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Roberts R, Vohora R, Demeyere N. Understanding the role of illness perceptions in the relationship between cognitive and emotional difficulties after stroke. Neuropsychol Rehabil 2024:1-19. [PMID: 39205633 DOI: 10.1080/09602011.2024.2387376] [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: 07/07/2023] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
ABSTRACTEmotional difficulties are common after stroke and up to one third of stroke-survivors develop post-stroke depression. Psychological distress in this population remains poorly understood, despite high prevalence and secondary implications. One established predictor of depressive symptoms after stroke is cognitive impairment, however, the mechanism underlying this relationship is unclear. This research investigated the potential role of stroke-related illness appraisals as a mediating factor to this known association. Seventy-seven participants, aged 45-94, were consecutively recruited from inpatient stroke units in Oxfordshire over 15-months and completed assessments of mood, cognition and illness appraisals, which were analyzed cross-sectionally. As expected, cognitive impairment significantly predicted depressive symptoms. Importantly, this relationship was shown to be mediated by perceptions of threat and control. Higher levels of cognitive impairment were significantly associated with lower perceived control and higher perceived threat, which partially explained the relationship between cognitive impairment and depressive symptoms. Perceptions of illness coherence were predictive of depressive symptoms but not associated with degree of cognitive impairment. This research has implications for the management of cognitive impairment in the early stages after stroke and suggests that illness appraisals may be an important intervention target for reducing depressive symptoms in patients with post-stroke cognitive impairments.
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Affiliation(s)
- Rebecca Roberts
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford, UK
| | - Reena Vohora
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford, UK
| | - Nele Demeyere
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Dangayach NS, Kreitzer N, Foreman B, Tosto-Mancuso J. Post-Intensive Care Syndrome in Neurocritical Care Patients. Semin Neurol 2024; 44:398-411. [PMID: 38897212 DOI: 10.1055/s-0044-1787011] [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: 06/21/2024]
Abstract
Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.
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Affiliation(s)
- Neha S Dangayach
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jenna Tosto-Mancuso
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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de Diego-Alonso C, Bellosta-López P, Hultqvist J, Vidaña-Moya L, Eklund M. Psychometric Properties of the Spanish Version of the Satisfaction With Daily Occupations and Occupational Balance in Spanish Stroke Survivors. Am J Occup Ther 2024; 78:7803205050. [PMID: 38640087 DOI: 10.5014/ajot.2024.050454] [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: 04/21/2024] Open
Abstract
IMPORTANCE Stroke survivors experience changes in participation level, satisfaction with participation, and participation balance, making it necessary to have a validated tool for their assessment. OBJECTIVE To evaluate the psychometric properties of the Spanish version of the Satisfaction With Daily Occupations and Occupational Balance (SDO-OB) in stroke survivors. DESIGN Psychometric study. SETTING National multicenter study (rehabilitation centers, and hospitals). PARTICIPANTS One hundred forty stroke survivors with and without a primary caregiver. OUTCOMES AND MEASURES Participants completed the SDO-OB, the five-level version of the EQ-5D (EQ-5D-5L), and the Activity Card Sort (ACS). Internal consistency, convergent validity, known-groups validity, and floor and ceiling effects were assessed. Intraobserver reliability was assessed 1 wk apart. RESULTS The internal consistency was acceptable; Cronbach's α = .80, 95% confidence interval (CI) [0.75, 0.85]. A moderate correlation was found between the SDO-OB summed participation level and summed participation satisfaction (ρ = .53). Both SDO-OB summed scores correlated with ACS scores (0.25 < ρ < .61). However, only summed participation satisfaction scores correlated with the emotional component of the EQ-5D-5L (ρ = .32). The SDO-OB discriminated between groups with and without a caregiver (p = .001) and had no floor or ceiling effects (<7%). Good intraclass correlation coefficients (ICCs) were obtained for summed participation level (ICC = .91; 95% CI [.85, .94]) and summed participation satisfaction (ICC = .86; 95% CI [.78, .92]). Standard error of measurement and minimum detectable change were 0.7 and 1.9 points, respectively, for summed participation level and 4.5 and 12.4, respectively, for summed participation satisfaction. CONCLUSIONS The Spanish version of the SDO-OB presented good psychometric properties, making it a suitable instrument to address participation level, participation satisfaction, and participation balance in stroke survivors. Plain-Language Summary: After a stroke, survivors experience changes in their participation in daily activities and how satisfied they are with them. This study examined whether a tool called Satisfaction With Daily Occupations and Occupational Balance (SDO-OB) could provide reliable information about this. We looked at 140 stroke survivors from different places in Spain to see whether they had someone caring for them, how healthy they were, and how their participation in daily activities changed after stroke. We found that the SDO-OB is helpful for understanding a stroke survivor's situation and can identify areas needing intervention and track changes caused by intervention plans.
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Affiliation(s)
- Cristina de Diego-Alonso
- Cristina de Diego-Alonso, OT, PT, MSc, is Research and Teaching Staff, MOTUS Research Group, Faculty of Health Sciences Research, Department of Physical Therapy, Universidad San Jorge, Campus Universitario, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Bellosta-López
- Pablo Bellosta-López, PT, PhD, is Research and Teaching Staff, MOTUS Research Group, Faculty of Health Sciences, Department of Physical Therapy, Universidad San Jorge, Campus Universitario, Villanueva de Gállego, Zaragoza, Spain;
| | - Jenny Hultqvist
- Jenny Hultqvist, OT, PhD, is Senior Lecturer, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Laura Vidaña-Moya
- Laura Vidaña-Moya, OT, PhD, is Research and Teaching Staff, Research Group Occare, Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa, Universitat Autònoma de Barcelona, Terrassa, Spain
| | - Mona Eklund
- Mona Eklund, OT, PhD, is Senior Professor, Department of Health Sciences, Lund University, Lund, Sweden
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Palumbo A, Balagula C, Turry A, Aluru V, Raghavan P. Music Upper Limb Therapy - Integrated (MULT-I) supports a positive transformation in sense of self post stroke: a thematic analysis. Disabil Rehabil 2024:1-13. [PMID: 38682830 DOI: 10.1080/09638288.2024.2346240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE To understand how the experience of Music Upper Limb Therapy - Integrated (MULT-I) interconnects with the experience of stroke. METHODS Thematic analysis of semi-structured interviews and video-recorded MULT-I sessions from a larger mixed-methods study. Thirty adults with post-stroke hemiparesis completed pre-intervention interviews, of whom fifteen participated in MULT-I. Thirteen of the participants in MULT-I completed post-intervention interviews. RESULTS The experience of stroke was characterized by five themes: (1) sudden loss of functional abilities, (2) disrupted participation, (3) desire for independence, (4) emotional distress and the need for support, and (5) difficulty negotiating changes in sense of self. The experience of MULT-I was characterized by three themes: (1) MULT-I activated movement and empowered personal choice, (2) MULT-I created a safe place to process emotional distress and take on challenges, and (3) MULT-I fostered a sense of belonging and a positive transformation in sense of self. These themes combined create a framework which illustrates the process by which MULT-I addressed each challenge described by survivors of stroke, facilitating a positive transformation in sense of self. CONCLUSION MULT-I promotes physical, emotional, and social wellbeing following a stroke. This integrated approach supports a positive transformation in sense of self. These findings have implications for improving psychosocial well-being post stroke.
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Affiliation(s)
- Anna Palumbo
- Rehabilitation Sciences Program, NYU Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
- Nordoff Robbins Center for Music Therapy, NYU Steinhardt School of Culture, Education and Human Development, New York, NY, USA
| | - Caitlin Balagula
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan Turry
- Nordoff Robbins Center for Music Therapy, NYU Steinhardt School of Culture, Education and Human Development, New York, NY, USA
- Department of Music and Performing Arts Professions, NYU Steinhardt School of Culture, Education and Human Development, New York, NY, USA
| | - Viswanath Aluru
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Physical Medicine & Rehabilitation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bartoli D, Brugnera A, Grego A, Alvaro R, Vellone E, Pucciarelli G. Stroke disease-specific quality of life trajectories and their associations with caregivers' anxiety, depression, and burden in stroke population: a longitudinal, multicentre study. Eur J Cardiovasc Nurs 2024; 23:160-168. [PMID: 37249041 DOI: 10.1093/eurjcn/zvad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
AIMS The aims of this study were to: (i) test if there are clusters of stroke survivors who experience distinct trajectories of quality of life (QOL) from hospital rehabilitation discharge to 12-month follow-up; (ii) test if any sociodemographic or clinical variables predict this class membership; and (iii) examine the associations between the clusters of stroke survivors' and their caregivers' trajectories of anxiety, depression, and burden over time. METHODS AND RESULTS A total of 415 stroke survivors and their caregivers were recruited in Italy for this 1-year, longitudinal, multicentre prospective study, filling out a survey at five time points. We found two distinct trajectories of change in stroke survivors' psychological QOL (i.e. Memory, Communication, Emotion, and Participation). The first trajectory (86% of the survivors) included those who started with greater levels of QOL and improved slightly to markedly in all psychological domains, while the second trajectory (14% of the survivors) comprised those who started with lower overall levels of psychological QOL and experienced a worsening or no changes at all in these dimensions up to 12-month follow-up. Very few clinical and sociodemographic variables at baseline predicted class membership. Finally, caregivers of those patients who experienced no change or a worsening in psychological QOL reported greater distress and burden over time. CONCLUSION Our results highlight the need for more tailored interventions to improve patients' psychological QOL and consequently their caregivers' well-being. This requires a shift from a stroke survivor-centred approach to a stroke survivor- and caregiver-centred one.
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Affiliation(s)
- Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Andrea Grego
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Shaik MA, Choo PY, Tan-Ho G, Lee JCK, Ho AHY. Recovery needs and psychosocial rehabilitation trajectory of stroke survivors (PReTS): A qualitative systematic review of systematic reviews. Clin Rehabil 2024; 38:263-284. [PMID: 37933440 DOI: 10.1177/02692155231207265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Stroke has a major impact on a person's life. While much research exists on stroke prevention and treatment, explorations into psychosocial recovery needs are lacking. This review critically consolidates the challenges and needs of stroke survivors and develops a trajectory that encapsulates their journey from illness to recovery. DATA SOURCES Six major databases were searched, including Academic Search Premier, CINAHL, Global Health, Medline, PsycArticles, and PsycINFO. METHODS This review adhered to the PRISMA guidelines and employed the PICo (population, phenomena of interest, context) framework to screen for relevant qualitative reviews published between 1 January 2010 and 31 August 2023. Following full-text screening and the assessment of methodological quality using a modified version of the Assessment of Multiple Systematic Reviews scale, a total of 17 reviews were included for thematic synthesis. RESULTS Included reviews referenced 400 qualitative primary studies involving more than 5623 stroke survivors. Data synthesis revealed 18 themes that were further organized into six conceptual categories: (1) The unfamiliar body, (2) compassionate healthcare system, (3) holistic rehabilitation, (4) intrapersonal strength, (5) interpersonal relations, and (6) thriving forward to form the psychosocial rehabilitation trajectory of stroke survivor (PReTS) model. The model recognizes the losses that can occur after a stroke and emphasizes the essentiality of addressing psycho-socio-emotional and spiritual needs alongside physical impairments. CONCLUSION The PReTS model is the first to highlight stroke survivors' losses, recovery journeys, and psychosocial needs. The conceptualization serves to inform and advance stroke rehabilitation practices with holistic and wellness recovery research.
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Affiliation(s)
- Muhammad Amin Shaik
- Psychology Programme, Nanyang Technological University, Singapore, Singapore
| | - Ping Ying Choo
- Psychology Programme, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology Programme, Nanyang Technological University, Singapore, Singapore
| | - Jimmy Chee-Keong Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Institute of Mental Health, Singapore, Singapore
| | - Andy Hau Yan Ho
- Psychology Programme, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- The Palliative Care Centre for Excellence in Education and Research (PalC), Singapore, Singapore
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Fournier H, Hasdenteufel M, Garrouteigt C, Perie M, Gliksohn A, Jouanne B, Hadj-Rabia S, Arveiler B, Morice-Picard F, Quintard B. The experience of albinism in France: a qualitative study on dyads of parents and their adult child with albinism. BMC Med 2024; 22:40. [PMID: 38281904 PMCID: PMC10823752 DOI: 10.1186/s12916-024-03251-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND To date, almost no research on the psychosocial implications of albinism has been conducted in France and an exploration of albinism-related experiences could be beneficial, in order to better understand this condition. The aim of this study was to examine how French people with albinism and their parents live with and adapt to this condition in all the areas of their lives. METHODS Semi-structured phone interviews were conducted with 9 parent-child dyads, each participating separately. Participants were recruited by convenience sampling, thanks to the combined efforts of a patient association (Genespoir) and professionals from the partner medical referral centers involved in the project. Dyads in which the individual with albinism had any comorbidity were excluded. The interviews were then transcribed and subjected to in-depth thematic analysis. Two codebooks were constructed in a mirrored process: one for people with albinism; the other for their parents. They were finally merged at the end of the coding step. RESULTS Four main categories were identified: personal perceptions and social representations of albinism, difficulties and obstacles encountered by people with albinism, resources and facilitators, and the importance of parent-child functioning. The results indicated that experiences of stigmatization during childhood and adolescence are common and that people with albinism face challenges in adapting to certain obstacles related to their visual impairments (VI) (e.g., inability to drive a car; eye strain...). Parents emerged as one, if not as the main, source of support for people with albinism throughout their development. Although external support systems exist to assist them in various aspects of their lives, some of them primarily rely on their own personal resources to cope. CONCLUSIONS This research highlights the importance of a systemic and transdisciplinary approach to make sure families receive the support that best meets their needs.
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Affiliation(s)
- Hugo Fournier
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France.
| | - Marie Hasdenteufel
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France
| | - Constance Garrouteigt
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France
| | - Mathieu Perie
- National Institute for Research in Digital Science and Technology, Talence, F-33405, France
| | - Antoine Gliksohn
- Genespoir Association, Rennes, F-35000, France
- Global Albinism Alliance, Fontenay-sous-Bois, F-94120, France
| | | | | | - Benoit Arveiler
- CHU Bordeaux, Bordeaux, F-33404, France
- Laboratory of Rare Diseases: Genetics and Metabolism (MRGM) INSERM U1211, University of Bordeaux, Bordeaux, F-33076, France
| | | | - Bruno Quintard
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France
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Nuccio E, Petrosino F, Simeone S, Alvaro R, Vellone E, Pucciarelli G. The needs and difficulties during the return to work after a stroke: a systematic review and meta-synthesis of qualitative studies. Disabil Rehabil 2023:1-14. [PMID: 38018092 DOI: 10.1080/09638288.2023.2287016] [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: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers. MATERIALS AND METHODS A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital. RESULTS Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients' group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges. CONCLUSIONS Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process.
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Affiliation(s)
- Emanuela Nuccio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Petrosino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvio Simeone
- Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Viale Europa, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Singh G, Battalova A, Miller WC, Simpson E, Rash I, Mohammadi S, Tao G, Chan J, Mortenson WB. Resilience practices among a broad spectrum of individuals with physical disabilities during the COVID-19 pandemic: A qualitative photo elicitation study. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2887-2905. [PMID: 37334433 DOI: 10.1002/jcop.23070] [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: 09/01/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
This community-based study explored resilience practices among people living with physical disabilities (i.e., stroke, spinal cord injury, and other physical disabilities) during the COVID-19 pandemic. In this photo elicitation study, during 1:1 interviews, participants shared and described photos that reflected their pandemic-related experiences. Data were analyzed thematically to identify resilience-related practices. Our analysis revealed three themes: (1) reflecting on the importance of family, friends, and community (e.g., recalling past memories and strengthening existing connections); (2) engaging in social and recreational activities (e.g., experiencing the outdoors and gardening); and (3) reframing personal contexts and social environment (e.g., adjusting to new social norms and overcoming physical barriers to navigating safely during the pandemic). The resilience that participants identified encompassed not only individual strategies but also family and community supports. Resilience can be fostered through community initiatives that support more equitable responses to health emergencies for people with disabilities.
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Affiliation(s)
- Gurkaran Singh
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - Alfiya Battalova
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- School of Humanitarian Studies, Royal Roads University, Victoria, British Columbia, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine University of British Columbia, Vancouver, British Columbia, Canada
| | - Ethan Simpson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - Isabelle Rash
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine University of British Columbia, Vancouver, British Columbia, Canada
| | - Somayyeh Mohammadi
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | - Gordon Tao
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice Chan
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
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Cisek K, Kelleher JD. Current Topics in Technology-Enabled Stroke Rehabilitation and Reintegration: A Scoping Review and Content Analysis. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3341-3352. [PMID: 37578924 DOI: 10.1109/tnsre.2023.3304758] [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: 08/16/2023]
Abstract
BACKGROUND There is a worldwide health crisis stemming from the rising incidence of various debilitating chronic diseases, with stroke as a leading contributor. Chronic stroke management encompasses rehabilitation and reintegration, and can require decades of personalized medicine and care. Information technology (IT) tools have the potential to support individuals managing chronic stroke symptoms. OBJECTIVES This scoping review identifies prevalent topics and concepts in research literature on IT technology for stroke rehabilitation and reintegration, utilizing content analysis, based on topic modelling techniques from natural language processing to identify gaps in this literature. ELIGIBILITY CRITERIA Our methodological search initially identified over 14,000 publications of the last two decades in the Web of Science and Scopus databases, which we filter, using keywords and a qualitative review, to a core corpus of 1062 documents. RESULTS We generate a 3-topic, 4-topic and 5-topic model and interpret the resulting topics as four distinct thematics in the literature, which we label as Robotics, Software, Functional and Cognitive. We analyze the prevalence and distinctiveness of each thematic and identify some areas relatively neglected by the field. These are mainly in the Cognitive thematic, especially for systems and devices for sensory loss rehabilitation, tasks of daily living performance and social participation. CONCLUSION The results indicate that IT-enabled stroke literature has focused on Functional outcomes and Robotic technologies, with lesser emphasis on Cognitive outcomes and combined interventions. We hope this review broadens awareness, usage and mainstream acceptance of novel technologies in rehabilitation and reintegration among clinicians, carers and patients.
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Bislick L, Dietz A, Duncan ES, Cornelius K. The Feasibility and Benefits of a Virtual Yoga Practice for Stroke Survivors With Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-10. [PMID: 37130156 DOI: 10.1044/2023_ajslp-22-00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to (a) examine the feasibility of a virtual, adapted, aphasia-friendly yoga program for people with aphasia; (b) evaluate evidence of improvement in patient-reported outcomes and word retrieval; (c) explore the immediate impact of a yoga session on participant subjective emotional state; and (d) assess participant motivation and perceived benefits of participating in a yoga program. METHOD This feasibility study employed a mixed-method design to document the feasibility of a virtual, 8-week adapted yoga program. A pre-/posttreatment design was used to assess patient-reported outcome measures for resilience, stress, sleep, and pain, as well as word-finding abilities. Semistructured interviews with participants were thematically analyzed to provide insight into participants' motivation and perceptions regarding their experience. RESULTS Comparisons of pre- and postprogram group means suggest that participation in an 8-week adapted yoga program may positively impact perceptions of resilience (large effect), stress (medium effect), sleep disturbance (medium effect), and pain (small effect) for people with aphasia. Findings from within-session reports and brief, semistructured interviews with participants indicated positive outcomes and subjective experiences and suggest that people with aphasia are motivated to participate in yoga for a variety of reasons. CONCLUSIONS This study is an important first step in confirming the feasibility of an adapted, aphasia-friendly yoga program offered via a remote platform for people with aphasia. The findings support recent work suggesting that yoga may be a potent adjunct to traditional rehabilitation efforts to improve resilience and psychosocial aspects in persons with aphasia. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22688125.
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Affiliation(s)
- Lauren Bislick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Aimee Dietz
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | - E Susan Duncan
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
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Lo TLT, Lee JLC, Ho RTH. Recovery beyond functional restoration: a systematic review of qualitative studies of the embodied experiences of people who have survived a stroke. BMJ Open 2023; 13:e066597. [PMID: 36759032 PMCID: PMC9923291 DOI: 10.1136/bmjopen-2022-066597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To synthesise the qualitative evidence of embodied experiences of people who have survived a stroke, the experiences of making sense of oneself, others and the world in the poststroke bodies.DesignQualitative systematic review. DATA SOURCES Five electronic databases, PsycINFO, PubMed, MEDLINE, CINAHL Plus and Cochrane Library, were employed to search for qualitative studies published up to February 2022. INCLUSION CRITERIA Literature in English that employed qualitative methods to investigate the embodied experiences of people who have survived a stroke. QUALITY APPRAISAL Two reviewers independently appraised the quality of the included studies based on the tool developed by Salter et al in 2008. It consists of seven questions assessing the credibility and relevance of the studies. Discrepancies were resolved until a consensus was reached. DATA EXTRACTION AND SYNTHESIS Thematic synthesis was applied to synthesise the related findings from all the included studies. Two reviewers were involved in the process. RESULTS 1482 records were identified. After the screening process, 34 studies were included in this review. Three analytical themes and their related descriptive themes emerged. Analytical themes included 'disconnection between oneself, others and the world,' 'the transitional period: exploring and negotiating,' and 'reconnecting with oneself, others and the world'. CONCLUSION The findings demonstrated that the embodied experiences of people who have survived a stroke progressed from feeling disconnected to reconnecting with themselves, others and the world. Stroke recovery should not only be limited to functional restoration. Approaching 're-embodiment', the realignment between oneself and one's body, is crucial in reintegrating with others and the world on the trajectory toward recovery. PROSPERO REGISTRATION NUMBER CRD42020183125.
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Affiliation(s)
- Temmy Lee Ting Lo
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Janet Lok Chun Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong SAR
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR
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13
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Wassenius C, Claesson L, Blomstrand C, Jood K, Carlsson G. The centrality of work in everyday life after stroke: A qualitative study of long-term stroke survivors. Scand J Occup Ther 2023; 30:539-549. [PMID: 36726231 DOI: 10.1080/11038128.2023.2170914] [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: 02/03/2023]
Abstract
BACKGROUND Work is an occupation of great concern for younger stroke survivors. Given the high rate of people not working after stroke, there is a need to explore work after stroke from a long-term perspective, including not just an initial return to work, but also the ability to retain employment and how this may affect everyday life after stroke. Therefore, the objective of this study was to explore experiences relating to work and to work incapacity among long-term stroke survivors. METHOD This study used thematic analysis on data gathered through individual semi-structured interviews with long-term stroke survivors. RESULTS The analysis resulted in four themes that together comprised the main theme 'The centrality of work in everyday life', containing descriptions of how everyday life was affected by aspects of work both for those who did work and those who did not return to work after stroke. CONCLUSION AND SIGNIFICANCE The results highlight the importance of addressing return to work not just as an isolated outcome but as part of everyday life after stroke. The results indicate a need for a more flexible approach to supporting return to work that continues past the initial return.
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Affiliation(s)
- Charlotte Wassenius
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Region Västra Götaland, Department of Research, Education and Innovation, Södra Älvsborg Hospital, Borås, Sweden
| | - Lisbeth Claesson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Stroke Centre West. The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Neurology, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Carlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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14
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Rojas Perez OF, Sanchez SE, Cruz V, Sánchez E, Levey E, Gelaye B. Comparative Performance of the Resilience Inventory (IRES) and Resilience Scale-14 (RS-14) Spanish Versions Among Postpartum Adolescent Mothers. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1069-1080. [PMID: 36439676 PMCID: PMC9684388 DOI: 10.1007/s40653-022-00458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 06/16/2023]
Abstract
We sought to evaluate the psychometric properties of two resilience scales; the Resilience Inventory (IRES) and the 14-item Resilience Scale (RS-14) among Peruvian postpartum adolescent mothers. This cross-sectional study included 785 adolescent mothers who delivered at a maternity hospital in Lima, Peru. The Spanish versions of IRES and RS-14 were used to evaluate the properties of the measures. We examined reliability using Cronbach's alpha. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity and factor structures of the two scales. Both scales had good internal consistency (Cronbach's alpha > 0.7). Correlation between IRES and RS-14 scores was fair (r = 0.53). The EFA results of both scales yielded a three-factor structure. EFA including all items from IRES and RS-14 yielded a six-factor structure. CFA results corroborated the original seven-factor structure for IRES and yielded measures indicating a good level of goodness of fit (comparative fit index of 0.93) and accuracy (root mean square error of approximation of 0.07). Overall, Spanish language versions of both the IRES and the RS-14 are reliable and valid scales for assessing resilience among Peruvian postpartum adolescent mothers. Additional research is needed to integrate culturally-specific traits into resilience measures.
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Affiliation(s)
| | - Sixto E. Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Asociación Civil PROESA, Lima, Peru
| | - Victor Cruz
- Peruvian National Institute of Mental Health, Honorio Delgado – Hideyo Noguchi, Lima, Peru
| | | | - Elizabeth Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Bizu Gelaye
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
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15
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Matérne M, Simpson G, Jarl G, Appelros P, Arvidsson-Lindvall M. Contribution of participation and resilience to quality of life among persons living with stroke in Sweden: a qualitative study. Int J Qual Stud Health Well-being 2022; 17:2119676. [PMID: 36062839 PMCID: PMC9467624 DOI: 10.1080/17482631.2022.2119676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Resilience contributes to positive adaptation after many health conditions, but little is known about its contribution to long-term recovery after stroke. This study investigated the lived experience of resilience and participation and their relationship to quality of life after stroke in Sweden. MATERIAL AND METHOD Semi-structured telephone interviews were conducted with 19 informants (10 male, 9 female), aged from 44-89 years and between 1 and 19 years post-stroke. Stroke severity ranged from mild (n = 8), moderate (n = 9) to severe (n = 2). Interviews were analysed using content analysis. RESULTS The analysis resulted in an overarching theme; Life with stroke has been adapted to but not accepted, built on five subthemes: 1) Adapting and adjusting life, 2) Meaningful values in life, 3) Inner resources, 4) Support and treatment from social relations, and 5) Support and treatment from external resources. CONCLUSION Participants described a tension between adapting and accepting life after stroke. Resilience was a useful framework, highlighting the contribution of inner, social and societal resources to recovery and quality of life, both directly and as enhanced through increased participation. Important factors for adaptation are meaningful values in life, individual strategies for adaptation and support from both social relationship and the society.
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Affiliation(s)
- Marie Matérne
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Grahame Simpson
- John Walsh Centre of Rehabilitation Research, University of Sydney, Sydney, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Gustav Jarl
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Peter Appelros
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mialinn Arvidsson-Lindvall
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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16
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Yan HY, Lin HR. Resilience in Stroke Patients: A Concept Analysis. Healthcare (Basel) 2022; 10:2281. [PMID: 36421605 PMCID: PMC9691242 DOI: 10.3390/healthcare10112281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 05/01/2024] Open
Abstract
(1) Background: Resilience enables individuals to develop positive coping strategies when faced with adversity. However, knowledge on resilience in stroke patients remains limited, and resilience assessment methods continue to be debated. (2) Aim: To perform a concept analysis of resilience in stroke patients. (3) Methods: The Walker and Avant approach to concept analysis was adopted. Searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Chinese Electronic Periodical Services (CEPS) databases and grey literature using the keywords "stroke patient", "resilience", and "concept analysis". (4) Results: The defining attributes of resilience in stroke patients were classified into internal personality traits and external environmental support. Antecedents included physical, mental, and familial and social impairments caused by the disease, and the consequences were good adaptation, which included active cooperation with rehabilitation activities, positive thinking, goal setting, and harboring hope for the future. (5) Conclusion: Resilience is of a diverse and complex nature. Optimism and positivity, problem-solving ability, and familial and social support may assist in re-adjusting or restoring the balance between physical and mental health when a stroke patient faces adversity. Key factors affecting resilience in stroke patients should be further investigated in future research to assist in the development of effective interventional treatment measures.
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Affiliation(s)
- Huey-Yeu Yan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
- Department of Nursing, University of Kang Ning, Taipei City 114311, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
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17
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Currie S, Douglas J, Winkler D. 'What's next?' The journey from hospital to community engagement from the perspectives of adults following severe acquired brain injury: a scoping review protocol. BMJ Open 2022; 12:e064226. [PMID: 36130757 PMCID: PMC9494587 DOI: 10.1136/bmjopen-2022-064226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Community integration and social participation remain a challenge for many individuals following acquired brain injury (ABI) and the transition from hospital to home is a complex journey. It is important to conceptualise this transition from the perspective of people with ABI, to inform future research with the overall aim of improving the experience of community re-engagement and maintaining important relationships within social networks. METHODS AND ANALYSIS The methodology outlined by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews will be used to guide the review. A comprehensive electronic database search will be conducted in MEDLINE, CINAHL, Scopus, Embase and PsychINFO. The search will aim to locate only published, qualitative or mixed methods studies and will be limited to citations published in English, from January 2014 to the date of final search completion. Quality assessment using the Critical Appraisal Skills Programme will be completed and reported.Data extraction will include participant and study characteristics.Finally, qualitative data from each citation, including participant quotes, will be extracted and thematic analysis will be completed to support conceptualisation of community participation from those who have experienced the transition to the community following discharge from hospital. Three individuals with lived experiences of ABI will be engaged as paid consultants to review and comment on the findings of the review. ETHICS AND DISSEMINATION It is intended that the findings from this review will be made available to relevant stakeholders through peer-reviewed publications and conference presentations. This scoping review does not require an ethics application.
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Affiliation(s)
- Suzanne Currie
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Research Unit, Summer Foundation, Blackburn, Victoria, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Research Unit, Summer Foundation, Blackburn, Victoria, Australia
| | - Di Winkler
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Research Unit, Summer Foundation, Blackburn, Victoria, Australia
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18
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Love MF, Brooks AN, Cox SD, Okpala M, Cooksey G, Cohen AS, Sharrief AZ. The effects of racism and resilience on Black stroke- survivor quality of life: Study protocol and rationale for a mixed-methods approach. Front Neurol 2022; 13:885374. [PMID: 36034272 PMCID: PMC9399920 DOI: 10.3389/fneur.2022.885374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Stroke, a life-threatening stressor, often negatively impacts stroke-survivor (SS) quality of life (QoL). Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, a significant stressor, occurs at structural, cultural, and interpersonal levels and contributes to health disparities for Black SS. Resilience, a dynamic process of positive adaptation to significant stress, is impacted by factors or resources both internal and external to the individual. This study aims to examine the effects of experiences of racism and resilience on Black SS QoL during early stroke recovery. This article presents the study protocol. Methods and analyses This will be a prospective observational mixed-methods study. Black community-dwelling adults who are within 4 weeks of a stroke will be eligible for inclusion. Baseline measures will include the exposure variables of experiences of racism and resilience. Covariates measured at baseline include sociodemographic variables (age, sex, marital status, education, income, health insurance, employment status, number of people in household, residential address), clinical variables (date and type of stroke, inferred Modified Rankin Scale, anxiety and depression screening), and psychosocial variables (COVID-19 stress, perceived stress, mindfulness). The outcome variable (QoL) will be assessed 6-months post-stroke. Multiple-level linear regression models will be used to test the direct effects of experiences of racism, and the direct and indirect effects of resilience, on QoL. Qualitative data will be collected via focus groups and analyzed for themes of racism, resilience, and QoL. Discussion Racism can compound the stress exerted by stroke on Black SS. This study will occur during the COVID-19 pandemic and in the aftermath of calls for social justice for Black Americans. Experiences of racism will be measured with instruments for both “everyday” discrimination and vigilance. Sociodemographic variables will be operationalized to assess specific social determinants of health that intersect with structural racism. Because of the long-standing history of racism in the United States of America (USA), cultural influences and access to resources are central to the consideration of individual-level resilience in Black SS. Study results may inform the development of interventions to support Black SS QoL through enhanced resilience.
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Affiliation(s)
- Mary F. Love
- College of Nursing, University of Houston, Houston, TX, United States
- *Correspondence: Mary F. Love
| | | | - Sonya D. Cox
- College of Nursing, University of Houston, Houston, TX, United States
| | - Munachi Okpala
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Gail Cooksey
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Audrey Sarah Cohen
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Anjail Z. Sharrief
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
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19
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Mangset M, Kitzmüller G, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne KJ, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation. Trials 2021; 22:850. [PMID: 34838094 PMCID: PMC8627040 DOI: 10.1186/s13063-021-05765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is "usual care." The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants' reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. METHODS Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur's interpretation theory guided the analysis. RESULTS The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants' feelings of control and their ability to cope. Other participants' statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. CONCLUSIONS RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02338869. Registered on October 4, 2014.
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Affiliation(s)
- Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Anne S. Evju
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Sanne Angel
- Department of Public Health – Research Unit for Nursing and Healthcare, Department of Science in Nursing, Aarhus University, 8000 Aarhus, Denmark
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
| | - Lena Aadal
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
- Hammel Neurorehabilitation Centre and University Research Clinic, 8450 Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, C, 8000 Aarhus, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
| | | | - Kari J. Kvigne
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
- The Faculty of Nursing and Health Sciences, Nord University, P.B. 1490, 8049 Bodø, Norway
| | - Line K. Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Ellen Gabrielsen Hjelle
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
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Mavaddat N, Sadler E, Lim L, Williams K, Warburton E, Kinmonth AL, Mckevitt C, Mant J. What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK. BMC Neurol 2021; 21:315. [PMID: 34388983 PMCID: PMC8362227 DOI: 10.1186/s12883-021-02338-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Levels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors. Methods Face to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’. Results Individuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals. Conclusions The disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02338-x.
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Affiliation(s)
- Nahal Mavaddat
- School of Medicine, Division of General Practice, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.
| | - Euan Sadler
- Department of Nursing, Midwifery and Health, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lisa Lim
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Kate Williams
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Elizabeth Warburton
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, R3, Box 83, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ann Louise Kinmonth
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Chris Mckevitt
- School of Population Health and Environmental Sciences, King's College London, Addison House, London, SE1 1UL, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
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21
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Anderson MA, Buffo C, Ketcher D, Nguyen H, MacKenzie JJ, Reblin M, Terrill AL. Applying the RISE Model of Resilience in Partners Post-Stroke: A Qualitative Analysis. Ann Behav Med 2021; 56:270-281. [PMID: 34228090 DOI: 10.1093/abm/kaab053] [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: 01/01/2023] Open
Abstract
BACKGROUND Resilience is dynamic and influenced by internal and external factors. In persons with chronic illness and/or disability, resilience is viewed as the ability to adapt to new life circumstances. Existing models of resilience typically focus on the absence of deficit and pathology in the individual, overlooking resources, well-being, and broader social impacts. Our proposed novel Relational, Intrapersonal, Social and Environmental (RISE) Model of resilience incorporates and describes the interconnection and influence of constructs that impact resilience and affect the quality of life. PURPOSE The purpose of this study is to examine the fit of the RISE Model against original interview data obtained from persons with stroke and their partners. METHODS This study is a secondary analysis of qualitative data collected from post-intervention interviews that were part of an intervention pilot study designed to promote resilience in couples coping with stroke. Interviews were coded to examine relationships between RISE Model constructs. RESULTS The study included 36 interviews from 18 cohabitating couples; mean participant age was 53.33 years (SD ±14.70). Examples of each construct within the RISE Model appeared in transcribed interviews and common patterns of co-occurring constructs were identified. CONCLUSION The constructs within the RISE Model were supported by the interviews. The impact of disability does not remain confined to a single individual and instead branches out into the broader social context, including close interpersonal relationships. A deeper understanding of resilience and its relationship with intrapersonal, interpersonal and socio-ecological constructs would add value to our understanding and fostering of resilience in persons with disabilities and/or chronic illness. CLINICAL TRIAL INFORMATION NCT03335358.
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Affiliation(s)
- Miranda A Anderson
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Corinne Buffo
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Dana Ketcher
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Hop Nguyen
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Justin J MacKenzie
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Alexandra L Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
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Han CY, Chen LC, Lin CC, Goopy S, Lee HL. How Emergency Nurses Develop Resilience in the Context of Workplace Violence: A Grounded Theory Study. J Nurs Scholarsh 2021; 53:533-541. [PMID: 33960107 PMCID: PMC8518509 DOI: 10.1111/jnu.12668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Purpose To understand how emergency nurses develop resilience in the context of workplace violence. Design This study employed grounded theory methodology. Thirty nurses from three hospital emergency departments in Taiwan were interviewed between August and December 2018. Methods Semistructured interviews were used to collect data. Interviews were audio‐recorded and transcribed verbatim. Findings The process through which emergency nurses who had experienced workplace violence developed resilience took place in three stages: the release of emotions after the assault; the interpretation of conflicting thoughts and actions; and the establishment of strategies to cope with workplace violence in the future. The core theme was the motivating role of professional commitment to emergency patient care. Conclusions The results of this study can inform the development of support systems to enhance the resilience of nurses experiencing workplace violence by alerting healthcare administrators and governing institutions to their needs. Clinical Relevance Emergency nurses viewed professional growth and professional commitment as an invisible motivator in the development of resilience following an encounter with workplace violence.
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Affiliation(s)
- Chin-Yen Han
- Associate Professor, Department of Nursing, and Clinical Competency Center Chang Gung University of Science and Technology; Associate Research Fellow (joint appointment) Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan, Republic of China
| | - Li-Chin Chen
- Director, Department of Nursing, New Taipei Municipal Tuncheng Hospital, Chang Gung Memorial Hospital; Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, Republic of China
| | - Chun-Chih Lin
- Associate Professor, Department of Nursing, Chang Gung University of Science and Technology; Associate Research Fellow (joint appointment) Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan, Republic of China
| | - Suzanne Goopy
- Senior Teaching Fellow and Programme Coordinator, Usher institute, University of Edinburgh, UK, and Adjunct Associate Professor at University of Calgary, Canada
| | - Hui-Ling Lee
- Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, Republic of China
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23
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Moss B, Northcott S, Behn N, Monnelly K, Marshall J, Thomas S, Simpson A, Goldsmith K, McVicker S, Flood C, Hilari K. 'Emotion is of the essence. … Number one priority': A nested qualitative study exploring psychosocial adjustment to stroke and aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:594-608. [PMID: 33826205 DOI: 10.1111/1460-6984.12616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Stroke and aphasia can have a profound impact on people's lives, and depression is a common, frequently persistent consequence. Social networks also suffer, with poor social support associated with worse recovery. It is essential to support psychosocial well-being post-stroke, and examine which factors facilitate successful adjustment to living with aphasia. AIMS In the context of a feasibility randomized controlled trial of peer-befriending (SUPERB), this qualitative study explores adjustment for people with aphasia in the post-acute phase of recovery, a phase often neglected in previous research. METHODS & PROCEDURES Semi-structured interviews were conducted with 20 people with aphasia and 10 significant others, who were purposively sampled from the wider group of 56 people with aphasia and 48 significant others. Interviews took place in participants' homes; they were analysed using framework analysis. OUTCOMES & RESULTS Participants with aphasia were 10 women and 10 men; their median (interquartile range-IQR) age was 70 (57.5-77.0) years. Twelve participants had mild aphasia, eight moderate-severe aphasia. Significant others were six women and four men with a median (IQR) age of 70.5 (43-79) years. They identified a range of factors that influenced adjustment to aphasia post-stroke. Some were personal resources, including mood and emotions; identity/sense of self; attitude and outlook; faith and spirituality; and moving forward. Significant others also talked about the impact of becoming carers. Other factors were external sources of support, including familial and other relationships; doctors, nurses and hospital communication; life on the ward; therapies and therapists; psychological support, stroke groups; and community and socializing. CONCLUSIONS & IMPLICATIONS To promote adjustment in the acute phase, hospital staff should prioritize the humanizing aspects of care provision. In the post-acute phase, clinicians play an integral role in supporting adjustment and can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. What this paper adds What is already known on the subject Anxiety and depression are common consequences of stroke, with depression rates high at 33% at 1 year post-onset. There is evidence that the psychological needs of people with aphasia are even greater than those of the general stroke population. Social support and social networks are also negatively impacted. Few studies have examined adjustment when people are still in hospital or in the early stages of post-stroke life in the community (< 6 months). Further, many stroke studies exclude people with aphasia. What this paper adds to existing knowledge Adjustment to living with stroke and aphasia begins in the early stages of recovery. While this partly depends on personal resources, many factors depend on external sources of help and support. These include doctors, nurses and hospital communication, their experience of life on the ward, and their therapists' person-centred care. What are the potential or actual clinical implications of this work? Clinicians play an integral role in facilitating people with aphasia to utilize their personal resources and support systems to adjust to life after stroke. They can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy.
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Affiliation(s)
- Becky Moss
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Sarah Northcott
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Behn
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Katie Monnelly
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Shirley Thomas
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care and Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Biostatistics Department, Division of Psychology and Systems Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sally McVicker
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
- Aphasia Re-Connect, London, UK
| | - Chris Flood
- School of Health and Social Care, London South Bank University, London, UK
| | - Katerina Hilari
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
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24
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van Dongen L, Hafsteinsdóttir TB, Parker E, Bjartmarz I, Hjaltadóttir I, Jónsdóttir H. Stroke survivors' experiences with rebuilding life in the community and exercising at home: A qualitative study. Nurs Open 2021; 8:2567-2577. [PMID: 33690972 PMCID: PMC8363348 DOI: 10.1002/nop2.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 01/27/2023] Open
Abstract
Aim This study aimed to explore how stroke survivors deal with stroke‐related impairments when rebuilding their lives in the community and their experiences of exercising at home. Design An explorative and descriptive qualitative study. Methods A purposive sample of ten stroke survivors residing at home was recruited to explore experiences of rebuilding their lives in the community and exercising at home. One focus group interview was conducted followed by semi‐structured interviews. Data were analysed using thematic analysis. Results Three main themes were identified: “Framing exercise within the context of everyday life” describes how stroke survivors integrate exercise in everyday activities with varying success and the social importance of exercising; “Managing the challenges of physical impairment” describes the taxing undertakings in daily living, loss of concentration and identity; “Long‐term challenges of everyday life” describes how the stroke survivors manage depression and live with a sense of uncertainty.
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Affiliation(s)
- Lisa van Dongen
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ethna Parker
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Ingibjörg Hjaltadóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
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25
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Harris Walker G, Gonzalez-Guarda R, Yang Q, Shah S, Prvu Bettger J. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. J Adv Nurs 2021; 77:2860-2874. [PMID: 33650219 DOI: 10.1111/jan.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022]
Abstract
AIMS Stroke is affecting an increasing number of young and middle-aged adults. Given the substantial diversion from anticipated life trajectories that younger stroke survivors experience as a result of their stroke deficits, their health-related quality of life (HRQOL) is likely to be negatively impacted during the immediate post-acute recovery period. The aim of this study was to generate a comprehensive understanding of the influences on HRQOL and acute recovery during the first three months following stroke for younger adults using a socio-ecological perspective. DESIGN Longitudinal, convergent mixed methods design. METHODS HRQOL survey data, assessed using the Patient Generated Index (N = 31), and qualitative interview data about survivors' recovery experiences (N = 20) were collected. Simple linear regression and effect size results were integrated with themes and sub-themes identified from conventional content analysis using joint data displays. RESULTS Depression and fatigue negatively affected recovery at the individual level. At the family and societal level, family functioning, social support including being married, having insurance, working, adequate income and being unemployed post-stroke all positively impacted recovery. Qualitative findings revealed determination, coping, and accessing healthcare to positively affect recovery though a meta-inference could not be drawn as no quantitative data addressed these concepts. CONCLUSION A variety of factors intersecting across socio-ecological levels were perceived by young stroke survivors to influence acute recovery experiences and outcomes. IMPACT This study identified individual-, family- and societal-level factors in younger adults' environments that may affect the acute stroke recovery experience. Findings underscore the need for research and clinical approaches that consider environmental factors at multiple levels of influence when supporting stroke recovery for younger adults.
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Affiliation(s)
| | | | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Duke University School of Nursing, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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26
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Tsai SJ, Li CC, Tsai SM, Kao SC, Chen HM, Pai HC. Illness Representation and Self-Efficacy: An Exploration of Fatigue Factors in Middle-Aged Stroke Survivors. Clin Nurs Res 2021; 30:1030-1037. [PMID: 33629607 DOI: 10.1177/1054773821997134] [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: 11/15/2022]
Abstract
The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients' illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients' self-efficacy, promote patients' resilience, and better function.
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Affiliation(s)
- Su-Ju Tsai
- Chung Shan Medical University Hospital, Taichung, Taiwan.,Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Chi Li
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shu-Mei Tsai
- Chung Shan Medical University Hospital, Taichung, Taiwan.,Chung Shan Medical University, Taichung, Taiwan
| | - Shu-Chuan Kao
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | - Hsiang-Chu Pai
- Chung Shan Medical University Hospital, Taichung, Taiwan.,Chung Shan Medical University, Taichung, Taiwan
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27
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Wassenius C, Claesson L, Blomstrand C, Jood K, Carlsson G. Integrating consequences of stroke into everyday life - Experiences from a long-term perspective. Scand J Occup Ther 2020; 29:126-138. [PMID: 33307938 DOI: 10.1080/11038128.2020.1857433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Occupational engagement encompasses both objective and subjective aspects of occupation. Long-term follow-up studies indicate that stroke can have a negative impact on the ability to perform IADL. Less is known about the subjective experiences of occupational engagement and how engagement may evolve after stroke. OBJECTIVE To explore stroke survivors' experiences of occupational engagement and how engagement changed over time and across contexts. MATERIAL AND METHODS Repeat, semi-structured interviews 15-18 years post-stroke, analysed using thematic analysis. Eight out of nine participants were classified as having had a mild stroke at onset. RESULTS The analysis resulted in five themes that together formed the main theme 'It takes time - integrating consequences of stroke into everyday life by engaging in occupation, using internal resources and adapting to context'. This illustrated how occupational outcome was the result of a continuous process in which occupational engagement was a way of gradually integrating consequences of stroke into everyday life. CONCLUSION AND SIGNIFICANCE Occupational engagement plays an important part in the process of moving on with life and can serve as both goal and means of achieving desired outcomes after stroke. Interventions that focus on enabling opportunities for occupational engagement in valued occupations and support the use of abilities and internal resources can reduce the impact of stroke in everyday life.
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Affiliation(s)
- Charlotte Wassenius
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Occupational therapy and Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden
| | - Lisbeth Claesson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Stroke Centre West, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Neurology, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Carlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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28
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Buczak-Stec E, König HH, Hajek A. Impact of stroke on affective well-being: findings from a large longitudinal nationally representative study. Aging Ment Health 2020; 24:2006-2013. [PMID: 31583890 DOI: 10.1080/13607863.2019.1671315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine whether the incidence of stroke influences affective well-being (positive affect and negative affect), and whether such a relationship is moderated by general self-efficacy. METHOD Longitudinal data from 2008, 2011 and 2014 were used from a population-based sample of community-residing individuals ≥ 40 years in Germany (n = 9,659 in regression analysis). Affective well-being was quantified using the established Positive and Negative Affect Schedule (PANAS). A well-established scale by Schwarzer and Jerusalem was used to assess general self-efficacy. General practitioner diagnosed stroke was reported. RESULTS Fixed effects regressions showed that the incidence of stroke was associated with a decrease in positive affect in the total sample (β = -.17, p < .001) and in both sexes (men: β = -.16, p < .05; women: β = -.19, p < .01). In contrast to these findings, the incidence of stroke was not associated with changes in negative affect (total sample; stratified by sex). Moreover, general self-efficacy moderated the relation between stroke and positive affect. CONCLUSION Panel regression models showed that the incidence of stroke was associated with a decline in positive affect in the total sample and in both sexes. As the general self-efficacy moderated this association, it may be beneficial to enhance self-efficacy and prioritize coping strategies among stroke survivals.
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Affiliation(s)
- Elżbieta Buczak-Stec
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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29
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Batuecas-Caletrío J, Rodríguez-Martín B. Family and personal coping process after a haemorrhagic stroke, a life-history. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01204-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Gray LA. Living the Full Catastrophe: A Mindfulness-Based Program to Support Recovery from Stroke. Healthcare (Basel) 2020; 8:healthcare8040498. [PMID: 33228109 PMCID: PMC7711731 DOI: 10.3390/healthcare8040498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/30/2022] Open
Abstract
Decades of research suggest that Mindfulness-Based Stress Reduction (MBSR) training supports a greater capacity to live with chronic medical conditions and contributes to lowering stress levels. This paper introduces a model for a Mindfulness-Based Recovery from Stroke (MBRfS) for promoting stroke recovery, informed by the lived experience of the author (a stroke survivor and certified MBSR instructor), the research literature regarding MBSR training, and the specific challenges of stroke recovery. Four themes emerged from the autoethnographic analysis that informed the proposed model: Readiness to accept the stroke event and the acquired brain injury, navigating uncertainties of stroke recovery with awareness and self-responsibility for outcomes, trusting the inherent wisdom of the body as a stroke recovery "teacher", and increased capacity to integrate complex emotions with self-compassion, and a sense of wholeness. A four-component MBRfS model is offered, which consists of an integration amongst a modified MBSR framework, emergent attitudinal themes, and insights from the autoethnographic vignettes. The MBRfS model offers a path for providing participants with a supportive experience within stroke recovery. Recommendations and suggestions for future studies are offered to support the development of MBRfS for stroke survivors and their caregivers, as well as contributing to healthcare providers.
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Affiliation(s)
- Lori A Gray
- Holistic Health Programs, Western Michigan University, Kalamazoo, MI 49008, USA
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31
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Meads H, Hunt J, Page A, Withy L, Plowman R, Calder A. Stroke survivors’ experiences of upper limb recovery: a systematic review of qualitative studies. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hayley Meads
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Jamie Hunt
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Alister Page
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Lee Withy
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Rose Plowman
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Allyson Calder
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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32
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Szigeti Z, Nalder E, King G, Farthing J, Gauvin-Lepage J. The Road to Family Resiliency: A Case Report of a Family's Experiences Following Adolescent Stroke. Rehabil Nurs 2020; 46:87-94. [PMID: 33038097 DOI: 10.1097/rnj.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This study generated an understanding of familial resiliency following an adolescent's stroke and what resiliency-related outcomes were important to this family. DESIGN AND METHODS A qualitative case study design was used to collect data during an in-person interview. The interview was transcribed verbatim and analyzed using thematic analysis. FINDINGS Participants' narratives revealed that reengaging and establishing new activities, reconstructing identities, and changing perceptions regarding health and life itself were important resiliency-related outcomes. CONCLUSIONS The findings from this case study highlight innovative strategies that can be used to facilitate resiliency during strenuous times in a family's life, such as following an adolescent's stroke. CLINICAL RELEVANCE Clinicians and service providers have the opportunity to help facilitate resiliency by identifying which protective factors and positive outcomes are most important to a family following an adolescent's stroke, allowing clinicians to assist in achieving these outcomes. This research illustrates ways for families to convert resources into personally meaningful resiliency-related outcomes. Further research is needed to study familial resiliency as a part of an intervention to promote occupational engagement.
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Affiliation(s)
| | | | | | - Julie Farthing
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
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33
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Hall J, Morton S, Hall J, Clarke DJ, Fitzsimons CF, English C, Forster A, Mead GE, Lawton R. A co-production approach guided by the behaviour change wheel to develop an intervention for reducing sedentary behaviour after stroke. Pilot Feasibility Stud 2020; 6:115. [PMID: 32821421 PMCID: PMC7429798 DOI: 10.1186/s40814-020-00667-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke. Methods A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two-stroke services (England and Scotland). Workshop format was informed by the behaviour change wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development. Findings Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.
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Affiliation(s)
- Jennifer Hall
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK.,Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - Sarah Morton
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4A, Edinburgh, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK.,Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK
| | - Claire F Fitzsimons
- Physical Activity for Health Research Centre, St Leonards Land, Holyrood Road, Edinburgh, EH8 8AQ 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, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4A, Edinburgh, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT UK
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Gibbs LAL, Anderson MI, Simpson GK, Jones KF. Spirituality and resilience among family caregivers of survivors of stroke: A scoping review. NeuroRehabilitation 2020; 46:41-52. [PMID: 32039873 DOI: 10.3233/nre-192946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stroke is the leading cause of disability in Australia and the third-leading cause of disability worldwide and a significant burden on caregivers. OBJECTIVE To map the extent, range and nature of the literature investigating spirituality and resilience among family caregivers of survivors of stroke. METHOD A scoping review. RESULTS Six studies were identified, conducted in the United States, United Kingdom, China and Turkey. These included two quantitative, one experimental and three qualitative designs. No studies linked spirituality to resilience. For the qualitative studies, spirituality was the primary focus of one, and the secondary focus of two others. Qualitative data reflected the lived experience of caregivers drawing upon spirituality to help cope with the burden of caregiving. For the two quantitative studies, spirituality was measured as a secondary focus and showed no significant links between spirituality or adjustment in caregivers. The one experimental study comprised a psycho-educational intervention focused on building resilience, finding a significant increase in social support not reflected in a matched control group. Clinical implications suggested the need for strength-based interventions, including spiritual needs and religious beliefs of the family caregiver. CONCLUSIONS Spirituality and resilience following stroke are essential factors in caregiver adjustment following stroke. Further research with a focus on causality and the link between spirituality, resilience and adjustment in this population is needed.
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Affiliation(s)
| | | | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,School of Human Services and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Kate Fiona Jones
- School of Human Services and Social Work, Griffith University, Gold Coast, QLD, Australia.,Royal Rehab Centre, Ryde, NSW, Australia.,Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
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Pedersen SG, Anke A, Aadal L, Pallesen H, Moe S, Arntzen C. Experiences of quality of life the first year after stroke in Denmark and Norway. A qualitative analysis. Int J Qual Stud Health Well-being 2020; 14:1659540. [PMID: 31547779 PMCID: PMC6781187 DOI: 10.1080/17482631.2019.1659540] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: This study aims to explore quality of life (QOL) during the first year of recovery after stroke in North Norway and Central Denmark. Method: Individual in-depth interviews with 11 stroke survivors were performed twelve months after stroke onset. An interpretative, inductive approach shaped the interview process and the processing of data. Results: We found that QOL reflected the individuals' reconstruction of the embodied self, which was identified by three intertwined and negotiating processes: a familiar self, an unfamiliar self, and a recovery of self. Further, we found that reconstruction of the embodied self and QOL could be framed as an ongoing and interrelated process of "being, doing, belonging and becoming". Enriching social relations, successful return to work, and continuity and presence in professional support during recovery enhanced the experience of QOL. Fatigue and sustained reduced function hindered participation in meaningful activities and influenced the perceived QOL negatively. Conclusions: The two countries differed in descriptions of continuity and support in the professional follow-up during the recovery process, influencing the degree of encouragement in reconstructing the embodied self. Reconstruction of the embodied self is a means of understanding stroke survivors' QOL during the first year of recovery, supporting an individualized and tailored rehabilitation practice.
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Affiliation(s)
- Synne G Pedersen
- Department of Rehabilitation, University Hospital of North Norway , Tromsø , Norway.,Department of Health and Care Sciences, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway , Tromsø , Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
| | - Lena Aadal
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Aarhus , Denmark
| | - Hanne Pallesen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Aarhus , Denmark
| | - Siri Moe
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
| | - Cathrine Arntzen
- Department of Rehabilitation, University Hospital of North Norway , Tromsø , Norway.,Department of Health and Care Sciences, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
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Prakash V, Ganesan M. What matters to patients with stroke in India and why: a qualitative study. Disabil Rehabil 2019; 43:2585-2592. [PMID: 31880184 DOI: 10.1080/09638288.2019.1706194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To gain insight into the preferred outcomes of patients with stroke living in India and develop a conceptual framework of participation in daily activities based on patient perspectives informed by the International Classification of Functioning, Disability, and Health. METHODS This study took a phenomenological approach. A purposive sample of 30 patients with stroke and diverse socio-demographic and disease related characteristics participated in semi-structured interviews. Interviews consisted of open-ended questions about their post stroke rehabilitation goals. Data were analyzed using content analysis. RESULTS Patients expressed preference for outcomes such as the use of eastern toilets, squatting and sitting on the floor, eating with the right hand, taking a "bucket bath," walking for long distances (1-2 km) and the use of public transportation. Patients attributed their outcome preferences to contextual factors such as the physical environment (natural and built environment), family structure and living conditions, cultural values, norms and practices. Based on the outcomes identified by the patients, we developed the conceptual framework of participation in daily activities relevant to Indian context consisting of Mobility, Self-care, Domestic Life, and Social participation domains informed by the International Classification of Functioning, Disability, and Health. CONCLUSIONS Outcome preferences of patients with stroke are not universal. The conceptual framework including its domains and contents developed in this study can be a useful guide to clinicians and researchers in choosing what to measure within Indian as well as other similar sociocultural contexts.Implications for rehabilitationPost-stroke functional outcome measurement is meaningful only when it is conceptualized within the context in which the personal, social, and cultural values of patients are well-recognized.There are notable differences in the type of activities constituting daily activities and how they were performed in India compared to a western cultural context.Patients' daily functioning is characterized by the differences in personal preferences, cultural norms and practices, family and living arrangements, lifestyle, and characteristics of natural and built environment and the available public infrastructure.Differentiating activities patients cannot do from the "no need to do" or "don't want to do" should be viewed as a critical aspect of patient reported outcome measurement.
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Affiliation(s)
- V Prakash
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science & Technology, Anand, Gujarat, India
| | - Mohan Ganesan
- Department of Physical Therapy, University of St Augustine, San Marcos, CA, USA
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Walder K, Molineux M. Listening to the client voice - A constructivist grounded theory study of the experiences of client-centred practice after stroke. Aust Occup Ther J 2019; 67:100-109. [PMID: 31840290 DOI: 10.1111/1440-1630.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Collaboration, choice and power-sharing are cornerstones of practice as occupational therapists support individuals to re-establish an occupational identity and reintegrate into the community following stroke. Yet evidence of unmet client needs suggests client-centred care is not optimal, and little is known of client perspectives of client-centred practice. A deeper understanding of the client experience of therapeutic relationships during adjustment following stroke, will help facilitate client-centred practice. This paper reports on a study exploring the research question: how do stroke survivors perceive their relationship with their health care team as they adjust to life following stroke? METHODS In this constructivist grounded theory study, in-depth interviews were conducted with six adult stroke survivors from South-East Queensland, Australia. Transcribed interviews were analysed using a constant comparative approach, identifying emerging concepts and patterns, to construct a theoretical understanding of the experience and meaning of adjustment and reintegration back into the community, with a specific focus on perceptions of therapeutic relationships and client-centred practice. RESULTS Participant perspectives of client-centred care during their rehabilitation following stroke were revealed and implications of this for their recovery identified. Themes of being understood; out of the driver's seat; knowing what's going on; and what I need when I need it emerged. Participants described not being: involved in decision making, provided with information, or receiving services aligned to their needs. Periods of frustration, loss of hope and fluctuating motivation were also common. CONCLUSION Findings shed further light on previously reported health service and discharge experiences. The insight gained into individual experiences of client-centred care following stroke suggest ways therapists can understand and address each client's adjustment experience and the impact this has on their needs, goal-setting, motivation, and confidence. Client-centred care must be grounded in client reality.
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Affiliation(s)
- Kim Walder
- School of Allied Health Sciences, Griffith University, Nathan, QLD, Australia
| | - Matthew Molineux
- School of Allied Health Sciences, Griffith University, Nathan, QLD, Australia
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Zhang W, Liu Z, Zhou X, Zhou L. Resilience among stroke survivors: A cohort study of the first 6 months. J Adv Nurs 2019; 76:504-513. [PMID: 31651047 DOI: 10.1111/jan.14247] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/19/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022]
Abstract
AIMS To explore (a) resilience among patients over the first 6 months following a first ischaemic stroke; (b) factors associated with resilience at hospitalization, 1, 3, and 6 months postdischarge; (c) baseline predictors of resilience at 6 months postdischarge. DESIGN a cohort study. METHODS From February 2017-January 2018, 217 patients presenting at two hospitals with a first ischaemic stroke were recruited. Their resilience, medical coping styles, general self-efficacy, functional independency, socio-demographic, and clinical data were assessed while they were still in hospital (baseline) and at 1, 3, and 6 months after discharge. RESULTS Resilience among stroke patients decreased significantly 1 month after hospital discharge and remained stable. Predictors of resilience were as follows: self-efficacy and resignation at baseline; number of children, functional independency, general self-efficacy, and resignation at 1 month; and religion, resignation, self-efficacy, confrontation at 3 months and 6 months. The baseline factors that predicted resilience at 6 months were income level, religion, stroke severity at discharge, self-efficacy, and resignation. CONCLUSION Stroke survivors experienced a significant decrease in resilience from hospitalization until 1-month postdischarge. Factors contributing to resilience after a stroke varied across time. Self-efficacy and coping styles were particularly important and contributed to long-term resilience. IMPACT Understanding resilience among stroke survivors is needed to inform the development of interventions to enhance the psychological recovery of survivors. The levels of resilience among stroke survivors were low compared with those in the normal older population. Nurses should provide greater psychological support during hospitalization to stroke survivors and especially to those with lower income, higher stroke severity at discharge, no religion, lower self-efficacy, or who use resignation as a coping strategy as those survivors may have lower resilience 6 months later. Future studies are needed to test interventions designed to change or modify stroke survivors' coping styles and promote self-efficacy, thereby enhancing higher resilience.
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Affiliation(s)
- Wei Zhang
- Nursing School, Second Military Medical University, Shanghai, China
| | - Zhihui Liu
- Assisted Reproductive Department, Shanghai First Maternity and Infant Hospital, Shanghai, China
| | - Xuan Zhou
- Nursing School, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Department of Clinical Nursing, Nursing School, Second Military Medical University, Shanghai, China
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Olofsson A, Nyman A, Kassberg AC, Malinowsky C, Larsson Lund M. Places visited for activities outside the home after stroke: Relationship with the severity of disability. Br J Occup Ther 2019. [DOI: 10.1177/0308022619879075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Knowledge about the places people visit or do not visit after stroke is lacking. The aim of this study was to describe and compare the places visited for activities outside the home of people with stroke of working age and to explore the influence of the severity of disability, fatigue, driving a car and sociodemographic characteristics on the total number of places visited for activities outside the home. Methods An exploratory cross-sectional study was conducted and 63 people with stroke were interviewed with instruments that covered places outside the home, severity of disability and fatigue. Data were analysed using non-parametric tests, analysis of variance and the general linear model. Results Significant difference in the total number of places visited for activities outside the home were found between all three groups of severity of disability. The good recovery group visited eight places to a significantly higher extent than those with severe/moderate disability. The severity of disability and driving a car were the only aspects that significantly influenced the total number of places visited. Conclusions Places for activities outside the home people with stroke visit and changes therein can add valuable knowledge about participation that can be used in the design of rehabilitation.
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Affiliation(s)
- Alexandra Olofsson
- Department of Health Science, Occupational therapy, Luleå University of Technology, Luleå, Sweden
| | - Anneli Nyman
- Department of Health Science, Occupational therapy, Luleå University of Technology, Luleå, Sweden
| | - Ann Charlotte Kassberg
- Department of Health Science, Occupational therapy, Luleå University of Technology, Luleå, Sweden
- Department of Research, Region Norrbotten, Luleå, Sweden
| | - Camilla Malinowsky
- Department of Neurobiology, Care Science and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Maria Larsson Lund
- Department of Health Science, Occupational therapy, Luleå University of Technology, Luleå, Sweden
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Illness beliefs and emotional responses in mildly disabled stroke survivors: A qualitative study. PLoS One 2019; 14:e0223681. [PMID: 31644550 PMCID: PMC6808550 DOI: 10.1371/journal.pone.0223681] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022] Open
Abstract
Background As acute stroke services improve, more persons experience mild stroke and need to cope daily with hidden disabilities, which may be influenced by how they perceive stroke, cognitively and emotionally. Objective To investigate cognitive illness beliefs and emotional responses in persons with mild stroke and their possible influences on daily coping. Methods Semi-structured interviews were conducted with 24 persons with mild stroke, on average 7.5 months (±0.89) after stroke occurrence. A thematic analysis on verbatim transcripts was guided by the Common-Sense Model of Self-Regulation. Results All participants experienced difficulties constructing an illness identity at both acute and chronic phase. Behavioral risk factors were less accepted as causes of stroke. Lack (or inappropriate timing) of information from healthcare providers led to limited medication knowledge and low perceived control of stroke recurrence which generated anxiety, fear, and low involvement in coping. Participants who considered stroke a chronic condition experienced more difficulties. Perceived support from relatives and healthcare providers was beneficial for participation in recovery and health behaviour change. Conclusion Despite having mildly disabilities, participants reported difficulties developing illness beliefs conducive to coping, and dealing with their emotional responses. These elements should be considered in tailored programs to improve coping with hidden disabilities post-stroke.
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Kitzmüller G, Mangset M, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne K, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Finding the Way Forward: The Lived Experience of People With Stroke After Participation in a Complex Psychosocial Intervention. QUALITATIVE HEALTH RESEARCH 2019; 29:1711-1724. [PMID: 30862270 DOI: 10.1177/1049732319833366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Stroke patients' well-being is threatened after stroke. A psychosocial intervention was developed for Norwegian stroke patients living in the community. Eight individual sessions between people with stroke and a trained health care professional were conducted 1 to 6 months post-stroke with one group of participants and 6 to 12 months post-stroke with another group. Subsequently, 19 of these stroke patients were interviewed to gain an in-depth understanding of their lived experience of the influence of the intervention on their adjustment process. Interview texts were analyzed using Ricoeur's interpretation theory. Two participants did not personally find the intervention useful. The remaining participants greatly appreciated dialogues with the empathetic intervention personnel, feeling free to discuss their fears and worries. The intervention raised these participants' awareness of their needs and resources. They were guided to resume their everyday life and adopt a future-oriented attitude. The intervention facilitated their meaning-making endeavors and post-stroke adjustment.
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Affiliation(s)
| | | | - Anne S Evju
- UiT The Arctic University of Norway, Narvik, Norway
| | - Sanne Angel
- Aarhus University, Aarhus, Denmark
- Molde University College, Molde, Norway
| | - Lena Aadal
- Aarhus University, Aarhus, Denmark
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Berit A Bronken
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Kari Kvigne
- Inland Norway University of Applied Sciences, Elverum, Norway
- Nord University, Sandnessjøen, Norway
| | - Line K Bragstad
- Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Unni Sveen
- Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
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Volz M, Ladwig S, Werheid K. Gender differences in post-stroke depression: A longitudinal analysis of prevalence, persistence and predictive value of known risk factors. Neuropsychol Rehabil 2019; 31:1-17. [PMID: 31379275 DOI: 10.1080/09602011.2019.1648301] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Post-stroke depression (PSD) is the most frequent psychiatric condition after stroke with a prevalence of approximately 33%. In the general population, depression is consistently reported to be more frequent in women than in men. Evidence about gender differences in PSD remains inconclusive and it is unknown if established risk factors exert gender-specific influence. The authors examined gender differences in PSD prevalence, persistence and influence of established risk factors using χ 2- and Welch's t-tests and continuous-time structural equation modelling (CT-SEM). Patients (N = 301) from the longitudinal Berlin-PSD-study were assessed six weeks (baseline), and up to four times during the first 2.5 years post-stroke using DSM-5 depression criteria and the Geriatric Depression Scale (GDS). Established risk factors were assessed at baseline. Women showed higher PSD prevalence and severity at baseline (p < .01) but not thereafter (p ≥ .43). CT-SEM analysis revealed that known risk factors predicted depression, yet predictive value and persistence did not differ between genders. Our results showed that established PSD risk factors influence both genders to a similar extent and that in contrast to depression in the general population, gender differences in PSD prevalence and severity disappeared within six months post-stroke. Thus, for reasons yet to be deciphered, gender differences in PSD appear to be time-dependent after stroke.
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Affiliation(s)
- Matthias Volz
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Ladwig
- Department of Psychology, Humboldt University Berlin, Berlin, Germany.,Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Katja Werheid
- Department of Psychology, Humboldt University Berlin, Berlin, Germany.,Klinikum Ernst von Bergmann, Potsdam, Germany
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Abstract
Purpose: This study examined the extent to which resilience is associated with well-being outcomes after traumatic brain injury, and whether those relationships are independent of global personality traits, such as affectivity.Materials and methods: Sixty-seven adults with complicated-mild to severe traumatic brain injury participated. Measures included the Connor-Davidson Resilience Scale, Modified Cumulative Illness Rating Scale, Disability Rating Scale, SF-12 Health Survey, Satisfaction with Life Scale, and Community Integration Measure.Results: Objective physical health and disability showed modest relation to resilience, indicating that adverse health conditions and disability decreased with increasing resilience. The three measures of subjective well-being showed modest-to-strong positive relation to resilience. These correlations between resilience and well-being generally remained significant after accounting for negative and positive affectivity. Results also suggest that the influence of resilience on well-being has a threshold effect: a greater influence on outcome among people with low or inadequate resilience than among people with average or high resilience.Conclusion: The experience of brain injury does not diminish the positive influence resilience may have on long-term well-being. Resilience may function as a buffer to trauma even in the challenging context of cognitive insult. Routine assessment of resilience might be beneficial to the rehabilitation team.Implications for rehabilitationResilience is positively associated with subjective and objective well-being among adults with moderate-to-severe traumatic brain injury, and it appears to function among adults with traumatic brain injury similarly to adults without cognitive disabilities.Resilience overlaps with overarching trait personality constructs such as affectivity; yet, it has unique characteristics and unique value in understanding well-being.The adverse effects of low resilience show stronger influence on well-being than do the positive effects of high resilience.Routine assessment of resilience might be beneficial to the rehabilitation team in understanding patients and their families, especially in discharge planning, where beliefs about personal capabilities to rebound from adversity shape likely future behavior.
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Affiliation(s)
- Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Christina G Wong
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan, USA
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McAleese N, Guzman A, O'Rourke SJ, Gillespie DC. Post-stroke emotionalism: a qualitative investigation. Disabil Rehabil 2019; 43:192-200. [PMID: 31136206 DOI: 10.1080/09638288.2019.1620876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Post-stroke emotionalism, outbursts of involuntary crying or laughing, is common after stroke. Little is known about the psychosocial factors associated with this neurological disorder.Aim: To investigate participant's experiences of emotionalism and explore how they managed their symptoms.Methods: A qualitative study that used framework analysis. Participants were recruited across inpatient and outpatient stroke settings. The average time since stroke was 4.3 months.Results: Eighteen semi-structured interviews were conducted. Four themes were identified: (1) Spontaneous and uncontrollable emotional reactions; (2) Incongruence; (3) Social reactions (sub-theme: The stigma of expressed emotions) and (4) Convalescence. Participants with negative experiences described greater disability, avoidance and mood problems. Positive experiences were shaped by a better understanding of the condition, an increased sense of control, social support and optimism. Few participants knew that their emotionalism was caused by stroke. Embarrassment and social withdrawal were commonly reported and had a detrimental effect on participant's mood and quality of life.Conclusions: Earlier recognition of emotionalism in clinical settings is needed as is promoting discussions about emotional reactions after-stroke. This will reduce the likelihood that patients will develop erroneous beliefs about emotionalism and unhelpful coping responses that may lead to adjustment difficulties in the months that follow their stroke.Implications for rehabilitationThe unpredictable and uncontrollable nature of emotionalism can be embarrassing and cause social withdrawal or avoidance.Waiting for emotionalism episodes to pass, distraction, humor or optimism and social support are successful means of managing the condition.Professionals play a key role in raising awareness that emotionalism is a neurological condition and not a clinical mood disorder as this will promote better understanding for patients, their families and those around them.Encouraging patients to talk about their emotional reactions early after stroke will normalize their experiences and may prevent them from developing unhelpful beliefs that could affect their approach to recovery.
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Affiliation(s)
- Niamh McAleese
- Clinical Neuropsychology Service, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Azucena Guzman
- The School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Suzanne J O'Rourke
- The School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - David C Gillespie
- Clinical Neuropsychology Service, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
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Crocker TF, Ozer S, Brown L, Hall J, Forster A. Non-pharmacological interventions for longer-term stroke survivors or their carers: an overview of Cochrane Reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Thomas F Crocker
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Seline Ozer
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Lesley Brown
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Jessica Hall
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Anne Forster
- University of Leeds; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House, Bradford Royal Infirmary Duckworth Lane Bradford UK BD9 6RJ
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Palstam A, Westerlind E, Persson HC, Sunnerhagen KS. Work-related predictors for return to work after stroke. Acta Neurol Scand 2019; 139:382-388. [PMID: 30657175 PMCID: PMC6617971 DOI: 10.1111/ane.13067] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/19/2018] [Accepted: 01/12/2019] [Indexed: 11/30/2022]
Abstract
Objectives Disability due to stroke imposes a large burden on individuals, and on society, in terms of impaired work ability and sick leave. The reported return to work (RTW) rate after stroke varies globally and is influenced by a range of different aspects. The aim of this study was to investigate the influence of work‐related factors on time to RTW after stroke, and possible differences between the sexes. Materials & Methods Data from 204 persons with first‐time stroke in the years 2009‐2010 in Gothenburg, Sweden, who were of working age and had worked prior to their stroke, were analysed. Disease‐related characteristics were retrieved from medical records, and work‐related‐ and socio‐economic data were collected up to 6 years post‐stroke from Statistics Sweden and the Swedish Social Insurance Agency. Cox regression was used to analyse predictors for time to RTW. Results We identified qualified occupation and large organizational size as work‐related predictors for shorter time to RTW after stroke. Being male predicted a faster and higher frequency of RTW. Qualified occupation predicted shorter time to RTW in men but not in women. For women, the only predictor for RTW was physical dependency at discharge. Conclusion Type of work and organizational size are work‐related factors of importance for RTW after stroke. Work‐related factors were important for RTW in men, but not in women. Reasons for differences between men and women in work‐related factors that influence RTW need to be further investigated to better understand how to support women in the RTW process.
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Affiliation(s)
- Annie Palstam
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Emma Westerlind
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Hanna C. Persson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Long-term participation 7-8 years after stroke: Experiences of people in working-age. PLoS One 2019; 14:e0213447. [PMID: 30865696 PMCID: PMC6415844 DOI: 10.1371/journal.pone.0213447] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 02/21/2019] [Indexed: 01/14/2023] Open
Abstract
Objective To enhance the understanding of long-term participation in working-aged people 7–8 years after stroke. Methods This study had a qualitative design, using a thematic analysis methodology. Eleven individuals took part in an in depth interview 7–8 years after a first time stroke. They had received care at the Sahlgrenska University Hospital in Gothenburg, and were recruited as a heterogenic sample with respect to age, gender, stroke severity and subtype. Results From the participants’ experiences four themes emerged: “Returning to work after stroke”; “Working life 7–8 years after stroke”; “Social life 7–8 years after stroke”; and “A state of reorientation in life”. Quotes about experienced participation in everyday life were summarized and presented as “Participation after stroke narratives”. Participants chose to emphasize on work- and social life when describing situations of successful participation. Being included in the wider community and having a sense of purpose, when interacting with others, were factors that these narratives had in common. Participants had gradually become accustomed to a somewhat altered life situation. Some consequences after stroke were still considered frustrating in social or work situations. However, the importance of these issues had reduced and were no longer problematized. Conclusions Participants felt content with their everyday life in general, which was a principal and positive result of this study. Reaching a stage of acceptance seemed to be a complex and continuous struggle, and an individual approach in long-term rehabilitation would be valuable to support this personal process. More knowledge about what factors that facilitate participation in people of working-age many years after stroke is needed, so that more people can reach a state of positive identity and participation.
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Douglas J. Loss of friendship following traumatic brain injury: A model grounded in the experience of adults with severe injury. Neuropsychol Rehabil 2019; 30:1277-1302. [PMID: 30755079 DOI: 10.1080/09602011.2019.1574589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Relationships make important contributions to wellbeing and maintenance of self-worth. For those who sustain traumatic brain injury (TBI), life is frequently characterized by declining interpersonal relationships. The aim of this study was to understand the post-injury experience of friendship from the perspective of adults with severe TBI. Participants were 23 adults who had sustained severe TBI on average 10 years earlier; the majority was between 25 and 45 years old. The experience of friendship was explored using a convergent mixed methods design (quantitative self-report measures and in-depth interviews). Qualitative analysis of interview transcripts employed open and focussed coding to reveal themes and categories. Participants nominated on average 3.35 (SD 2.19) friends. When paid carers and family members were excluded, the mean dropped to 1.52 (SD 1.38). Exploratory correlations between number of friends and quality of life, depression and strong-tie support revealed significant associations of moderate to large effects. The post-injury experience of friendship was broadly conceptualized as "going downhill" with four overlapping phases: losing contact, being misunderstood, wanting to share and hanging on. Participants' stories illustrated how rehabilitation can focus on friendship by supporting established relationships and facilitating access to activities that afford interpersonal encounters and opportunities to share experiences.
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Affiliation(s)
- Jacinta Douglas
- Living with Disability Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Summer Foundation, Melbourne, Australia.,NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Canberra, Australia
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