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Velez M, Lugo-Agudelo LH, Patiño Lugo DF, Glenton C, Posada AM, Mesa Franco LF, Negrini S, Kiekens C, Spir Brunal MA, Roberg ASB, Cruz Sarmiento KM. Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 2:CD014823. [PMID: 36780267 PMCID: PMC9918343 DOI: 10.1002/14651858.cd014823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve. OBJECTIVES To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation. SEARCH METHODS We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions. DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members. Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others. Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members. In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services. Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances. AUTHORS' CONCLUSIONS This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.
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Affiliation(s)
- Marcela Velez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | | | - Claire Glenton
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ana M Posada
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University La Statale , Milano, Italy
- Laboratory of Evidence Based Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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The telehealth program of occupational therapy among older people: an up-to-date scoping review. Aging Clin Exp Res 2023; 35:23-40. [PMID: 36344805 PMCID: PMC9640899 DOI: 10.1007/s40520-022-02291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The average life expectancy of older people is increasing, and most seniors desire to age at home and are capable of living independently. Occupational therapy (OT) is client-centered and uses patients' meaningful activities, or occupations, as treatment methods, thus playing an important role in later adulthood. Telemedicine removes the constraints of time and space, and the combination of OT and telemedicine can greatly improve medical efficiency and clinical effectiveness. AIMS The purpose of this scoping review was to examine the scope and effectiveness of telehealth OT for older people. METHODS This scoping review was conducted following the methodological framework proposed by Arksey and O'Malley. We searched the literature in five databases following the PICOS (Population, Intervention, Comparison, Outcome, Study design) guideline, from inception to April 2022. Two trained reviewers independently retrieved, screened, and extracted data, and used a descriptive synthesizing approach to summarize the results. RESULTS The initial search yielded 1249 studies from databases and manual searches, of which 20 were eligible and were included in the final review. A thematic analysis revealed five main themes related to telehealth OT: occupational assessment, occupational intervention, rehabilitation counseling, caregiver support, and activity monitoring. CONCLUSIONS Telehealth OT has been used widely for older people, focusing primarily on occupational assessment and intervention provided conveniently for occupational therapists and older clients. In addition, telehealth OT can monitor patients' activities and provide rehabilitation counseling and health education for the elderly and their caregivers, thus improving the security of their home life and the efficacy of OT. During the COVID-19 pandemic, telehealth will be an effective alternative to face-to-face modalities.
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van der Veen DJ, Jellema S, van der Wees PJ, Graff MJL, de Swart BJM, Steultjens EMJ. Enhancing the role of the social network in activity (re)engagement post-stroke: a focus group study with rehabilitation professionals. BMC PRIMARY CARE 2022; 23:285. [PMID: 36397003 PMCID: PMC9673324 DOI: 10.1186/s12875-022-01897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND People post-stroke are at risk of not being able to participate in valued activities. It is important that rehabilitation professionals prepare people post-stroke for the transition home and provide needed support when they live at home. Several authors have suggested that members of the broad social network should play an active role in rehabilitation. This includes informing them about the importance of activity (re)engagement post-stroke and learning strategies to provide support. It is not clear when and how the broad social network can best be equipped to provide adequate activity support. This study aimed to explore stroke professionals' perspectives on strategies that establish a social network that supports activity (re)engagement of people post-stroke, when strategies are best implemented, and the factors that influence the implementation of these strategies. METHODS Two focus groups were executed. Content analysis was used to analyze the transcripts of the recorded conversations. RESULTS Eighteen professionals with various professional backgrounds and roles in treating people post-stroke participated. Strategies to establish a supportive social network included identifying, expanding, informing, and actively engaging network members. Working with the network in the immediate post-stroke phase was regarded as important for improving long-term activity outcomes. Participants expressed that most strategies to equip the social network to support people post-stroke need to take place within community care. However, the participants experienced difficulties in implementing network strategies. Perceived barriers included interprofessional collaboration, professional knowledge, self-efficacy, and financial structures. CONCLUSIONS Strategies to involve the social network of people post-stroke are not fully implemented. Although identifying members of a social network should begin during inpatient rehabilitation, the main part of actively engaging the network will have to take place when the people post-stroke return home. Implementing social network strategies requires a systematic process focusing on collaboration, knowledge, attitude, and skill development.
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Affiliation(s)
- Dinja J van der Veen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
- HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Sandra Jellema
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Maud J L Graff
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Bert J M de Swart
- HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Esther M J Steultjens
- HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Choo WT, Jiang Y, Chan KGF, Ramachandran HJ, Teo JYC, Seah CWA, Wang W. Effectiveness of caregiver-mediated exercise interventions on activities of daily living, anxiety and depression post-stroke rehabilitation: A systematic review and meta-analysis. J Adv Nurs 2022; 78:1870-1882. [PMID: 35451521 DOI: 10.1111/jan.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/21/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
AIMS This review aims to examine updated evidence to evaluate the effectiveness of caregiver-mediated exercise interventions on basic and extended activities of daily living (ADL), anxiety and depression of post-stroke rehabilitation individuals. DESIGN A systematic review and meta-analysis. DATA SOURCES Six electronic databases, including CINAHL, CENTRAL, Embase, PubMed, PsycINFO and Scopus, grey literature and trial registry were searched from inception until February 2021. METHODS Only randomized controlled trials written in English were included. Meta-analyses were conducted for basic and extended ADL, anxiety and depression outcomes using RevMan software. Overall quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation framework. RESULTS A total of 11 randomized controlled trials comprising 2120 participants were identified, with 10 trials meta-analysed. Meta-analyses indicated statistically significant effects favouring caregiver-mediated exercise interventions for basic ADL. Subgroup analyses revealed significant effects for exercise-only interventions mediated by caregivers for basic ADL. No significant effects were found for extended ADL, anxiety and depression for stroke survivors. CONCLUSION Caregiver-mediated exercise interventions appear to have beneficial impacts on basic ADL for stroke survivors, suggesting caregiver-mediated exercise interventions as a potentially feasible way to improve functional independence. IMPACT Caregiver-mediated intervention with exercises as a major component could be a promising approach to augment stroke rehabilitation. Future research should include high-quality studies with focus on specific intervention components or to explore caregiver outcomes.
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Affiliation(s)
- Wen Ting Choo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kendy Gui Fang Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuen Wei Alvin Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Young R, Broom D, O'Brien R, Sage K, Smith C. Users' experience of community-based power assisted exercise: a transition from NHS to third sector services. Int J Qual Stud Health Well-being 2021; 16:1949899. [PMID: 34252010 PMCID: PMC8276664 DOI: 10.1080/17482631.2021.1949899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE Seated Power Assisted Exercise (PAE) equipment is an accessible exercise mode for people with limited mobility following stroke and is available at a small number of community-based venues. The purpose of this qualitative study was to understand the lived experience of using PAE amongst PwS in a community venue and identify recommendations for the development and advancement of PAE equipment. METHOD Semi-structured interviews were conducted with 8 participants (PwS) attending a community stroke venue where PAE equipment was available. Transcribed data were analysed using interpretative phenomenological analysis. RESULTS Three overarching themes emerged from the analysis; 1) Don't tell me I've plateaued; 2) PAE facilitates the transition into long-term recovery; 3) Reframing the experience of stroke. Participants associated the uptake of PAE alongside venue membership as a turning point in their adjustment to life following stroke. In addition, recommendations for future development of the equipment were identified. CONCLUSION These findings indicate that membership of a stroke venue alongside engagement with PAE facilitated transition from early stroke rehabilitation into longer term recovery. The results of this study have informed the need for future product design and highlighted PAE is an effective mode for continued rehabilitation in third-sector services.
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Affiliation(s)
- Rachel Young
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Academy of Sport and Physical Activity, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Rachel O'Brien
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Karen Sage
- Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Christine Smith
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Hansen LS, Præstegaard J, Lehn-Christiansen S. Patient-centeredness in Physiotherapy - A literature mapping review. Physiother Theory Pract 2021; 38:1843-1856. [PMID: 34096445 DOI: 10.1080/09593985.2021.1923095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and purpose: Research on patient-centeredness within physiotherapy points to a need for clarification about what the concept entails in science and practice and how research positions itself within health care. Thus, the aim is to systematically map the characteristics of research on patient-centeredness in physiotherapy and critically discuss the dominant understandings within. Methods: A systematic research mapping was carried out, based on searches in leading bibliographic databases. Four categories were selected in order to characterize the research field: focus, design, theoretical approach and inherent logic. Findings: Of 5,324 studies, 101 were included in the final mapping, pointing to a limited amount of research. The papers included were published in 47 different journals. Two major research foci emerges: one testing or developing technologies (tools) to promote patient-centeredness and one exploring patients' or professionals' experiences related to physiotherapy practice. Most papers reported on empirical research and there seems to be a dearth of conceptual papers. The theoretical approaches applied were mainly psychological, pedagogical and biomedical. The papers included were divided into equal amounts of studies carried out within inherent logics of causality and complexity. Conclusion: The mapping suggests an incipient awareness of patient-centeredness within the research field of physiotherapy. Empirical studies dominate the field, whereas conceptual and critical papers seem in need of wider acknowledgment. The research field is divided into two mutually disconnected trends: one concerned with understanding the complexity of clinical practice and patients' experiences of treatment and illness, and another trend concerned with solving "the problem" of patient involvement.
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Affiliation(s)
- Louise Søgaard Hansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University Roskilde, Denmark
| | - Jeanette Præstegaard
- Centre for Nutrition and Rehabilitation, Department of Physiotherapy, University College Absalon, Roskilde, Denmark
| | - Sine Lehn-Christiansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University Roskilde, Denmark
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Last N, Packham TL, Gewurtz RE, Letts LJ, Harris JE. Exploring patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation. Disabil Rehabil 2021; 44:4201-4210. [PMID: 33569980 DOI: 10.1080/09638288.2021.1881830] [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: 10/22/2022]
Abstract
BACKGROUND Patient participation is recognized as an important element of rehabilitation. However, few studies have used a qualitative lens to specifically examine factors influencing patient participation in stroke rehabilitation. AIM The purpose of this study was to investigate patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation. METHODS Semi-structured interviews were conducted with 11 patients, with confirmed diagnoses of stroke, recruited from three separate rehabilitation settings. Analysis of the interviews was guided by a process of interpretive description to identify key barriers and facilitators to participation in stroke rehabilitation. RESULTS Four main themes and corresponding sub-themes were constructed concerning participation in rehabilitation: (i) Environmental Factors, (ii) Components of Therapy, (iii) Physical and Emotional Well-Being, and (iv) Personal Motivators. An exploratory model of personalized rehabilitation emerged, integrating the themes emerging from the data. DISCUSSION Personalized rehabilitation can be considered in comparison to person-centred care principles. The barriers and enablers experienced by patients in this study contribute to the existing knowledge of the patient experience of stroke rehabilitation and may be used to inform clinical practices and future research.Implications for RehabilitationThe surrounding environments can facilitate participation in rehabilitation using strategies to reduce noise and disruption and also by encouraging social interactions among patients.Increasing the frequency and consistency of communication with patients about rehabilitation goals and progress could enhance participation.Designing interventions to include activities that are meaningful and focused on the resumption of valued life roles is key to participation.Therapy intensity, time spent sedentary, and the emotional impact of stroke are aspects of rehabilitation patient's feel are neglected.
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Affiliation(s)
- Nicole Last
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tara L Packham
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Regional Rehabilitation Program, Hamilton Health Sciences, Hamilton, Canada
| | - Rebecca E Gewurtz
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Lori J Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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van Dijk M, Vreven J, Deschodt M, Verheyden G, Tournoy J, Flamaing J. Can in-hospital or post discharge caregiver involvement increase functional performance of older patients? A systematic review. BMC Geriatr 2020; 20:362. [PMID: 32962653 PMCID: PMC7510152 DOI: 10.1186/s12877-020-01769-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Regaining pre-hospitalization activity levels is only achieved in 30-50% of older patients. Extra physiotherapy time has been proven to improve functional outcome and shorten length of stay, but is costly. Considering their key role in caring for older people, involving informal caregivers in rehabilitation might further improve functional performance. AIM To determine if in-hospital or post discharge caregiver involvement can increase functional performance in older adults. The secondary aim was to determine if caregiver involvement can influence, quality of life of patient and caregiver, medical costs, readmission rate, discharge location, and mortality. DESIGN Systematic review with narrative synthesis. METHODS The electronic bibliographic databases MEDLINE, Embase, CINAHL, Cochrane and Web of Science were searched for (quasi) experimental and observational studies, with the following inclusion criteria; caregiver involvement regarding functional performance, mean age over 65 years, admitted to a hospital unit and subsequently discharged to their home setting. Risk of bias was assessed with the Rob 2 (randomized trials) and the ROBINS-1 tool (non-randomized studies). RESULTS Eight studies of an initial 4683 were included: four randomized controlled trials, one prospective cohort study, one non-randomized controlled trial, one subgroup analysis of an RCT and one prospective pre-post study. All but one study included patients with stroke. Three types of caregiver interventions could be distinguished: a care pathway (inclusion of caregivers in the process of care), education on stroke and teaching of bed-side handling-skills, and caregiver-mediated exercises. The one study evaluating the care pathway reported 24.9% more returns home in the intervention group. Studies evaluating the effect of education and bed-side handling-skills reported higher effect sizes for several outcomes with increasing session frequency. All studies with caregiver-mediated exercises showed beneficial effects on functional performance, immediately after the intervention and within 3 months follow-up. CONCLUSION The findings of this review suggest that involvement of caregivers in the rehabilitation of older adults leads to better functional performance up to 3 months after initiation. However, evidence is low and mainly focusing on stroke.
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Affiliation(s)
- Margaretha van Dijk
- Department of Physical Medicine and Rehabilitation, UZ Leuven - University Hospitals Leuven, campus Pellenberg, Weligerveld 1, 3212, Pellenberg, Belgium.
| | - Jasmien Vreven
- Department of Physical Medicine and Rehabilitation, UZ Leuven - University Hospitals Leuven, campus Pellenberg, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Geriatrics and Gerontology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Nursing Science (INS), Department of Public Health, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Healthcare and Ethics, Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, Geriatrics and Gerontology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department Geriatric Medicine, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Geriatrics and Gerontology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department Geriatric Medicine, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
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Olafsdottir SA, Jonsdottir H, Bjartmarz I, Magnusson C, Caltenco H, Kytö M, Maye L, McGookin D, Arnadottir SA, Hjaltadottir I, Hafsteinsdottir TB. Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study. BMC Health Serv Res 2020; 20:562. [PMID: 32571316 PMCID: PMC7310069 DOI: 10.1186/s12913-020-05432-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality. Methods A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings. Results Ten stroke survivors aged 55–79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (− 4.2) and 5xSST (− 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying − 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES. Conclusions ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.
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Affiliation(s)
- Steinunn A Olafsdottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland.
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ingibjörg Bjartmarz
- Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Mikko Kytö
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland.,Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Laura Maye
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - David McGookin
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - Solveig Asa Arnadottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thora B Hafsteinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2020; 3:CD003316. [PMID: 32196635 PMCID: PMC7083515 DOI: 10.1002/14651858.cd003316.pub7] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function. OBJECTIVES The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function. SEARCH METHODS In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons. AUTHORS' CONCLUSIONS Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
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Affiliation(s)
- David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Daniel D Carter
- University of LimerickSchool of Allied Health, Faculty of Education and Health SciencesLimerickIreland
| | - Hannah Jarvis
- Manchester Metropolitan UniversityResearch Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and EngineeringJohn Dalton BuildingChester StreetManchesterUKM1 5GD
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Chouvarda I, Mountford N, Trajkovik V, Loncar-Turukalo T, Cusack T. Leveraging Interdisciplinary Education Toward Securing the Future of Connected Health Research in Europe: Qualitative Study. J Med Internet Res 2019; 21:e14020. [PMID: 31719026 PMCID: PMC6881783 DOI: 10.2196/14020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/15/2019] [Accepted: 10/22/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Connected health (CH) technologies have resulted in a paradigm shift, moving health care steadily toward a more patient-centered delivery approach. CH requires a broad range of disciplinary expertise from across the spectrum to work in a cohesive and productive way. Building this interdisciplinary relationship at an earlier stage of career development may nurture and accelerate the CH developments and innovations required for future health care. OBJECTIVE This study aimed to explore the perceptions of interdisciplinary CH researchers regarding the design and delivery of an interdisciplinary education (IDE) module for disciplines currently engaged in CH research (engineers, computer scientists, health care practitioners, and policy makers). This study also investigated whether this module should be delivered as a taught component of an undergraduate, master's, or doctoral program to facilitate the development of interdisciplinary learning. METHODS A qualitative, cross-institutional, multistage research approach was adopted, which involved a background study of fundamental concepts, individual interviews with CH researchers in Greece (n=9), and two structured group feedback sessions with CH researchers in Ireland (n=10/16). Thematic analysis was used to identify the themes emerging from the interviews and structured group feedback sessions. RESULTS A total of two sets of findings emerged from the data. In the first instance, challenges to interdisciplinary work were identified, including communication challenges, divergent awareness of state-of-the-art CH technologies across disciplines, and cultural resistance to interdisciplinarity. The second set of findings were related to the design for interdisciplinarity. In this regard, the need to link research and education with real-world practice emerged as a key design concern. Positioning within the program context was also considered to be important with a need to balance early intervention to embed integration with later repeat interventions that maximize opportunities to share skills and experiences. CONCLUSIONS The authors raise and address challenges to interdisciplinary program design for CH based on an abductive approach combining interdisciplinary and interprofessional education literature and the collection of qualitative data. This recipe approach for interdisciplinary design offers guidelines for policy makers, educators, and innovators in the CH space. Gaining insight from CH researchers regarding the development of an IDE module has offered the designers a novel insight regarding the curriculum, timing, delivery, and potential challenges that may be encountered.
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Affiliation(s)
- Ioanna Chouvarda
- Lab of Computing, Medical Informatics & Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nicola Mountford
- School of Business, Maynooth University, Maynooth, County Kildare, Ireland
| | - Vladimir Trajkovik
- Faculty of Computer Science and Engineering, Saints Cyril and Methodius University, Skopje, the Former Yugoslav Republic of Macedonia
| | | | - Tara Cusack
- Health Sciences Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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12
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Stark A, Färber C, Tetzlaff B, Scherer M, Barzel A. Stroke patients' and non-professional coaches' experiences with home-based constraint-induced movement therapy: a qualitative study. Clin Rehabil 2019; 33:1527-1539. [PMID: 31104476 PMCID: PMC6716206 DOI: 10.1177/0269215519848813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the experiences of chronic stroke patients and
non-professional coaches with home-based constraint-induced movement therapy
(homeCIMT). Design: Qualitative study embedded within a cluster randomized controlled trial
investigating the efficacy of homeCIMT to improve the use of the affected
arm in daily activities. Setting: Patients’ home environment. Participants: 13 stroke patients and 9 non-professional coaches’ alias family members who
had completed the four-week homeCIMT programme in the context of the
HOMECIMT trial. Interventions: Semi-structured interviews; qualitative data were analysed using the
methodology of the hermeneutic phenomenological data analysis. Results: We identified six themes in the qualitative analysis describing the
experiences of patients and non-professional coaches with homeCIMT: (1)
homeCIMT can be integrated into everyday life with varying degrees of
success; (2) training together may produce positive experiences as well as
strain; (3) self-perceived improvements during and following homeCIMT; (4)
using the affected arm in everyday life is challenging; (5) subjective
evaluation of and experiences with homeCIMT-specific exercises; and (6)
impact of professional therapists’ guidance and motivation during homeCIMT.
Statements regarding theme five and six were only provided by patients,
whereas the other themes contain both, the experiences of stroke patients
and non-professional coaches. Conclusion: Patients’ and non-professional coaches’ narratives offer a detailed insight
into the manifold experiences with the practical implementation of homeCIMT
that may help improve implementing the homeCIMT programme and similar
approaches involving increased training duration and intensity and/or
involvement of family members.
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Affiliation(s)
- Anne Stark
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Färber
- 2 Department of Health Sciences, Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Britta Tetzlaff
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Barzel
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,3 Department of Innovation and Collaboration in Ambulatory Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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13
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Vloothuis J, Depla M, Hertogh C, Kwakkel G, van Wegen E. Experiences of patients with stroke and their caregivers with caregiver-mediated exercises during the CARE4STROKE trial. Disabil Rehabil 2018; 42:698-704. [PMID: 30384780 DOI: 10.1080/09638288.2018.1507048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: Caregiver-mediated exercises are a novel way of delivering augmented exercise therapy for patients with stroke, in which patients do additional therapeutic exercises together with a caregiver. This explorative qualitative study is part of the CARE4STROKE trial and focused on how participants manage these exercises together. The research questions were: (1) how do the patient-caregiver couples exercise together? and (2) what does exercising together bring about, besides more hours of practice?Methods: Semi-structured interviews were conducted with patients and caregivers who participated in the CARE4STROKE intervention. Inductive thematic data analysis was applied.Results: Seven patients and seven caregivers were interviewed. Three different role-dynamics were found during caregiver-mediated exercises: (1) patient in control, (2) in concert, and (3) the caregiver as informal carer. In addition, three themes were identified about what exercising together brings about: (a) tailor-made exercises through active involvement, (b) preparation for the home situation, and (c) opportunity to be involved.Conclusion: Different role-dynamics are at play in caregiver-mediated exercises, and it is important for participating staff to be aware of their possible effects on the strain of patient or caregiver. Caregiver-mediated exercises were found to enhance individualization of the treatment plan and preparation for home discharge.Implications for rehabilitationCaregiver-mediated exercises, in which a caregiver does exercises with a patient, are currently under investigation as a new form of augmented exercise delivery after strokeDoing exercises together seems to make patient and caregivers actively involved in rehabilitation, which they appreciate, and which seems to help them prepare for the home situationCaregiver selection and monitoring role-dynamics during exercising is an important task of the rehabilitation team.
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Affiliation(s)
- Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Marja Depla
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
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14
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Horgan S, O'Donovan A. The Impact of Exercise during Radiation Therapy for Prostate Cancer on Fatigue and Quality of Life: A Systematic Review and Meta-analysis. J Med Imaging Radiat Sci 2018; 49:207-219. [DOI: 10.1016/j.jmir.2018.02.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 12/14/2022]
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15
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Kim SB, Lee KW, Lee JH, Lee SJ, Park JG, Park JW. Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series. Ann Rehabil Med 2018; 42:195-203. [PMID: 29765872 PMCID: PMC5940595 DOI: 10.5535/arm.2018.42.2.195] [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: 06/02/2017] [Accepted: 07/26/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To evaluate the effect of caregiver driven robot-assisted in-ward training in subacute stroke patients. Methods A retrospective evaluation was performed for patients treated with caregiver driven robot-assisted in-ward training to retain gait function from June 2014 and December 2016. All patients received more than 2 weeks of caregiver driven robot-assisted in-ward training after undergoing conventional programs. The robot was used as a sitting device, a standing frame, or a high-walker depending on functional status of the patient. Patients were evaluated before and after robot training. Patient records were assessed by Korean version of Modified Barthel Index (K-MBI), Functional Independence Measure (FIM), and Functional Ambulation Category (FAC). Results Initially, patients used the robot as a sitting device (n=6), a standing frame (n=7), or a partial body-weight support high-walker (n=2). As patient functions were improved, usage level of the robot was changed to the next level. At the end of the treatment, the robot was used as a sitting device (n=1), a standing frame (n=6), or high-walker (n=8). Scores of K-MBI (Δ17.47±10.72) and FIM (Δ19.80±12.34) were improved in all patients. Conclusion Patients' usage level of the robot and functional scores were improved. Therefore, performing additional caregiver driven robot-assisted in-ward training is feasible and beneficial for subacute stroke patients.
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Affiliation(s)
- Sang Beom Kim
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Jin Gee Park
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Joo Won Park
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
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16
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Luker J, Murray C, Lynch E, Bernhardsson S, Shannon M, Bernhardt J. Carers' Experiences, Needs, and Preferences During Inpatient Stroke Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2017; 98:1852-1862.e13. [DOI: 10.1016/j.apmr.2017.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/30/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
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French H, Galvin R. Musculoskeletal services in primary care in the Republic of Ireland: an insight into the perspective of physiotherapists. Physiotherapy 2017; 103:214-221. [DOI: 10.1016/j.physio.2016.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
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18
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Rosbergen IC, Grimley RS, Hayward KS, Walker KC, Rowley D, Campbell AM, McGufficke S, Robertson ST, Trinder J, Janssen H, Brauer SG. Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before-after pilot study. Clin Rehabil 2017; 31:1516-1528. [PMID: 28459184 DOI: 10.1177/0269215517705181] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. DESIGN Controlled before-after pilot study. SETTING An acute stroke unit in a regional Australian hospital. PARTICIPANTS Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. INTERVENTION Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. MAIN MEASURES Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. RESULTS The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in 'any' activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). CONCLUSIONS Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.
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Affiliation(s)
- Ingrid Cm Rosbergen
- 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,2 Allied Health Medical Services, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia
| | - Rohan S Grimley
- 3 Sunshine Coast Clinical School, The University of Queensland, Nambour, QLD, Australia
| | - Kathryn S Hayward
- 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,4 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada.,5 Stroke Division, The Florey Institute of Neuroscience & Mental Health, Melbourne, VIC, Australia.,6 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, VIC, Australia
| | - Katrina C Walker
- 2 Allied Health Medical Services, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia
| | - Donna Rowley
- 7 Nursing and Midwifery, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia
| | - Alana M Campbell
- 2 Allied Health Medical Services, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia
| | - Suzanne McGufficke
- 2 Allied Health Medical Services, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia
| | - Samantha T Robertson
- 2 Allied Health Medical Services, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia
| | - Janelle Trinder
- 7 Nursing and Midwifery, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia
| | - Heidi Janssen
- 6 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, VIC, Australia.,8 Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Sandra G Brauer
- 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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19
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Stretton CM, Mudge S, Kayes NM, McPherson KM. Interventions to improve real-world walking after stroke: a systematic review and meta-analysis. Clin Rehabil 2016; 31:310-318. [PMID: 27056251 DOI: 10.1177/0269215516640863] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained. DATA SOURCES EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies. REVIEW METHODS Proximity searching with keywords such as ambulat*, walk*, gait, mobility*, activit* was used. Randomized controlled trials that used measures of real-world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data. RESULTS Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real-world walking (SMD 0.29 (0.17, 0.41)). Five studies provided follow-up data at >3-6 months, which demonstrated sustained benefits (SMD 0.32 (0.16, 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (-0.11, 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12, 0.41)) were. CONCLUSIONS A small but significant effect was found for current interventions and benefits can be sustained. Interventions that include behaviour change techniques appear more effective at improving real-world walking habits than exercise alone.
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Affiliation(s)
- Caroline M Stretton
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Suzie Mudge
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Nicola M Kayes
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Kathryn M McPherson
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
- 2 Health Research Council of New Zealand, Auckland, New Zealand
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van den Berg M, Crotty M, Liu E, Killington M, Kwakkel G, van Wegen E. Early Supported Discharge by Caregiver-Mediated Exercises and e-Health Support After Stroke: A Proof-of-Concept Trial. Stroke 2016; 47:1885-92. [PMID: 27301941 DOI: 10.1161/strokeaha.116.013431] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This proof-of-concept trial investigated the effects of an 8-week program of caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden. METHODS Sixty-three hospitalized stroke patients (mean age 68.7, 64% female) were randomly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care. Primary outcome was the Stroke Impact Scale mobility domain. Secondary outcomes included length of stay, other Stroke Impact Scale domains, readmissions, motor impairment, strength, walking ability, balance, mobility, (extended) activities of daily living, psychosocial functioning, self-efficacy, quality of life, and fatigue. Additionally, caregiver's self-reported fatigue, symptoms of anxiety, self-efficacy, and strain were assessed. Assessments were completed at baseline and at 8 and 12 weeks. RESULTS Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility (P=0.6); however, carers reported less fatigue (4.6, confidence interval [CI] 95% 0.3-8.8; P=0.04) and higher self-efficacy (-3.3, CI 95% -5.7 to -0.9; P=0.01) at week 12. Per-protocol analysis, examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility (-9.8, CI 95% -20.1 to 0.4; P=0.06), significantly improved extended activities of daily living scores at week 8 (-3.6, CI 95% -6.3 to -0.8; P=0.01) and week 12 (3.0, CI 95% -5.8 to -0.3; P=0.03), a 9-day shorter length of stay (P=0.046), and fewer readmissions over 12 months (P<0.05). CONCLUSIONS Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice, resulting in improved patient-extended activities of daily living, reduced length of stay with fewer readmissions post stroke, and reduced levels of caregiver fatigue with increased feelings of self-efficacy. The current findings justify a larger definite phase III randomized controlled trial. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN12613000779774.
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Affiliation(s)
- Maayken van den Berg
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.).
| | - Maria Crotty
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Enwu Liu
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Maggie Killington
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Gert Kwakkel
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
| | - Erwin van Wegen
- From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.)
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Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2016; 3:CD003316. [PMID: 27010219 PMCID: PMC6464717 DOI: 10.1002/14651858.cd003316.pub6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results. AUTHORS' CONCLUSIONS Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationSt Leonards LandHolyrood RoadEdinburghUKEH8 2AZ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickDepartment of Clinical TherapiesLimerickIreland
| | - Maeve Kilrane
- Royal Infirmary of EdinburghDepartment of Stroke MedicineWard 201 ‐ Stroke UnitLittle FranceEdinburghUKEH16 4SA
| | - Carolyn A Greig
- University of BirminghamSchool of Sport, Exercise and Rehabilitation Sciences, MRC‐ARUK Centre for Musculoskeletal Ageing ResearchEdgbastonBirminghamUKB15 2TT
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Objective Assessment of Activity in Inpatients with Traumatic Brain Injury: Initial Findings. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose:Use accelerometers to examine the physical activity behaviours of individuals following TBI undergoing inpatient rehabilitation.Method:Twenty-one individuals with Traumatic brain injury (TBI) undergoing inpatient rehabilitation (9 females, 12 males;Mage = 43.8 ± 14.7 years;MGCS = 9.1 ± 4.3;Mtime since injury = 40.8 ± 22.1 days;Mlength of stay (LOS) = 30 ± 14 days) wore accelerometers for an average of 8.4 ± 2.0 consecutive days (1440 minutes/day). Activity counts (AC) were collected at 1 minute epochs and descriptive statistics were calculated to assess intensity of activity and time spent being active and sedentary.Results:During scheduled therapy, time individuals completed an average of 161.4 ± 65.5 AC/minute, which decreased to 114.5 ± 51.3 during non-therapy time and 22.2 ± 10 when sleeping. Using population level cut points, individuals were on average considered inactive during therapy, inactive or sedentary during non-therapy time, and only one participant spent >1 minute in moderate intensity activity. The mean length of active and sedentary bouts was 9 minutes.Discussion:Findings indicate that the amount and intensity of activity completed is low amongst individuals completing inpatient rehabilitation after TBI, with the majority considered sedentary or inactive. While the sample is small, it is important to develop and implement safe and effective strategies to increase activity levels during rehabilitation.
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