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Tsang WN, Lee JJ, Yang SC, Poon JCY, Lau EYY. Stroke caregivers' perception on instant messaging application use for psychological intervention: a qualitative study. PSYCHOL HEALTH MED 2024; 29:1208-1221. [PMID: 38528430 DOI: 10.1080/13548506.2024.2332925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/15/2024] [Indexed: 03/27/2024]
Abstract
In caring for patients with stroke, the leading cause of death and disability affecting over 80 million people worldwide, caregivers experience substantial psychological and physical burdens and difficulties in help-seeking owing to physical and time-constraints. Social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic further restricted them from using caregiver support services. While the use of telehealth emerged as a global prevailing trend during the COVID-19 pandemic, evidence for utilising instant messaging (IM) applications for psychological intervention is scanty. This study aimed to explore stroke caregivers' perceived potential utility of IM-delivered psychological intervention. Between January and August 2020, 36 adult family stroke caregivers in Hong Kong were recruited to individual telephone semi-structured interviews using purposive sampling. The interviews were audio-recorded, transcribed verbatim and analysed using an interpretive description approach. Three themes of caregivers' perceptions towards IM-delivered psychological intervention emerged: perceived high convenience and ease of use, perceived advantages that overcome existing barriers to services and message delivery tailored to individual needs. Our findings suggested that there is an imminent need among stroke caregivers for personalised psychological interventions and that IM is a potential modality for overcoming existing barriers in delivering accessible support to caregivers in real-time, real-world settings. Our study highlighted caregivers' acceptance and perceived benefits of IM-delivered psychological intervention and provided practical insights into the design of IM-delivered psychological interventions.
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Affiliation(s)
- Wing Nga Tsang
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Sook Ching Yang
- Department of Medicine, St Vincent's Hospital, Sydney, Australia
| | - Joan Chung Yan Poon
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
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Sauvé-Schenk K, Duong P, Samonte-Brown S, Sheehy L, Trudelle M, Savard J. Supporting post-stroke access to services and resources for individuals with low income: understanding usual care practices in acute care and rehabilitation settings. Disabil Rehabil 2024; 46:1391-1399. [PMID: 37067052 DOI: 10.1080/09638288.2023.2199462] [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: 10/28/2022] [Accepted: 03/30/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Following stroke, individuals who live in a low-income or are at risk of living in a low-income situation face challenges with timely access to social services and community resources. Understanding the usual care practices of stroke teams, specifically, how they support this access to services and resources, is an important first step in promoting the implementation of practice change. METHOD A qualitative multiple-case study of acute care, inpatient, and outpatient rehabilitation stroke teams in an urban area of Canada. Semi-structured interviews and questionnaires about the workplace context were conducted with 19 professionals (social workers, occupational therapists, physiotherapists, speech-language pathologists) at four sites. RESULTS In their usual practice, stroke teams prioritized immediate care needs. The stroke team professionals did not address income or resources unless it directly affected discharge. Usual care was influenced by factors such as time constraints, lack of knowledge about services and resources, and social service system limitations. CONCLUSION To better support post-stroke access to social services and resource for low-income individuals, a multidisciplinary approach, with actions beginning earlier on and extending throughout the continuum of care, is recommended, in addition to system-level advocacy.
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Affiliation(s)
- Katrine Sauvé-Schenk
- School of Rehabilitation, University of Ottawa, Ottawa, Canada
- Institut du Savoir Montfort, Ottawa, Canada
| | - Patrick Duong
- School of Rehabilitation, University of Ottawa, Ottawa, Canada
| | | | | | | | - Jacinthe Savard
- School of Rehabilitation, University of Ottawa, Ottawa, Canada
- Institut du Savoir Montfort, Ottawa, Canada
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3
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Rose D, Newman SD, Mueller M, Magwood GS, Lutz BJ. Working-Age Caregivers of Stroke Survivors: Needs, Concerns, and Quality of Life. Rehabil Nurs 2024; 49:33-43. [PMID: 38345829 DOI: 10.1097/rnj.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
PURPOSE The purpose of this study was to characterize the unmet needs and concerns of working-age caregivers of stroke survivors and to explore the relationships between these unmet needs and concerns and factors such as stroke survivor functional independence, caregiver strain, caregiver self-efficacy, caregiver perceived social support, and caregiver quality of life (QoL). DESIGN Cross-sectional descriptive design was used in this study. METHODS Participants ( N = 103) completed an online survey. Descriptive statistics, bivariate Pearson correlation, and linear regression analysis was performed. RESULTS Negative correlations were found between caregiver needs and concerns and both stroke survivor functional independence and caregiver self-efficacy. Positive correlations were identified between caregiver needs and concerns and caregiver strain. In multiple regression models, stroke survivor functional independence, caregiver self-efficacy, race, and gender were statistically significantly associated with caregiver QoL. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING Results of this study can inform nurses as they collaborate with informal caregivers and researchers in optimizing the rehabilitation and discharge process and aiding in the support of caregiver QoL. CONCLUSION Working-age caregivers of stroke survivors expressed many needs and concerns. These needs, along with other factors, can affect outcomes including QoL in caregivers and stroke survivors.
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Affiliation(s)
- Dixie Rose
- The University of Texas at Tyler, Tyler, TX, USA
| | - Susan D Newman
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Barbara J Lutz
- University of North Carolina Wilmington, Wilmington, NC, USA
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Chiu V, Fields BE, Lin YN, Kang JH, Han DS, Wu YH, Su Y, Skidmore ER, Chang FH. Implementing strategy training in Taiwan: perspectives of individuals with Acquired brain injury. Disabil Rehabil 2024; 46:1121-1129. [PMID: 36970997 DOI: 10.1080/09638288.2023.2191013] [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: 07/29/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity-related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training. MATERIALS AND METHODS Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis. RESULTS This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training. CONCLUSIONS All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts.IMPLICATIONS FOR REHABILITATIONStrategy training provides clients the opportunity to actively engage in their own goal setting and decision making.Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities.Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community.Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training.
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Affiliation(s)
- Valeria Chiu
- Department of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Beth E Fields
- Occupational Therapy Program, Department of Kinesiology, University of Wisconsin-Madison, Madison, MI, USA
| | - Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu Su
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Shapiro-Rosenbaum A, Jaffe MP. Education, Training, and Support Across the Continuum of Recovery for Caregivers of Persons with Disorders of Consciousness. Phys Med Rehabil Clin N Am 2024; 35:193-208. [PMID: 37993189 DOI: 10.1016/j.pmr.2023.06.015] [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] [Indexed: 11/24/2023]
Abstract
Evolving knowledge highlights the deleterious effects of caregiving on the emotional, psychosocial, and financial well-being of caregivers of persons with disorders of consciousness (DoC). Current practice guidelines and minimal competency recommendations emphasize the importance of identifying and addressing DoC caregiver needs. This article serves as a dissemination tool to enhance communication between providers and caregivers. Essential components of education and training are outlined for each level of care. Addressing caregiver needs may mitigate the level of perceived burden, reduce the risk of burnout, and increase care proficiency and likelihood of community discharge, thus potentially reducing long-term costs of care for this population.
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Affiliation(s)
- Amy Shapiro-Rosenbaum
- Department of Brain Injury Rehabilitation, Park Terrace Care Center, Queens, NY, USA; TBI Model System, Icahn School of Medicine at Mount Sinai, New York, NY, USA; BrainMatters Neuropsychological Services, PLLC, Plainview, NY, USA.
| | - Michelle P Jaffe
- Department of Brain Injury Rehabilitation, Park Terrace Care Center, Queens, NY, USA; BrainMatters Neuropsychological Services, PLLC, Plainview, NY, USA; North Shore University Hospital, Northwell Health, Kings Point, NY, USA
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6
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Fowler K, Mayock P, Byrne E, Bennett K, Sexton E. "Coming home was a disaster, I didn't know what was going to happen": a qualitative study of survivors' and family members' experiences of navigating care post-stroke. Disabil Rehabil 2024:1-13. [PMID: 38265039 DOI: 10.1080/09638288.2024.2303368] [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: 07/01/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Understanding navigational barriers and facilitators has the potential to advance equitable stroke care delivery. The aim of this study was to explore, using a qualitative study, the experiences of stroke survivors and their families as they journey through the stroke care system, both before and during the COVID-19 pandemic. METHODS In-depth semi-structured interviews were conducted with 18 stroke survivors and 12 family members during 2021 and 2022. Participants were recruited through voluntary organisations, social media, and stroke support groups. Data analysis followed a systematic process guided by the framework method with steps including familiarisation, coding, framework development, and charting and interpretation. RESULTS The experiences of navigating stroke care were particularly challenging following discharge from hospital into the community. Barriers to stroke care continuity included insufficient appropriate services and information, unsatisfactory relationships with healthcare professionals and distressed mental health. There were particular navigational challenges for survivors with aphasia. Facilitators to effective navigation included having prior knowledge of the health system, harnessing support for care co-ordination, and being persistent. CONCLUSION Greater support for patient navigation, and person-centred referral pathways, particularly during times of increased pressure on the system, have the potential to improve access to services and wellbeing among stroke survivors.
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Affiliation(s)
- Karen Fowler
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eithne Sexton
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Yang P, Ma M, Guan Q, Du X, Fan Y. Assessing the needs of informal caregivers of patients with chronic non-communicable diseases: A systematic review of self-assessment tools. Nurs Open 2023; 10:7467-7486. [PMID: 37789573 PMCID: PMC10643841 DOI: 10.1002/nop2.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 05/25/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
AIM To synthesize self-administrated needs assessment tools of informal caregivers for patients with chronic non-communicable diseases (CNCDs), evaluate the quality of psychometric properties and identify main needs assessment themes. DESIGN Systematic review. METHODS Eight electronic databases both in English and Chinese were searched for. The psychometric properties of tools were evaluated according to the quality criteria for good psychometric properties developed by Terwee et al. Both the content analysis and thematic extraction methods were used. Needs assessment themes were categorized based on the 7-level Maslow's Hierarchy of Needs Theory. RESULTS A total of 17 tools were synthesized. Thirteen of them targeted informal caregivers of patients with cancer. The psychometric properties evaluated for most of these tools were content validity, internal consistency and construct validity. A total of 27 needs themes were identified and matched to six levels based on the 7-level Maslow's Hierarchy of Needs theory, besides the aesthetic needs level. NO PATIENT OR PUBLIC CONTRIBUTION No primary data are being collected.
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Affiliation(s)
- Panpan Yang
- School of NursingBinzhou Medical UniversityYantaiShandongChina
| | - Mengzhen Ma
- School of NursingBinzhou Medical UniversityYantaiShandongChina
| | - Qingyi Guan
- School of NursingBinzhou Medical UniversityYantaiShandongChina
| | - Xingbin Du
- School of NursingBinzhou Medical UniversityYantaiShandongChina
| | - Yanyan Fan
- School of NursingBinzhou Medical UniversityYantaiShandongChina
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Shafer JS, Haley KL, Jacks A. Barriers to Informational Support for Care Partners of People With Aphasia After Stroke. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2211-2231. [PMID: 37566895 DOI: 10.1044/2023_ajslp-22-00391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Care partners of people with aphasia after stroke need various informational supports, such as aphasia education and resources for psychosocial support. However, informational support may vary across clinicians, and access to these supports remains a persistent unmet need. Using implementation science frameworks can help to assess the gap between what is known about an issue and what is occurring in practice. AIM The aim was to identify barriers to providing informational support for care partners of people with aphasia after stroke. METHOD AND PROCEDURE We performed a secondary analysis of qualitative data collected from two of our previous studies. New themes were identified by comparing feedback from both speech-language pathologists and care partners, and previously assigned codes were interpreted relative to the Knowledge to Action (KTA) framework. OUTCOMES AND RESULTS We identified four implementation themes that were specifically related to the action cycle of the KTA framework: (a) Aphasia rehabilitation tends to exclude care partners, (b) aphasia rehabilitation can be hard to understand, (c) structure is lacking for care partner check-ins, and (d) care partner informational support rarely extends beyond the acute phases of recovery. CONCLUSION The results suggest that changes are needed at both systemic and care provider levels to ensure that tailored information is provided to care partners of people with aphasia.
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Affiliation(s)
- Jennifer S Shafer
- Program on Integrative Medicine, The University of North Carolina at Chapel Hill
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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9
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Sperber NR, Boucher N, Hughes JM, Bruening R, Zullig LL, Decosimo K, Tucker M, Christensen LA, Allen KD, Hastings SN, Van Houtven CH. Mandated Caregiver Training in the Veterans Health Administration: Caregiver Inquiry Informs National Dissemination. THE GERONTOLOGIST 2023; 63:534-544. [PMID: 36327120 PMCID: PMC10461180 DOI: 10.1093/geront/gnac162] [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: 03/15/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported the implementation and expansion of caregiver training and support. The Department of Veterans Affairs (VA) has developed a national Caregiver Support Program and collaborated with VA health services researchers to explore caregivers' acceptance of an evidence-based training program in preparation for system-wide dissemination. RESEARCH DESIGN AND METHODS This approach entailed a convergent mixed-methods design, which involved separate analyses of quantitative and qualitative data. Survey questions based on the Kirkpatrick model for training evaluation measured caregivers' reaction and learning, and interview questions elicited caregivers' reports about the value of the program for them. RESULTS Most caregivers reported satisfaction with the training when responding to survey questions, although qualitative interviews revealed caveats suggesting need to hone the best timing and specific group of caregivers for maximal benefit. DISCUSSION AND IMPLICATIONS Our findings indicate that understanding program-user fit may be particularly critical when implementing training for caregivers as they come to the program at different points along their caregiving journey, needing differing types and intensities of support. While a general program may appeal to policymakers aiming to scale caregiver training within a large, heterogeneous system, there may be shortcomings in terms of end-user acceptance and subsequent downstream outcomes such as reach and ultimately program effectiveness. Good, iterative communication flow between program developers and policymakers facilitates this understanding and, in turn, decisions about scaling.
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Affiliation(s)
- Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Nathan Boucher
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca Bruening
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Leah A Christensen
- Veteran's Health Administration Central Office, Washington, District of Columbia, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
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10
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Forster A, Ozer S, Brindle R, Barnard L, Hardicre N, Crocker TF, Chenery M, Moreau L, Wright A, Burton LJ, Hartley S, Hulme C, Dawkins B, Holloway I, House A, Hewison J, Farrin A. An intervention to support stroke survivors and their carers in the longer term: results of a cluster randomised controlled feasibility trial (LoTS2Care). Pilot Feasibility Stud 2023; 9:40. [PMID: 36922866 PMCID: PMC10015731 DOI: 10.1186/s40814-023-01258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND To address the limited provision of longer-term stroke care, we conducted a programme of research (LoTS2Care) to develop and test an intervention to form part of a replicable longer-term care strategy. New Start, a programme of facilitated self-management, was developed to be delivered at 6 months post-stroke by trained facilitators. Here, we report the findings from the final workstream of this programme, which aimed to evaluate the feasibility and acceptability of implementing a future definitive cluster randomised controlled trial of the developed intervention (New Start) to support stroke survivors and their carers in the longer term. METHODS A feasibility cluster randomised controlled trial was conducted in English and Welsh NHS stroke services. Stroke services (clusters) were randomised on a 1:1 basis to implement New Start or continue with usual care only. Community-dwelling stroke survivors between 4 and 6 months post-stroke were invited to participate in the trial by post. Outcome measures were collected via post at 3, 6 and 9 months after recruitment. Recruitment and follow-up rates, delivery and uptake of the intervention, data collection feasibility (including postal outcome measures of health and disability, mental well-being at 3, 6, and 9 months post-recruitment) and safety were assessed. RESULTS Ten stroke services were recruited. A total of 1127 stroke survivors were screened for participation, and 269 were registered (New Start, n = 145; usual care, n = 124). Retention was high with 239 (89%) stroke survivors being available for follow-up at 9 months, and high return rates of postal questionnaires were achieved (80.3% at 9 months). Intervention training was successfully delivered, and New Start was offered to 95.2% of trial participants in the intervention arm. Uptake was variable, however, ranging from 11.8 to 75.0%. There were no safety concerns. CONCLUSIONS Stroke service recruitment and longer-term stroke survivor postal recruitment and outcome data collection are feasible; however, refinement of intervention targeting and delivery is required prior to undertaking a definitive trial. TRIAL REGISTRATION ISRCTN38920246. Registered 22 June 2016 ( http://www.isrctn.com/ISRCTN38920246 ).
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Marie Chenery
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK.,Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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11
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MARTIN RA, JOHNS JK, HACKNEY JJ, BOURKE JA, YOUNG TJ, NUNNERLEY JL, SNELL DL, DERRETT S, DUNN JA. Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke. J Rehabil Med 2023; 55:jrm00363. [PMID: 36748979 PMCID: PMC9926496 DOI: 10.2340/jrm.v55.4825] [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: 10/03/2022] [Accepted: 11/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rates of return-to-work after stroke are low, yet work is known to positively impact people's wellbeing and overall health outcomes. OBJECTIVE To understand return-to-work trajectories, barriers encountered, and resources that may be used to better support participants during early recovery and rehabilitation. PARTICIPANTS The experiences of 31 participants (aged 25-76 years) who had or had not returned to work after stroke were explored. METHODS Interview data were analysed using reflexive thematic analysis methods within a broader realist research approach. RESULTS Participants identified an early need to explore a changed and changing occupational identity within a range of affirming environments, thereby ascertaining their return-to-work options early after stroke. The results articulate resources participants identified as most important for their occupational explorations. Theme 1 provides an overview of opportunities participants found helpful when exploring work options, while theme 2 explores fundamental principles for ensuring the provided opportunities were perceived as beneficial. Finally, theme 3 provides an overview of prioritized return-to-work service characteristics. CONCLUSION The range and severity of impairments experienced by people following stroke are broad, and therefore their return-to-work needs are diverse. However, all participants, irrespective of impairment, highlighted the need for early opportunities to explore their changed and changing occupational identity.
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Affiliation(s)
- Rachelle A. MARTIN
- Burwood Academy Trust, Christchurch,Department of Medicine, University of Otago Wellington
| | | | | | - John A. BOURKE
- Burwood Academy Trust, Christchurch,Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin
| | | | - Joanne L. NUNNERLEY
- Burwood Academy Trust, Christchurch,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch
| | - Deborah L. SNELL
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch
| | - Sarah DERRETT
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jennifer A. DUNN
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch
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12
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Berg A, Tapiola T, Hujala M. Spouses' need for information and satisfaction with the patient's care and rehabilitation after stroke. Importance of depression and prescheduled follow-up. PATIENT EDUCATION AND COUNSELING 2023; 107:107589. [PMID: 36508974 DOI: 10.1016/j.pec.2022.107589] [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: 05/18/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES We aimed to study the information needs of the spouses of stroke survivors, and whether the functional ability, depressive mood, or demographic factors of the survivors or spouses associate with the information needs or satisfaction with care. We also investigated whether prescheduled follow-up improves information provision. METHODS Ninety-six spouses of consecutive stroke survivors completed a questionnaire on their information needs and satisfaction with care 21 months post-stroke. The results of samples before (n = 59) and after (n = 37) the implementation of the prescheduled follow-up were compared. RESULTS Before the follow-up, 75% of the spouses had received information on stroke and the well-being of the survivor, with 31% having received information on the survivors' and 18% on the spouses' own mood. The information provision improved after the follow-up: 86%, 44%, and 50%, respectively. The need for more information and satisfaction with care were associated with the spouse's depression, but not with functional impairment. CONCLUSIONS Even if information on stroke is satisfactorily provided, the mood and well-being of spouses is often neglected. Information provision and support can be improved with systematic prescheduled follow-up. PRACTICE IMPLICATIONS Our results suggest the routine assessment of the depressive symptoms and needs of spouses of stroke survivors.
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Affiliation(s)
- Anu Berg
- Neurological Unit, South Karelia Central Hospital, South Karelia Social and Health Care District, Lappeenranta, Finland.
| | - Tero Tapiola
- Neurological Unit, South Karelia Central Hospital, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Maija Hujala
- School of Business and Management, Lappeenranta-Lahti University of Technology LUT, Lappeenranta, Finland
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Lobo EH, Frølich A, Abdelrazek M, Rasmussen LJ, Grundy J, Livingston PM, Islam SMS, Kensing F. Information, involvement, self-care and support-The needs of caregivers of people with stroke: A grounded theory approach. PLoS One 2023; 18:e0281198. [PMID: 36719929 PMCID: PMC9888718 DOI: 10.1371/journal.pone.0281198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Globally, stroke is a leading cause of death and disability, with most care undertaken by caregivers who are generally family and friends without prior experience of care. The lack of experience or unpreparedness results in feelings of uncertainty, burnout, anxiety, burden, etc. Hence, it is necessary to identify the needs of caregivers to better support them in their caregiving journey and improve the quality of care delivered. METHODS The study employed a grounded theory methodology that utilizes information gathered from literature reviews and social media to represent the needs and create a storyline visually. The storyline is further refined and evaluated using an online survey of 72 participants recruited through online stroke caregiving communities. RESULTS The study identified four core categories of needs: (i) Information: sufficient information delivered in layman's terms based on the individual situation of the caregiver and survivor through oral and hands-on demonstrations, (ii) Involvement: inclusion in the decision-making processes at different stages of recovery through face-to-face communication at the hospital, (iii) Self-care: ability to engage in work and leisure activities, (iv) Support: receive support in the form of resources, services and finances from different other stakeholders. CONCLUSIONS There is a need to create a caregiver-centered approach in stroke recovery to ensure limited obstruction to care and reduced uncertainty in stroke recovery. Moreover, through the inclusion of caregivers in stroke recovery, it may be possible to reduce the burden of care to the caregiver and ensure the satisfaction of the healthcare system throughout stroke recovery.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | | | | | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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14
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Effect of an individualized digital coaching program on swallowing function in stroke patients. Acta Neurol Belg 2022:10.1007/s13760-022-02153-2. [DOI: 10.1007/s13760-022-02153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
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15
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Enoch J, Dickinson C, Potts J, Subramanian A. An exploratory study on support for caregivers of people with vision impairment in the UK. Ophthalmic Physiol Opt 2022; 42:858-871. [PMID: 35416314 PMCID: PMC9320821 DOI: 10.1111/opo.12989] [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: 11/24/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
Purpose Many of the UK's 2.5 million individuals living with vision loss receive support from relatives or friends (so‐called ‘informal caregivers’). However, there is limited understanding of how caregivers of people with visual impairment (PVI) are, or feel, supported by UK healthcare/statutory services and charities. This exploratory study was conducted to explore caregivers' experiences and their suggestions for enhancing support. Methods Participants self‐identifying as UK‐based caregivers of PVI (N = 100) volunteered to undertake an online survey, distributed through charity partners. The survey was comprised of the Client Satisfaction Questionnaire‐8 (CSQ‐8, a validated, self‐report measure of satisfaction with support services), Likert‐type questions and two open‐ended, free‐text questions. Interview participants (N = 22) were then selected from survey respondents, and semi‐structured interviews were conducted to focus on caregivers' ideas for improving support. The Framework Method was used for inductive analysis of the free‐text question responses and interview data. Results The mean (SD) CSQ‐8 score was 21.60 (7.2), with no significant differences by demographic, relationship or vision‐related factors, likely limited by the small subgroup sizes. Qualitative data demonstrated the heterogeneity of participating caregivers' experiences, highlighting the importance of personalised support for caregivers. Many participants advocated enhancing informational, practical, emotional and social support for caregivers, and stressed the importance of accessible services and consistent points of contact to turn to for support and advice. Conclusions Although our sample was arguably better connected to support services than the general caregiver population, this study identified concrete suggestions to improve practical, emotional and peer support for caregivers of PVI.
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Affiliation(s)
- Jamie Enoch
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Christine Dickinson
- Division of Pharmacy & Optometry, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | | | - Ahalya Subramanian
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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16
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“Everything Is Changing, but I Am Not Alone”: Nurses’ Perceptions of Social Support during COVID-19. SUSTAINABILITY 2022. [DOI: 10.3390/su14063262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
COVID-19 has created numerous stressors for nurses, which have impacted their work, self-efficacy, and wellness. Social support helps manage stress and burnout. Through 24 semi-structured interviews, the current article explores the perspectives of nurses who worked with COVID-19 patients in the initial days of the pandemic in the United States. This study unpacks the types and sources of social support nurses sought during this time, especially as they faced significant burnout. Through thematic analysis, the current study found that these nurses interacted with the crisis situation to evaluate their social support needs and the plausibility of fulfilling these needs. They focused on the support that was available or at least perceived to be available and let go of certain needs that could not plausibly be addressed in that moment. Peer-to-peer support was critical during this process, and nurses avoided sharing concerns with their families as they enacted protective buffering. The findings also highlight the complex and dynamic nature of social support as nurses interact with their peers and evaluate the support they receive. Peers helped with haptic support like providing hugs to coworkers, and at times even became surrogates for coworkers’ family members as they participated in communal coping. Organizational support was critical for sharing information centrally with nurses and for organizational sustainability.
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17
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Elsheikh MA, Moriyama M, Rahman MM, Kako M, El-Monshed AH, Zoromba M, Zehry H, Khalil MH, El-Gilany AH, Amr M. Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: a randomised controlled trial. BMJ Open 2022; 12:e049741. [PMID: 35168963 PMCID: PMC8852666 DOI: 10.1136/bmjopen-2021-049741] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a tailored multidimensional intervention in reducing the care burden of family caregivers of stroke survivors. This intervention considered caregivers' perceived needs and incorporated three evidence-based dimensions (psychoeducation, skill-building and peer support). DESIGN A prospective randomised control trial. SETTING A community-based study conducted in Egypt. PARTICIPANTS A total of 110 caregivers aged ≥18 years who cared for a survivor within 6 months of stroke, with modified Rankin Scale scores of 3-5, and without other physical disabilities or terminal illnesses were recruited between December 2019 and May 2020. Participants were assigned to the intervention group (IG; n=55) and control group (CG; n=55) through open-label, parallel 1:1 randomisation. INTERVENTION The IG was provided with tailored multidimensional interventions for 6 months until November 2020, including three home visits, six home-based telephone calls and one peer-support session. The CG received simple educational instructions at a single visit. OUTCOME The participants completed the Zarit Burden Interview (primary outcome) and the WHO Quality of Life-BREF (secondary outcome) before the intervention (T0), at 3 months (T1) and at 6 months (T2). RESULTS No differences were observed between the characteristics of the groups at baseline (T0). The independent t-test showed no significant differences in the care burden and Quality of Life (QoL) at T1 and T2 between the groups. The intervention had no significant effect on the outcomes between or within groups over time, as shown by the repeated-measures analysis of variance. However, the group and time interaction had significant main effects on caregivers' QoL (psychological and social domains). CONCLUSION The main results showed that participants in the IG did not experience an improvement in the main outcomes. Nevertheless, the improvement in the psychological and social domains may have been attributed to our intervention. TRIAL REGISTRATION NUMBER NCT04211662.
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Affiliation(s)
- Mahmoud Ahmed Elsheikh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ahmed Hashem El-Monshed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Nursing Department, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
| | - Mohamed Zoromba
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Hamada Zehry
- New Mansoura General Hospital, Neurology, Egypt Ministry of Health and Population, Mansoura, Egypt
| | - Maha Hazem Khalil
- Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mostafa Amr
- Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Formal Health and Social Services That Directly and Indirectly Benefit Stroke Caregivers: A Scoping Review of Access and Use. Can J Nurs Res 2022; 54:211-233. [PMID: 35130749 PMCID: PMC9109593 DOI: 10.1177/08445621211019261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Stroke can be a life altering event that necessitates considerable amounts of
formal and informal care. The impacts of stroke often persist over time
requiring ongoing support for stroke survivors. Family members provide the
majority of care and experience many life changes as a result of their
caregiving role including social, financial, employment and health impacts.
Formal supports such as counselling, respite, and health promotion initiatives
that directly benefit caregivers or benefit them indirectly through supporting
the stroke survivor, are well-placed to help caregivers manage their caregiving
role. However, to date little is known about formal service use by stroke
caregivers and the factors that influence their service use. This scoping review
provides a critique and synthesis of what is known about stroke caregivers’
access and use of formal services intended to support them. Findings suggest
that while services are available, caregivers’ ability to use them are impacted
by both facilitators and barriers. Facilitators included: sex, age, and having a
higher household income (depending on services used). Barriers included: high
cost, poor service quality and deficient knowledge/communication regarding
service availability. This review highlights a significant gap in our knowledge
of caregivers’ experience in accessing and using formal services.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Burns SP, Lutz BJ, Magwood GS. 'Timing it Right': needs of African American adults with stroke and their caregivers across the care continuum. ETHNICITY & HEALTH 2022; 27:420-434. [PMID: 31752519 DOI: 10.1080/13557858.2019.1693512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 11/02/2019] [Indexed: 06/10/2023]
Abstract
Objective: African Americans are disproportionately affected by stroke in the United States (US). The purpose of this study is to explore experiences, wants, and needs of African Americans with stroke and their family caregivers residing in the stroke belt across the care continuum using the 'Timing It Right' (TIR) framework as a conceptual guide.Design: We conducted a series of focus groups among 20 African Americans living with stroke and 19 family caregivers. Focus groups were audio-recorded and transcribed verbatim. For this secondary analysis, we coded qualitative data using the TIR framework.Results: Participants in this sample identified pre-stroke needs in addition to the TIR phases that span across the care continuum and into community living. We identified four important contextual factors and real-world conditions that operate in the background and influence the post-stroke needs of this specific population across the TIR framework: (1) religion, faith, and church, (2) healthcare delivery, (3) community, and (4) sentinel events.Conclusions: We propose a TIR model that expands upon the original TIR framework which includes factors important for consideration when developing and delivering community-based interventions among African Americans with stroke and family caregivers in the southeastern US.
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Affiliation(s)
- Suzanne Perea Burns
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
| | - Barabara J Lutz
- College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Gayenell S Magwood
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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20
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Mulder M, Nikamp C, Nijland R, van Wegen E, Prinsen E, Vloothuis J, Buurke J, Kwakkel G. Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial. BMC Neurol 2022; 22:29. [PMID: 35039010 PMCID: PMC8762867 DOI: 10.1186/s12883-021-02533-w] [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: 09/28/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke. METHODS A multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up. RESULTS During 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist. CONCLUSIONS We hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services. TRIAL REGISTRATION Netherlands Trial Register, NL7422 . Registered 11 December 2018.
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Affiliation(s)
- Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Corien Nikamp
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Rinske Nijland
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
| | - Erik Prinsen
- Roessingh Research and Development, Enschede, The Netherlands.,Department op Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Roessingh, Centre for Rehabilitation, Enschede, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands. .,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands. .,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
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Abstract
OBJECTIVE Family caregiving research has evolved since its inception in the late 1970s. The objective of this brief report was to summarize the research areas and findings to date with the goal of highlighting directions for future research. DESIGN Narrative review. SETTING Not applicable. PARTICIPANTS Published scientific articles in neurological populations including spinal cord injury, traumatic brain injury, and stroke. INTERVENTIONS Not applicable. OUTCOME MEASURES Not applicable. RESULTS Caregiving research began with a description of the impact of providing care on caregiver health and wellbeing. Intervention research followed to support caregivers in their role and improve caregiving outcomes. Recent reviews conclude a "one size fits all" intervention will not be sufficient to support caregivers. New research suggests caregivers have different patterns of adjustment to the caregiving role highlighting heterogeneity in the caregiving population. Research is also advancing to support patients and families as they transition across care environments by enhancing the timing of intervention delivery. Health care systems do not routinely adopt evidence-based caregiver interventions. As a result, recent research has begun to identify factors that influence the adoption of evidence-based caregiver interventions by health care systems. Ultimately, family centered care that addresses the needs of not only the patient but also the caregiver may be the best way to meet the needs of a heterogeneous group of caregivers across the care continuum. CONCLUSIONS Family caregivers make an important contribution to the health and wellbeing of individuals with spinal and other neurological conditions. Ultimately, system changes, like family centered care, may be best suited to meet the complex needs of this heterogeneous group of caregivers.
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Affiliation(s)
- Jill I. Cameron
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Jill I. Cameron, Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 160–500 University Ave., Office room 922, Toronto, ONM5G 1V7, Canada; Ph: 416-978-2041 (office); 416-523-4689 (cell). ; @Caregiving_UofT
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Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev 2021; 11:CD001919. [PMID: 34813082 PMCID: PMC8610078 DOI: 10.1002/14651858.cd001919.pub4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety. SEARCH METHODS We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews. SELECTION CRITERIA Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence. MAIN RESULTS We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being. AUTHORS' CONCLUSIONS Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
| | - Peter Knapp
- Department of Health Sciences, University of York and the Hull York Medical School, York, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
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Tiwari S, Joshi A, Rai N, Satpathy P. Impact of Stroke on Quality of Life of Stroke Survivors and Their Caregivers: A Qualitative Study from India. J Neurosci Rural Pract 2021; 12:680-688. [PMID: 34737502 PMCID: PMC8559087 DOI: 10.1055/s-0041-1735323] [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] [Indexed: 10/26/2022] Open
Abstract
Objectives Stroke is a significant global public health challenge attributable to an array of disabilities it causes alongside an impairment in cognition. The monetary impact of stroke care includes acute treatment expenses as well as outrageous expenses of postdischarge chronic hospital care and rehabilitation services. The current study aimed to study the perceptions along with experiences of stroke survivors and caregivers. Materials and Methods In-depth interviews (IDIs) of stroke survivors and their primary caregivers were conducted at their home 2 months after their discharge from the hospital in Bhopal, India. These IDIs were later analyzed. Results The following eight themes emerged: pervasive and irreversible, multifunction loss and dependency, holistic impact on the health of person and family, money and matter, nonaccommodative cost and baffled belief, professional paralysis, social crisis, and slow and obscured progress. The added obligation of taking care of a disabled stroke survivor along with adjusting their own lifestyle with financial apprehensions, worry about future, prolonged hours of care, and stress are major factors that increase the burden of the caregivers. Conclusion Caregivers should be sensitized with proper counseling and training through health care institutions to ensure appropriate care and management of stroke survivors at home, as it will also help in addressing their psychosocial needs, and minimizing the knowledge gap, doubts and uncertainties about the disease and its aftereffects.
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Affiliation(s)
- Sharad Tiwari
- National Mental Health Program, National Health Mission, Madhya Pradesh, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Parmeshwar Satpathy
- Department of Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
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Girardi G, Farnese ML, Scarponi F, De Tanti A, Bartolo M, Intiso D, Formisano R, Antonucci G. User-centered practices in the eyes of informal caregivers of in-patients with severe acquired brain injury: needs, caring experience, and satisfaction. Brain Inj 2021; 35:1402-1412. [PMID: 34487469 DOI: 10.1080/02699052.2021.1972338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study examines the perceived needs, experience, and satisfaction of informal caregivers (ICGs) in in-hospital settings, related to their involvement in the design and delivery of services together with hospital staff, namely co-production. DESIGN To obtain a picture of current ICG-staff relationship, a multicenter observational study was carried out. Participants were 75 ICGs recruited in five dedicated in-patient neurorehabilitation wards. Participants answered a self-report questionnaire tapping perceived information/communication needs, emotional/social needs, and their satisfaction; family-centered practices implemented by the staff (namely involving practices and cooperative communication); and ICGs' satisfaction with the service. RESULTS Need satisfaction related positively to staff practices aimed at involving IGCs in treatment and training, but not in decision-making. Involving practices concerning treatment also related positively to ICGs' information/communication needs. In addition, the more the staff involved ICGs in decision-making and promoted cooperative communication regarding treatment, the more ICGs felt that their collaboration in the healthcare process was valuable. Finally, all involvement practices and cooperative communication were positively related to ICGs' overall satisfaction with the service. CONCLUSION The results of the study help to identify gaps in meeting ICGs' needs and to promote strategies to implement family participation toward co-production in in-hospital settings.
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Affiliation(s)
- Giovanna Girardi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Antonio De Tanti
- Istituto S. Stefano Riabilitazione, Centro Cardinal Ferrari, Fontanellato, PR, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA Zingonia, Bergamo, Italy
| | - Domenico Intiso
- UOC di Medicina Fisica e Riabilitativa, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCSS Santa Lucia Foundation, Rome, Italy
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25
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Kristensson L, Björkdahl A. Experience of Information Provision at the Stroke Unit From the Perspective of Relatives to Stroke Survivors. Rehabil Process Outcome 2021; 9:1179572720947086. [PMID: 34497469 PMCID: PMC8282136 DOI: 10.1177/1179572720947086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/11/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Stroke not only affects the stroke survivor, it also significantly affects their families. Given the important supportive role that relatives of stroke survivor have, they should receive information that helps them plan and cope with the new situation. The objective of the study was to explore how relatives to stroke survivors perceived the information provided by the stroke unit. Methods: This qualitative study was based on extensive semi-structured interviews with an inductive approach. A heterogeneous convenience sample of relatives to stroke survivor (n=14) was selected. Qualitative content analysis served to analyze the transcribed interview texts. Results: The content analysis yielded four categories, each with 2–3 subcategories. The overall theme was “to be acknowledged or not”: it encompassed the underlying meaning and the relationships between the categories. The four categories were as follows: shifting information needs; striving for information; lacking of continuity and structure; and taking part and being acknowledged. Conclusions: The study highlighted that the relatives of stroke survivors have a strong need for information and showed that the relatives experienced that they did not always feel satisfactorily informed and supported by the healthcare professionals in the stroke unit. A challenge for the healthcare professionals was to be able to give the right information at the right time and in the appropriate way. The study also showed that when the relatives were acknowledged and invited to participate in the rehabilitation process, they were less anxious of the discharge.
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Affiliation(s)
- Linda Kristensson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg.,Institute of Neuroscience and Physiology, Department of Occupational Therapy, Sahlgrenska Academy, University of Gothenburg
| | - Ann Björkdahl
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg.,Institute of Social Science, Ersta Sköndal Bräcke University Collage, Campus Bräcke, Gothenburg
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26
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Wasilewski MB, Cimino SR, Kokorelias KM, Simpson R, Hitzig SL, Robinson L. Providing Rehabilitation to Patients Recovering from COVID-19: A Scoping Review. PM R 2021; 14:239-258. [PMID: 34240576 PMCID: PMC8441670 DOI: 10.1002/pmrj.12669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022]
Abstract
Objective To synthesize the nature and extent of research on rehabilitation care provision to patients with COVID‐19. Specifically, we aimed to (1) describe the impact of COVID on patients and associated rehabilitation needs, (2) outline the adaptations and preparations required to enable the provision of COVID rehabilitation, (3) describe the types of rehabilitation services and treatments provided to COVID patients, and (4) identify barriers and facilitators to delivering COVID rehabilitation. Literature Survey We searched Medline, PsychINFO, Embase, and CINAHL on June 26, 2020 using key words such as “rehabilitation,” “physical medicine,” “allied health professionals,” and variations of “COVID.” The search was updated on October 13, 2020. We included articles published in English and that focused on some aspect of COVID rehabilitation for adults. We excluded articles focused on pediatric populations and those not focused (or minimally focused) on rehabilitation for COVID patients. Methodology Data were charted based on article type (ie, primary data, secondary data, guidelines). Key information extracted included (1) COVID sequelae; (2) rehabilitation adaptations; (3) structure, function, and content of rehabilitation services/programs; (4) facilitators and/or barriers to providing COVID rehabilitation; and (5) recommendations for COVID rehabilitation programming. Data were synthesized narratively. Synthesis In total, 128 articles were included in the review that reported primary data (n = 33), secondary data (n = 82), and clinical practice/patient self‐management guidelines (n = 13). Evidence begins to suggest that rehabilitation is necessary and valuable for addressing COVID‐related declines in health, function, and well‐being. Most articles recommended that an individualized rehabilitation program be provided across the continuum of care by an interdisciplinary team of professionals and that the nature and extent of rehabilitation be informed by the care setting and COVID severity. Most issues that challenged COVID rehabilitation delivery were directly addressed by the facilitators and adaptations identified. Conclusions Future recommendations include a greater emphasis on the psychosocial aspects of COVID rehabilitation, inclusion of families in rehabilitation planning, and the use of qualitative approaches to complement clinical data.
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27
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Chen D, Zhu J, Xu Q, Wang F, Ji C, Di H, Yuan P, Bai X, Chen L. The role of informal caregivers for patients with glioma: a systematic review and meta-synthesis of qualitative studies. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1020. [PMID: 34277820 PMCID: PMC8267327 DOI: 10.21037/atm-21-2761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022]
Abstract
Background This study aimed to systematically review, appraise, and synthesize the current evidence on the experiences and needs encountered by informal caregiver of patients with glioma throughout the disease trajectory and to provide a set of practical implications for health professionals. Methods Seven English databases and four Chinese databases were searched in this systematic review and meta-analysis. Additional manual searches were completed to identify primary studies, with the language limited by English and Chinese. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used to appraise the methodological quality of each study. Results The systematic review included 16 papers that yielded 71 findings and 6 categories. Finally, 2 synthesized findings were extracted: (I) role transition of caregivers for glioma patients throughout the disease trajectory; (II) support and information need by caregivers of glioma patients. Accordingly, there is a need to recognize the importance of permanent and tailored support for caregivers by providing accurate, practical, and evidence-based information. Discussion This is the first attempt to systematically evaluate the breadth and quality of the literature concerning the experiences of caregivers with glioma patients. The results generated from the review may shed some light on problems encountered by glioma patients and their families. A limitation of this review is that in most selected studies, the reflexivity of interviewees is not addressed, which may influence the interpretation of the findings. Moreover, the selected studies were reported in English or Chinese, therefore, caution is needed in interpreting the results.
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Affiliation(s)
- Dan Chen
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jinfeng Zhu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Medical School of Nanjing University, Nanjing, China
| | - Qiuning Xu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Fang Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cuiling Ji
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hengdan Di
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ping Yuan
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoyan Bai
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lu Chen
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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28
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Optimizing Critical Illness Recovery: Perspectives and Solutions From the Caregivers of ICU Survivors. Crit Care Explor 2021; 3:e0420. [PMID: 34079948 PMCID: PMC8162533 DOI: 10.1097/cce.0000000000000420] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: To understand the unmet needs of caregivers of ICU survivors, how they accessed support post ICU, and the key components of beneficial ICU recovery support systems as identified from a caregiver perspective. Design: International, qualitative study. Subjects: We conducted 20 semistructured interviews with a diverse group of caregivers in the United States, the United Kingdom, and Australia, 11 of whom had interacted with an ICU recovery program. Setting: Seven hospitals in the United States, United Kingdom, and Australia. Interventions: None. Measurements and Main Results: Content analysis was used to explore prevalent themes related to unmet needs, as well as perceived strategies to improve ICU outcomes. Post-ICU care was perceived to be generally inadequate. Desired caregiver support fell into two main categories: practical support and emotional support. Successful care delivery initiatives included structured programs, such as post discharge telephone calls, home health programs, post-ICU clinics, and peer support groups, and standing information resources, such as written educational materials and online resources. Conclusions: This qualitative, multicenter, international study of caregivers of critical illness survivors identified consistently unmet needs, means by which caregivers accessed support post ICU, and several care mechanisms identified by caregivers as supporting optimal ICU recovery.
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29
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Chen L, Xiao LD, Chamberlain D, Newman P. Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review. J Clin Nurs 2021; 30:2786-2807. [PMID: 33872424 DOI: 10.1111/jocn.15807] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care. BACKGROUND Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period. DESIGN A systematic review and meta-synthesis. METHODS A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied. RESULTS The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home. CONCLUSIONS Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care. RELEVANCE TO CLINICAL PRACTICE Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.
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Affiliation(s)
- Langduo Chen
- 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
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30
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Lobo EH, Frølich A, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M, Kensing F. Understanding the Methodological Issues and Solutions in the Research Design of Stroke Caregiving Technology. Front Public Health 2021; 9:647249. [PMID: 33937175 PMCID: PMC8085388 DOI: 10.3389/fpubh.2021.647249] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
The rise in the number of cases of stroke has resulted in a significant burden on the healthcare system. As a result, the majority of care for the person living with stroke occurs within the community, resulting in caregivers being a central and challenged agent in care. To better support caregivers during the recovery trajectory poststroke, we investigated the role of health technologies to promote education and offer various kinds of support. However, the introduction of any new technology comes with challenges due to the growing need for more user-centric systems. The integration of user-centric systems in stroke caregiving has the potential to ensure long-term acceptance, success, and engagement with the technology, thereby ensuring better care for the person living with stroke. We first briefly characterize the affordances of available technologies for stroke caregiving. We then discuss key methodological issues related to the acceptance to such technologies. Finally, we suggest user-centered design strategies for mitigating such challenges.
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Affiliation(s)
- Elton H Lobo
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia.,Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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31
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Chong WFW, Ng LH, Ho RMH, Koh GCH, Hoenig H, Matchar DB, Yap P, Venketasubramanian N, Tan KB, Ning C, Menon E, Chang HM, De Silva DA, Lee KE, Tan BY, Young SHY, Ng YS, Tu TM, Ang YH, Yeo TT, Merchant RA, Kong KH, Singh R, Ng YL, Cheong A. Stroke Rehabilitation Use and Caregiver Psychosocial Health Profiles in Singapore: A Latent Profile Transition Analysis. J Am Med Dir Assoc 2021; 22:2350-2357.e2. [PMID: 33812841 DOI: 10.1016/j.jamda.2021.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify and describe caregiver profiles based on their psychosocial health characteristics over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at 12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and 12 months post-stroke after accounting for covariates. DESIGN Latent profile transition analysis of caregiver psychosocial health with stroke rehabilitation use at 12 month post-stroke as outcome. SETTING AND PARTICIPANTS A total of 149 stroke patient-caregiver dyads from the Singapore Stroke Study. METHODS Cross-sectional latent profile analyses were conducted on caregiver psychosocial health indicators of burden, depression, health status, quality of relationship with patient, and social support. Changes in latent profile classification over 3 time points (baseline, 3 months, and 12 months post-stroke) were analyzed using latent transition analysis. A transition model with stroke rehabilitation use at 12 months post-stroke as the outcome was tested after accounting for covariates. RESULTS Two distinct caregiver psychosocial health latent profiles were found across time: nondistressed and distressed. Most caregivers were classified as nondistressed and remained nondistressed over time. Distressed caregivers at baseline were 76% likely to become nondistressed at 12 month post-stroke. Regardless of profile transition patterns, nondistressed caregivers at 12 months post-stroke tended to have cared for stroke rehabilitation nonusers at 12 months post-stroke. Patient depression explained profile classification at 3 months and 12 months post-stroke. After accounting for covariates, rehabilitation users at 3 months post-stroke tended to continue using rehabilitation at 12 months post-stroke only when they had nondistressed caregivers at 3 months post-stroke. CONCLUSIONS AND IMPLICATIONS Whether caregiver adaptation explains the associations between the latent profile transition patterns and rehabilitation use at 12 months post-stroke should be examined. Early psychosocial health assessment and sustained support should be made available to stroke caregivers to enhance their well-being and subsequent patient rehabilitation participation.
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Affiliation(s)
- Wayne F W Chong
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore; GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore.
| | - Leong Hwee Ng
- GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore
| | - Ringo M-H Ho
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore
| | - Gerald C H Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; Office of Healthcare Transformation, Ministry of Health, Singapore, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Science, Durham Veterans Administration Medical Center, Durham, NC, USA; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David B Matchar
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore, Singapore; Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | | | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; InfoComm, Technology and Data Group, Ministry of Health, Singapore, Singapore, Singapore
| | - Chou Ning
- CHOU Neuroscience Clinic, Farrer Park Hospital, Singapore, Singapore, Singapore; Chou Neurosurgery Pte Ltd, Gleneagles Hospital, Singapore, Singapore, Singapore
| | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore, Singapore, Singapore
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Deidre A De Silva
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore, Singapore
| | | | - Sherry H Y Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University of Singapore, Singapore, Singapore, Singapore
| | - Reshma A Merchant
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Department of Medicine (Division of Geriatric Medicine), National University Hospital, Singapore, Singapore, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yu Li Ng
- Manpower Planning and Strategy, Ministry of Health, Singapore, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore
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A Validation Study of the Revised Caregiving Burden Instrument in Korean Family Caregivers of Stroke Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062960. [PMID: 33799335 PMCID: PMC7998833 DOI: 10.3390/ijerph18062960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
Background: The purpose of the present study was to examine the internal consistency reliability and construct validity of the Caregiving Burden Instrument in Korean informal caregivers of stroke survivors. Methods: A descriptive survey design was used with a convenience sample of 208 primary caregivers of stroke survivors. Internal consistency reliability was assessed using Cronbach’s alpha coefficients. Construct validity was assessed using exploratory and known-group analysis. Results: Each subscale and the total scale demonstrated satisfactory internal consistency reliability. Exploratory factor analysis identified five factors: family support, patient’s dependency, physical health, financial burden, and psychological health, which together accounted for 62.7% of the variance. Known-group analysis indicated that caregivers with more than one year of experience reported significantly higher mean scores for the total burden score and its five subscales compared to those with less than one year. Conclusions: This 23-item instrument demonstrates good internal consistency reliability and construct validity. The tool can be used to effectively assess burden in caregivers of stroke survivors and the data obtained can form the basis for the development of family interventions.
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33
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Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, Farrin A. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified.
Objectives
The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations).
Design
Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales.
Setting
The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales.
Participants
Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services.
Data sources
Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified.
Intervention
Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks.
Results
A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains.
Conclusions
We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation.
Future work
Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation.
Trial registration
Current Controlled Trials ISRCTN38920246.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, School of Medicine, University of Leeds, Leeds, UK
| | | | - Josie Dickerson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gill Carter
- Patient and public involvement contributor, York, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robbie Foy
- Division of Primary Care, Palliative Care and Public Health, School of Medicine, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Arvin Prashar
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ross Atkinson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca J Hawkins
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicola Cornwall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Laetitia Schmitt
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Speed
- Patient and public involvement contributor, York, UK
| | - Katie Grenfell
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Lee JJ, Tsang WN, Yang SC, Kwok JYY, Lou VWQ, Lau KK. Qualitative Study of Chinese Stroke Caregivers' Caregiving Experience During the COVID-19 Pandemic. Stroke 2021; 52:1407-1414. [PMID: 33588588 DOI: 10.1161/strokeaha.120.032250] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The coronavirus disease 2019 (COVID-19) outbreak has led to disruptions in health care service delivery worldwide, inevitably affecting stroke survivors requiring ongoing rehabilitation and chronic illness management. To date, no published research has been found on stroke caregiving during the COVID-19 pandemic. This study aimed to explore Hong Kong stroke caregivers' caregiving experiences in the midst of this difficult time. METHODS Individual semistructured interviews were conducted with 25 Chinese adult primary stroke caregivers from May to June 2020 via telephone. Interviews were transcribed verbatim and analyzed using an interpretive description approach and constant comparison strategy. RESULTS Five themes of the stroke caregiving experience during the COVID-19 pandemic emerged: care service adversities, additional caregiving workload and strain, threatened relationship between caregiver and stroke survivors, threats to caregivers' physical and psychological well-being, and needs for continuing caregiving roles. Our findings suggested that caregivers have worsened physical and psychological well-being because of increases in care burden with simultaneously reduced formal and informal support. The relationship between caregiver and stroke survivor was subsequently affected, placing some survivors at heightened risk of abuse. CONCLUSIONS Our study provides valuable findings about stroke caregiving experiences and needs during the pandemic. Delivery of psychological support, telemedicine, and household hygiene resources would be useful to mitigate caregivers' psychological distress during the COVID-19 pandemic.
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Affiliation(s)
- Jung Jae Lee
- School of Nursing (J.J.L., W.N.T., J.Y.Y.K.), The University of Hong Kong, Hong Kong SAR
| | - Wing Nga Tsang
- School of Nursing (J.J.L., W.N.T., J.Y.Y.K.), The University of Hong Kong, Hong Kong SAR
| | - Sook Ching Yang
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (S.C.Y.).,Now with Central Coast Local Health District, New South Wales Health, Australia (S.C.Y)
| | - Jojo Yan Yan Kwok
- School of Nursing (J.J.L., W.N.T., J.Y.Y.K.), The University of Hong Kong, Hong Kong SAR
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, Department of Social Work and Social Administration (V.W.Q.L.), The University of Hong Kong, Hong Kong SAR
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine (K.K.L.), The University of Hong Kong, Hong Kong SAR
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Psychometric Properties of the Preparedness Assessment for the Transition Home After Stroke Instrument. Rehabil Nurs 2021; 46:113-121. [DOI: 10.1097/rnj.0000000000000310] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lobo EH, Frølich A, Kensing F, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M. mHealth applications to support caregiver needs and engagement during stroke recovery: A content review. Res Nurs Health 2020; 44:213-225. [PMID: 33341958 DOI: 10.1002/nur.22096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Caregiving in stroke results in severe physical, psychological, and social impacts on the caregiver. Over the past few years, researchers have explored the use of mHealth technologies to support healthcare-related activities due to their ability to provide real-time care at any given place or time. The purpose of this content review is to investigate mHealth apps in supporting stroke caregiving engagement based on three aspects: motivation, value, and satisfaction. We searched app stores and repositories for apps related to stroke caregiving published up to September 2020. Extracted apps were reviewed and filtered using inclusion criteria, and then downloaded onto compatible devices to determine eligibility. Results were compared with evidence-based frameworks to identify the ability of these apps in engaging and supporting the caregiver. Forty-seven apps were included in this review that enabled caregivers to support their needs, such as adjustment to new roles and relationships, involvement in care and caring for oneself using several different functionalities. These functionalities include information resources, risk assessment, remote monitoring, data sharing, reminders and so on. However, no single app was identified that focuses on all aspects of stroke caregiving. We also identified several challenges faced by users through their reviews and the factors associated with value and satisfaction. Our findings can add to the knowledge of existing mHealth technologies and their functionalities to support stroke caregiving needs, and the importance of considering user engagement in the design. They can be used by developers and researchers looking to design better mHealth apps for stroke caregiving.
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Affiliation(s)
- Elton H Lobo
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia
| | - Mohamed Abdelrazek
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
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Sauvé-Schenk K, Duong P, Savard J, Durand F. A systematic review of social service and community resource interventions following stroke. Disabil Rehabil 2020; 44:2948-2957. [PMID: 33280453 DOI: 10.1080/09638288.2020.1851780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Finding and accessing social services and community resources are a challenge for stroke survivors and care partners. The purpose of this systematic review was to identify and review interventions that aimed to increase access and use of such services and resources post stroke. METHOD A systematic review of the published literature was performed using MEDLINE, CINAHL, PsycINFO, and ProQuest Nursing and Allied Health (January 2008 to May 2020). Studies were included if they were quantitative designs and reported on outcomes of interventions addressing post-stroke access to social services or community resources. Results were synthesised narratively. RESULTS 3566 titles and abstracts were reviewed. Ten articles met the inclusion criteria. The interventions included in this review varied in terms of target group, timing, and type of support provided (passive or active tailored information provision, referral service, navigation assistance). Outcome measures, for social service and community resource access, included discharge preparedness measures, service counts, observations, satisfaction evaluations, interviews, and open-ended questions. CONCLUSION Overall, interventions demonstrated some improvements in information received and access to social services and community resources following stroke. Future research should focus on carrying out high quality studies that examine the effectiveness of various social service and community resource interventions, and on setting valid and reliable outcome measures.IMPLICATIONS FOR REHABILITATIONStroke survivors and care partners have unmet social service and community resource needs.Stroke survivors and care partners can benefit from interventions that provide information, referrals, and ongoing support to access services and resources.Clearly identifying social service and community resource needs is important for tailoring interventions to individual situations.Interventions should ideally be provided throughout the hospital stay, in acute care and rehabilitation, and continue on in the community.
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Affiliation(s)
- Katrine Sauvé-Schenk
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Patrick Duong
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Jacinthe Savard
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - François Durand
- Institut du Savoir Montfort, Ottawa, Canada.,Telfer School of Management, University of Ottawa, Ottawa, Canada
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“Hyperacute” Stroke Rehabilitation Care: Common Issues and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stroke survivors’ experiences and perceptions of post-stroke fatigue education in the subacute phase of stroke. The FASE qualitative study. Br J Occup Ther 2020. [DOI: 10.1177/0308022620963741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction Post-stroke fatigue significantly impacts stroke survivors’ rehabilitation, morbidity and quality of life. The evidence-base of post-stroke fatigue education is scarce and inconsistently translated to practice. Research is necessary to understand the current provision, impact and perceptions of post-stroke fatigue education from the stroke survivor’s perspective. The aim of this study is to develop an understanding of stroke survivors’ current experiences and perceptions of fatigue and the role of post-stroke fatigue education in subacute stroke. Methods A United Kingdom-based qualitative inquiry using semi-structured interviews involving 10 participants who had experienced subacute stroke was conducted using thematic data analysis. Findings The overarching theme of acceptance and adaptation reflected possible mechanisms in how stroke survivors manage post-stroke fatigue. Theme one highlighted the individual and diverse nature of post-stroke fatigue. Theme two, the variability of stroke survivors’ current experiences, reflected variability in content and context of post-stroke fatigue education. Theme three, the role of stroke services, described perceived responsibility and ability of stroke services to provide post-stroke fatigue education. Conclusions Post-stroke fatigue education is variable in practice. The results suggest further investigation of a stroke pathway approach for post-stroke fatigue education, involving core aspects suitable for a spectrum of stroke survivors with additional components tailored to individual needs.
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Fisher K, Markle-Reid M, Ploeg J, Bartholomew A, Griffith LE, Gafni A, Thabane L, Yous ML. Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada. JOURNAL OF COMORBIDITY 2020; 10:2235042X20963390. [PMID: 33117723 PMCID: PMC7573753 DOI: 10.1177/2235042x20963390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/13/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.
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Affiliation(s)
- Kathryn Fisher
- Aging, Community and Health Research Unit (ACHRU), McMaster University, Hamilton, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit (ACHRU), McMaster University, Hamilton, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit (ACHRU), McMaster University, Hamilton, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
| | - Amy Bartholomew
- Aging, Community and Health Research Unit (ACHRU), McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Amiram Gafni
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Lee Yous
- Aging, Community and Health Research Unit (ACHRU), McMaster University, Hamilton, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Kes D, Aydin Yildirim T. The relationship of religious coping strategies and family harmony with caregiver burden for family members of patients with stroke. Brain Inj 2020; 34:1461-1466. [PMID: 32811207 DOI: 10.1080/02699052.2020.1810317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Patients with stroke experience various challenges such as motor and cognitive and sensory problems, which can increase the caregiver burden of family members in long-term care. Understanding the factors related to caregiver burden is important to develop strategies to support informal caregivers. Therefore, this study aimed to examine the relationship of religious coping strategies and family harmony to caregiver burden for family members of patients with stroke. METHOD The sample of this descriptive, cross-sectional study consisted of 181 family caregivers who completed the Religious Coping Scale, Burden Interview Scale, and Family Harmony Scale - Short Form. Multiple linear regression and Pearson's correlation were performed. RESULTS Pearson's correlation analysis indicated a significant positive relationship between caregiver burden and negative religious coping. A significant negative relationship was found of caregiver burden and family harmony with positive religious coping. Multiple regression analysis indicated that family harmony, amount of time spent on caregiving, and negative and positive religious coping were predictors of caregiver burden. Given the significant relationship of caregiver burden and family harmony to positive religious coping, future research should integrate religious coping strategies into multidisciplinary caregiver intervention programs to reduce caregiver burden.
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Affiliation(s)
- Duygu Kes
- Nursing Department, Faculty of Health Sciences, Karabuk University , Karabuk, Turkey
| | - Tugba Aydin Yildirim
- Nursing Department, Faculty of Health Sciences, Karabuk University , Karabuk, Turkey
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Costa TFD, Pimenta CJL, Nóbrega MMLD, Fernandes MDGM, França ISXD, Pontes MDLDF, Costa KNDFM. Burden on caregivers of patients with sequelae of cerebrovascular accident. Rev Bras Enferm 2020; 73:e20180868. [PMID: 32785520 DOI: 10.1590/0034-7167-2018-0868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 02/25/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the burden and its relationship with the sociodemographic characteristics of caregivers of people with sequelae of stroke. METHODS a cross-sectional, exploratory, and quantitative study was conducted with 151 caregivers of people with sequelae of stroke, through home interviews between September and December 2017. RESULTS there was a general mean of low burden. The items that indicated the worst changes were: "My time for social activities with friends," "My time for family activities," "My ability to cope with stress," and "My physical functioning." There was an association of burden with the female sex and with caregivers who have been assisting for longer. CONCLUSIONS the results allow us to reflect on the need to create a policy aimed at family caregivers to reduce the impact of care delivery.
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Imani-Goghary Z, Ghaljeh M. The experience of family caregivers caring for a patient with chronic disorders of consciousness: a qualitative content analysis. Int J Palliat Nurs 2020; 26:301-309. [PMID: 32841084 DOI: 10.12968/ijpn.2020.26.6.301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Management of a patient with chronic disorders of consciousness is a long-term and stressful situation for family caregivers. AIMS The aim of this study was to describe the experiences of family caregivers of patients with chronic disorders of consciousness. METHODS Purposeful sampling was used, data were collected through semi-structured, in-depth interviews at participants' homes. Data were analysed using qualitative content analysis. FINDINGS Results indicated that family caregivers of patients with chronic disorders of consciousness face many difficulties in providing care to vegetative state (VS) and minimally conscious state (MCS) patients; they experience it as a challenging type of care, which influences their mental health. CONCLUSION Family caregivers are faced with many challenges because of the high burden of care, round-the-clock concern, taking care of an alive but unresponsive patient without receiving enough support. They experience mental and inner turmoil because of social isolation and dealing with contradictory feelings in their daily life.
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Affiliation(s)
- Zahra Imani-Goghary
- Assistant Professor of Nursing, Sirjan School of Medical Science, Sirjan, Iran
| | - Mahnaz Ghaljeh
- Assistant Professor of Nursing, Community Nursing Research Center, Zahedan University of Medical Science, Zahedan, Iran
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44
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Kokorelias KM, Gignac MAM, Naglie G, Rittenberg N, MacKenzie J, D’Souza S, Cameron JI. A grounded theory study to identify caregiving phases and support needs across the Alzheimer’s disease trajectory. Disabil Rehabil 2020; 44:1050-1059. [DOI: 10.1080/09638288.2020.1788655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kristina M. Kokorelias
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Monique A. M. Gignac
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Work and Health, Toronto, Canada
| | - Gary Naglie
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - Nira Rittenberg
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer MacKenzie
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Ontario Shores Centre for Mental Health Sciences, Geriatric Transitional Unit, Whitby, Canada
| | - Samantha D’Souza
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jill I. Cameron
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
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Supported cognitive-behavioural therapy self-help versus treatment-as-usual for depressed informal caregivers of stroke survivors (CEDArS): feasibility randomised controlled trial. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Demands placed on informal caregivers can result in an increased likelihood of experiencing common mental health difficulties that may affect their ability to undertake the caring role. Currently, however, few evidence-based interventions have been specifically developed for informal caregivers and available interventions are difficult to access. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to evidence-based psychological therapies for all groups and may therefore present an opportunity to meet informal caregiver needs. Located within the MRC Complex Intervention Framework, a Phase II feasibility randomised controlled trial (RCT) examines key methodological, procedural and clinical uncertainties associated with running a definitive Phase III RCT of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. Recruitment was low despite different recruitment strategies being adopted, highlighting significant challenges moving towards a Phase III RCT until resolved. Difficulties with study recruitment may reflect wider challenges engaging informal caregivers in psychological interventions and may have implications for IAPT services seeking to improve access for this group. Further attempts to develop a successful recruitment protocol to progress to a Phase III RCT examining effectiveness of the adapted CBT self-help intervention should be encouraged.
Key learning aims
After reading this article, readers should be able to:
(1)
Consider key feasibility issues with regard to recruitment and attrition when running a randomised controlled trial of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors.
(2)
Understand potential barriers experienced by an informal caregiving population to accessing psychological interventions.
(3)
Appreciate implications for clinical practice to enhance access to IAPT services and low-intensity CBT working with an informal caregiver population.
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Rochette A, Dugas A, Morissette-Gravel AS. Inclusion of relatives in stroke rehabilitation: Perception of quality of services they received in the context of early supported discharged (ESD), in- and out-patient services. Top Stroke Rehabil 2020; 28:142-152. [PMID: 32657250 DOI: 10.1080/10749357.2020.1790731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Relatives of stroke patients should be an integral part of the continuum of rehabilitation services. OBJECTIVE The objective was to describe their perception of the quality of the services they received in the context of early supported discharged (ESD), in- and out-patient rehabilitation services. METHODS Descriptive study using the Quality of Services Questionnaire for Relatives post-stroke (QSQR) completed online by relatives after the patient's discharge. It consists of 22 statements with respect to three subscales: 1) the training/instructions, 2) the information provision and 3) the organizational process of the service offer. Space is allowed for free comments and two open-ended questions. Quantitative data were analyzed descriptively, and we used a content analysis for qualitative data. RESULTS One-third (30/90; 33.3%) of the sample are composed of relatives aged 55 and under, with a majority (81%) of women and 51.3% of spouses. The training/instructions and information provision were perceived positively with a mean % agreement at 85.0 ± 29.6 and 84.8 ± 22.4, respectively. The mean % agreement was 91.4 ± 17.8 for the organizational process subscale. A significantly higher score (p = 0,03; Kruskal Wallis test) was found for out-patient services (n = 20) as compared to ESD (n = 29) or in-patient rehabilitation (n = 41). Qualitatively, a lack of involvement of relatives was mentioned as well as a lack of personalized information about stroke and its consequences and provision of resources available. However, communication between professionals, their availability, and their professionalism were appreciated. CONCLUSION Despite quantitative high scores, qualitative data allowed the identification of concrete avenues for improvement to truly and systematically include relatives in stroke rehabilitation.
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Affiliation(s)
- Annie Rochette
- Occupational Therapy Program, School of Rehabilitation, University of Montreal , Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Canada
| | - Ariane Dugas
- Occupational Therapy Program, School of Rehabilitation, University of Montreal , Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Canada
| | - Anne-Sophie Morissette-Gravel
- Occupational Therapy Program, School of Rehabilitation, University of Montreal , Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Canada
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Hall J, Morton S, Fitzsimons CF, Hall JF, Corepal R, English C, Forster A, Lawton R, Patel A, Mead G, Clarke DJ. Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers. BMC Public Health 2020; 20:967. [PMID: 32560713 PMCID: PMC7305625 DOI: 10.1186/s12889-020-09113-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. METHODS Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 h) were analysed thematically and interview data (n = 31 stroke survivors, n = 12 caregivers) were analysed using the Framework approach. RESULTS Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers' influence on, and role in influencing stroke survivors' sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers' inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. CONCLUSIONS Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.
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Affiliation(s)
- Jennifer Hall
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK. .,Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK.
| | - Sarah Morton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire F Fitzsimons
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Jessica Faye Hall
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Rekesh Corepal
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | | | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
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Messina R, Dallolio L, Fugazzaro S, Rucci P, Iommi M, Bardelli R, Costi S, Denti M, Accogli MA, Cavalli E, Pagliacci D, Fantini MP, Taricco M. The Look After Yourself (LAY) intervention to improve self-management in stroke survivors: Results from a quasi-experimental study. PATIENT EDUCATION AND COUNSELING 2020; 103:1191-1200. [PMID: 31982203 DOI: 10.1016/j.pec.2020.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To test the efficacy of a self-management intervention for stroke survivors vs. usual care. METHODS Using a quasi-experimental study, participants were recruited from three public Italian hospitals. Questionnaires assessing self-efficacy (SSEQ), quality of life (SF-12), physical performance (SPPB), depression (GDS) and activities of daily living (MBI) were administered at baseline, discharge and two months after discharge. Mixed models with a propensity score were used between experimental group (EG) and control group (CG). Logistic models were used to compare the use of health services. RESULTS Eighty-two stroke survivors were enrolled in the EG and 103 in the CG. Self-efficacy in self-management improved in the EG compared to the CG during hospitalization. Improvements from baseline to discharge were found in the EG in the mental component of SF-12 and in MBI. The EG were 8.9 times more likely to contact general practitioners after discharge and 2.9 times to do regular exercise than CG. Notably, EG with higher education benefitted more from the intervention. CONCLUSION The intervention was efficacious in improving self-efficacy, mental health and activities of daily living. PRACTICE IMPLICATIONS Structured educational interventions based on problem-solving and individual goal setting may improve self-management skills in stroke survivors.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marica Iommi
- Advanced School for Health Policy-Specialisation School for Public Administration, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Roberta Bardelli
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences-University of Modena and Reggio-Emilia, Modena, Italy; Scientific Directorate-Local Health Authority-IRCCS of Reggio-Emilia, Reggio-Emilia, Italy
| | - Monica Denti
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Monia Allisen Accogli
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Enrica Cavalli
- University Hospital Authority St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Donatella Pagliacci
- Department of Community Health Care Agency USL Tuscany, Northwest, Pisa, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Mariangela Taricco
- University Hospital Authority St. Orsola-Malpighi Polyclinic, Bologna, Italy
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Tseung V, Jaglal S, Salbach NM, Cameron JI. A Qualitative study assessing organisational readiness to implement caregiver support programmes in Ontario, Canada. BMJ Open 2020; 10:e035559. [PMID: 32448793 PMCID: PMC7252954 DOI: 10.1136/bmjopen-2019-035559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To qualitatively explore factors affecting implementation of caregiver support programmes in healthcare institutions in a regional stroke system. DESIGN A qualitative descriptive study with the Ontario Stroke System (OSS) was conducted. Data were collected through focus groups and in-depth interviews. Transcripts were coded and analysed using inductive thematic analysis. SETTING Regional Stroke System, Ontario, Canada. PARTICIPANTS OSS stakeholders including medical directors, executives, programme directors, education coordinators, rehabilitation and community and long-term care specialists, primary care leaders and healthcare professionals. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Data collection explored perceptions of the need for caregiver support programmes and factors that may affect their implementation. RESULTS Four focus groups (n=43) and 29 interviews were completed. Analyses identified themes related to (1) evidence that a caregiver programme will improve health and health system outcomes, (2) personnel requirements, (3) barriers associated with current billing and referral processes and (4) integration with current practice and existing workflow processes. CONCLUSIONS Implementation strategies to adopt caregiver programmes into clinical practice should incorporate evidence and consider personnel and existing workflow processes.
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Affiliation(s)
- Victrine Tseung
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Nancy Margaret Salbach
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jill I Cameron
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
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