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Shrubsole K, Power E, Hallé MC. Communication partner training with familiar partners of people with aphasia: A systematic review and synthesis of barriers and facilitators to implementation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:601-628. [PMID: 36417196 DOI: 10.1111/1460-6984.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Factors influencing the implementation of communication partner training (CPT) with familiar partners of people with aphasia (PWA) have previously been documented using disparate approaches. To date there has been no synthesis of these factors using a common theoretical framework. Investigating CPT implementation factors using a common theoretical framework may further our understanding of universal barriers and guide future development of tailored, theoretically informed implementation strategies. AIMS (1) To determine the perceived and/or observed barriers and facilitators to implementing CPT with familiar partners of adults with aphasia; (2) to map extracted barriers and facilitators to a common theoretical framework; (3) to synthesize extracted barriers and facilitators; and (4) to identify potential implementation strategies to address the most frequently identified barriers and facilitators. METHODS & PROCEDURES A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science) were systematically searched in April 2021. Empirical qualitative and/or quantitative research studies reporting barriers/facilitators to speech-language therapists (SLTs) implementing CPT with familiar partners of adults with aphasia were included. The search was limited to English or French articles with no date limit applied. Methodological quality of included studies was assessed using the Mixed-Methods Appraisal Tool (MMAT). A framework and content analysis was then conducted to extract and synthesize the implementation factors in alignment with the Theoretical Domains Framework (TDF), followed by a theoretically informed mapping exercise to identify potential implementation strategies. RESULTS & MAIN CONTRIBUTION The database searches yielded 2115 studies. Following screening, 17 studies were included in the review. Overall, the included studies had good methodological quality. Extracted implementation factors were classified as barriers, facilitators or mixed (i.e., both) and aligned with 13 of the 14 TDF domains, plus two additional domains: 'carer perspectives on the CPT intervention' and 'patient/carer characteristics'. Synthesized data revealed eight key theoretical domains: Environmental context and resources; Social influences; Beliefs about consequences; Skills; Memory, attention and decision-making; Knowledge; Beliefs about capabilities; and Reinforcement. Within each domain, the research team identified common categories and developed illustrative examples of theoretically informed implementation strategies. CONCLUSIONS & IMPLICATIONS This systematic review and theory-informed synthesis of previously reported CPT implementation factors enabled the identification of key barriers to SLTs delivering this best practice. This led to proposed implementation strategies that should be validated, refined and evaluated in future research involving stakeholders who have contextual understanding of implementing CPT. WHAT THIS PAPER ADDS What is already known on the subject CPT of familiar partners of PWA is an effective intervention that is inconsistently used in clinical settings. Factors influencing CPT implementation have previously been identified, but using disparate approaches and frameworks. A synthesis of these factors articulated around a common framework is currently not available. What this paper adds to existing knowledge This paper provides a theory-informed synthesis of previously reported barriers and facilitators to SLTs implementing CPT with familiar partners of PWA. It highlights key factors influencing the uptake of this best practice and includes suggestion of implementation strategies to address them. What are the potential or actual clinical implications of this work? The key influencing factors and proposed implementation strategies reported in this paper may support stakeholders in the future design of tailored and theoretically informed implementation strategies aiming to improve the delivery of familiar CPT in their setting.
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Affiliation(s)
- Kirstine Shrubsole
- The Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Victoria, Australia
| | - Emma Power
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Victoria, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Marie-Christine Hallé
- Speech and Language Pathology Department, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
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Guldager R, Nordentoft S, Poulsen I, Aadal L, Loft MI. Wants and needs for involvement experienced by relatives of patients with an acquired brain injury: a scoping review. JBI Evid Synth 2022; 21:886-912. [PMID: 36729839 DOI: 10.11124/jbies-22-00022] [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
OBJECTIVE This scoping review identifies and maps the breadth of available evidence on relatives' wants and needs for involvement in the care of patients with an acquired brain injury. INTRODUCTION Acquired brain injuries often occur suddenly and unexpectedly. Suffering from an acquired brain injury has major consequences, not only for the patients, due to the devastating impact on their physical, cognitive, social, and psychological well-being, but also for the relatives who may need to take on a lifelong role as carers. Research has cited some benefits of involving relatives in the care of patients, including positive effects on the patients' health outcomes; however, there are few studies showing how relatives can be involved. INCLUSION CRITERIA Studies that defined or assessed relatives' wants and needs for involvement with the care of patients with an acquired brain injury in all settings were included. Studies were included if they described any kind of wants and needs for involvement experienced from the perspective of relatives. The review considered all study designs, except for literature reviews. METHODS The JBI methodology for conducting a scoping review was employed in accordance with an a priori published protocol. An extensive search was conducted in MEDLINE (PubMed), CINAHL (EBSCO), and Embase (Ovid). Gray literature was searched using Grey Matters and BASE. The initial search was conducted in February 2020 and updated in September 2021. This review was limited to studies published in English, German, or Scandinavian languages since January 2010. The data were extracted using a data extraction tool (authors, year of publication, country of origin, setting, study methods, and findings related to wants and needs for involvement) created by the authors. The review findings are reported as a descriptive summary, with tables and figures supporting the data. RESULTS The search identified 3854 studies, 31 of which were included. The studies were published between 2010 and 2021 and were conducted across 9 countries. In total, 16 studies applied a qualitative study design, 4 studies used a descriptive approach, 4 studies used a quantitative research design, 4 studies reported using a mixed methods design, and 3 studies employed a multi-methods design. The studies were conducted across a variety of settings, ranging from acute care to home. The international literature on the involvement of relatives with patients with acquired brain injuries comprises multiple published studies on different aspects of the topic and within various care contexts. The findings identified few studies describing wants and needs experienced by relatives in relation to involvement in the patient's disease trajectory. CONCLUSIONS The findings show that relatives' wants and needs are primarily related to information and communication, but are also related to collaboration with health care professionals. The findings illustrate that the complexity of involvement is comprehensive, with multiple aspects to consider.
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Affiliation(s)
- Rikke Guldager
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital Hvidovre, Denmark.,Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mia Ingerslev Loft
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark.,Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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Brown SE, Scobbie L, Worrall L, Mc Menamin R, Brady MC. Access G-AP: development of an accessible goal setting and action planning resource for stroke survivors with aphasia. Disabil Rehabil 2022:1-11. [PMID: 35695078 DOI: 10.1080/09638288.2022.2085331] [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: 11/03/2022]
Abstract
PURPOSE Goal setting is key to stroke rehabilitation, but access for people with aphasia is challenging. Based on the Goal setting and Action Planning (G-AP) framework, we developed an accessible goal setting resource (Access G-AP). METHODS Access G-AP was designed using a three-phase, user-centred design process. Phase 1: Access G-AP Draft A was designed using evidence-based recommendations. Phase 2: Draft A was reviewed by stroke survivors with aphasia (focus groups 1&2) and rehabilitation staff (questionnaire). Phase 3: Suggested recommendations informed Access G-AP Draft B, which was further reviewed by stroke survivors with aphasia (focus group 3). The final version of Access G-AP was approved by stroke survivors with aphasia at a debrief meeting. Data were analysed using content analysis. RESULTS Recommended design improvements included reducing text, adding bullet points, and diversifying images. Both participant groups highlighted that Access G-AP should be used collaboratively to support stroke survivor involvement. Staff recommended Access G-AP training and additional resources to support stroke survivors with severe aphasia. CONCLUSIONS Access G-AP was co-developed to support people with aphasia to access and engage in stroke rehabilitation goal setting. Further research is required to establish the feasibility of Access G-AP in clinical practice.IMPLICATIONS FOR REHABILITATIONEvidence-based accessible formatting strategies and an iterative design process can inform the design of accessible goal setting resources.Accessible goal setting materials should be relevant to stroke survivors with aphasia and responsive to their needs.Rehabilitation staff require training and support to use accessible goal setting resources (like Access G-AP) with stroke survivors with aphasia, especially those with severe aphasia.Evaluation of the feasibility of Access G-AP in clinical practice is now required.
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Affiliation(s)
| | - Lesley Scobbie
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | | | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Ramazanu S, Chisale MRO, Baby P, Wu VX, Mbakaya BC. Meta-synthesis of family communication patterns during post-stroke vascular aphasia: Evidence to guide practice. Worldviews Evid Based Nurs 2022; 19:282-296. [PMID: 35587739 DOI: 10.1111/wvn.12580] [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: 08/07/2021] [Revised: 11/14/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have predominantly focused on the needs of persons with aphasia (PWA), after a stroke diagnosis. However, aphasia is found to cause communication challenges in persons with stroke and their family caregivers as a unit. Evidence is inconclusive about the communication patterns of both persons with aphasia and their family caregivers after a stroke. Studies have not been synthesized on facilitators and barriers of communication patterns between PWA and family caregivers after a stroke. AIMS A meta-synthesis of qualitative evidence was conducted to explore family communication patterns after post-stroke vascular aphasia. METHODS An electronic literature search of PubMed, CINAHL, Cochrane Library, PsyINFO, and Scopus was performed from January to March 2021. The methods of qualitative meta-synthesis were underpinned by Sandelowski and Barosso's guidelines. Data analysis was facilitated by Braun and Clarke thematic analysis, using NVivo 11 software. RESULTS A total of twenty studies were included for meta-synthesis. Three themes with corresponding subthemes were identified: (1) changes in family communication patterns (subthemes: adapting to the changes in PWA after a stroke, striving toward communication recovery); (2) facilitators of family communication patterns (subthemes: supportive communication techniques, hope of recovery, time to re-adjust, and community engagement [recreational activities]); and (3) barriers of communication (subthemes: emotional turmoil and daunting tasks of rehabilitation). LINKING EVIDENCE TO ACTION Although persons with aphasia and family caregivers are striving to achieve normalcy in communication, they are often challenged by communication deficits and protective family behaviors. Therefore, to establish effective communication, it is of paramount importance for nursing professionals to educate PWAs and their caregivers on facilitators and barriers of family communication patterns. Technology-based family communication facilitation and support groups for PWA and their family caregivers are recommended to promote family communication. The review was registered with PROSPERO (CRD42021235519).
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Affiliation(s)
- Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Singapore, Singapore
| | | | - Priya Baby
- College of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in Poststroke Aphasia: Perspectives of Significant Others of People With Aphasia on Receiving Information About Recovery. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:896-911. [PMID: 35050706 DOI: 10.1044/2021_ajslp-21-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Knowing what to expect poststroke is important for many significant others of people with aphasia, yet an understanding of their perceptions and preferences in receiving prognostic information is limited. This knowledge is needed to inform the formulation and delivery of aphasia prognoses as conversations about prognosis can be harmful or helpful depending on their alignment with key stakeholder perspectives. Our preliminary study sought insight into the perspectives of significant others of people with aphasia on receiving prognostic information, with an aim toward informing evidence-based practice in aphasia prognostication. METHOD We interviewed seven significant others of people with aphasia, 3-12 months poststroke. The interviews were semistructured, conducted one-to-one, and analyzed qualitatively using reflexive thematic analysis. RESULTS Five themes were drawn from the interviews: (a) You don't know what you don't know. (b) Having them alive is the best you can ask for. (c) Recovery in the eye of the beholder. (d) Outcomes don't matter unless they help me help them. (e) It's my prognosis too if I'm living with aphasia. CONCLUSIONS A significant other's prognosis-related perceptions and preferences are products of their poststroke reality and may inadvertently shape that of the person with aphasia. In order to facilitate recovery, prognostication practices need to consider the needs of significant others both as providers of care and as requiring care themselves for their first-hand experiences of third-party disability.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
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Babbitt EM, Worrall L, Cherney LR. "It's like a lifeboat": stakeholder perspectives of an intensive comprehensive aphasia program (ICAP)". APHASIOLOGY 2021; 36:10.1080/02687038.2021.1873905. [PMID: 38529517 PMCID: PMC10961968 DOI: 10.1080/02687038.2021.1873905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/05/2021] [Indexed: 03/27/2024]
Abstract
Background Intensive comprehensive aphasia programs (ICAPs) have gained popularity in recent years. Outcomes from ICAPs have demonstrated measurable improvements for most who take part, but how do people with aphasia and their family members experience an ICAP? Aim The aim of this paper was to explore, through qualitative interviews, the experiences of persons with aphasia and their family members who took part in an ICAP. Methods & Procedures Twelve interviews were conducted with persons with aphasia and family members regarding their experiences with the ICAP that they had just completed. Nine persons with aphasia were interviewed with their family members and three chose to take part in the interview alone. The Framework Analysis method was used to identify themes from the transcribed interviews. Outcomes & Results The interviewees discussed four themes related to treatment, psychosocial environments, physical environments, and outcomes. The interviewees remarked on the challenges that were provided by the treatment and how the treatment was different from previous treatment. Comments were made related to the relationships the participants and families developed within the context of the program. The physical environment allowed for relationships to develop. The interviewees discussed the physical and social environment as important additional factors that contribute to the overall therapeutic effect of the ICAP. Positive outcomes were noted in language skills and psychosocial contexts. Conclusions Based on interviewees' descriptions of this one ICAP, the concept of a therapeutic milieu was developed to describe how the intersection of the treatment, psychosocial interactions, and physical setting related to outcomes. Interviewees described how the therapeutic milieu of the ICAP was interwoven with the intensive therapy to create a "package" of therapy that led to improved outcomes. Implications for non-ICAP clinical practice is that participants linked more intensive therapy and greater social interactions with better outcomes.
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Affiliation(s)
- Edna M. Babbitt
- Center for Aphasia Research & Treatment, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leora R. Cherney
- Center for Aphasia Research & Treatment, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
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Manning M, MacFarlane A, Hickey A, Galvin R, Franklin S. The relevance of stroke care for living well with post-stroke aphasia: a qualitative interview study with working-aged adults. Disabil Rehabil 2020; 44:3440-3452. [PMID: 33356970 DOI: 10.1080/09638288.2020.1863483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aimed to explore the perspectives of working-aged adults with post-stroke aphasia (PWA) towards what has or would help them in living well with aphasia (LWA). This paper reports the findings in relation to stroke care and its relevance for LWA. MATERIALS AND METHODS This qualitative study was designed with input from a Public and Patient Involvement advisory group. We conducted in-depth, semi-structured interviews with 14 PWA. Data were analysed following principles of reflexive thematic analysis. RESULTS Support services and LWA spanned five themes: Inpatient care; Support in the community; Speech therapy; Mental health; and Aphasia education and training. Per the findings, all aspects of stroke care were affected and challenged by aphasia. Access to services and information was variable. PWA of working-age, their families and children need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery. Healthcare workers must be equipped with aphasia competency. CONCLUSIONS The results highlight a need for equitable, transparent, responsive access to services, information and stroke liaison support. The findings extend knowledge of the importance of stroke care for supporting working-aged adults and their families to live well in the context of aphasia.Implications for rehabilitationThere is a need for equitable, transparent access to a responsive integrated pathway of stroke care to support living well with aphasia.People with aphasia post-stroke and their families need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery.This includes flexible access to mental healthcare and speech and language therapy.In order to access relevant care, people with post-stroke aphasia need access to information and stroke liaison support.Training to improve aphasia competency is imperative for healthcare workers.
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Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne MacFarlane
- Graduate Entry Medical School (GEMS), Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
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Croteau C, McMahon-Morin P, Le Dorze G, Baril G. Impact of aphasia on communication in couples. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:547-557. [PMID: 32400928 DOI: 10.1111/1460-6984.12537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Communication is at the heart of relationships, especially for couples. When language is altered, as it is in aphasia, communication in couples can be affected. AIMS To explore how members of a couple perceive the impact of aphasia on their communication. METHODS & PROCEDURES Nine French-speaking couples participated in the study. One member of each couple had chronic stroke-related aphasia, which varied in type and severity. The 18 participants took part in individual semi-structured interviews to understand their perspective on communication within their couple. The interviews were recorded, transcribed and analysed with a qualitative thematic analysis. OUTCOMES & RESULTS Three main themes emerged: (1) experiencing limitations in conversation; (2) assuming changed speaking and listening roles; and (3) experiencing new emotions, feelings and reactions in communication. Couples experienced diminished frequency and duration of conversations as well as restrained topics after the onset of aphasia. Ten participants reported that each member's communication role of listener versus speaker had changed, and that the person with aphasia became a less active participant. Communication was described as 'positive' before aphasia and 'fine' to 'difficult' following aphasia. Persons with aphasia and spouses expressed experiencing difficulties managing emotions related to communication. Frustration and caution towards the other member of the couple had been associated with aphasia. In addition, five spouses reported that they refrained from initiating discussions on specific topics in order to maintain a positive relationship with the person with aphasia. CONCLUSION & IMPLICATIONS The results describe some of the consequences of aphasia on communication in couples. Clinicians could use interviews to understand the impact of aphasia on a couple's communication. This may help to design communication partner training (CPT) that better aligns with the particular needs of couples living with aphasia, acknowledging the importance of emotional dimensions of relationships. What this paper adds What is already known on the subject The general psychosocial impacts of aphasia on persons with aphasia and spouses are known. Their conversations have been described and used as a focus for CPT. However, CPT may be difficult to implement in clinical settings. What this paper adds to the existing knowledge This paper provides in-depth descriptions of perceived changes in relational or transactional communication by the PWA and their spouse. The frequency, duration and topics of conversations changed and emotions such as frustration and caution appeared. Participants assumed changed speaking and listening roles. What are the potential or actual clinical implications of this work? The participants' description of communication could be used by speech-language pathologists when conducting CPT to illustrate how aphasia affects communication in couples. Emotions emerging as a result of changes in communication following aphasia should be assessed before CPT and could be a starting point to work on communication. This could support clients' commitment in CPT.
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Affiliation(s)
- Claire Croteau
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal Métropolitain, Montréal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Montréal, QC, Canada
| | - Paméla McMahon-Morin
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Guylaine Le Dorze
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal Métropolitain, Montréal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Montréal, QC, Canada
| | - Geneviève Baril
- Centre de recherche interdisciplinaire en réadaptation du Montréal Métropolitain, Montréal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Montréal, QC, Canada
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The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
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Manning M, MacFarlane A, Hickey A, Franklin S. Perspectives of people with aphasia post-stroke towards personal recovery and living successfully: A systematic review and thematic synthesis. PLoS One 2019; 14:e0214200. [PMID: 30901359 PMCID: PMC6430359 DOI: 10.1371/journal.pone.0214200] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 03/08/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is increased focus on supporting people with chronic conditions to live well via person-centred, integrated care. There is a growing body of qualitative literature examining the insider perspectives of people with post-stroke aphasia (PWA) on topics relating to personal recovery and living successfully (PR-LS). To date no synthesis has been conducted examining both internal and external, structural influences on living well. In this study, we aimed to advance theoretical understanding of how best to promote and support PR-LS by integrating the perspectives of PWA on a wide range of topics relating to PR-LS. This is essential for planning and delivering quality care. METHODS AND FINDINGS We conducted a systematic review, following PRISMA guidelines, and thematic synthesis. Following a search of 7 electronic databases, 31 articles were included and critically appraised using predetermined criteria. Inductive and iterative analysis generated 5 analytical themes about promoting PR-LS. Aphasia occurs in the context of a wider social network that provides valued support and social companionship and has its own need for formal support. PWA want to make a positive contribution to society. The participation of PWA is facilitated by enabling environments and opportunities. PWA benefit from access to a flexible, responsive, life-relevant range of services in the long-term post-stroke. Accessible information and collaborative interactions with aphasia-aware healthcare professionals empower PWA to take charge of their condition and to navigate the health system. CONCLUSION The findings highlight the need to consider wider attitudinal and structural influences on living well. PR-LS are promoted via responsive, long-term support for PWA, friends and family, and opportunities to participate autonomously and contribute to the community. Shortcomings in the quality of the existing evidence base must be addressed in future studies to ensure that PWA are meaningfully included in research and service development initiatives. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews PROSPERO 2017: CRD42017056110.
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Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| | - Anne MacFarlane
- Graduate Entry Medical School (GEMS), Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Republic of Ireland
| | - Anne Hickey
- Dept Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
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Kong APH, Wong CWY. An Integrative Analysis of Spontaneous Storytelling Discourse in Aphasia: Relationship With Listeners' Rating and Prediction of Severity and Fluency Status of Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1491-1505. [PMID: 30458505 PMCID: PMC6436460 DOI: 10.1044/2018_ajslp-18-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/08/2018] [Accepted: 06/04/2018] [Indexed: 06/09/2023]
Abstract
Purpose This study investigated which of the three analytic approaches of oral discourse, including linguistically based measures, proposition-based measures, and story grammar, best correlated with aphasia severity and with naïve listeners' ratings on aphasic productions. The predictive power of these analytic approaches to aphasia severity and fluency status of people with aphasia (PWA) was examined. Finally, which approach best discriminated fluent versus nonfluent PWA was determined. Method Audio files and orthographic transcriptions of the storytelling task "The Boy Who Cried Wolf" from 68 PWA and 68 controls were extracted from the Cantonese AphasiaBank. Each transcript was analyzed using these 3 systems. Results The linguistic approach of discourse analysis best correlated with aphasia severity and naïve listeners' subjective ratings. Although both linguistically based and proposition-based measures significantly predicted aphasia severity, a subset of linguistic measures focusing on the quantity and efficiency of production were particularly useful for clinical estimation of the fluency status of aphasia. Conclusions The linguistically based measures appeared to be the most clinically effective and powerful in reflecting PWA's performance of spoken discourse.
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Affiliation(s)
- Anthony Pak-Hin Kong
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Cherie Wan-Yin Wong
- Department of Special Education and Counselling, The Education University of Hong Kong
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Luker J, Murray C, Lynch E, Bernhardsson S, Shannon M, Bernhardt J. Carers' Experiences, Needs, and Preferences During Inpatient Stroke Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2017; 98:1852-1862.e13. [DOI: 10.1016/j.apmr.2017.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/30/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
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Krishnan S, Pappadis MR, Weller SC, Stearnes M, Kumar A, Ottenbacher KJ, Reistetter TA. Needs of Stroke Survivors as Perceived by Their Caregivers: A Scoping Review. Am J Phys Med Rehabil 2017; 96:487-505. [PMID: 28628537 PMCID: PMC5493392 DOI: 10.1097/phm.0000000000000717] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Caregivers usually are not involved while planning the stroke survivor's medical and rehabilitation goals and interventions. This review aimed to identify the needs of stroke survivors as perceived by their caregivers. DESIGN A literature search from 2003 to 2014 was conducted using Medline, CINAHL, PsychINFO, and Google Scholar. Sixty-six studies were included. Most studies excluded did not encompass caregivers' perspectives. Four reviewers screened the titles, abstracts, and full texts of the articles for inclusion. The data extracted from these studies were synthetized into metathemes. RESULTS Fifty-two qualitative, ten quantitative survey, and four mixed-methods studies were included in the final synthesis. The studies came from 11 countries. The data synthesis produced following three metathemes: (a) body functional needs, including psychological function, physical function, cognitive function, and uncertainty related to function; (b) activity and participatory needs, including healthy lifestyle, physical activities, speech, independence, cognitive activities, and uncertainty related to activities and participation; and (c) environmental needs, encompassing support, services, safety, accommodation and accessibility, and uncertainty related to environmental factors. CONCLUSIONS This scoping review identified a range of needs of stroke survivors as perceived by their caregivers. Incorporating the caregiver's preferences and values into clinical decisions may improve outcomes among stroke survivors.
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Affiliation(s)
- Shilpa Krishnan
- Department of Occupational therapy, University of Texas Medical Branch
| | | | - Susan C. Weller
- Preventive Medicine and Community Health, University of Texas Medical Branch
| | | | - Amit Kumar
- Department of Health Services, Policy and Practice, Brown University
| | | | - Timothy A. Reistetter
- Department of Occupational therapy, University of Texas Medical Branch
- Division of Rehabilitation Sciences, University of Texas Medical Branch
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Wielaert SM, Berns P, van de Sandt-Koenderman MWME, Dammers N, Sage K. 'Now it is about me having to learn something ….' Partners' experiences with a Dutch conversation partner training programme (PACT). INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2017; 52:143-154. [PMID: 27363586 DOI: 10.1111/1460-6984.12248] [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: 07/17/2015] [Accepted: 01/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The increase in the number of reported conversation partner programmes for conversation partners of people with aphasia demonstrates increased awareness of partner needs and the positive effect of trained partners on the communicative abilities of the person with aphasia. Predominantly small-scale studies describe the effectiveness of conversation partner training (CPT) and how partners perceive this training. The view of partners on this service commission remains largely unknown. AIMS To explore the experiences of partners of people with aphasia with a CPT programme when it was newly introduced into rehabilitation settings. METHODS & PROCEDURES Seventeen partners of people with aphasia were interviewed using a semi-structured format about their experience with Partners of Aphasic Clients Conversation Training (PACT). Transcribed interviews were analysed using qualitative content analysis. OUTCOMES & RESULTS Four categories representative of the practical nature and individual tailoring of PACT were identified: engaging with PACT; learning from PACT; reflecting on behaviour and emotions; and experiences with earlier speech and language therapy (SLT). Two themes were identified cutting across all categories: the nature of communication is difficult to grasp; and balancing roles as partner, carer and client. CONCLUSIONS & IMPLICATIONS Partners appreciated the training programme once their initial lack of awareness of the interactive nature of communication had been addressed. SLTs need to be clear about the collaborative nature of conversations and what can be offered within the rehabilitation trajectory to address conversation alongside language training.
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Affiliation(s)
- Sandra M Wielaert
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
- Centre for Health and Clinical Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Philine Berns
- Rotterdam University of Applied Sciences-School of Health Care and Research Centre, Innovations in Care Programme for Speech and Language Therapy, Rotterdam, the Netherlands
| | - Mieke W M E van de Sandt-Koenderman
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
- Erasmus Mc Rotterdam, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
| | - Nina Dammers
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
| | - Karen Sage
- Faculty of Health and Well Being, Sheffield Hallam University, Sheffield, UK
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15
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Wielaert S, van de Sandt-Koenderman MW, Dammers N, Sage K. ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings. Disabil Rehabil 2016; 40:76-89. [DOI: 10.1080/09638288.2016.1243160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Nina Dammers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Karen Sage
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Chen P, Fyffe DC, Hreha K. Informal caregivers' burden and stress in caring for stroke survivors with spatial neglect: an exploratory mixed-method study. Top Stroke Rehabil 2016; 24:24-33. [PMID: 27216085 DOI: 10.1080/10749357.2016.1186373] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Spatial neglect prolongs stroke survivors' recovery to independence. However, little is known about the impact of spatial neglect on caregivers of stroke survivors. OBJECTIVE To explore the factors associated with burden and stress among informal caregivers of stroke survivors with spatial neglect. METHODS Following the previous study of 108 stroke survivors, we reached 24 stroke survivors' caregivers, and 20 caregivers (age: M±SD=56.9±12.7 years; 12 females) completed the study. 10 survivors had symptoms of spatial neglect, and 10 did not (i.e., SN+ or SN-, respectively) at the time when discharged from inpatient rehabilitation, which was 9.3±6.2 months before the present study. Via a semi-structured telephone interview, we assessed caregivers' burden and stress qualitatively and quantitatively. RESULTS No difference was observed across caregiver groups in cognitive function, depressive mood, or community mobility. In comparison, caregivers of the SN+ group allocated more time to care, controlling for survivors' disability (adjusted effective size d = 1.80). Their self-perceived burden and stress were more severe than the other group (adjusted d = .99). Qualitative analysis indicated caregivers of the SN+ group were more likely to describe economic stressors and undesirable changes in career and vacation planning. While 80% of participants preferred their care recipients to receive additional motor or mobility therapy, caregivers of the SN+ group were more likely to suggest additional therapy for cognitive impairment. CONCLUSIONS This exploratory study suggests that spatial neglect may heighten caregivers' burden and stress levels. Future studies with a large sample size are required.
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Affiliation(s)
- Peii Chen
- a Kessler Foundation , 1199 Pleasant Valley Way, West Orange, New Jersey , 07052 , USA.,b Department of Physical Medicine and Rehabilitation , Rutgers University , USA
| | - Denise C Fyffe
- a Kessler Foundation , 1199 Pleasant Valley Way, West Orange, New Jersey , 07052 , USA.,b Department of Physical Medicine and Rehabilitation , Rutgers University , USA
| | - Kimberly Hreha
- c Department of Biobehavioral Sciences , Teachers College, Columbia University , USA.,d Kessler Institute for Rehabilitation , USA
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