[Strategies for self-management support by patients with stroke: integrative review]

Evaluating the Dissemination and Implementation Impact of a Rehabilitation Intervention: The Graded Repetitive Arm Supplementary Program (GRASP)

Purpose

To evaluate the dissemination and implementation impacts of a rehabilitation intervention.

Methods

Systematic evaluation of data sources including academic publishing metrics, publications, and surveys was used to describe the dissemination and implementation impact of the graded repetitive arm supplementary program (GRASP). Three categories in the Payback Framework were evaluated: knowledge production and dissemination, benefits to future research and research use, and real-world uptake and implementation.

Results

In the Knowledge production and dissemination category, seven publications, authored by the GRASP research team, were associated with the GRASP, and there were approximately 17,000 download counts of GRASP manuals from the website from 120 countries. In the Benefits to future research and research use category, 15 studies and 8 registered clinical trials, authored by researchers outside of the GRASP team, have used GRASP as an intervention. In the real-world uptake and implementation category, GRASP has informed recommendations in 2 clinical guidelines and 20 review papers, and had high implementation uptake (e.g., 35% [53/154] of UK therapists surveyed had used GRASP; 95% [649/681] who downloaded GRASP had used it). More than 75% of those who had used GRASP identified that GRASP provides more intensity in upper extremity rehabilitation, is evidence-based and easy to implement, and the equipment and manual are easy to obtain.

Conclusion

The Payback Framework is useful to evaluate the dissemination and implementation impacts of a rehabilitation intervention. GRASP has been implemented extensively in clinical practice and community in a relatively short time since it has been developed.

Effects of Chronic Care Model-based interventions on self-management, quality of life and patient satisfaction in patients with ischemic stroke: A single-blinded randomized controlled trial

AIM

This study was designed to evaluate the effect of Chronic Care Model (CCM)-based interventions on primary outcomes (self-efficacy, quality of life/QoL, patient satisfaction) and secondary outcomes (activities of daily living/ADL, metabolic control variables, stroke knowledge level, healthy eating habits, physical activity, taking regular medication, measuring blood pressure regularly, living in harmony with the disease, outcomes regarding telephone interviews) in patients with ischemic stroke.

METHOD

The intervention group (IG) received a 12-week StrokeCARE intervention protocol based on the four components of the CCM. The control group (CG) received only routine patient care. Changes between scores at two time points regarding self-efficacy, QoL, ADL, and metabolic control variables were calculated for each group, and then the mean changes were compared between the two groups.

RESULTS

The mean ages of the patients were 55.9 ± 11.44 and 58.9 ± 13.82 years (respectively IG; CG), and 64.7% of the patients were male in both groups. Most patients had other chronic diseases accompanying ischemic stroke. No significant differences were found between the two groups with respect to self-efficacy and QoL. Patient satisfaction was significantly higher in the IG. Positive feedback percentages of the patients in the IG regarding stroke knowledge level and consuming whole-grain food at the end of the 12 weeks increased significantly. This protocol had no significant effects on the secondary outcomes.

CONCLUSION

The CCM-based interventions may increase the satisfaction level of the patients and help to raise awareness of the risk of a secondary stroke. More studies are needed to examine the effects of these interventions (ClinicalTrials.gov-Identifier Number:NCT04161820).

The Implementation of Teleconsultations in a Physiotherapy Service During Covid-19 Pandemic in Brazil: a Case Report

INTRODUCTION

The Brazilian Council of Physiotherapy and Occupational Therapy regulated the use of teleconsultation during the COVID-19 pandemic, creating uncertainty about its use in Brazil.

OBJECTIVE

To describe the experience of teleconsultations during the COVID-19 pandemic.

METHODS

Four patients participated in the study with the following diagnoses: Parkinson's disease, stroke, peripheral facial paralysis, and tibial plateau fracture. Patients underwent up to 10 physiotherapy sessions via digital tools. The 5-A self-management tool (Assess, Advise, Agree, Assist, Arrange) guided the sessions.

RESULTS

The teleconsultation type varied between synchronous (n = 1; 25%); asynchronous (n = 2; 50%) and synchronous/asynchronous (n = 1; 25%). There was 75% (n = 3) adherence and one withdrawal (25%). As the benefits of teleconsultations, the patients pointed out the convenience, maintenance of the exercises, and contact with the professional. The reported limitations were the lack of the use of physiotherapeutic devices.

CONCLUSION

Teleconsultations contribute to the continuity of physiotherapy treatment during social isolation. Adherence to treatment was facilitated by access to the technology and by offering patients the choice of teleconsultation type.

Perception of post-stroke patients on case management conducted by nurses

OBJECTIVE

To identify the perception of post-stroke patients on the case management conducted by nurses.

METHOD

Qualitative descriptive study with 13 post-stroke patients, followed-up with case management conducted by a nurse for six months, and interviewed at home one month after the end of the follow-up. The interviews were recorded, transcribed in full and analyzed with the help of a software.

RESULTS

Of the 13 participants, 57.14% were men and 50% were between 50 and 59 years. Content analysis resulted in three categories: "Self-management of care", which addressed changes in attitudes towards treatment, mainly due to concern of recurrence in a short period of time; "Sequelae and late repercussions of the stroke", which presents participants' difficulties after the event; and "Support received after a stroke", which emphasizes the actions and attitudes of the case manager nurse during the follow-up period.

CONCLUSION

Case management was perceived by the participant as a health-promoting tool capable of increasing treatment adherence.

Factors associated with performing activities of daily living in women after suffering a stroke

OBJECTIVE

To associate sociodemographic variables and risk factors for stroke to the degree of dependence for performing the activities of daily living of women of childbearing age after suffering a stroke.

METHOD

A prospective and analytical longitudinal study conducted in three public hospitals in Fortaleza, CE, Brazil. The Modified Barthel Index was used at the time of attending the unit and 3 months after the stroke to assess the degree of disability in the performance of activities of daily living. The chi-squared and likelihood ratio tests were chosen to analyze the association between variables.

RESULTS

There were 109 women of childbearing age who participated in the study. There was an association between higher degrees of dependence in women from the interior/rural areas, with lower income and black people (p = 0.032, p = 0.043, p = 0.03, respectively). Regarding personal risk factors, there was a greater dependency in women with heart disease (p = 0.040), sedentary (p = 0.030) and alcoholics (p = 0.017).

CONCLUSION

The results show the factors associated with higher degrees of dependence for performing activities of daily living by women of childbearing age after the occurrence of stroke.

Development care for children with special health needs in home care at Paraná - Brazil

Abstract Objective: To describe the development of care for children with special health needs in Paraná services of homecare. Method: Quantitative, descriptive, exploratory, and multiple case study was applied. Data were collected by telephone and e-mail, with professionals from the eight services of homecare of Parana, from October 2016 to January 2017. The data was treated with descriptive statistics analysis. Results: Among 35 children in homecare, 25.7% had cerebral palsy, 60% had a tracheostomy. The care provided by the services includes a management of tubes, administration of medication, changing dressings, caregiver guidance for tracheostomy suctioning and a management of diet. Conclusions and implications for practice: Services weaknesses were mainly related to low utilization of the singular therapeutic project and the counter-reference to primary care. The flow of successful practices are developed in the municipality of an isolated manner. Showing positive experiences promotes reflection and improvement of the work process of caring for children with special health needs in homecare.

Profile of patients attended by the speech therapists of the home care service

ABSTRACT Objective: to ascertain the profile of home care service (HCS) users with speech and language complaints in João Pessoa, Paraíba (PB). Methods: a descriptive and quantitative study using an indirect documentation technique based on an analysis of primary source documents, characterized as a documentary study, conducted at a HCS, in João Pessoa, PB, that stores user information in the form of medical records. All patient records included by the HCS from June 2012 to June 2016 were analyzed. After the eligibility criteria were applied, the sample consisted of 114 medical records. The collected data were entered into a Microsoft Excel spreadsheet to generate descriptive statistics using IBM SPSS (version 21.0). Results: most patients were males (59.6%), elderly (62.3%), had been diagnosed with a stroke (57.9%),had histories of dysphagia (76.3%), speech problems (58.8%), swallowing disorders (80.7%), and abnormal chewing (77.2%). Dysphagia is often associated with stroke, predominantly among males and the elderly. Conclusion difficulty in swallowing, or dysphagia, is often associated with stroke, predominantly in the presence of the sociodemographic and clinical variables associated with men and the elderly.