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Zhou Z, Fang X, Huang Y, Hu J, Zhang K, Jia S. A scoping review of factors associated with self-management in young adults with stroke. PATIENT EDUCATION AND COUNSELING 2024; 125:108308. [PMID: 38705023 DOI: 10.1016/j.pec.2024.108308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To synthesize the available evidence on factors associated with self-management behavior in young stroke patients. METHODS The methodological guidelines for scoping reviews developed by the Joanna Briggs Institute and the PRISMA-scR-checklist for scoping reviews were used. A total of 5586 studies were identified through bibliographic searches of the scientific databases Medline (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO, limited to the period 2000-2023. Studies were independently assessed for inclusion and exclusion criteria by two reviewers. Quantitative observational data and qualitative studies were extracted, mapped, and summarized to provide a descriptive summary of trends and considerations for future research. RESULTS Nine papers were finally selected to answer the research question. Young patients' self-management was mainly influenced by demographic factors (age, gender, income, education, and stroke knowledge), disease-related factors (functionality and independence, duration of stroke diagnosis, cognitive function, and poststroke fatigue), and psychosocial factors (hardiness, spiritual self-care, self-efficacy, and social support). CONCLUSION Further research is needed to determine the trajectory of poststroke self-management over time and its potential predictors, which should lead to the development of specific stroke rehabilitation and stroke self-management support programs for young people (considering factors that influence return to work in young stroke patients' self-management). PRACTICE IMPLICATIONS Healthcare providers can design more efficient interventions to improve the quality of life of young stroke patients after discharge. Gaining an in-depth understanding of the factors that influence self-management can help achieve this.
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Affiliation(s)
- Zifang Zhou
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Xiaoqun Fang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Youhong Huang
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Jiangyu Hu
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Kaibing Zhang
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Shulei Jia
- School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, China.
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Xu X, Chen H, Xu D, Tan F, Li X. A scoping review of hospital to home transitional care programmes for stroke survivors. J Clin Nurs 2024. [PMID: 38887147 DOI: 10.1111/jocn.17070] [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: 10/18/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 06/20/2024]
Abstract
AIM The study was aimed at exploring the current scope of hospital to home transitional care programmes for stroke survivors. BACKGROUND Stroke survivors face the dilemma of solving many complex problems that leave survivors at high risk for readmission as they discharge from hospital. The transitional care model has proved to be effective in reducing readmissions and mortality, thereby improving health outcomes and enhancing patient satisfaction for survivors with stroke. DESIGN A scoping review. METHODS Conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCES A comprehensive search was conducted in nine databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL, Medline, China Knowledge Net-work, Wanfang Database and China Biomedical Literature Database (SinoMed) from January 2014 to June 2023. RESULTS Title and abstract screening was performed on 10,171 articles resulting in 287 articles for full-text screening. Full-text screening yielded 49 articles that met inclusion criteria. CONCLUSION This study identified transitional care programmes for stroke survivors, as well as areas for future consideration to be explored in more depth to help improve transitional care for stroke survivors as they transition from hospital to home. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This study demonstrates that multidisciplinary collaboration becomes an integral part of the transitional care model for stroke survivors, which provides comprehensive and precise medical care to them. REPORTING METHOD PRISMA checklist for scoping reviews. PATIENT AND PUBLIC CONTRIBUTION No patient or public contribution was part of this study.
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Affiliation(s)
- Xuewei Xu
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Huijie Chen
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Dandan Xu
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Fengying Tan
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
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Hall P, Lawrence M, Kroll T, Blake C, Matthews J, Lennon O. Reducing risk behaviours after stroke: An overview of reviews interrogating primary study data using the Theoretical Domains Framework. PLoS One 2024; 19:e0302364. [PMID: 38669261 PMCID: PMC11051587 DOI: 10.1371/journal.pone.0302364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Lifestyle changes, in addition to preventive medications, optimise stroke secondary prevention. Evidence from systematic reviews support behaviour-change interventions post-stroke to address lifestyle-related risk. However, understanding of the theory-driven mediators that affect behaviour-change post-stroke is lacking. METHODS Electronic databases MEDLINE, Embase, Epistemonikos and Cochrane Library of Systematic Reviews were searched to March 2023 for systematic reviews addressing behaviour-change after stroke. Primary studies from identified systematic reviews were interrogated for evidence supporting theoretically-grounded interventions. Data were synthesized in new meta-analyses examining behaviour-change domains of the Theoretical Domains Framework (TDF) and secondary prevention outcomes. RESULTS From 71 identified SRs, 246 primary studies were screened. Only 19 trials (N = 2530 participants) were identified that employed theoretically-grounded interventions and measured associated mediators for behaviour-change. Identified mediators mapped to 5 of 14 possible TDF domains. Trial follow-up ranged between 1-12 months and no studies addressed primary outcomes of recurrent stroke or cardiovascular mortality and/or morbidity. Lifestyle interventions targeting mediators mapped to the TDF Knowledge domain may improve the likelihood of medication adherence (OR 6.08 [2.79, 13.26], I2 = 0%); physical activity participation (OR 2.97 [1.73, 5.12], I2 = 0%) and smoking cessation (OR 10.37 [3.22, 33.39], I2 = 20%) post-stroke, supported by low certainty evidence; Lifestyle interventions targeting mediators mapping to both TDF domains of Knowledge and Beliefs about Consequences may improve medication adherence post-stroke (SMD 0.36 [0.07, 0.64], I2 = 13%, very low certainty evidence); Lifestyle interventions targeting mediators mapped to Beliefs about Capabilities and Emotions domains may modulate low mood post-stroke (SMD -0.70 [-1.28, -0.12], I2 = 81%, low certainty evidence). CONCLUSION Limited theory-based research and use of behaviour-change mediators exists within stroke secondary prevention trials. Knowledge, Beliefs about Consequences, and Emotions are the domains which positively influence risk-reducing behaviours post-stroke. Behaviour-change interventions should include these evidence-based constructs known to be effective. Future trials should address cardiovascular outcomes and ensure adequate follow-up time.
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Affiliation(s)
- Patricia Hall
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
- iPASTAR (Improving Pathways for Acute Stroke and Rehabilitation) Collaborative Doctoral Award, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maggie Lawrence
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, Health Science Centre, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
| | - James Matthews
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
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Yan T, Liang W, Chan CWH, Shen Y, Liu S, Li M. Effects of motor imagery training on gait performance in individuals after stroke: a systematic review and meta-analysis. Disabil Rehabil 2024:1-15. [PMID: 38638087 DOI: 10.1080/09638288.2024.2337091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/09/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE This review systematically explores and summarise the effects of motor imagery training (MIT) compared to conventional therapy on gait performance in individuals after stroke. MATERIALS AND METHODS Randomised controlled trials (RCTs) were systematically searched in five electronic databases (PubMed, EMBASE, PsycINFO, OVID Nursing and CINAHL) from inception to 30 December 2022. Studies investigating MITs, targeted at individuals after stroke were eligible. Data were extracted related to study and intervention characteristics. RESULTS Sixteen studies were included. Compared with 'routine methods of treatment or training', the meta-analyses showed that MIT was more effective in improving cadence immediately post intervention (SMD: 1.22, 95% CI: 0.59, 1.85, p = 0.0001, I2 = 25%) and at 1- or 2-months post intervention (SMD: 0.78, 95% CI: 0.35, 1.20, p = 0.0004, I2 = 46%). The results also showed that MIT improves the step length of the affected side and the unaffected side at 1- or 2-months post intervention. Separate meta-analyses were also conducted on different tests of walking endurance (assessed by the 6-Minute Walk Test) and functional mobility (assessed by the Timed-Up-and-Go test). CONCLUSIONS MIT effectively improved gait performance. The findings in individuals after stroke remain inconclusive due to significant heterogeneity in included studies.
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Affiliation(s)
- Tingting Yan
- School of Nursing, Peking University, Beijing, China
| | - Wei Liang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Yao Shen
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuling Liu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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Castellote JM, Kofler M, Mayr A. The benefit of knowledge: postural response modulation by foreknowledge of equilibrium perturbation in an upper limb task. Eur J Appl Physiol 2024; 124:975-991. [PMID: 37755580 PMCID: PMC10879248 DOI: 10.1007/s00421-023-05323-z] [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: 02/09/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
For whole-body sway patterns, a compound motor response following an external stimulus may comprise reflexes, postural adjustments (anticipatory or compensatory), and voluntary muscular activity. Responses to equilibrium destabilization may depend on both motor set and a subject`s expectation of the disturbing stimulus. To disentangle these influences on lower limb responses, we studied a model in which subjects (n = 14) were suspended in the air, without foot support, and performed a fast unilateral wrist extension (WE) in response to a passive knee flexion (KF) delivered by a robot. To characterize the responses, electromyographic activity of rectus femoris and reactive leg torque was obtained bilaterally in a series of trials, with or without the requirement of WE (motor set), and/or beforehand information about the upcoming velocity of KF (subject`s expectation). Some fast-velocity trials resulted in StartReact responses, which were used to subclassify leg responses. When subjects were uninformed about the upcoming KF, large rectus femoris responses concurred with a postural reaction in conditions without motor task, and with both postural reaction and postural adjustment when WE was required. WE in response to a low-volume acoustic signal elicited no postural adjustments. When subjects were informed about KF velocity and had to perform WE, large rectus femoris responses corresponded to anticipatory postural adjustment rather than postural reaction. In conclusion, when subjects are suspended in the air and have to respond with WE, the prepared motor set includes anticipatory postural adjustments if KF velocity is known, and additional postural reactions if KF velocity is unknown.
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Affiliation(s)
- Juan M Castellote
- Radiology, Rehabilitation and Physiotherapy Department, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Andreas Mayr
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
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Saragih ID, Everard G, Saragih IS, Lee BO. The beneficial effects of transitional care for patients with stroke: A meta-analysis. J Adv Nurs 2024; 80:789-806. [PMID: 37727124 DOI: 10.1111/jan.15850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Transitional care interventions have emerged as a promising method of ensuring treatment continuity and health care coordination when patients are discharged from hospital to home. However, few studies have investigated the frequency and duration of interventions and the effects of interventions on physical function. Therefore, this study aimed to determine the efficacy of transitional care for patients with stroke. METHODS Six databases and the grey literature were searched to obtain relevant articles from October 1, 2022 to March 10, 2023. The primary outcomes studied were motor performance, walking speed, activities of daily living (ADLs) and caregiver burden following hospital-to-home transitional care. The quality of the studies was assessed with Cochrane risk of bias version 2. The quality and sensitivity of the evidence were assessed to ensure rigour of the findings. Meta-analyses were performed using stata 17.0. RESULTS A total of 2966 patients were identified from 23 studies. Transitional care improved post-stroke motor performance, walking speed and ADLs, and reduced caregiver burden. CONCLUSION The findings suggest that provision of transitional care model implementation in patients with stroke is important because it reduces disability in stroke patients and helps to decrease caregivers' burden. IMPACT The findings of the study emphasize the importance of transitional care programmes for stroke patients after they are discharged from the hospital and returned to their homes. To meet the needs of patients, all levels of health professionals including nurses should be aware of the discharge process and care plan.
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Affiliation(s)
| | - Gauthier Everard
- Centre Interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, QC, Canada
- Pole d'Hépato-Gastro-Entérologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgium
| | - Ice Septriani Saragih
- Department of Medical Surgical Nursing, STIkes Santa Elisabeth Medan, Medan, Indonesia
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
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Bal C, Koç Z. Technology-Based Health Promotion Training Among Stroke Patients: A Randomized Controlled Trial. Clin Nurs Res 2024; 33:81-94. [PMID: 38047449 DOI: 10.1177/10547738231211980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Stroke is a disease with a heavy social and familial care burden that can cause permanent brain damage, long-term disability, and/or death. This study aimed to determine the effect of technology-based health promotion training on the daily life activities, quality of life, and self-care of stroke patients. The study design was a Randomized Controlled Trial. The study sample included persons diagnosed with stroke diagnosed with stroke and were receiving inpatient treatment in the neurology clinic of a university hospital. The sample size was calculated as a total of 70 patients, 35 interventions and 35 controls. The intervention group patients received telephone-based education and follow-up grounded in Orem's Self-Care Theory over a 12-week period subsequent to their discharge. The educational content was divided into three distinct categories: self-care needs with regard to health deviations, developmental self-care needs, and universal self-care practices. Data were collected using the Montreal Cognitive Assessment Scale, the Katz Index of Independence in Activities of Daily Living, Stroke-Specific Quality of Life Scale, and the Exercise of Self-Care Agency Scale. The Independent Sample T-Test was used for intergroup comparisons, and the Dependent Sample T-Test was used for intragroup pre-test and post-test comparisons. Independent variables affecting the post-test scores, such as age and gender, were analyzed using the multiple linear regression model. The scale sub-dimension variables were compared using the multivariate analysis of variance test according to the groups. When compared with the control group patients after the training, it was determined that there was a statistically significant difference in the intervention group patients' mean scores for the Stroke-Specific Quality of Life Scale (t = 11.136, p = .001) and the Exercise of Self-Care Agency Scale (t = 14.358, p = .000). Training interventions led to enhanced awareness and knowledge about stroke among the intervention group patients. They also fostered the development of healthier lifestyle behaviors and bolstered both self-care abilities and quality of life.
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Affiliation(s)
- Cansev Bal
- Ondokuz Mayıs University, Samsun, Turkey
| | - Zeliha Koç
- Ondokuz Mayıs University, Samsun, Turkey
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Egan M, Kessler D, Gurgel-Juarez N, Chopra A, Linkewich E, Sikora L, Montgomery P, Duong P. Stroke rehabilitation adaptive approaches: A theory-focused scoping review. Scand J Occup Ther 2024; 31:1-13. [PMID: 37976402 DOI: 10.1080/11038128.2023.2257228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Stroke rehabilitation consists of restorative and adaptive approaches. Multiple adaptive approaches exist. AIMS/OBJECTIVES The objective of this study was to develop a framework for categorising adaptive stroke rehabilitation interventions, based on underlying theory. MATERIAL AND METHODS We searched multiple databases to April 2020 to identify studies of interventions designed to improve participation in valued activities. We extracted the name of the intervention, underlying explicit or implicit theory, intervention elements, and anticipated outcomes. Using this information, we proposed distinct groups of interventions based on theoretical drivers. RESULTS Twenty-nine adaptive interventions were examined in at least one of 77 studies. Underlying theories included Cognitive Learning Theory, Self-determination Theory, Social Cognitive Theory, adult learning theories, and Psychological Stress and Coping Theory. Three overarching theoretical drivers were identified: learning, motivation, and coping. CONCLUSIONS At least 29 adaptive approaches exist, but each appear to be based on one of three underlying theoretical drivers. Consideration of effectiveness of these approaches by theoretical driver could help indicate underlying mechanisms and essential elements of effective adaptive approaches. SIGNIFICANCE Our framework is an important advance in understanding and evaluating adaptive approaches to stroke rehabilitation.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | | | - Anchal Chopra
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | | | - Patrick Duong
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Ouyang RG, Long Y, Zhang JQ, Cao Z. Interventions for improving self-efficacy in patients after stroke based on self-efficacy-related principles of Bandura's cognition theory: a systematic review and meta-analysis. Top Stroke Rehabil 2023; 30:820-832. [PMID: 36755444 DOI: 10.1080/10749357.2023.2172832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Interventional approaches based on Bandura's cognition theory are effective in improving self-efficacy poststroke. However, a systematical investigation for identifying effectives therapeutic components of the intervention has not yet been conducted. OBJECTIVE This meta-analysis was conducted to systematically investigated the effects of interventions with different principles on improving self-efficacy after stroke. METHODS Searches were conducted in PubMed, EMBASE, CINAHL, PsycINFO, MEDLINE, Cochrane Library, and two randomized controlled trials registration websites for randomized controlled trials from inception to 18th January 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The meta-analysis was performed using Review Manager and Stata software. RESULTS In total, 36 RCTs were included. Interventions using any one of the self-efficacy principles - principle 1 (Mastery), principle 2 (Modeling), principle 3 (Social persuasion), and principle 4 (Understanding), were more effective in improving self-efficacy in patients with stroke at post-training and follow-up, compared with the control group. Psycho-educational interventions might significantly improve self-efficacy in both post-intervention and follow-up stages, compared with control group. Meta-regression revealed time since stroke onset was significantly associated with effect sizes. CONCLUSION Interventions developed based on Bandura's cognition theory are beneficial to the improvement of self-efficacy. This review highlights principles of Bandura's cognition theory are worth considering to be integrated to interventions targeted at improving self-efficacy. The application of self-efficacy principles with Bandura's cognitive theory could be encouraged in clinical practice in the future. PROTOCOL REGISTRATION NUMBER PROSPERO CRD42020154984.
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Affiliation(s)
- Rang-Ge Ouyang
- Department of Rehabilitation, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Yi Long
- Department of Rehabilitation, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Jia-Qi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Zeng Cao
- Department of Rehabilitation, Xiangya Hospital Central South University, Changsha, Hunan, China
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Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Bordeianu A, Corlatescu AD, Ciurea AV. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines 2023; 11:2617. [PMID: 37892991 PMCID: PMC10604797 DOI: 10.3390/biomedicines11102617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.
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Affiliation(s)
- Vicentiu Mircea Saceleanu
- Neurosurgery Department, Sibiu County Emergency Hospital, 550245 Sibiu, Romania;
- Neurosurgery Department, “Lucian Blaga” University of Medicine, 550024 Sibiu, Romania
| | - Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 020022 Bucharest, Romania
| | - Horia Ples
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babes” University of Medicine and Pharmacy, 300736 Timisoara, Romania
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Hildebrand MW, Geller D, Proffitt R. Occupational Therapy Practice Guidelines for Adults With Stroke. Am J Occup Ther 2023; 77:7705397010. [PMID: 37862268 DOI: 10.5014/ajot.2023.077501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
IMPORTANCE Stroke is a leading cause of disability. Occupational therapy practitioners ensure maximum participation and performance in valued occupations for stroke survivors and their caregivers. OBJECTIVE These Practice Guidelines are meant to support occupational therapy practitioners' clinical decision making when working with people after stroke and their caregivers. METHOD Clinical recommendations were reviewed from three systematic review questions on interventions to improve performance and participation in daily activities and occupations and from one question on maintaining the caregiving role for caregivers of people after stroke. RESULTS The systematic reviews included 168 studies, 24 Level 1a, 90 Level 1b, and 54 Level 2b. These studies were used as the basis for the clinical recommendations in these Practice Guidelines and have strong or moderate supporting evidence. CONCLUSIONS AND RECOMMENDATIONS Interventions with strong strength of evidence for improving performance in activities of daily living and functional mobility include mirror therapy, task-oriented training, mental imagery, balance training, self-management strategies, and a multidisciplinary three-stages-of-care rehabilitation program. Constraint-induced therapy has strong strength of evidence for improving performance of instrumental activities of daily living. Moderate strength of evidence supported cognitive-behavioral therapy (CBT) to address balance self-efficacy, long-term group intervention to improve mobility in the community, and a wearable upper extremity sensory device paired with training games in inpatient rehabilitation to improve social participation. Practitioners should incorporate problem-solving therapy in combination with CBT or with education and a family support organizer program. What This Article Adds: These Practice Guidelines provide a summary of strong and moderate evidence for effective interventions for people with stroke and for their caregivers.
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Affiliation(s)
- Mary W Hildebrand
- Mary W. Hildebrand, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA
| | - Daniel Geller
- Daniel Geller, EdD, MPH, OTR/L, is Assistant Professor of Rehabilitation and Regenerative Medicine, Programs in Occupational Therapy, Columbia University, New York, NY
| | - Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Missouri, Columbia
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12
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Stepanian N, Larsen MH, Mendelsohn JB, Mariussen KL, Heggdal K. Empowerment interventions designed for persons living with chronic disease - a systematic review and meta-analysis of the components and efficacy of format on patient-reported outcomes. BMC Health Serv Res 2023; 23:911. [PMID: 37626346 PMCID: PMC10463815 DOI: 10.1186/s12913-023-09895-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Empowerment approaches are essential for building the capacity of individuals with chronic disease to be in control of their health. Reviews of empowerment interventions have been focused on specific chronic diseases, thereby limiting the scope of findings. This study had three aims: 1) to describe the characteristics of empowerment interventions covering a broad range of chronic diseases, 2) to clarify consistency with the World Health Organization`s (WHO) definition of empowerment as a process composed of four fundamental components and 3) to summarize outcome measures and estimate the effects in group and individual intervention formats. METHODS Systematic literature review and meta-analysis. CINAHL, Medline, Embase, PsycINFO, Web of Science, COCHRANE and Central Register of Controlled Trials were searched using Chronic Disease, NCD, Empowerment, as MeSH terms. Eligible randomized and quasi randomized controlled trials were included. Review Manager 5.4 was used to conduct the meta-analysis. Risk of bias was assessed with the Cochrane risk-of-bias tool (ROB 2). RESULTS Thirty-nine articles representing 8,011 participants were included in the review. A majority (82%) of studies reported robust evidence for changes on study-defined outcome measures in favor of interventions. Intervention content was assessed against WHO's four fundamental components of empowerment, showing that all studies incorporated one component, but none targeted all components. Components reflecting knowledge acquisition, patient engagement with their health care providers and facilitating environment were scarcely reported. Meta-analyses found evidence for positive effects of group-format interventions measuring empowerment, HbA1c, and self-efficacy. Effects on empowerment were also found in some individual-format interventions. High levels of heterogeneity and variability among the conceptual frameworks were identified. CONCLUSION Empowerment interventions in group-format were most efficient, however, considerable conceptual inconsistencies were identified. Future studies should consolidate conceptual understandings by using WHO's empowerment framework to ensure that fundamental components of empowerment are explicitly included in intervention design. Furthermore, there is a need to clarify the role of empowerment through pathways that include patient activation, self- management, and clinical outcomes. This systematic review will inform the clinicians and researchers who aim to develop novel empowerment interventions to assist patients in the process of gaining control of their health. TRIAL REGISTRATION PROSPERO: International Prospective register of systematic reviews ID=CRD42020178286.
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Affiliation(s)
- Natalie Stepanian
- College of Health Professions, Pace University, One Pace Plaza, New York, NY, 10038, USA
| | | | - Joshua B Mendelsohn
- College of Health Professions, Pace University, One Pace Plaza, New York, NY, 10038, USA
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggaten 15, 0456, Oslo, Norway
| | - Kristin Heggdal
- Faculty of Health, VID Specialized University, Theodor Dahls Vei 10, 0370, Oslo, Norway.
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13
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Jiang N, Xv Y, Sun X, Feng L, Wang YB, Jiang XL. Study on self-management of real-time and individualized support in stroke patients based on resilience: a protocol for a randomized controlled trial. Trials 2023; 24:493. [PMID: 37537646 PMCID: PMC10401848 DOI: 10.1186/s13063-023-07475-x] [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: 04/23/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The transitional period from hospital to home is vital for stroke patients, but it poses serious challenges. Good self-management ability can optimize disease outcomes. However, stroke patients in China have a low level of self-management ability during the transitional period, and a lack of effective support may be the reason. With the rapid development of technology, using wearable monitors to achieve real-time and individualized support may be the key to solving this problem. This study uses a randomized controlled trial design to assess the efficacy of using wearable technology to realize real-time and individualized self-management support in stroke patients' self-management behavior during the transitional period following discharge from hospital. METHODS This parallel-group randomized controlled trial will be conducted in two hospitals and patients' homes. A total of 183 adult stroke patients will be enrolled in the study and randomly assigned to three groups in a 1:1:1 ratio. The smartwatch intervention group (n = 61) will receive Real-time and Individualized Self-management Support (RISS) program + routine care, the wristband group (n = 61) will wear a fitness tracker (self-monitoring) + routine care, and the control group (n = 61) will receive routine stroke care. The intervention will last for 6 months. The primary outcomes are neurological function status, self-management behavior, quality of life, biochemical indicators, recurrence rate, and unplanned readmission rate. Secondary outcomes are resilience, patient activation, psychological status, and caregiver assessments. The analysis is intention-to-treat. The intervention effect will be evaluated at baseline (T0), 2 months after discharge (T1), 3 months after discharge (T2), and 6 months after discharge (T3). DISCUSSION The cloud platform designed in this study not only has the function of real-time recording but also can push timely solutions when patients have abnormal conditions, as well as early warnings or alarms. This study could also potentially help patients develop good self-management habits through resilience theory, wearable devices, and individualized problem-solution library of self-management which can lay the foundation for long-term maintenance and continuous improvement of good self-management behavior in the future. TRIAL REGISTRATION The ethics approval has been granted by the Ethics Committee of West China Hospital, Sichuan University (2022-941). All patients will be informed of the study details and sign a written informed consent form before enrollment. The research results will be reported in conferences and peer-reviewed publications. The trial registration number is ChiCTR2300070384 . Registered on 11 April 2023.
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Affiliation(s)
- N Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Y Xv
- Department of Surgical Anesthesiology, Tai'an City Central Hospital, Tai'an, China
| | - X Sun
- Department of Neurology, Tianjin Third Central Hospital, Tianjin, China
| | - L Feng
- Department of Neurology/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Y B Wang
- Tai'an Tax Bureau, State Administration of Taxation, Tai'an, China
| | - X L Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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14
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Pflugeisen CM, Boomgaarden A, Denaro AA, Konicek D, Robinson E. Patient Empowerment Among Transgender and Gender Diverse Youth. LGBT Health 2023; 10:429-438. [PMID: 37126404 PMCID: PMC10468556 DOI: 10.1089/lgbt.2022.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose: Patient empowerment is becoming increasingly important as health care moves toward more collaborative models of care. The goal of this study was to evaluate and characterize patient empowerment in a sample of transgender/gender-diverse/nonbinary (TGDNB) youth aged 14-24 who have had at least one conversation with a medical health care provider about gender-affirming care. Methods: We adapted a health care empowerment scale for use with TGDNB young people and collected patient empowerment and sociodemographic data among TGDNB youth in the United States over an 8-week period in the spring of 2022. Overall and domain-specific empowerment (including knowledge and understanding, control, identity, decision-making, and supporting others) were assessed on a four-point scale from a low of 1 to a high of 4. Results: A total of 177 youth completed the survey. Mean age was 18.4 ± 3.0 years, the sample was 39.5% gender-diverse/nonbinary, 16.4% transfemme, 44.1% transmasc, and 81.9% White. Average empowerment was 0.22 points higher in youth with supportive caregivers than those without (99% confidence interval [CI] 0.05-0.38, p < 0.001) and 0.20 points higher in youth who sought gender-affirming mental health support (99% CI 0.04-0.36, p = 0.001). Caregiver support increased youths' sense of control over their health/health care (estimated increase 0.29, 99% CI 0.09-0.50, p < 0.001), and mental health support increased youths' decision-making agency by 0.30 points (99% CI 0.06-0.53, p = 0.001). Conclusions: This is the first study to assess patient empowerment in TGDNB youth. Several sociodemographic factors were significantly associated with overall and domain-level empowerment. Further work in this area, both longitudinal and in larger samples, is warranted.
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Affiliation(s)
| | - Anna Boomgaarden
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Aytch A. Denaro
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Danielle Konicek
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
- School of Social Work & Criminal Justice, University of Washington, Tacoma, Washington, USA
| | - Emily Robinson
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
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15
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Oliveira-Kumakura ARDS, Batista LMOS, Spagnol GS, Valler L. Functionality and quality of life in Brazilian patients 6 months post-stroke. Front Neurol 2023; 14:1020587. [PMID: 37153670 PMCID: PMC10157197 DOI: 10.3389/fneur.2023.1020587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/14/2023] [Indexed: 05/10/2023] Open
Abstract
Background Surviving a stroke poses a social and economic impact that requires the care system to be reformulated and the patient to be addressed in a comprehensive approach. Purpose This study aims to investigate if there is a relationship between functional activities performed before the stroke, patients' clinical and hospitalization data, and functionality and quality of life measures in the first 6 months after the stroke. Methods This study used a prospective cohort of 92 patients. We investigated sociodemographic and clinical data, the modified Rankin Scale (mRS), and the Frenchay Activities Index (FAI) during hospitalization. The Barthel Index (BI) and EuroQol-5D (EQ-5D) were applied at the following time points: 30 days (T1), 90 days (T2), and 180 days (T3) following postictal state. Statistical analysis was conducted using Spearman's coefficient, Friedman's non-parametric test, and multiple linear regression models. Results No correlation was found between FAI, BI, and EQ-5D average scores. Severe patients, patients with comorbidities, and patients with extended hospital stays showed lower BI and EQ-5D scores □in the follow-up. BI and EQ-5D scores increased. Conclusion This research found no relationship between activities performed before the stroke and functionalities and quality of life after the stroke, but comorbidities and extended hospital stay were associated with worse outcomes.
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Affiliation(s)
- Ana Railka de Souza Oliveira-Kumakura
- School of Nursing, University of Campinas, Campinas, Brazil
- Nursing Sciences Research Chair, Laboratory Education and Health Promotion, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Gabriela Salim Spagnol
- Nursing School, Anhanguera University, Sumaré, Brazil
- Knowledge Management and Education Solutions, Cogna Education, Valinhos, Brazil
| | - Lenise Valler
- Clinical Hospital, University of Campinas, Campinas, Brazil
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16
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Gauthier LV, Rider JV, Donkers S. Applying Behavior Change Techniques to Support Client Outcomes in Outpatient Neurorehabilitation: A Clinician Guide. Arch Phys Med Rehabil 2023; 104:711-715. [PMID: 36502892 DOI: 10.1016/j.apmr.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
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17
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Kotler JM, Mahoney D, Nilsen DM, Gillen G. Effectiveness of Occupational Therapy Interventions to Improve Performance and Participation in Instrumental Activities of Daily Living (IADL) Among Adult Stroke Survivors (2009-2019). Am J Occup Ther 2023; 77:24108. [PMID: 37220004 DOI: 10.5014/ajot.2023.77s10009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme and/or subthemes, related to a specific topic. This Systematic Review Brief summarizes findings from the systematic review on interventions to improve performance and participation in instrumental activities of daily living among adult stroke survivors. This theme reports on the effectiveness of virtual reality, exercise, vision rehabilitation, and community-based stroke empowerment group interventions.
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Affiliation(s)
- Joshua M Kotler
- Joshua M. Kotler, OTD, OTR/L, CBIS, is Assistant Professor, Clinical Occupational Therapy, University of Southern California
| | - Danielle Mahoney
- Danielle Mahoney, OTD, OTR/L, is Assistant Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTR/L, FAOTA, is Professor and Interim Program Director, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center; and Per Diem Occupational Therapist, New York Presbyterian-Columbia University Irving Medical Center
| | - Glen Gillen
- Glen Gillen, EdD, OTR/L, FAOTA, is Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
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18
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Honado AS, Atigossou OLG, Roy JS, Daneault JF, Batcho CS. Relationships between Self-Efficacy and Post-Stroke Activity Limitations, Locomotor Ability, Physical Activity, and Community Reintegration in Sub-Saharan Africa: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2286. [PMID: 36767651 PMCID: PMC9915935 DOI: 10.3390/ijerph20032286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Stroke self-efficacy is under-investigated in sub-Saharan Africa. In particular, studies focusing on the relationship between self-efficacy and post-stroke functional outcomes are scarce. This cross-sectional study aimed to explore the association between self-efficacy and post-stroke activity limitations, locomotor ability, physical activity, and community reintegration in Benin, a sub-Saharan African country. To achieve this purpose, a selection of stroke patients was made from the admission registers of the physiotherapy clinics (rehabilitation units) of three reference hospitals in Benin from January to April 2018. Stroke patients who were still continuing their rehabilitation sessions were informed by direct contact. Those who had already finished their sessions were informed by telephone. Sixty stroke patients of those contacted gave their consent and were recruited for this study. The sample consisted of 44 men and 16 women with a mean age of 56.7 ± 10.4 years. Activity limitations, locomotor ability, physical activity, community reintegration, and self-efficacy were self-reported using ACTIVLIM-Stroke, Abiloco-Benin, the Africa francophone version of the International Physical Activity Questionnaire (IPAQ-AF), the Reintegration to Normal Living Index (RNLI), and a French version of the Stroke Self-efficacy Questionnaire (SSEQ-F), respectively. Spearman's rank correlation coefficients (ρ) were calculated to characterize the relationship between self-efficacy and activity limitations, locomotor ability, physical activity, and community reintegration. According to the results, self-efficacy showed a moderate correlation with physical activity (ρ = 0.65; p < 0.001) and high correlations with activity limitations (ρ = 0.81; p < 0.001), locomotor ability (ρ = 0.72; p < 0.001), and community reintegration (ρ = -0.84; p < 0.001). Thus, self-efficacy emerges as an important factor associated with the functional recovery of stroke patients in sub-Saharan Africa.
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Affiliation(s)
- Aristide S. Honado
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- Centre Hospitalier Universitaire Départemental de l’Ouémé-Plateau, Porto-Novo 01 BP 52, Benin
| | - Orthelo Léonel Gbètoho Atigossou
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- École Supérieure de Kinésithérapie, Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou 01 BP 188, Benin
- Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
| | - Jean-François Daneault
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ 07107, USA
| | - Charles Sèbiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
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19
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Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Patel T, Ho CH, Packer TL, Lofters AK, Hahn-Goldberg S, McCarthy LM, Guilcher SJT. Medication self-management interventions for persons with stroke: A scoping review. PLoS One 2023; 18:e0285483. [PMID: 37200316 DOI: 10.1371/journal.pone.0285483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
The use of multiple medications is common following a stroke for secondary prevention and management of co-occurring chronic conditions. Given the use of multiple medications post-stroke, optimizing medication self-management for this population is important. The objective of this scoping review was to identify and summarize what has been reported in the literature on interventions related to medication self-management for adults (aged 18+) with stroke. Electronic databases (Ovid Medline, Ovid Embase, EBSCO CINAHL, Ovid PsycINFO, Web of Science) and grey literature were searched to identify relevant articles. For inclusion, articles were required to include an adult population with stroke undergoing an intervention aimed at modifying or improving medication management that incorporated a component of self-management. Two independent reviewers screened the articles for inclusion. Data were extracted and summarized using descriptive content analysis. Of the 56 articles that met the inclusion criteria, the focus of most interventions was on improvement of secondary stroke prevention through risk factor management and lifestyle modifications. The majority of studies included medication self-management as a component of a broader intervention. Most interventions used both face-to-face interactions and technology for delivery. Behavioural outcomes, specifically medication adherence, were the most commonly targeted outcomes across the interventions. However, the majority of interventions did not specifically or holistically target medication self-management. There is an opportunity to better support medication self-management post-stroke by ensuring interventions are delivered across sectors or in the community, developing an understanding of the optimal frequency and duration of delivery, and qualitatively exploring experiences with the interventions to ensure ongoing improvement.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tejal Patel
- University of Waterloo School of Pharmacy, Kitchener, ON, Canada
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, ON, Canada
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tanya L Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- OpenLab, University Health Network, Toronto, ON, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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20
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Oh HX, De Silva DA, Toh ZA, Pikkarainen M, Wu VX, He HG. The effectiveness of self-management interventions with action-taking components in improving health-related outcomes for adult stroke survivors: a systematic review and meta-analysis. Disabil Rehabil 2022; 44:7751-7766. [PMID: 34757862 DOI: 10.1080/09638288.2021.2001057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This systematic review and meta-analysis aims to synthesise the evidence of the effectiveness of self-management interventions with action-taking components in improving self-efficacy, health-related quality of life, basic and instrumental activities of daily living, and depression for adult stroke survivors. MATERIALS AND METHODS Nine electronic databases were searched for relevant studies, including grey literature and ongoing studies. Randomised controlled trials targeting adult stroke survivors comparing health-related outcomes of patients receiving self-management interventions with action-taking components to usual care, placebo, or no-treatment were included. Screening, data extraction, and methodological quality assessment were conducted by two reviewers. Meta-analyses were performed. Overall quality of evidence was assessed using the GRADE tool. RESULTS A total of seventeen studies were included. Meta-analyses showed that the intervention may result in a slight increase in self-efficacy (SMD = 0.29, 95% CI [0.07-0.52], p = 0.010, I2 = 47%) and basic activities of daily living (SMD = 0.31, 95% CI [0.16-0.46], p < 0.001, I2 = 0%), but not for the other outcomes. CONCLUSIONS Self-management interventions with action-taking components may result in a slight improvement in self-efficacy and rehabilitation of basic activities of daily living. Future research should investigate which core self-management skill, or combination of them, is most effective in improving short-term and long-term outcomes.IMPLICATIONS FOR REHABILITATIONStroke can be a chronic condition as approximately half of stroke survivors suffer from permanent disabilities.Self-management interventions are one form of rehabilitation programmes available to stroke survivors.Self-management interventions with action-taking components may result in a slight increase in patient self-efficacy and carrying out basic activities of daily living compared to usual care given.
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Affiliation(s)
- Hui Xian Oh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Minna Pikkarainen
- Oslomet -Oslo Metropolitan University, Oslo, Norway.,Chalmers University of Technology, Gothenburg, Sweden.,University of Oulu, Oulu, Finland
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
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21
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The longitudinal association between patient empowerment and patient-reported outcomes: What is the direction of effect? PLoS One 2022; 17:e0277267. [DOI: 10.1371/journal.pone.0277267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background
Theoretical literature and cross-sectional studies suggest empowerment is associated with other patient-reported outcomes (PROs). However, it is not known if patient empowerment is leading to improvements in other PROs or vice versa.
Aims
The present study aimed to examine the direction of effects between patient empowerment and PROs in young persons with congenital heart disease (CHD).
Methods
As part of the STEPSTONES-CHD trial, adolescents with CHD from seven pediatric cardiology centers in Sweden were included in a longitudinal observational study (n = 132). Data were collected when patients were 16 (T0), 17 (T1) and 18 ½ years old (T2). The Gothenburg Young Persons Empowerment Scale (GYPES) was used to measure patient empowerment. Random intercepts cross-lagged panel models between patient empowerment and PROs (communication skills; patient-reported health; quality of life; and transition readiness) were undertaken.
Results
We found a significant cross-lagged effect of transition readiness over patient empowerment between T1 and T2, signifying that a higher level of transition readiness predicted a higher level of patient empowerment. No other significant cross-lagged relationships were found.
Conclusion
Feeling confident before the transition to adult care is necessary before young persons with CHD can feel in control to manage their health and their lives. Clinicians interested in improving patient empowerment during the transitional period should consider targeting transition readiness.
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22
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Allegue DR, Sweet SN, Higgins J, Archambault PS, Michaud F, Miller WC, Tousignant M, Kairy D. Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study. JMIR Rehabil Assist Technol 2022; 9:e31305. [PMID: 36107484 PMCID: PMC9523527 DOI: 10.2196/31305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/05/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician. Objective We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians. Methods This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors’ use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory. Results Three stroke survivors (n=2, 67%, women and n=1, 33%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors’ safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts. Conclusions This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions. International Registered Report Identifier (IRRID) RR2-10.2196/14629
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Affiliation(s)
- Dorra Rakia Allegue
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
| | - Shane Norman Sweet
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Johanne Higgins
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
| | - Philippe S Archambault
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Francois Michaud
- Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - William C Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michel Tousignant
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging (CdRV), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dahlia Kairy
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
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Lau SCL, Judycki S, Mix M, DePaul O, Tomazin R, Hardi A, Wong AWK, Baum C. Theory-Based Self-Management Interventions for Community-Dwelling Stroke Survivors: A Systematic Review and Meta-Analysis. Am J Occup Ther 2022; 76:23320. [PMID: 35772070 DOI: 10.5014/ajot.2022.049117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Self-management is a critical component of stroke rehabilitation. A better understanding of the use of theory and behavior change techniques (BCTs) informs the development of more effective stroke self-management interventions. OBJECTIVE To examine what theories and BCTs have been applied in stroke self-management interventions; investigate the extent to which these interventions encourage implementation of behavior changes; and appraise their effectiveness to enhance self-efficacy, quality of life, and functional independence. DATA SOURCES Ovid MEDLINE, Embase, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched from inception to May 26, 2020. STUDY SELECTION AND DATA COLLECTION Randomized controlled trials (RCTs) in six databases were reviewed for inclusion and analysis. We included trials that involved community-dwelling adult stroke survivors, assessed the effectiveness of self-management interventions, and explicitly mentioned the use of theory in the development of the intervention. We assessed use of theory and BCTs using the Theory Coding Scheme and BCT taxonomy v1, respectively. FINDINGS A total of 3,049 studies were screened, and 13 RCTs were included. The predominant theory and BCT categories were Social Cognitive Theory (7 studies) and goals and planning (12 studies), respectively. Significant and small effect sizes were found for self-efficacy (0.27) and functional independence (0.19). CONCLUSIONS AND RELEVANCE Theory-based self-management interventions have the potential to enhance stroke outcomes. Systematic reporting on the use of theory and BCTs is recommended to enhance clarity and facilitate evaluations of future interventions. What This Article Adds: This review supports and guides occupational therapy practitioners to use theory-based self-management intervention as a routine part of stroke rehabilitation to improve stroke survivors' experience in the community.
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Affiliation(s)
- Stephen C L Lau
- Stephen C. L. Lau, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Stephanie Judycki
- Stephanie Judycki, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Mikayla Mix
- Mikayla Mix, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Olivia DePaul
- Olivia DePaul, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Rachel Tomazin
- Rachel Tomazin, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Angela Hardi
- Angela Hardi, MLIS, is Librarian, Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Alex W K Wong
- Alex W. K. Wong, PhD, DPhil, is Assistant Professor, Program in Occupational Therapy, Department of Neurology, and Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Carolyn Baum
- Carolyn Baum, PhD, is Professor, Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO;
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24
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Zhang M, Sit JWH, Chan DNS, Akingbade O, Chan CWH. Educational Interventions to Promote Cervical Cancer Screening among Rural Populations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116874. [PMID: 35682457 PMCID: PMC9180749 DOI: 10.3390/ijerph19116874] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023]
Abstract
The urban-rural gap in cervical cancer screening uptake is a significant public health consideration. Educational interventions are commonly adopted to promote cervical cancer screening among females in rural areas; however, the characteristics and effectiveness of these educational interventions remain unclear. In this review, we aimed to identify the characteristics of educational interventions used in rural populations and to evaluate the effects of these interventions on cervical cancer screening-related outcomes. Seven English databases were searched in January 2022. Randomized controlled trials (RCTs) and quasi-experimental studies were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies were used for quality appraisal. RevMan 5.4 software was used for the meta-analysis. A narrative synthesis was conducted in instances where a meta-analysis was inappropriate. Three RCTs and seven quasi-experimental studies conducted in six countries were included. A social cognitive theory-based framework, the community setting, group sessions, healthcare professional-led approaches, and culture-tailored materials were implemented in the educational interventions for cervical cancer screening. The educational content mainly included basic information on cervical cancer screening, psychological issues, barriers and strategies to overcome them, and locally available resources. Educational interventions increased the knowledge and uptake of cervical cancer screening in the rural population. However, the studies only evaluated the short-term effects of these educational interventions, with the cervical screening behavior only being assessed in one instance for each participant. Educational interventions promote cervical cancer screening among females in rural areas. Theory-driven, community-involved, group-based, and healthcare professional-led approaches should be prioritized in the application of educational interventions in rural populations. Both the short- and long-term, influences of educational interventions on the cervical cancer screening behavior of females in rural areas need to be recognized.
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Affiliation(s)
- Mengyue Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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Kristensson J, Saldert C, Östberg P, Smith SR, Åke S, Longoni F. Naming vs. non-naming treatment in aphasia in a group setting-A randomized controlled trial. JOURNAL OF COMMUNICATION DISORDERS 2022; 97:106215. [PMID: 35367876 DOI: 10.1016/j.jcomdis.2022.106215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting. METHODS In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication. RESULTS Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group. CONCLUSIONS Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.
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Affiliation(s)
- Joana Kristensson
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden.
| | - Charlotta Saldert
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Per Östberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Rödseth Smith
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Sabina Åke
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Francesca Longoni
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
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26
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Lin S, Xiao LD, Chamberlain D, Ullah S, Wang Y, Shen Y, Chen Z, Wu M. Nurse-led health coaching programme to improve hospital-to-home transitional care for stroke survivors: A randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2022; 105:917-925. [PMID: 34294494 DOI: 10.1016/j.pec.2021.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the effects of a nurse-led health coaching programme for stroke survivors and family caregivers in hospital-to-home transition care. METHODS A total of 140 dyads of stroke survivors and their family caregivers were recruited and randomly assigned to either the intervention group (received a 12-week nurse-led health coaching programme) or the usual care group. The primary outcome was self-efficacy, and secondary outcomes were quality of life (QoL), stroke-related knowledge, and caregiver-related burden. The outcomes were measured at baseline, 12 and 24 weeks. RESULTS Stroke survivors in the intervention group demonstrated a significant improvement in self-efficacy at 12 weeks (x̅: 24.9, 95%CI: 20.2-29.6, p < 0.001) and at 24 weeks (x̅: 23.9, 95%CI: 19.2-28.6, p < 0.001) compared to the usual care group. Findings also demonstrated significant increases in stroke survivors' QoL, stroke-related knowledge, and reduction in unplanned hospital readmissions and caregiver-related burden. There were no statistically significant changes in other outcomes between the two groups. CONCLUSION The nurse-led health coaching programme improved health outcomes for both stroke survivors and their caregivers. PRACTICE IMPACTION Findings from the study suggest that nurse-led health coaching should be incorporated into routine practice in hospital-to-home transitional care for stroke survivors and their caregivers.
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Affiliation(s)
- Shuanglan Lin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Australia
| | - Yanjiang Wang
- Department of Neurology and Centre for Clinical Neuroscience, the Third Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yingying Shen
- Department of Neurology and Centre for Clinical Neuroscience, the Third Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhenfang Chen
- Department of Neurology and Centre for Clinical Neuroscience, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Min Wu
- Department of Neurology and Centre for Clinical Neuroscience, the First Affiliated Hospital of Army Medical University, Chongqing, China
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Gangwani R, Cain A, Collins A, Cassidy JM. Leveraging Factors of Self-Efficacy and Motivation to Optimize Stroke Recovery. Front Neurol 2022; 13:823202. [PMID: 35280288 PMCID: PMC8907401 DOI: 10.3389/fneur.2022.823202] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/13/2022] [Indexed: 01/01/2023] Open
Abstract
The International Classification of Functioning, Disability and Health framework recognizes that an individual's functioning post-stroke reflects an interaction between their health condition and contextual factors encompassing personal and environmental factors. Personal factors significantly impact rehabilitation outcomes as they determine how an individual evaluates their situation and copes with their condition in daily life. A key personal factor is self-efficacy-an individual's belief in their capacity to achieve certain outcomes. Self-efficacy influences an individual's motivational state to execute behaviors necessary for achieving desired rehabilitation outcomes. Stroke rehabilitation practice and research now acknowledge self-efficacy and motivation as critical elements in post-stroke recovery, and increasing evidence highlights their contributions to motor (re)learning. Given the informative value of neuroimaging-based biomarkers in stroke, elucidating the neurological underpinnings of self-efficacy and motivation may optimize post-stroke recovery. In this review, we examine the role of self-efficacy and motivation in stroke rehabilitation and recovery, identify potential neural substrates underlying these factors from current neuroimaging literature, and discuss how leveraging these factors and their associated neural substrates has the potential to advance the field of stroke rehabilitation.
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Affiliation(s)
- Rachana Gangwani
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Human Movement Sciences Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amelia Cain
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy Collins
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica M. Cassidy
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Azar NS, Radfar M, Baghaei R. Spiritual Self-care in Stroke Survivors: A Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2022; 61:493-506. [PMID: 32445043 DOI: 10.1007/s10943-020-01030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Self-care and quality of life challenges significantly affect post-stroke life. Stroke patients look for strategies to improve their performance and cope with their new situation. The aim of this study was to explore spirituality in self-care from the perspective of stroke survivors in the northwest of Iran. Purposive sampling is done on 15 participants through Semi-structured interviews of obtained data through conventional content analysis approach. Two categories of "spiritual self-care" as the main theme included "supplication" comprising subcategories of "worship and prayer", "resort" and "trust" and "religious beliefs" with subcategories of "divine providence" and "divine blessing". Based on results of this study, Spirituality increases motivation for self-care and adaptation, reduces stress and helps patiently manage diseases as realities.
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Affiliation(s)
- Nooshin Salmany Azar
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Moloud Radfar
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Rahim Baghaei
- Patient Safety Research Center, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Callegari B, Garcez DR, Júnior ATVDC, Almeida ADSSC, Candeira SRA, do Nascimento NIC, de Castro KJS, de Lima RC, Barroso TGCP, Souza GDS, e Silva ADAC. Gait patterns in ischemic and hemorrhagic post-stroke patients with delayed access to physiotherapy. Hong Kong Physiother J 2021; 41:77-87. [PMID: 34177196 PMCID: PMC8221981 DOI: 10.1142/s1013702521500074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES (1) To assess the effects of a conventional, delayed physiotherapy protocol used by Ischemic Stroke (IS) and Hemorrhagic Stroke (HS) post-stroke patients, in their electromyographic activation patterns during hemiparetic gait; and (2) to study whether this protocol may improve the functional abilities in this population. METHODS This is an observational, descriptive, and analytical quasi-experimental trial. Forty patients with unilateral IS ( n = 25 ) and HS ( n = 15 ) stroke were recruited; the stroke involved the motor cortex or sub-cortical areas, and the patients were able to walk independently. Interventions with standard protocols of physiotherapy were carried out. Evaluations (clinical and gait assessment) were performed at the time of admission and at the end of the protocol. Outcome measures include Stroke Impact Scale, Timed Up and Go Test, and gait electromyographic evaluation. RESULTS Only IS patients (with an average of 124 . 4 ± 45 . 4 months delayed access to physiotherapy rehabilitation) had improvements in Timed Up and Go Test (change in speed =- 8 . 0 seg p < 0 . 05 ) and presented an anticipation of the onset in Upper leg muscles after the intervention. BF ( p = 0 . 05 ), ST ( p = 0 . 001 ), and RF ( p = 0 . 024 ), started their recruitment (onset) earlier at the swing phase of the gait cycle, which is more similar to the normal pattern (grey shadow). IS and HS ( 120 . 4 ± 28 . 4 months since last stroke) patients presented higher electromyographic activation, after physiotherapy, of the posterior leg muscles (gastrocnemius, semitendinosus and biceps femoris) during stance phase ( p < 0 . 05 ). CONCLUSION IS patients had improvements after delayed conventional physiotherapy. For HS limited response to intervention was observed.
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Affiliation(s)
- Bianca Callegari
- Laboratory of Human Motricity Sciences, Federal University of Pará Av. Generalíssimo Deodoro 01, 66050-160, Belém, Pará, Brazil
- Tropical Medicine Center, Federal University of Pará Av. Generalíssimo Deodoro 92, 66050-240, Belém, Pará, Brazil
- Master’s Program in Human Movement Sciences, Federal University of Pará Av. Generalíssimo Deodoro 01, 66050-160, Belém, Pará, Brazil
| | - Daniela Rosa Garcez
- University Hospital Bettina Ferro de Souza, Federal University of Pará R. Augusto Correˆa, n1, 66075-110, Belém, Pará, Brazil
| | - Alex Tadeu Viana da Cruz Júnior
- Laboratory of Human Motricity Sciences, Federal University of Pará Av. Generalíssimo Deodoro 01, 66050-160, Belém, Pará, Brazil
- Tropical Medicine Center, Federal University of Pará Av. Generalíssimo Deodoro 92, 66050-240, Belém, Pará, Brazil
| | | | | | | | | | - Ramon Costa de Lima
- Neuroscience and Cell Biology Graduate Program, Federal University of Pará R. Augusto Corrêa, n 1, 66075-110, Belém, Pará, Brazil
| | | | - Givago da Silva Souza
- Tropical Medicine Center, Federal University of Pará Av. Generalíssimo Deodoro 92, 66050-240, Belém, Pará, Brazil
- Neuroscience and Cell Biology Graduate Program, Federal University of Pará R. Augusto Corrêa, n 1, 66075-110, Belém, Pará, Brazil
| | - Anselmo de Athayde Costa e Silva
- Master’s Program in Human Movement Sciences, Federal University of Pará Av. Generalíssimo Deodoro 01, 66050-160, Belém, Pará, Brazil
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Walker DM, Fletcher-Smith J, Sprigg N, Pandyan A. Designing a trial of early electrical stimulation to the stroke-affected arm: Qualitative findings on the barriers and facilitators. Br J Occup Ther 2021. [DOI: 10.1177/03080226211008706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: This study aimed to explore the barriers and facilitators to implementing early therapeutic electrical stimulation (ES) treatment from both the patient and therapist perspectives as part of a feasibility study. Methods Design: Interviews were conducted with patients and their carers and focus groups with the therapists post-intervention period. Setting: Interviews were in the patient’s homes and for the focus groups in a specialist stroke unit in Nottinghamshire. Subjects: Fifteen patient participants (34% of sample) were interviewed (intervention n = 9; control group n = 3; carers n = 3). Sixteen therapists (9 occupational therapists; 7 physiotherapists) took part in the three focus groups. Intervention: Participants were randomized to receive usual care or usual care and ES to wrist flexors and extensors for 30 min, twice a day, 5 days a week for 3 months. Findings: The barriers to ES treatment cited by the therapists outweighed the barriers mentioned by patients. Therapists’ barriers included lack of confidence and staff knowledge regarding ES and time pressures of delivering the ES. No patients mentioned time as a barrier and considered the treatment regime to be acceptable; however, lack of staff support was mentioned 14 times by them. Conclusion: Although initially the perceived barrier for therapists was time restrictions, after analysing the data, it appears that confidence/knowledge is the real barrier, and time is the manifestation of this underlying self-doubt. Patients were able to confidently self-manage treatment, and although efficacy was not measured, patients volunteered information regarding its perceived benefit, and no adverse effects were reported.
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Affiliation(s)
- Dawn-Marie Walker
- School of Health Sciences, Highfield Campus, University of Southampton, Southampton, UK
| | | | - Nikola Sprigg
- Faculty of Medicine & Health Sciences, Nottingham City Hospital, Nottingham, UK
| | - Anand Pandyan
- School of Health and Rehabilitation, Keele University, Keele, UK
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Kalav S, Bektas H, Ünal A. 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. Jpn J Nurs Sci 2021; 19:e12441. [PMID: 34264000 DOI: 10.1111/jjns.12441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/23/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
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).
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Affiliation(s)
- Simge Kalav
- Faculty of Nursing, Department of Internal Medicine Nursing, Aydin Adnan Menderes University, Aydin, Turkey
| | - Hicran Bektas
- Faculty of Nursing, Department of Internal Medicine Nursing, Akdeniz University, Antalya, Turkey
| | - Ali Ünal
- Neurology Department, Akdeniz University School of Medicine, Antalya, Turkey
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da Rosa Pinheiro DR, Cabeleira MEP, da Campo LA, Corrêa PS, Blauth AHEG, Cechetti F. Effects of aerobic cycling training on mobility and functionality of acute stroke subjects: A randomized clinical trial. NeuroRehabilitation 2021; 48:39-47. [PMID: 33386826 DOI: 10.3233/nre-201585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies demonstrate the benefits of aerobic cycling training in subacute and chronic stroke subjects, but there is a lack in the literature about its effects on the acute phase. OBJECTIVE Verify the effects of aerobic cycling training on lower limbs muscle strength, gait speed, balance, mobility and functionality of acute stroke subjects. METHODS Control group (CG) performed conventional physiotherapy twice a day and the intervention group (IG) performed a conventional physiotherapy and a cycle ergometer session, for five consecutive days. Subjects were assessed for muscle strength by a digital dynamometer, gait speed by the 10-meter-walk-test, balance by the Berg Balance Scale, mobility by the ICU-Mobility-Scale and functionality by the Perme Score. RESULTS Twenty subjects were enrolled in the study, 10 in the CG and 10 in the IG. Lower limbs muscle strength, the main endpoint, was better in the IG compared to the CG. The same was found in the secondary endpoints. The intragroup analysis was also positive for the CG in the mobility and functionality. CONCLUSIONS Conventional physiotherapy combined with cycling exercise showed better results in the improvement of muscle strength of lower limbs, mobility and functionality of subjects who suffered from acute stroke.
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Affiliation(s)
- Douglas Rafael da Rosa Pinheiro
- Universidade Federal de Ciências da Saúde de Porto Alegre, Post-Graduation Program in Rehabilitation Sciences, Porto Alegre, Brazil.,Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Luigi Antonio da Campo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Post-Graduation Program in Rehabilitation Sciences, Porto Alegre, Brazil
| | - Philipe Souza Corrêa
- Universidade Federal de Ciências da Saúde de Porto Alegre, Post-Graduation Program in Rehabilitation Sciences, Porto Alegre, Brazil
| | - Ariane Haydeé Estrada Gamarra Blauth
- Universidade Federal de Ciências da Saúde de Porto Alegre, Post-Graduation Program in Rehabilitation Sciences, Porto Alegre, Brazil.,Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Fernanda Cechetti
- Universidade Federal de Ciências da Saúde de Porto Alegre, Post-Graduation Program in Rehabilitation Sciences, Porto Alegre, Brazil
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Tanev KS, Federico LE, Sydnor VJ, Leveroni CL, Hassan K, Biffi A. Neuropsychiatric symptoms in a occipito-temporal infarction with remarkable long-term functional recovery. Cortex 2021; 137:205-214. [PMID: 33640852 DOI: 10.1016/j.cortex.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/12/2020] [Accepted: 01/13/2021] [Indexed: 11/18/2022]
Abstract
Posterior circulation infarctions (PCI) constitute 5-25% of ischemic strokes. PCI of the occipital lobe present with a panoply of symptoms including quadrantanopsia, topographical disorientation, and executive dysfunction. Long-term cognitive recovery after PCI is not well described. However, the adult brain is remarkably plastic, capable of adapting and remodeling. We describe a 43-year-old right-handed woman who complained of black spots in both eyes, headaches, photophobia, and a feeling she would faint. Initial neurological exam and a CT scan were normal; she was diagnosed with ocular migraine. A second neurological exam a week later showed left superior quadrantopsia; an MRI scan suggested right occipito-temporal infarct. In subsequent months, the patient complained of fatigue, quadrantanopsia, memory problems, and topographical disorientation. The patient participated in multi-modality treatment, and in self-directed arts projects and physical activities. Six years later, she reported noticeable improvements in cognition and daily functioning, which were documented on neurocognitive testing. Comparison between initial and subsequent MRIs using FreeSurfer 5.3 identified neuroplastic brain changes in areas serving similar functions to the areas injured from the stroke. The case illustrates the neuropsychiatric presentation after right occipito-temporal stroke, the value of formal and self-directed cognitive rehabilitation, the extended time to cognitive recovery, and the ability of the brain to undergo neuroplastic changes.
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Affiliation(s)
| | | | - Valerie J Sydnor
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA.
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Liu Y, Guo H. Empowerment in Chinese primary caregivers of post-stroke patients with disability: A cross-sectional study. Medicine (Baltimore) 2021; 100:e23774. [PMID: 33592833 PMCID: PMC7870185 DOI: 10.1097/md.0000000000023774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 01/05/2023] Open
Abstract
To investigate the status quo of empowerment ability of primary caregivers in post-stroke patients with disability and its influencing factors.A cross-sectional design and a convenience sample were used. Participants (N = 189) from 3 hospital in Beijing were recruited from October 2018 to June 2019. The following measurement tools were used in this study: Barthel index, Main Caregiver Empowerment Measurement, General Self-Efficacy Scale, Simplified Coping Style Questionnaire and Social Support Rating Scale. Multiple linear stepwise regression analysis was used to statistically infer the influencing factors of empowerment ability of primary caregivers.The total score of main caregivers' empowerment measurement among the participants was 161.03 ± 14.678, the median (interquartile range) score was 162.00 (150.00-171.50). The average scores of each dimension ranged from high to low: relationship with the person being cared for, goodwill care, expectation for care outcomes, subjectivity of caregiver, faith in care, understanding of care role, knowledge and skills of care, scruples about the surroundings, personal resources. The single factor analysis showed that the patient's payment method for medical expenses, whether the patient accompanied by other chronic diseases and the gender of the caregiver had an effect on the empowerment ability of primary caregivers, and the positive coping style, negative coping style, self-efficacy and subjective support of primary caregivers were positively correlated with their empowerment ability (P < .05). Multiple linear stepwise regression analysis showed that the type of payment for treatment of patients (b = 7.449, P < .01), and gender of caregivers (b = 5.039, P < .05), subjective support of caregivers (b = 0.439, P < .05), positive coping style of caregivers (b = 0.585, P < .01), self-efficacy of caregivers (b = 6.456, P < .01) were the main influencing factors of empowerment ability of primary caregivers.The empowerment ability of the primary caregivers of post-stroke patients with disability in China is at the upper middle level. However, there are more scruples about the surrounding and less personal resources, which deserve attention. Furthermore, the identification of the factors related to empowerment lays a foundation for clinical nursing practitioners to further develop targeted interventions on empowerment of caregivers.
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Affiliation(s)
- Youhua Liu
- School of Nursing, Beijing University of Traditional Chinese Medicine, Beijing
- Shantou Health School, Shantou, China
| | - Hong Guo
- School of Nursing, Beijing University of Traditional Chinese Medicine, Beijing
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Alegiani AC, Rahn AC, Steckelberg A, Thomalla G, Heesen C, Köpke S. Quality of Stroke Patient Information Applied in Randomized Controlled Trials-Literature Review. Front Neurol 2020; 11:526515. [PMID: 33365010 PMCID: PMC7750452 DOI: 10.3389/fneur.2020.526515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Strokes have a huge impact on patients' quality of life. Although there are potentially effective secondary preventions and treatment options for stroke patients, adherence is mostly low. Low disease and treatment-related knowledge and, consequently, a lack of informed decision-making in stroke patients may contribute to this problem. However, stroke patient information did not seem to have relevant effects on patients' knowledge in randomized controlled trials. One contributing factor may be the lack of thoroughly developed patient information materials. Methods: We aimed to evaluate the quality of patient information materials for stroke patients by using randomized controlled trials, applying quality criteria for evidence-based patient information (EBPI). We conducted a literature search (MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL). To be included in the review, research had to be randomized controlled trials that provided stroke patient information, were published in English, and had knowledge assessed as the primary endpoint. Authors of primary studies were contacted and asked for information materials applied. Results: We screened 15,507 hits and identified 30 eligible studies. Information materials were available for only eight studies. Analyses revealed that all available materials had important shortcomings concerning EBPI quality criteria [concerning, for example, structural information (e.g., reporting conflicts of interest), content information (e.g., reporting sources of information), or comprehensive descriptions of treatment effects and side effects]. Frequently, treatment effects were reported only narratively without providing absolute numbers, values, or frequencies. Conclusion: Quality of materials differed, but none sufficiently fulfilled EBPI quality criteria. Unsatisfactory trial results concerning patient knowledge and patient involvement in decision-making may at least partially be explained by limitations of the provided materials. Future patient information should consider EBPI quality criteria.
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Affiliation(s)
- Anna C Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne C Rahn
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Melo LP, Oliveira DC, Dantas AATSG, Silva Júnior RA, Ribeiro TS, Campos TF. Predictive factors of functional independence in basic activities of daily living during hospitalization and after discharge of stroke patients. Brain Inj 2020; 35:26-31. [PMID: 33369484 DOI: 10.1080/02699052.2020.1861649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The aim of this study was to identify the predictive factors of functional independence in the basic activities of daily living during hospitalization, on the 10th and 28th day after stroke.Methods: A total of 433 patients (204 men and 229 women) took part. Functional independence data were collected using the Step 1 from an instrument called Stepwise. Analysis was conducted by logistic regression.Results: Due to the OR values below 1.0 we can verify that the age of 59 years or less and the presence of physiotherapy in the hospital were protective factors of functional independence. Other predictive factors were the number of stroke risk factors (bathing: OR = 0.4; p = .005, transfer: OR = 0.487; p = .025), the amount of medication used before stroke (bathing: OR = 1.7; p = .013), sex (grooming: OR = 1.6; p = .026); type of stroke (continence: OR = 2.2; p = .003-10th day; OR = 1.9; p = .013-28th day), previous strokes (eating: OR = 0.5; p = .036).Conclusions: According to the results, the risk of impaired functional independence decreased in bathing and eating and increased for dressing, grooming and transfer during clinical recovery suggesting the need for greater therapeutic intervention in different basic activities of daily living.
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Affiliation(s)
- Luciana Protásio Melo
- Departamento de Fisioterapia, Laboratório de Intervenção e Análise do Movimento Humano, Universidade Federal do Rio Grande do Norte, Natal, Brasil
| | - Débora Carvalho Oliveira
- Departamento de Fisioterapia, Laboratório de Intervenção e Análise do Movimento Humano, Universidade Federal do Rio Grande do Norte, Natal, Brasil
| | | | | | - Tatiana Souza Ribeiro
- Departamento de Fisioterapia, Laboratório de Intervenção e Análise do Movimento Humano, Universidade Federal do Rio Grande do Norte, Natal, Brasil
| | - Tania Fernandes Campos
- Departamento de Fisioterapia, Laboratório de Intervenção e Análise do Movimento Humano, Universidade Federal do Rio Grande do Norte, Natal, Brasil
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Effects of virtual reality training on occupational performance and self-efficacy of patients with stroke: a randomized controlled trial. J Neuroeng Rehabil 2020; 17:150. [PMID: 33187532 PMCID: PMC7666452 DOI: 10.1186/s12984-020-00783-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background Virtual reality (VR) has been broadly applied in post-stroke rehabilitation. However, studies on occupational performance and self-efficacy as primary outcomes of stroke rehabilitation using VR are lacking. Thus, this study aims to investigate the effects of VR training on occupational performance and self-efficacy in patients with stroke. Methods This was an assessor-blinded, randomized controlled trial. Sixty participants with first-ever stroke (< 1-year onset) underwent rehabilitation in a single acute hospital. Participants were randomly assigned to either the VR group (n = 30) or control group (n = 30). Both groups received dose-matched conventional rehabilitation (i.e., 45 min, five times per week over 3 weeks). The VR group received additional 45-min VR training for five weekdays over 3 weeks. The primary outcome measures were the Canadian Occupational Performance Measure and Stroke Self-Efficacy Questionnaire. Secondary outcome measures included Modified Barthel Index, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity. The assessment was conducted at baseline and after the 3-week intervention. Results A total of 52 participants (86.7%) completed the trial. Significant between-group differences in Stroke Self-Efficacy Questionnaire (Median Difference = 8, P = 0.043) and Modified Barthel Index (Median Difference = 10, P = 0.030) were found; however, no significant between-group differences in Canadian Occupational Performance Measure, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity were noted. No serious adverse reactions related to the program were reported. Conclusions Additional VR training could help improve the self-efficacy and activities of daily living of patients with stroke; however, it was not superior to conventional training in the improvement of upper limb functions, occupational performance, and satisfaction. Nevertheless, VR could be integrated into conventional rehabilitation programs to enhance self-efficacy of patients after stroke. Trial registration This study was successfully registered under the title “Effects of virtual reality training on occupational performance and self-efficacy of patients with stroke” on October 13 2019 and could be located in https://www.chictr.org with the study identifier ChiCTR1900026550.
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Greenway A, Gustafsson L, Bower K, Walder K. Exploring self-management within hospital-based stroke care: current and future opportunities. Disabil Rehabil 2020; 44:2340-2346. [PMID: 33053309 DOI: 10.1080/09638288.2020.1833092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE This study explored stroke self-management within a tertiary hospital setting from the perspectives of health professionals working across the continuum of stroke care. MATERIALS AND METHODS A qualitative descriptive design guided five focus groups in the acute stroke service (n = 2), inpatient rehabilitation (n = 2), and outpatient day hospital service (n = 1). Focus groups were transcribed verbatim and analysed using thematic analysis. RESULTS Twenty-eight health professionals participated representing medical, nursing, and allied health services. Two themes emerged from the data: Pieces of the puzzle illustrates the inconsistent understanding about self-management with elements of the puzzle described but rarely within the full concept of self-management; Readiness for self-management highlighted that although self-management should commence in the acute setting, there were many factors influencing why this was not always happening. CONCLUSIONS A consistent conceptualisation and approach to stroke self-management in the hospital setting is required. Interprofessional education and shared intentional language can enhance understanding and practice.IMPLICATIONS FOR REHABILITATIONUnderstanding and application of stroke self-management varies among members of hospital-based stroke teams.Health professionals working in hospital-based stroke care should use the term self-management with their patients.Education of healthcare teams is necessary to develop knowledge about self-management and develop consistent practices across the continuum of care.
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Affiliation(s)
- Amelia Greenway
- School of Allied Health - Occupational Therapy, Griffith University, Gold Coast, Australia
| | - Louise Gustafsson
- School of Allied Health - Occupational Therapy, Griffith University, Gold Coast, Australia
| | - Kylie Bower
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Kim Walder
- School of Allied Health - Occupational Therapy, Griffith University, Gold Coast, Australia
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Lin S, Xiao LD, Chamberlain D, Newman P, Xie S, Tan JY. The effect of transition care interventions incorporating health coaching strategies for stroke survivors: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:2039-2060. [PMID: 32532632 DOI: 10.1016/j.pec.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To systematically analyse health coaching strategies in transition care and synthesise the effect of these strategies on health care outcomes for stroke survivors. METHODS A systematic search of nine databases in two languages was conducted. Meta-analysis was conducted when data were available. RESULTS Twenty-five randomised controlled trials met the inclusion criteria. The meta-analysis revealed that health coaching strategies in transition care interventions significantly improve quality of life (QoL) (p < 0.001), activities of daily living (ADL) (p = 0.002) and reduce depression (p = 0.001) for stroke survivors at 3 months. Further subgroup analysis demonstrated that transition care interventions with a greater number of health coaching strategies are associated with a larger effect size on QoL (SMD=1.15) and ADL (SMD=1.177) at 3 months, and a medium effect size (SMD=0.674) on depression reduction. However, the effects of health coaching strategies on readmission, mortality and falls in stroke survivors remain inconclusive. CONCLUSIONS This review provides evidence that incorporating health coaching strategies in transitional care improves health outcomes of stroke survivors. PRACTICE IMPLICATION More trials of health coaching interventions to improve transition care with a rigorous study design are much needed to address the lack of support for stroke survivors and their caregivers in this crucial care period.
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Affiliation(s)
- Shuanglan Lin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Shiqi Xie
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, NT, Australia
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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Magagnin AB, Heidemann ITSB. Empowerment of family caregiver in front of stroke in hospital environment. Rev Bras Enferm 2020; 73:e20190165. [PMID: 32609175 DOI: 10.1590/0034-7167-2019-0165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/10/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to understand how the empowerment of family caregivers of people with stroke occurs in the hospital environment. METHODS a qualitative research, participatory action research, articulated with Paulo Freire's Research Itinerary, developed in April 2018 with family caregivers, in a Stroke Unit. RESULTS three predominant codes were coded: the need for empowerment and autonomy to experience the care situation; the challenges experienced in becoming a caregiver; and family support. Participants presented a lack of information inherent to the care process, with distancing from empowerment to perform the function in dehospitalization. Dialogue revealed empowerment as a possibility for critical awareness and skill development. CONCLUSIONS it highlights the importance of directing health promotion for caregivers, inserting them in the care process, recognizing their needs and intensifying practices that promote empowerment for care, bypassing curative actions.
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Kristine Stage Pedersen S, Lillelund Sørensen S, Holm Stabel H, Brunner I, Pallesen H. Effect of Self-Management Support for Elderly People Post-Stroke: A Systematic Review. Geriatrics (Basel) 2020; 5:geriatrics5020038. [PMID: 32570761 PMCID: PMC7345508 DOI: 10.3390/geriatrics5020038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
A systematic review was undertaken to determine the efficacy of self-management interventions for people with stroke over the age of 65 in relation to psychosocial outcomes. PubMed, Embase, and PsycInfo were searched for randomized controlled clinical trials. Studies were eligible if the included people with stroke had a mean age ≥65 years in both the intervention and control group. Data on psychosocial measurements were extracted and an assessment of methodological quality was undertaken. Due to heterogeneity across the studies, the results were synthesized narratively. Eleven studies were identified. They included different self-management interventions in terms of theoretical rationales, delivery, and content. Seven psychosocial outcomes were identified: i) self-management, ii) self-efficacy, iii) quality of life, iv) depression, v) activities of daily living, vi) active lifestyle, and vii) other measures. Self-management interventions for people with stroke over the age of 65 may be beneficial for self-management, self-efficacy, quality of life, activity of daily living, and other psychosocial outcomes. However, low study quality and heterogeneity of interventions, as well as variation in time of follow-up and outcome measures, limit the possibility of making robust conclusions.
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Affiliation(s)
- Sedsel Kristine Stage Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, 8450 Hammel, Denmark; (S.L.S.); (H.H.S.); (I.B.); (H.P.)
- Correspondence: ; Tel.: +45-40-17-10-98
| | - Susanne Lillelund Sørensen
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, 8450 Hammel, Denmark; (S.L.S.); (H.H.S.); (I.B.); (H.P.)
| | - Henriette Holm Stabel
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, 8450 Hammel, Denmark; (S.L.S.); (H.H.S.); (I.B.); (H.P.)
| | - Iris Brunner
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, 8450 Hammel, Denmark; (S.L.S.); (H.H.S.); (I.B.); (H.P.)
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, 8450 Hammel, Denmark; (S.L.S.); (H.H.S.); (I.B.); (H.P.)
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
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Buxbaum LJ, Varghese R, Stoll H, Winstein CJ. Predictors of Arm Nonuse in Chronic Stroke: A Preliminary Investigation. Neurorehabil Neural Repair 2020; 34:512-522. [PMID: 32476616 DOI: 10.1177/1545968320913554] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background. Nonuse (NU) after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that NU is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been directly tested, and we have poor understanding of the predictors of NU. Objective. We aimed to provide preliminary evidence regarding demographic, neuropsychological (ie, apraxia, attention/arousal, neglect), and psychological (ie, self-efficacy) factors that may influence NU in chronic stroke. Methods. Twenty chronic stroke survivors with mild to moderate sensory-motor impairment characterized by the Upper-Extremity Fugl-Meyer (UEFM) were assessed for NU with a modified version of the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use in spontaneous versus forced conditions. Participants were also assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy. Using stepwise multiple regression, we determined which variables predicted AAUT NU scores. Results. Scores on the UEFM as well as attention/arousal predicted the degree of NU (P < .05). Attention/arousal predicted NU above and beyond UEFM (P < .05). Conclusions. The results are consistent with the importance of attention and engagement necessary to fully incorporate the paretic limb into daily activities. Larger-scale studies that include additional behavioral (eg, sensation, proprioception, spasticity, pain, mental health, motivation) and neuroanatomical measures (eg, lesion volume and white matter connectivity) will be important for future investigations.
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Affiliation(s)
- Laurel J Buxbaum
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Thomas Jefferson University, Philadelphia, PA, USA
| | - Rini Varghese
- University of Southern California, Los Angeles, CA, USA
| | - Harrison Stoll
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Appalasamy JR, Subramanian P, Tan KM, Seeta Ramaiah S, Joseph JP, Chua SS. The Needs and Barriers of Medication-Taking Self-Efficacy Among Poststroke Patients: Qualitative Study. JMIR Nurs 2019; 2:e14399. [PMID: 34345772 PMCID: PMC8279437 DOI: 10.2196/14399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/09/2019] [Accepted: 06/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background Stroke is one of the top 10 leading diseases worldwide, with high mortality and morbidity rates. There is an incomplete understanding of the various types of self-efficacy involved in the prevention of recurrent stroke, and one of them is medication-taking self-efficacy. Objective This study aimed to explore the fundamental needs and barriers of medication-taking self-efficacy in poststroke patients in Malaysia. Methods We performed in-depth individual interviews with poststroke patients (N=10) from the Outpatient Neurology Clinic, Hospital Kuala Lumpur. All interviews were transcribed verbatim, and an inductive thematic analysis was performed on the data collected from the interviews. Results Two key themes were identified: (1) self-efficacy in taking the effort to understand stroke and its preventative treatment for recurrent stroke and (2) self-efficacy in taking prescribed medication to prevent stroke. Patients needed to be proactive in seeking reliable information about stroke and the perceived benefits of preventative treatment for stroke. The discussion was focused on eliciting the needs and barriers related to medication-taking self-efficacy. Patients needed to develop independence and self-reliance to overcome barriers such as dependency and low motivation. External factors such as limited information resources, low perceived severity, poor social environment, and poor communication add to the challenges of poststroke patients to improve their self-efficacy of managing their medications. Conclusions The study identified potential key findings related to the needs of patients in a localized setting, which are also related to several health behavioral concepts and constructs, indicating the importance of overcoming barriers to improve the quality of life in poststroke patients. We anticipate that the results will be taken into consideration for future personalized patient education interventions.
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Affiliation(s)
- Jamuna Rani Appalasamy
- Jeffrey Cheah School of Medicine and Health Sciences Monash University Bandar Sunway Malaysia
| | | | - Kit Mun Tan
- Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | | | | | - Siew Siang Chua
- Faculty of Health & Medical Sciences Taylor's University Subang Jaya Malaysia
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Baricich A, Picelli A, Carda S, Smania N, Cisari C, Santamato A, de Sire A, Invernizzi M. Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study. Ann Phys Rehabil Med 2019; 62:214-219. [DOI: 10.1016/j.rehab.2019.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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Bird ML, Mortenson BW, Chu F, Acerra N, Bagnall E, Wright A, Hayley K, Yao J, Eng JJ. Building a Bridge to the Community: An Integrated Knowledge Translation Approach to Improving Participation in Community-Based Exercise for People After Stroke. Phys Ther 2019; 99:286-296. [PMID: 30698783 PMCID: PMC6383711 DOI: 10.1093/ptj/pzy146] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/05/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND People who have had a stroke and are living in the community have low levels of physical activity, which reduces their functional capacity and increases risks of developing secondary comorbid conditions. Exercise delivered in community centers can address these low levels of physical activity; however, implementing evidence-based programs to meet the needs of all community stakeholders is challenging. OBJECTIVES The objective of this study was to determine implementation factors to facilitate participation in relevant exercise and physical activity for people with chronic health conditions, like stroke. DESIGN The design consisted of a qualitative observational study using an integrated knowledge translation approach. METHODS Supported by an integrated knowledge translation approach, a series of focus groups-with stakeholder group representation that included people who had had a stroke and care partners, community organizations (ie, support groups, community center staff), health care providers, and exercise deliverers-was conducted. During the focus groups, participants provided perspectives on factors that could influence implementation effectiveness. Focus groups were recorded, transcribed, and thematically analyzed. RESULTS Forty-eight stakeholders participated. Based on the themes, a new implementation model that describes the importance of relationships between community centers, clinicians, and people who have had a stroke is proposed. The development of partnerships facilitates the implementation and delivery of exercise programs for people with ongoing health needs. These partnerships address unmet needs articulated in the focus groups and could fill a gap in the continuity of care. CONCLUSIONS Data from this study support the need for the community sector to offer a continuing service in partnership with the health system and people with chronic health needs. It indicates the potential of clinicians to partner with people with chronic health conditions and empower them to improve participation in relevant health behaviors, like community-based exercise.
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Affiliation(s)
- Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - B William Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia
| | - Francis Chu
- Vancouver Coastal Health Authority, Community, Vancouver, British Columbia, Canada
| | - Nicole Acerra
- Vancouver Coastal Health Authority, Division of Physical Therapy
| | - Eric Bagnall
- West Vancouver Community Centre, Health and Wellness, Vancouver, British Columbia, Canada
| | | | | | - Jennifer Yao
- Vancouver Coastal Health Authority, Division of Physical Medicine and Rehabilitation
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, 212-2177 Westbrook Mall, Vancouver, BC, V6T 1Z3 Canada,Address all correspondence to Dr Eng at:
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Perez-Marcos D, Bieler-Aeschlimann M, Serino A. Virtual Reality as a Vehicle to Empower Motor-Cognitive Neurorehabilitation. Front Psychol 2018; 9:2120. [PMID: 30450069 PMCID: PMC6224455 DOI: 10.3389/fpsyg.2018.02120] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022] Open
Abstract
In this paper, we advocate the combination of four key ingredients that we believe are necessary to design long-lasting effective treatments for neurorehabilitation: (i) motor-cognitive training, (ii) evidence-based neuroscience principles, in particular those related to body perception, (iii) motivational games, and (iv) empowerment techniques. Then, we propose virtual reality (VR) as the appropriate medium to encompass all the requirements mentioned above. VR is arguably one of the most suitable technologies for neurorehabilitation able to integrate evidence-based neurorehabilitation techniques and neuroscience principles into motivating training approaches that promote self-management by empowering patients to own their recovery process. We discuss the advantages and challenges of such an approach on several exemplary applications and outline directions for future developments. We strongly believe that the combination of positive psychology and positive technology mediated by VR-based interventions can heavily impact the rehabilitation outcomes of motor-cognitive functions along all the stages of the rehabilitation path.
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Affiliation(s)
| | - Mélanie Bieler-Aeschlimann
- MindMaze SA, Lausanne, Switzerland.,Leenaards Memory Centre, University Hospital of Lausanne, Lausanne, Switzerland
| | - Andrea Serino
- MindMaze SA, Lausanne, Switzerland.,Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland.,Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
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Menichetti J, Graffigna G, Steinsbekk A. What are the contents of patient engagement interventions for older adults? A systematic review of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2018; 101:995-1005. [PMID: 29246493 DOI: 10.1016/j.pec.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/07/2017] [Accepted: 12/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe the contents of interventions reported in RCTs focusing on patient engagement of older adults. METHODS A systematic literature review based on a search for "patient engagement/activation/empowerment/involvement/participation". Interventions were classified according to: (i) specific components (micro level), (ii) single/multiple dimensions (educational, behavioral, affective) (meso level), and (iii) the studies' main educational, behavioral or affective dimension (macro level). RESULTS After screening 2749 articles, 35 were included. 20 unique components were identified, mostly behavioral or educational (45.5% each) (e.g., goal setting or written informational materials). Most interventions with a single-focus were classified as educational (31%), one was solely affective (3%). Half of the interventions covered more than one dimension, with four (11%) combining all three dimensions. Studies mainly focusing on the affective dimension included older participants (72 vs. 67 years), had a higher proportion of females (71% vs. 44%), and included other dimensions more frequently (67% vs. 31%) than did studies with a main focus on the educational dimension. CONCLUSION The contents of the interventions that focused on patient engagement of older adults tend to focus more on behavioral and educational dimensions than the affective dimension. PRACTICE IMPLICATIONS The possibility of adding the affective dimension into behavioral and/or educational interventions should be explored.
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Affiliation(s)
- Julia Menichetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
| | | | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
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What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14050510. [PMID: 28489044 PMCID: PMC5451961 DOI: 10.3390/ijerph14050510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/17/2017] [Accepted: 04/28/2017] [Indexed: 11/17/2022]
Abstract
Stroke is a major cause of disability and mortality worldwide; yet; prior to this study; there had been no sufficient evidence to support the effectiveness of various transitional care interventions (TCI) on the disability and mortality of stroke survivors. This meta-analysis aimed to assess the effectiveness of TCI in reducing mortality and improving the activities of daily life (ADL) of stroke patients. PubMed; Web of Science; OVID; EMBASE; CINAHL; and Sino-Med were searched for articles published before November 2016. Thirty-one randomized controlled trials (RCTs) were identified in the study. This analysis showed that the total effect of TCI on reducing mortality was limited (Risk Ratio (RR) = 0.86; 95% Confidence Interval (CI): 0.75-0.98); that only home-visiting programs could reduce mortality rates (RR = 0.34; 95% CI: 0.17-0.67) compared with usual care; and that the best intervention was led by a multidisciplinary team (MT) ≤3 months (RR = 0.19; 95% CI: 0.05-0.71). In addition; home-visiting programs also produced ADL benefit (RR = 0.56; 95% CI: 0.31-0.81). Overall; there was a statistically significant difference in improving patients' independence between TCI and usual care (RR = 1.12; 95% CI: 1.02-1.23). However; none of the interventions was effective when they were differentiated in the analysis. It is the conclusion of this study that home-visiting programs; especially those led by MTs; should receive the greatest consideration by healthcare systems or providers for implementing TCI to stroke survivors.
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