [Indexed: 11/14/2022] Open
Abstract
Background Stroke is a common cause of physical disability but is also strongly associated with cognitive impairment and a risk for future dementia. Despite national clinical guidelines, the service provided for stroke survivors with cognitive and memory difficulties varies across localities. This study critically evaluated the views of healthcare professionals about barriers and facilitators to their care. Methods Seventeen semi-structured individual interviews were conducted by a single interviewer with both primary and secondary care clinicians in regular contact with stroke-survivors. This included stroke medicine specialists, specialist nurses, physiotherapists, occupational therapists, general practitioners and primary care nurses. Topics included individual experiences of the current care offered to patients with cognitive impairment, assessment processes and inter-professional communication. Interviews were audio recorded and transcribed verbatim. Transcripts were thematically analysed and themes grouped into broad categories to facilitate interpretation. Results Data analysis identified four key themes as barriers to optimal care for stroke-survivors with memory difficulties: 1) Less focus on memory and cognition in post-stroke care; 2) Difficulties bringing up memory and cognitive problems post-stroke; 3) Lack of clarity in current services; and, 4) Assumptions made by healthcare professionals introducing gaps in care. Facilitators included stronger links between primary and secondary care in addition to information provision at all stages of care. Conclusions The care provided by stroke services is dominated by physical impairments. Clinicians are unsure who should take responsibility for follow-up of patients with cognitive problems. This is made even more difficult by the lack of experience in assessment and stigma surrounding potential diagnoses associated with these deficits. Service development should focus on increased cohesiveness between hospital and community care to create a clear care pathway for post-stroke cognitive impairment.
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Affiliation(s)
- Eugene Yee Hing Tang
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle University, Level 2, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - Christopher Price
- Institute of Neuroscience, Stroke Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom Christa Maree Stephan
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle University, Level 2, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Robinson
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle University, Level 2, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Catherine Exley
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Krishnan S, Pappadis MR, Weller SC, Stearnes M, Kumar A, Ottenbacher KJ, Reistetter TA. Needs of Stroke Survivors as Perceived by Their Caregivers: A Scoping Review. Am J Phys Med Rehabil 2017; 96:487-505. [PMID: 28628537 PMCID: PMC5493392 DOI: 10.1097/phm.0000000000000717] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Caregivers usually are not involved while planning the stroke survivor's medical and rehabilitation goals and interventions. This review aimed to identify the needs of stroke survivors as perceived by their caregivers. DESIGN A literature search from 2003 to 2014 was conducted using Medline, CINAHL, PsychINFO, and Google Scholar. Sixty-six studies were included. Most studies excluded did not encompass caregivers' perspectives. Four reviewers screened the titles, abstracts, and full texts of the articles for inclusion. The data extracted from these studies were synthetized into metathemes. RESULTS Fifty-two qualitative, ten quantitative survey, and four mixed-methods studies were included in the final synthesis. The studies came from 11 countries. The data synthesis produced following three metathemes: (a) body functional needs, including psychological function, physical function, cognitive function, and uncertainty related to function; (b) activity and participatory needs, including healthy lifestyle, physical activities, speech, independence, cognitive activities, and uncertainty related to activities and participation; and (c) environmental needs, encompassing support, services, safety, accommodation and accessibility, and uncertainty related to environmental factors. CONCLUSIONS This scoping review identified a range of needs of stroke survivors as perceived by their caregivers. Incorporating the caregiver's preferences and values into clinical decisions may improve outcomes among stroke survivors.
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Affiliation(s)
- Shilpa Krishnan
- Department of Occupational therapy, University of Texas Medical Branch
| | | | - Susan C. Weller
- Preventive Medicine and Community Health, University of Texas Medical Branch
| | | | - Amit Kumar
- Department of Health Services, Policy and Practice, Brown University
| | | | - Timothy A. Reistetter
- Department of Occupational therapy, University of Texas Medical Branch
- Division of Rehabilitation Sciences, University of Texas Medical Branch
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35
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Miles A, Watt T, Wong WY, McHutchison L, Friary P. Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting. Gerontol Geriatr Med 2016; 2:2333721416665523. [PMID: 28680937 PMCID: PMC5486486 DOI: 10.1177/2333721416665523] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022] Open
Abstract
Objective: Where swallowing difficulties are chronic or progressive, or a patient is palliative, tube feeding is often not deemed appropriate. Instead, patients continue to eat and drink despite the risks of pneumonia and death. There is currently little evidence to guide clinical practice in this field often termed “risk feeding.” This qualitative study investigated staff, patient, and family member perceptions of risk feeding practices in one New Zealand hospital. Method: Twenty-nine staff members and six patients and/or their family were interviewed. Results: Thematic analysis revealed four global themes: supporting practice, communication, complexity of feeding decisions, and patient and family-centered care. Staff described limited education and organizational policy around risk feeding decisions. Communication was considered a major factor in the success. Conclusion: Feeding decisions are complex in the hospital environment. The themes identified in this study provide a foundation for hospital guideline development and implementation.
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Affiliation(s)
| | | | | | - Louise McHutchison
- The University of Auckland, New Zealand.,Hutt Valley District Health Board, Lower Hutt, New Zealand
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36
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Davoody N, Koch S, Krakau I, Hägglund M. Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services. BMC Med Inform Decis Mak 2016; 16:66. [PMID: 27267889 PMCID: PMC4895891 DOI: 10.1186/s12911-016-0307-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/01/2016] [Indexed: 12/04/2022] Open
Abstract
Background Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients’ information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes. Methods Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed. Content analysis was used to analyse the data. Stroke patients’ information needs was explored using patient journey model. Results Four main events (discharge from hospital, discharge from rehab clinic, coming home, and clinical encounters) and two phases (at rehab clinic, at home) have been identified in patients’ post-discharge journey. The main categories identified in this study indicate that patients not only need to have access to health related information about their care and rehabilitation processes but also practical guidance through healthcare and community services. Patients also have different information needs at different events and during different phases. Potential supportive eHealth services were suggested by the researchers considering different parts of the patients’ journeys. Conclusions Patient journey models and qualitative analysis of patients’ information needs are powerful tools that can be used to improve healthcare from a patient perspective. As patients’ understanding of their illness changes over time, their need of more flexible support throughout the care and rehabilitation processes increases. To design appropriate eHealth services that meet patients’ information needs, it is imperative to understand the current care and rehabilitation processes and identify patients’ information needs throughout their journey.
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Affiliation(s)
- Nadia Davoody
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Sabine Koch
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Ingvar Krakau
- Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Maria Hägglund
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care. Br J Gen Pract 2016; 66:e568-76. [PMID: 27215572 PMCID: PMC4979933 DOI: 10.3399/bjgp16x685609] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023] Open
Abstract
Background Medications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal. Aim To identify and report barriers to medication adherence for the secondary prevention of stroke/TIA. Design and setting A qualitative interview study was conducted within general practice surgeries in the East of England, UK. Method Patients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here. Results In total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment. Conclusion Patients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour.
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Danzl MM, Harrison A, Hunter EG, Kuperstein J, Sylvia V, Maddy K, Campbell S. "A Lot of Things Passed Me by": Rural Stroke Survivors' and Caregivers' Experience of Receiving Education From Health Care Providers. J Rural Health 2015; 32:13-24. [PMID: 26100171 DOI: 10.1111/jrh.12124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to examine rural Appalachian Kentucky stroke survivors' and caregivers' experiences of receiving education from health care providers with the long-term goal of optimizing educational interactions and interventions for an underserved population. METHODS An interprofessional research team, representing nursing, occupational therapy, physical therapy, and speech language pathology, conducted a qualitative descriptive study involving semistructured interviews with 13 stroke survivors and 12 caregivers. Qualitative content analysis included predetermined and emerging coding. This article presents an in-depth analysis of a subset of data from the coding scheme of a larger study that examined the overall experience of stroke for participants. FINDINGS Findings are presented within a developing model of patient and caregiver education constructs including providers and receivers of education and the content, timing, and delivery of information. CONCLUSIONS Understanding the experience of receiving education for survivors and caregivers will help practitioners provide the right education, to the right people, at the right time, and in the right way to better support underserved groups. Improving patient and caregiver education is paramount to supporting health behavior change to optimize life poststroke and prevent future strokes. Our results suggest the need for improved access to educational providers, proactive identification of informational needs by providers, greater inclusion of caregivers in education, enhanced communication with information provision, and education from multiple providers using multiple delivery methods at multiple time points.
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Affiliation(s)
- Megan M Danzl
- Physical Therapy Program, Bellarmine University, Louisville, Kentucky
| | - Anne Harrison
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Elizabeth G Hunter
- Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky
| | - Janice Kuperstein
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Violet Sylvia
- Appalachian Regional Healthcare Inc, Lexington, Kentucky
| | - Katherine Maddy
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Sarah Campbell
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
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Older people and decision-making following acute stroke in China: ‘hiding’ as a barrier to active involvement. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15000549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACTDecision-making among older patients with stroke, their families and professionals has been extensively studied in a Western context, but there has been little prior work in China. The study reported here explored how decision-making took place between older people with stroke, their family carers and professionals in an acute care context in mainland China using a constructivist grounded theory approach. Data were collected through semi-structured interviews, participant observation and documentary analysis. Constant comparative analysis of the data was carried out. This paper focuses on the key social process of ‘hiding’ and its dynamic relationship with the core category ‘keeping the peace’. In order to meet the traditional Chinese cultural value of ‘maintaining harmony’, both family carers and professionals hid essential information from older stroke survivors who, as a consequence, were effectively precluded from playing an active role in major decisions. In understanding ‘hiding’, the paper draws upon both Chinese cultural values and ‘awareness context theory’ and in so doing questions the relevance to the Chinese context of key Western notions such as involvement in health-care decision-making. A better understanding of the experiences of decision-making processes between older people with stroke, their family carers and professionals in China will help professionals to provide the best possible support and care whilst promoting informed decision-making amongst all concerned.
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40
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Taule T, Strand LI, Skouen JS, Råheim M. Striving for a life worth living: stroke survivors' experiences of home rehabilitation. Scand J Caring Sci 2015; 29:651-61. [PMID: 25648326 DOI: 10.1111/scs.12193] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/10/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND For mild-to-moderate stroke survivors, early supported discharge from hospital, followed by home rehabilitation is preferred over conventional care. How this mode of service contributes to recovery from stroke survivors' perspective needs further investigation. AIM The aim of this study was to explore mild-to-moderate stroke survivors' experiences with home rehabilitation after early supported discharge from hospital. METHODS A qualitative interpretive interview design was used in the context of a randomised controlled trial. A purposive sample of eight participants (45-80 years) was followed by an ambulant team, and a specific healthcare team provided home rehabilitation. Data were analysed using interpretive description, systematic text condensation and coping theory. FINDINGS A crucial determinant for the participants' hopes for a life worth living was the mutual confidence expressed in encounters with healthcare professionals and the participants' ability to make sense of their now-altered body. The professional caretakers' communication qualities and their ability to attend to individual needs were important. Help in processing the emotional reactions caused by a changed body and in socialising was requested by participants. Professional caretakers providing home rehabilitation should strive for a more flexible- and individually tailored service and should seek increased cooperation among stakeholders. CONCLUSION The focus on therapeutic communicative qualities, bodily changes, emotional processes, social concerns and long-term follow-up should be increased in order to achieve a more beneficial experience for stroke survivors.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital (HUH), Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physiotherapy, HUH, Bergen, Norway
| | - Jan Sture Skouen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physical Medicine and Rehabilitation, HUH, Bergen, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Methodology of the Stroke Self-Management Rehabilitation Trial: An International, Multisite Pilot Trial. J Stroke Cerebrovasc Dis 2015; 24:297-303. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/06/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022] Open
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Bauler S, Jacquin-Courtois S, Haesebaert J, Luaute J, Coudeyre E, Feutrier C, Allenet B, Decullier E, Rode G, Janoly-Dumenil A. Barriers and facilitators for medication adherence in stroke patients: a qualitative study conducted in French neurological rehabilitation units. Eur Neurol 2014; 72:262-70. [PMID: 25277833 DOI: 10.1159/000362718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 04/06/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. METHOD A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. RESULTS Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of over medication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. CONCLUSION This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.
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Affiliation(s)
- Stephanie Bauler
- Pôle de Rééducation et de Réadaptation Fonctionnelles, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France
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Short J, McCormack J, Copley A. The current practices of speech-language pathologists in providing information to clients with traumatic brain injury. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:219-230. [PMID: 24588453 DOI: 10.3109/17549507.2014.882413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The provision of information about cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) is important given the impact these communication impairments can have on the rehabilitation of people with TBI. This study describes the results of an online survey which investigated the current practices of 74 Australian speech-language pathologists (SLPs) working with adults with TBI. Thirty-seven SLPs outlined their practices in information provision. SLPs reported they provide information to adults with TBI about CCDs, the impact of CCDs on participation in life activities, and rehabilitation from CCDs. In addition, SLPs identified barriers and facilitators to information provision. Barriers identified included time, impairments resulting from TBI, and personal characteristics of the client. Facilitators included family functioning and support and the multidisciplinary team. Findings of this research indicate a need for some changes in the format and content of information that SLPs provide to adults with TBI, to ensure they can achieve fundamental levels of health literacy and better health outcomes.
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Ang SY, Tin AS, Pavitar G, Ng WM, Lee KE, Lim LH, Peh SC, Peng XJ, Tye SNJ, Chua TL. A Qualitative Study into Stroke Caregivers' Educational Needs — Perspectives of Caregivers and Healthcare Professionals. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Healthcare professionals (HCPs) often provide information based on what they thought caregivers would need and like to know, rather than on the latter's perceived or actual needs. The current descriptive study was undertaken to find out more about HCP's and caregivers' perceptions of educational needs while the stroke survivor is still being cared for in an acute hospital. Methods: Ten caregivers, five nurses, and two neurologists were interviewed about their perceptions of educational needs during the stroke survivors' stay in acute care. All interviews were audiotaped, transcribed verbatim, and then analysed to identify main patterns of responses. The Framework Approach, which involves the steps of familiarisation, identifying a thematic framework, indexing, charting, mapping, and interpretation was used to inform the analysis. Results: Caregivers and HCPs agreed on the need for information on disease progression, prevention of recurrence, practical and emotional care. However, HCPs felt caregivers should also know about medication, which was not mentioned by any of the caregivers. Caregivers preferred “hands-on experience” and “hearing” from HCP to print materials. While some caregivers felt that their active involvement in caregiving training was not required if a foreign domestic worker (FDW) was to be hired, HCPs interviewed felt strongly that next-of-kin should, nonetheless, be trained as well. Conclusion: The expressed needs on stroke education did not differ greatly between caregivers and HCPs. Perhaps unique to the Singapore context, is the availability of FDWs to take on the care-giving role. HCPs should be aware of differences in expectations in the level of involvement of family members in the presence of a FDW.
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Affiliation(s)
| | - Aung Soe Tin
- Singhealth Centre for Health Services Research, Singapore
| | - Gill Pavitar
- Singhealth Centre for Health Services Research, Singapore
| | - Wai May Ng
- National Neuroscience Institute, Singapore
| | - Kim En Lee
- National Neuroscience Institute, Singapore
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Creasy KR, Lutz BJ, Young ME, Ford A, Martz C. The impact of interactions with providers on stroke caregivers' needs. Rehabil Nurs 2013; 38:88-98. [PMID: 23529947 DOI: 10.1002/rnj.69] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Preparation for caregiving is improved through engaged interactions between stroke family caregivers and healthcare providers throughout the care trajectory. We explored caregivers' perceptions about interactions with providers in rehabilitation, and how these experiences affected caregiver preparation. DESIGN Seventeen caregivers, included in this grounded theory study, were interviewed during a rehabilitation stay and postdischarge. Data were analyzed using dimensional and comparative analysis. FINDINGS Caregivers described interactions with providers on a continuum from collaborative to disconnected, and a range of strategies to enhance interactions. CONCLUSIONS Caregivers want to be actively engaged with providers during inpatient rehabilitation and collaborative interactions enhance preparedness and care satisfaction. RELEVANCE Family members should be assessed for caregiving capacity and interactions between providers and caregivers should be individualized to specific needs. Providers must also be aware that many caregivers are not active information seekers. They must engage caregivers who may not even know what questions to ask.
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Affiliation(s)
- Kerry Rae Creasy
- College of Nursing, University of Florida, Gainesville, FL, USA.
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Kim JI, Lee S, Kim JH. Effects of a web-based stroke education program on recurrence prevention behaviors among stroke patients: a pilot study. HEALTH EDUCATION RESEARCH 2013; 28:488-501. [PMID: 23515115 DOI: 10.1093/her/cyt044] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The effectiveness of methods to prevent stroke recurrence and of education focusing on learners' needs has not been fully explored. The aims of this study were to assess the effects of such interventions among stroke patients and their primary caregivers and to evaluate the feasibility of a web-based stroke education program. The participants were 36 patients with a clinical diagnosis of ischemic stroke within 12 months post-stroke and their primary caregivers. The participants were randomly assigned to either an experimental or a control group. The primary measures included blood chemistry, self-reported health behaviors, sense of control, and health motivation for stroke patients, and caregiver mastery for caregivers. To test the feasibility of the intervention program, the rates of participation and occurrence of technical problems were calculated. The experimental group tended to improve significantly more than the control group in terms of exercise, diet, sense of control and health motivation for the stroke patients and in terms of caregiver mastery for the primary caregivers. The rate of participation in the web-based program was 63.1%. This program, which focuses on recurrence prevention in stroke patients and caregivers, has the potential to improve health behaviors for stroke patients.
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Affiliation(s)
- Jae-Il Kim
- Department of Neurology and Department of Nursing, College of Medicine, Dankook University, Anseo-dong, Cheonan, Chungnam 330714, Republic of Korea
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Eames S, Hoffmann T, Worrall L, Read S, Wong A. Randomised controlled trial of an education and support package for stroke patients and their carers. BMJ Open 2013; 3:bmjopen-2012-002538. [PMID: 23657469 PMCID: PMC3651972 DOI: 10.1136/bmjopen-2012-002538] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education. This study aimed to evaluate the effects of an education package which utilised both strategies on the knowledge, health and psychosocial outcomes of stroke patients and carers. DESIGN Multisite, randomised trial comparing usual care with an education and support package. SETTING Two acute stroke units. PARTICIPANTS Patients and their carers (N=138) were randomised (control n=67, intervention n=71) of which data for 119 participants (control n=59, intervention n=60) were analysed. INTERVENTION The package consisted of a computer-generated, tailored written information booklet and verbal reinforcement provided prior to, and for 3 months following, discharge. OUTCOME MEASURES Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors. The primary outcome was stroke knowledge (score range: 0-25). Secondary outcomes were: self-efficacy (1-10), anxiety and depression (0-21), ratings of importance of information (1-10), feelings of being informed (1-10), satisfaction with information (1-10), caregiver burden (carers) (0-13) and quality of life (patients) (1-5). RESULTS Intervention group participants reported better: self-efficacy for accessing stroke information (adjusted mean difference (MD) of 1.0, 95% CI 0.3 to 1.7, p=0.004); feeling informed (MD 0.9, 95% CI 0.2 to 1.6, p=0.008); and satisfaction with medical (MD 2.0, 95% CI 1.1 to 2.8, p<0.001); practical (MD 1.1, 95% CI 0.3 to 1.9, p=0.008), services and benefits (MD 0.9, 95% CI 0.1 to 1.8, p=0.036) and secondary prevention information (MD 1.7, 95% CI 0.9 to 2.5, p<0.001). There was no significant effect on other outcomes. CONCLUSIONS Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information, but other outcomes were not significantly affected. Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies. ACTRN12608000469314.
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Affiliation(s)
- Sally Eames
- Brighton Health Campus & Services, Brighton, Queensland, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia and School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Linda Worrall
- Communication Disability Centre and the CCRE in Aphasia Rehabilitation, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Stephen Read
- Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andrew Wong
- Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Nickles A, Fiedler J, Roberts S, Lyon-Callo S, Hurst R, Reeves M. Compliance With the Stroke Education Performance Measure in the Michigan Paul Coverdell National Acute Stroke Registry. Stroke 2013; 44:1459-62. [DOI: 10.1161/strokeaha.111.000763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke education, 1 of 8 endorsed stroke performance measures, consists of 5 specific subcomponents: risk factors, stroke warning signs, emergency medical service activation, physician follow-up, and discharge medications. We identified predictors of stroke education performance measure compliance in the Michigan Paul Coverdell National Acute Stroke Registry.
Methods—
Data were collected on 9609 acute stroke admissions to 20 registry hospitals during 2008 and 2009. Predictors of measure compliance (delivery of all 5 subcomponents) were determined using multivariable logistic regression.
Results—
Overall compliance with the stroke education measure was 61.8% (hospital-level compliance ranged between 16% and 93%). Compliance with individual subcomponents were risk factors (65.5%), stroke warning signs (68.9%), emergency medical service activation (66.8%), physician follow-up (92.9%), and discharge medications (91.5%). Age, gender, stroke subtype, prestroke ambulation, discharge destination, and hospital size were all significant independent predictors of compliance. Stroke education was delivered less often to patients who were ≥70 years of age, nonambulatory prestroke, not discharged to home, had transient ischemic attack, or hemorrhagic stroke.
Conclusions—
Only 60% of patients received stroke education consistent with the endorsed performance measures. Strategies to increase stroke education, including the impact of incorporating stroke-specific education measures into hospital care protocols, should be explored.
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Affiliation(s)
- Adrienne Nickles
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Jay Fiedler
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Stacey Roberts
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Sarah Lyon-Callo
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Rochelle Hurst
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Mathew Reeves
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
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Luo G. Open issues in intelligent personal health record--an updated status report for 2012. J Med Syst 2013; 37:9943. [PMID: 23584758 DOI: 10.1007/s10916-013-9943-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/20/2013] [Indexed: 12/16/2022]
Abstract
To improve the capability and usability of the personal health record (PHR) as a tool to empower consumers in the management of their own health, we have proposed the concept of an intelligent PHR (iPHR) and built a prototype iPHR system with four functions. These four functions use various health knowledge and computer science techniques to automatically provide users with personalized healthcare information to facilitate their well-being. This paper discusses several open issues in iPHR, including two enhancements to an existing function and two potential new functions. The two enhancements are for automatically compiling relevant self-care activities for each health issue and automatically identifying contraindicated self-care activities, respectively. One potential new function is personalized search for individual healthcare providers. Another potential new function is personalized local search for health-related services to help maintain patients in their homes. We include some preliminary thoughts on how to address these open issues with the hope to stimulate future research work on iPHR.
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics, University of Utah, HSEB Room 5725B, 26 South 2000 East, Salt Lake City, UT, 84112, USA,
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Hoffmann T, Ladner Y. Assessing the suitability of written stroke materials: an evaluation of the interrater reliability of the suitability assessment of materials (SAM) checklist. Top Stroke Rehabil 2012; 19:417-22. [PMID: 22982829 DOI: 10.1310/tsr1905-417] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Written materials are frequently used to provide education to stroke patients and their carers. However, poor quality materials are a barrier to effective information provision. A quick and reliable method of evaluating material quality is needed. This study evaluated the interrater reliability of the Suitability Assessment of Materials (SAM) checklist in a sample of written stroke education materials. METHODS Two independent raters evaluated the materials (n = 25) using the SAM, and ratings were analyzed to reveal total percentage agreements and weighted kappa values for individual items and overall SAM rating. RESULTS The majority of the individual SAM items had high interrater reliability, with 17 of the 22 items achieving substantial, almost perfect, or perfect weighted kappa value scores. The overall SAM rating achieved a weighted kappa value of 0.60, with a percentage total agreement of 96%. CONCLUSION Health care professionals should evaluate the content and design characteristics of written education materials before using them with patients. A tool such as the SAM checklist can be used; however, raters should exercise caution when interpreting results from items with more subjective scoring criteria. Refinements to the scoring criteria for these items are recommended. The value of the SAM is that it can be used to identify specific elements that should be modified before education materials are provided to patients.
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Affiliation(s)
- Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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