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Zarzycki M, Seddon D, Petrovic M, Morrison V. Supporting Individuals With an Acquired Brain Injury: An Interpretative Phenomenological Study Exploring the Everyday Lives of Caregivers. QUALITATIVE HEALTH RESEARCH 2024:10497323241242046. [PMID: 38884621 DOI: 10.1177/10497323241242046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Acquired brain injury (ABI) is one of the most common causes of disability and death globally. Support from informal caregivers is critical to the well-being and quality of life of people with ABI and supports the sustainability of global health and social care systems. This study presents an in-depth qualitative analysis of the experiences of eight British informal caregivers supporting someone with ABI. Semi-structured interviews were conducted with narratives transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Three superordinate themes were generated: making sense of brain injury; being consumed by caregiving; and, the changing self. These data highlight the impact of caregiving on the caregiver's illness perceptions and sense of self. By identifying negative and positive changes in the caregiver's sense of self, and dilemmas regarding the care recipient's behaviour, we address less understood aspects of caregiver experiences. Caregiving can pose both challenges to the caregiver's sense of identity and an opportunity for self-growth. Some caregivers exhibit resilience throughout their journey, with post-traumatic growth more apparent in the later stages of caregiving. Illness perceptions shape caregiver well-being and family dynamics and indicate the need to address stigmatisation and discrimination faced by ABI survivors and caregivers. Although some caregivers acquired positive meaning and enrichment from their caregiving, previously described challenges of ABI caregiving are supported. Overall, our findings support the need for timely psychological/mental health support for caregivers, caregiver education, and the provision of short breaks from caregiving.
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Affiliation(s)
- Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Diane Seddon
- School of Health Sciences, College of Medicine and Health, Bangor University, Bangor, UK
| | - Milica Petrovic
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Depression Research Centre of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Val Morrison
- School of Psychology and Sports Science, College of Medicine and Health, Bangor University, Bangor, UK
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Heim R, Satink T, van Nes F. "Standing alone": understanding the self-management of family caregivers of persons post-stroke at the time of acute care. Disabil Rehabil 2024; 46:2871-2879. [PMID: 37461245 DOI: 10.1080/09638288.2023.2236020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/07/2023] [Indexed: 06/20/2024]
Abstract
PURPOSE To support family caregivers of persons post-stroke adequately from the start and to develop self-management interventions, we aim to gain a better understanding of family caregivers experiences at the time of acute care and therefore achieve a better understanding of how they manage their new situation. METHODS AND MATERIALS We chose a qualitative descriptive methodology using individual semi-structured interviews with eleven family caregivers of persons post-stroke. We conducted interviews retrospectively, between 2 and 10 months post-stroke, and analysed transcripts using thematic analysis. RESULTS The themes (1) being in survival mode, (2) feeling supported by family and friends, (3) feeling left alone by the treatment team and (4) insisting on information emerged from the data. CONCLUSION During acute care, many self-management skills are required from family caregivers but are just starting to be developed. This development can first be observed as co-management with the social network and is often combined with shared decision-making. Information-sharing, foundational for developing self-management, is essential for family caregivers and should be supported proactively by health professionals from the beginning. Further, from the start, health professionals should raise awareness about role changes and imbalances of activities among family caregivers to prevent negative influences on their health.
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Affiliation(s)
- Romana Heim
- Cantonal Hospital Winterthur, Institute of Therapy and Rehabilitation, Occupational Therapy, Winterthur, Switzerland
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ton Satink
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Researchgroup Neurorehabilitation - Self-regulation and Participation, HAN_University of Applied Sciences, Nijmegen, Netherlands
| | - Fenna van Nes
- Faculty of Health, European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Klockar E, Kylén M, Gustavsson C, Finch T, Jones F, Elf M. Self-management from the perspective of people with stroke - An interview study. PATIENT EDUCATION AND COUNSELING 2023; 112:107740. [PMID: 37059027 DOI: 10.1016/j.pec.2023.107740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Self-management support can improve quality of life, mood, self-efficacy, and physical function following a stroke. Knowledge of how people with stroke understand and experience self-management in different contexts is crucial to developing effective self-management support. This study explored how people with stroke understand and practice self-management during the post-acute phase. METHOD A descriptive study using qualitative content analysis to explore data from semistructured interviews RESULTS: Eighteen participants were interviewed. Most participants interpreted self-management as 'taking care of their business' and 'being independent". However, they encountered difficulties performing daily activities, for which they felt unprepared. Although interest in implementing self-management support increases, participants did not report receiving specific advice from healthcare professionals. CONCLUSION People continue to feel unprepared to manage everyday activities after hospital discharge and must largely work things out for themselves. There is an overlooked opportunity to start the process of self-management support earlier in the stroke pathway, with healthcare professionals and people with stroke combining their skills, ideas and expertise. This would enable confidence to self-management to flourish rather than decrease during the transition from hospital to home. PRACTICAL IMPLICATIONS Individual tailored self-management support could help people with stroke more successfully manage their daily lives post-stroke.
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Affiliation(s)
- Erika Klockar
- School of Health and Welfare, Dalarna University, Falun, Sweden.
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Health Sciences, Lund University, Lund, Sweden
| | - Catharina Gustavsson
- School of Health and Welfare, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna - Uppsala University, Falun, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Fiona Jones
- Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, London, UK
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Yu J, Jin Y, Si H, Bian Y, Liu Q, Qiao X, Ji L, Wang W, Wang C. How does social support interact with intrinsic capacity to affect the trajectory of functional ability among older adults? Findings of a population-based longitudinal study. Maturitas 2023; 171:33-39. [PMID: 37001477 DOI: 10.1016/j.maturitas.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/08/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The ecological model of health and ageing has proposed that functional ability (FA) is determined by the interaction between intrinsic capacity (IC) and environmental characteristics. This study empirically examined how social support, as an important social environmental resource, interacts with IC to affect FA trajectories among older adults. METHODS This was a prospective three-wave cohort study with a sample of 775 community-dwelling older adults. Social support, IC and FA were assessed using the Social Support Rating Scale, the revised Integrated Care for Older People screening tool and the Lawton Instrumental Activities of Daily Living Scale, respectively. Latent growth curve models (LGCM) were implemented to test their relationships. RESULTS FA significantly declined over 3 years, and the detrimental effect of impaired IC on the deterioration rate of FA was buffered by subjective support but was aggravated by support utilization and was not changed by objective support. FA decline among older adults with impaired IC was observed in those with low subjective support or with high support utilization but not in those with high subjective support or with low support utilization. Among older adults with intact IC, FA decline was observed in those with low support utilization but not in those with high support utilization or with low or high subjective support. CONCLUSIONS Subjective support may prevent FA decline among older adults with impaired IC, while support utilization may benefit older adults with intact IC but may be detrimental for those with impaired IC. Social support interventions to optimize FA trajectories should improve older adults' perceptions of support and bridge the gap in support utilization among older adults with impaired IC.
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Norman A, Curro V, Holloway M, Percuklievska N, Ferrario H. Experiences of individuals with acquired brain injury and their families interacting with community services: a systematic scoping review. Disabil Rehabil 2023; 45:739-751. [PMID: 35244507 DOI: 10.1080/09638288.2022.2043465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE This scoping review aims to (1) synthesise the research findings on the experiences of individuals with acquired brain injuries, and their families, when interacting with, or accessing, community-based services and (2) identify where gaps in service provision may exist and their cause. METHODS A systematic search strategy was employed across multiple databases to identify all studies relating to the experiences of individuals with acquired brain injuries and their families when interacting with, or accessing, community-based services. Inclusion was assessed by at least two reviewers at each stage and data extraction was completed by one researcher and validity checked by another. A narrative synthesis was employed. RESULTS A total of 101 papers met the inclusion criteria with the narrative synthesis identifying three main themes of (1) unmet needs, (2) types of access, and (3) barriers to access. CONCLUSIONS The results identify that those with acquired brain injuries, and their families, experience significant difficulties interacting with community-based services and often do not receive appropriate access. Many barriers to access were identified including a lack of knowledge of the long-term effects of acquired brain injury amongst professionals working in health and social care services.Implications for rehabilitationBrain injury is a leading cause of disability worldwide with a range of physical, cognitive, emotional, and behavioural difficulties.It is important that service users and families are given appropriate information about the long-term difficulties associated with ABI so they are better informed about the types of support they may need upon discharge from hospital.Rehabilitation professionals need to ensure they have good level of knowledge of the difficulties associated with ABI to ensure appropriate access to services for individuals and their families.Understanding more about unmet needs allows community rehabilitation services to be tailored and person-centred.
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Affiliation(s)
- Alyson Norman
- School of Psychology, University of Plymouth, Plymouth, UK
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Liu Q, Jin Y, Wang Y, Feng J, Qiao X, Ji L, Si H, Bian Y, Wang W, Yu J, Wang C. Association between self-efficacy and self-management behaviours among individuals at high risk for stroke: Social support acting as a mediator. J Clin Nurs 2023; 32:71-82. [PMID: 34981582 DOI: 10.1111/jocn.16191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To explore the association between self-efficacy and self-management by modelling three types of social support as mediators among stroke high-risk populations. BACKGROUND Self-efficacy and social support (i.e. objective support, subjective support and support utilisation) are important for self-management among stroke high-risk populations. Self-efficacy activates three types of social support, and the effect of social support on self-management varies by types among chronic patients. Therefore, social support may act as a mediator between self-efficacy and self-management, and the mediating role may vary by types of social support. Disentangling the role of these different types of social support can guide tailored interventions. DESIGN A cross-sectional study. METHODS This study was conducted among 448 Chinese adults at high risk for stroke. Self-efficacy, self-management and social support were assessed using the Self-Efficacy Scale, the Stroke Self-management Scale and the Social Support Rating Scale respectively. The PROCESS SPSS Macro version 3.3, model 4 was used to explore the mediating role of different types of social support in the relationship between self-efficacy and self-management. This study followed STROBE checklist for cross-sectional studies (Appendix S1). RESULTS Self-efficacy improved three types of social support, and subjective support and support utilisation promoted self-management, but objective support hindered self-management. The specific indirect effect of objective support and subjective support was significant but not that of support utilisation. Objective support, subjective support and support utilisation attenuated the total effect of self-efficacy on self-management by -23.8%, 23.8% and 7.7% respectively. CONCLUSIONS Mediating effect of social support in the relationship between self-efficacy and self-management varies by type, and the positive effect of subjective support is offset by the detrimental effect of objective support. RELEVANCE TO CLINICAL PRACTICE Among stroke high-risk populations, interventions should target objective support and subjective support as well as self-efficacy to efficiently improve their self-management.
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Affiliation(s)
- Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Ying Wang
- Liaocheng People's Hospital, Liaocheng, China
| | | | - Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Lili Ji
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, Beijing, China
| | - Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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Rahman MS, Peng W, Adams J, Sibbritt D. The use of self-management strategies for stroke rehabilitation: a scoping review. Top Stroke Rehabil 2022:1-16. [PMID: 36165711 DOI: 10.1080/10749357.2022.2127651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Self-management is generally considered a dynamic and collaborative process by individuals and caregivers to manage a chronic condition. Self-management has recently emerged as a promising strategy for stroke rehabilitation. This scoping review aims to examine and summarize self-management strategies utilized by stroke survivors for stroke rehabilitation. METHODS PubMed, Scopus, CINAHL (EBSCO), Embase, and ProQuest were searched for articles published between January 2010 and December 2021. Studies were selected if they were published in English in a peer-reviewed journal, utilized a non-experimental research design, and focused on adult stroke survivors. All relevant information from the included articles was extracted in a systematic way using a pre-developed data extraction form. Two authors performed data extraction and quality evaluation independently. All issues were resolved through discussion among the authors. RESULTS We narratively summarized the findings of 15 quantitative, qualitative, and mixed-method studies, including a total of 1,494 stroke survivors. The stroke survivors used a range of self-management strategies for their stroke rehabilitation, including domains related to lifestyle, social support, communication, knowledge and information, and goal-setting. Gender, age, stroke-related disability, fatigue, self-management education, social support, and communication with others were found to be associated with self-management use in stroke rehabilitation. CONCLUSIONS This scoping review provides an important overview on stroke survivors' use of self-management strategies and their experience. Their use of self-management strategies is complicated and multifaceted, comprising several domains and involving a diverse range of approaches and personal experiences. However, we identified several gaps in the literature and more research is required.
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Affiliation(s)
- Md Sazedur Rahman
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Wenbo Peng
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
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Kephart G, Packer T, Audulv Å, Chen YT, Robinson A, Olsson I, Warner G. Item selection, scaling and construct validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) measurement tool in adults. Qual Life Res 2022; 31:2867-2880. [PMID: 35759127 PMCID: PMC9356954 DOI: 10.1007/s11136-022-03165-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Purpose To select and scale items for the seven domains of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) and assess its construct validity. Methods Using an online survey, data on 100 potential items, and other variables for assessing construct validity, were collected from 1055 adults with one or more chronic health conditions. Based on a validated conceptual model, confirmatory factor analysis (CFA) and item response models (IRT) were used to select and scale potential items and assess the internal consistency and structural validity of the PRISM-CC. To further assess construct validity, hypothesis testing of known relationships was conducted using structural equation models. Results Of 100 potential items, 36 (4–8 per domain) were selected, providing excellent fit to our hypothesized correlated factors model and demonstrating internal consistency and structural validity of the PRISM-CC. Hypothesized associations between PRISM-CC domains and other measures and variables were confirmed, providing further evidence of construct validity. Conclusion The PRISM-CC overcomes limitations of assessment tools currently available to measure patient self-management of chronic health conditions. This study provides strong evidence for the internal consistency and construct validity of the PRISM-CC as an instrument to assess patient-reported difficulty in self-managing different aspects of daily life with one or more chronic conditions. Further research is needed to assess its measurement equivalence across patient attributes, ability to measure clinically important change, and utility to inform self-management support. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03165-4.
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Affiliation(s)
- George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada. .,School of Health Administration, Dalhousie University, Halifax, Canada. .,Department of Nursing, Umeå University, Umeå, Sweden.
| | - Tanya Packer
- School of Health Administration, Dalhousie University, Halifax, Canada.,School of Occupational Therapy, Dalhousie University, Halifax, Canada.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Åsa Audulv
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Yu-Ting Chen
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Alysia Robinson
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Ingrid Olsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
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Self-Management Embedded in Daily Activities: A Photoelicitation Focus Group Study among Persons with Spinal Cord Injury and Their Primary Caregivers in Bangladesh. Occup Ther Int 2022; 2022:2705104. [PMID: 35359429 PMCID: PMC8941582 DOI: 10.1155/2022/2705104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/24/2022] [Indexed: 12/19/2022] Open
Abstract
Purpose This study explored how community-dwelling persons with spinal cord injury (SCI) and their primary caregivers execute self-management strategies in daily activities. These strategies were mapped to a preexisting self-management framework. Methods Photoelicitation focus group discussions were conducted among 14 adults with SCI and their primary caregivers (in two groups). Moreover, a constant comparative framework was used to analyze the data. Results This study identified nine groups of self-management strategies, some of which could not be categorized under the three main self-management components generally accepted in the literature. Accordingly, a new component is proposed based off of this analysis, entitled management of social complexities, which includes crucial strategies such as (1) relocating to another environment, (2) behaving in an assertive manner, and (3) advocating for social change. Conclusion The results show that self-management, traditionally described as medical, emotional, and role management, should also include the management of social complexities. The identified strategies could be considered in the development of self-management enhancement programs in lower-middle-income countries.
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Lo SHS, Chau JPC. Exploring community-dwelling stroke survivors' experiences of receiving a nurse-led theory-based stroke self-management programme: A qualitative study. Medicine (Baltimore) 2021; 100:e27256. [PMID: 34664874 PMCID: PMC8448033 DOI: 10.1097/md.0000000000027256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/28/2021] [Indexed: 01/01/2023] Open
Abstract
International evidence-based guidelines recommend self-management support for stroke survivors to improve their health outcomes. We developed a 4-week nurse-led stroke self-management programme (SSMP) and conducted a randomised controlled trial to assess its effects. This paper reports the findings of a qualitative study nested within the randomised controlled trial to explore stroke survivors' experiences of SSMP participation. Semi-structured interviews were conducted with all adult participants who were clinically diagnosed with a first or recurrent ischaemic or haemorrhagic stroke, residing at home, communicable in Cantonese, had a Montreal Cognitive Assessment score below the second percentile, and participated in at least 1 SSMP session. All interviews were conducted in Cantonese, lasted approximately 45 minutes, and were audio-recorded. Interview data were transcribed verbatim and analysed thematically. Sixty-four stroke survivors (mean age 66.33 years, SD 12.34) were recruited, and 59 were interviewed via phone immediately after completion of SSMP. Three themes were derived. Overall, participants were satisfied with the SSMP. Their understanding of self-management was improved, and they recognised its importance in recovery. Their confidence in self-management was also enhanced through the use of multifaceted strategies. Suggestions were made to enhance their participation experiences, including increased home visits and group sessions, making group session attendance optional and arranging them more accessibly, meeting the survivors who shared their survival experiences in the videos, and access to the videos online. This study concurred that the SSMP enhanced stroke survivors' self-efficacy in self-management. Rearrangement of the programme format and enhancements in accessibility could be further examined to enable more effective stroke self-management.
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Majid U, Kandasamy S. The rationales for and challenges with employing arts-based health services research (ABHSR): a qualitative systematic review of primary studies. MEDICAL HUMANITIES 2021; 47:266-273. [PMID: 32958530 DOI: 10.1136/medhum-2020-011845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Health services research (HSR) is an interdisciplinary field that investigates and improves the design and delivery of health services from individual, group, organisational and system perspectives. HSR examines complex problems within health systems. Qualitative research plays an important role in aiding us to develop a nuanced understanding of patients, family, healthcare providers, teams and systems. However, the overwhelming majority of HSR publications using qualitative research use traditional methods such as focus groups and interviews. Arts-based research-artistic and creative forms of data collection such as dance, drama and photovoice-have had limited uptake in HSR due to the lack of clarity in the methods, their rationales and potential impacts. To address this uncertainty, we conducted a qualitative systematic review of studies that have employed arts-based research in HSR topics. We searched four databases for peer-reviewed, primary HSR studies. Using conventional content analysis, we analysed the rationales for using arts-based approaches in 42 primary qualitative studies. We found four rationales for using arts-based approaches for HSR: (1) Capture aspects of a topic that may be overlooked, ignored or not conceptualised by other methods (ie, quantitative and interview-based qualitative methods). (2) Allow participants to reflect on their own experiences. (3) Generate valuable community knowledge to inform intervention design and delivery. (4) Formulate research projects that are more participatory in nature. This review provides health services researchers with the tools, reasons, rationales and justifications for using arts-based methods. We conclude this review by discussing the practicalities of making arts-based approaches commensurable to HSR.
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Affiliation(s)
- Umair Majid
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sujane Kandasamy
- Health Research Methods, Evidence & Impact, Health Research Methdology PhD Program, McMaster University, Hamilton, Ontario, Canada
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Baumgartner-Dupuits M, Sep SJS, Verbunt J, Bosma H, van Eijk J. Peer Support to Enhance Social and Emotional Self-Management Following Acquired Brain Injury Rehabilitation: Design of a Pre-post Study With Process Evaluation. Front Neurol 2021; 12:647773. [PMID: 34393968 PMCID: PMC8360636 DOI: 10.3389/fneur.2021.647773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Specialized rehabilitation following acquired brain injury provides intensive multidisciplinary treatment to individuals with complex disabilities for optimizing recovery and supporting a safe transition to the community. Post-specialist rehabilitation, patients and caregivers have reported a need for support. We present the design of an implementation study to evaluate a new self-management support service for individuals with acquired brain injury and their caregivers. Methods: This is a pre–post intervention study with a mixed-method design. The study population comprises individuals aged ≥18 years with acquired brain injury living independently following specialized rehabilitation in the Southern part of the Netherlands. All participants receive a post-rehabilitation support service. The support service consists of several house visits by a peer support volunteer in the first weeks after specialized rehabilitation treatment. The peer support volunteers are trained according to an adapted version of the previously developed Self-Management Support (SMS) program. The SMS program is directed at improving social and emotional self-management. Patient outcomes are assessed by questionnaire pre-, directly post-, and 6 months post-intervention. The primary patient outcome measure is self-efficacy. Secondary outcomes are perceived autonomy, quality of life, and psychological well-being. A process evaluation will be performed to gain insight into barriers and facilitators for the implementation of peer-led SMS by combining both quantitative, questionnaire data and qualitative data derived from focus groups with peer supporters and patients. In a workshop with relevant stakeholders, possibilities for dissemination and sustainability will be explored. Discussion: This paper describes the design of a practice-based study on feasibility, barriers, and facilitators to the implementation of a home-based, peer-led self-management support intervention for patients with acquired brain injury. We will quantitatively and qualitatively evaluate the change in relevant patient outcomes pre- and post-intervention and the barriers and facilitators related to the implementation of the intervention. Following a positive evaluation, the final stage of the study aims to facilitate deployment and utilization of the intervention.
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Affiliation(s)
- Milou Baumgartner-Dupuits
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Simone J S Sep
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Jeanine Verbunt
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands
| | - Jacques van Eijk
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands
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Kose E, Endo H, Hori H, Hosono S, Kawamura C, Kodama Y, Yamazaki T, Yasuno N. Pharmacist medication instructions are associated with continued medication self-management in older adults: a retrospective observational study. J Pharm Health Care Sci 2021; 7:11. [PMID: 33653415 PMCID: PMC7927227 DOI: 10.1186/s40780-021-00194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Various factors are related to self-management of medication. However, few reports comprehensively examine the factors related to patients, medication levels, and other factors related to the recuperative environment, such as family support. The aim of this study was to investigate factors affecting the continuation of medication self-management among hospitalized older adults receiving convalescent rehabilitation. Methods We conducted a retrospective observational study with 274 consecutive patients newly admitted to the convalescent rehabilitation wards at a single hospital in Japan between January 2017 and May 2018. Participants who were assessed for their ability to take their medication using the Japanese Regimen Adherence Capacity Tests, were deemed to be self-manageable, and were able to successfully continue to self-manage their medication from admission to discharge were categorized as the “continuation group,” and those who were not able to continue were categorized as the “non-continuation group.” We analyzed the groups’ demographic data, laboratory data, and Functional Independence Measure. The primary outcome was the continuation of medication self-management from admission to discharge. Results After enrollment, 134 patients (median age 82 years; 62.7% women) were included in the final analysis. Some 60.4% of eligible patients were able to maintain medication self-management during their hospitalization. The multiple logistic regression analysis for the continuation of medication self-management during hospitalization after adjusting for confounding factors revealed that pharmacist medication instructions were independently and positively correlated with successful continuation of medication self-management (odds ratio: 1.378; 95% confidence interval 1.085–1.831; p = 0.0076). Conclusion Successful continuation of medication self-management is associated with pharmacist medication instructions among hospitalized older adults undergoing rehabilitation. Trail registration The Ethics Committee’s registration number is “TGE01216–066”.
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Affiliation(s)
- Eiji Kose
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.
| | - Hidetatsu Endo
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Hiroko Hori
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Shingo Hosono
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Chiaki Kawamura
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Yuta Kodama
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Takashi Yamazaki
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Nobuhiro Yasuno
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.,Laboratory of Hospital Pharmacy, School of Pharmacy, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
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14
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Packer T, Kephart G, Audulv Å, Keddy A, Warner G, Peacock K, Sampalli T. Protocol for development, calibration and validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC). BMJ Open 2020; 10:e036776. [PMID: 32998919 PMCID: PMC7528366 DOI: 10.1136/bmjopen-2020-036776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Assessing and measuring patients' chronic condition self-management needs are critical to quality health care and to related research. One in three adults around the world live with multiple chronic conditions. While many patient-reported measures of self-management have been developed, none has emerged as the gold standard, and all have one or more of the following limitations: (1) they fail to measure the different domains of self-management important to patients, (2) they lack sufficient specificity to support patient-centred care or identify the specific components of self-management interventions that work and/or (3) they lack suitability for patients with multiple chronic conditions. METHODS AND ANALYSIS The Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is being developed to overcome these shortcomings. It will measure respondents' perceived success (or difficulty) in self-managing seven domains important to patients. The protocol has three phases. Phase 1 is conceptual model development and item generation. Phase 2 is assessment of the relevance and understanding of items by people with chronic conditions. Phase 3 is item analysis, dimensionality assessment, scaling and preliminary validation of the PRISM-CC using an online survey of people with chronic conditions (n~750). The expected completion date is early 2021. ETHICS AND DISSEMINATION This study will adhere to the Canadian Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans. Ethics approval for all phases has been obtained from the Nova Scotia Health Authority Research Ethics Board. Once completed, the PRISM-CC will be made available for research and healthcare at minimal to no cost.
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Affiliation(s)
- Tanya Packer
- Schools of Occupational Therapy and Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- Rehabilitation Department, Radboud Unversity Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Åsa Audulv
- Department of Nursing, Umeå Universitet Medicinska fakulteten, Umea, Sweden
| | - America Keddy
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grace Warner
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
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15
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Dimaguila GL, Batchelor F, Merolli M, Gray K. 'We are very individual': anticipated effects on stroke survivors of using their person-generated health data. BMJ Health Care Inform 2020; 27:bmjhci-2020-100149. [PMID: 32928779 PMCID: PMC7488803 DOI: 10.1136/bmjhci-2020-100149] [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: 03/18/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Person-generated health data (PGHD) are produced by people when they use health information technologies. People who use PGHD may experience changes in their health and care process, such as engagement with their own healthcare, and their sense of social support and connectedness. Research into evaluating those reported effects has not kept up; thus, a method for measuring PGHD outcomes was previously designed and applied to the exemplar case of Kinect-based stroke rehabilitation systems. A key step of the method ensures that the patient's voice is included. Allowing stroke survivors to participate in the development and evaluation of health services and treatment can inform healthcare providers on decisions about stroke care, and thereby improve health outcomes. OBJECTIVE This paper presents the perspectives of stroke survivors and clinicians on the anticipated effects of stroke survivors' use of PGHD from a poststroke simulated rehabilitation technology. METHODS This study gathered the perspectives of stroke survivors and clinicians through three focus groups and three interviews, recruited for convenience. Participants were also asked questions intended to encourage them to comment on the initial items of the patient-reported outcome measure-PGHD. Deductive thematic analysis was performed. RESULTS This paper has further demonstrated that outcomes of using PGHD can be measured. For instance, stroke survivors described that using PGHD could result in positive, negative and nil effects on their health behaviours. Survivors and clinicians had varying perspectives in three of the six themes presented, and emphasise the importance of allowing stroke survivors to participate in the evaluation of digital health services.
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Affiliation(s)
- Gerardo Luis Dimaguila
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia .,Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Frances Batchelor
- National Ageing Research Institute, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Merolli
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Schnabel S, van Wijck F, Bain B, Barber M, Dall P, Fleming A, Kerr A, Langhorne P, McConnachie A, Molloy K, Stanley B, Young HJ, Kidd L. Experiences of augmented arm rehabilitation including supported self-management after stroke: a qualitative investigation. Clin Rehabil 2020; 35:288-301. [PMID: 32907393 DOI: 10.1177/0269215520956388] [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: 11/16/2022]
Abstract
OBJECTIVE To explore the experiences of stroke survivors and their carers of augmented arm rehabilitation including supported self-management in terms of its acceptability, appropriateness and relevance. DESIGN A qualitative design, nested within a larger, multi-centre randomized controlled feasibility trial that compared augmented arm rehabilitation starting at three or nine weeks after stroke, with usual care. Semi-structured interviews were conducted with participants in both augmented arm rehabilitation groups. Normalization Process Theory was used to inform the topic guide and map the findings. Framework analysis was applied. SETTING Interviews were conducted in stroke survivors' homes, at Glasgow Caledonian University and in hospital. PARTICIPANTS 17 stroke survivors and five carers were interviewed after completion of augmented arm rehabilitation. INTERVENTION Evidence-based augmented arm rehabilitation (27 additional hours over six weeks), including therapist-led sessions and supported self-management. RESULTS Three main themes were identified: (1) acceptability of the intervention (2) supported self-management and (3) coping with the intervention. All stroke survivors coped well with the intensity of the augmented arm rehabilitation programme. The majority of stroke survivors engaged in supported self-management and implemented activities into their daily routine. However, the findings suggest that some stroke survivors (male >70 years) had difficulties with self-management, needing a higher level of support. CONCLUSION Augmented arm rehabilitation commencing within nine weeks post stroke was reported to be well tolerated. The findings suggested that supported self-management seemed acceptable and appropriate to those who saw the relevance of the rehabilitation activities for their daily lives, and embedded them into their daily routines.
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Affiliation(s)
- Stefanie Schnabel
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Frederike van Wijck
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Brenda Bain
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Mark Barber
- Medicine for the Elderly and Stroke, NHS Lanarkshire, University Hospital Monklands, Monkscourt Avenue, Airdrie, South Lanarkshire, UK
| | - Philippa Dall
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Alexander Fleming
- Different Strokes, Different Strokes Central Services, 9 Canon Harnett Court, Wolverton Mill, Milton Keynes, UK
| | - Andrew Kerr
- Bioengineering, University of Strathclyde, Glasgow, UK
| | | | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Kathleen Molloy
- Different Strokes, Different Strokes Central Services, 9 Canon Harnett Court, Wolverton Mill, Milton Keynes, UK
| | - Bethany Stanley
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Heather Jane Young
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Lisa Kidd
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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17
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Kılınç S, Erdem H, Healey R, Cole J. Finding meaning and purpose: a framework for the self-management of neurological conditions. Disabil Rehabil 2020; 44:219-230. [DOI: 10.1080/09638288.2020.1764115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephanie Kılınç
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Hannah Erdem
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Rebecca Healey
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Joanne Cole
- Neuro Key (working title of the Tees Valley, Durham and North Yorkshire Neurological Alliance), Acklam Green Centre, Middlesbrough, UK
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18
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Wray F, Clarke D, Forster A. How do stroke survivors with communication difficulties manage life after stroke in the first year? A qualitative study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:814-827. [PMID: 31273892 DOI: 10.1111/1460-6984.12487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Interest in how stroke survivors might be better supported to manage life after stroke has grown rapidly in recent years, with a particular emphasis on enabling 'self-management'. Post-stroke communication difficulties may pose a unique barrier to longer term adaptation and adjustment. It is important to understand how stroke survivors with communication difficulties manage life after stroke and what support may be needed to facilitate this process. AIMS To explore how stroke survivors with communication difficulties manage life after stroke in the first year. METHODS & PROCEDURES A cross-sectional qualitative study involving in-depth semi-structured interviews with stroke survivors with communication difficulties (aphasia, dysarthria or apraxia of speech) and/or their family members at single time points during the first year post-stroke. A total of 21 participants (14 stroke survivors and seven family members) took part in interviews for the study. Interview data were analysed using thematic analysis. OUTCOME & RESULTS A total of six themes were identified: (1) strategies to manage changes to communication; (2) testing communication outside of the home; (3) balancing support and independence; (4) hope for recovery; (5) obtaining support from healthcare professionals; and (6) adapting activities and keeping busy. Stroke survivors with communication difficulties and their family members undertook significant work (practical, relational, emotional) to manage their condition. Adaptation and adjustment was often facilitated by 'doing'; testing out which activities could be managed independently and which required additional support. Some stroke survivors and their family members demonstrated considerable resourcefulness and creativity in developing strategies to manage their communication difficulties. Despite the work undertaken, many expressed a lack of confidence in their ability and feelings of powerlessness and abandonment at the point of discharge from community services. CONCLUSIONS & IMPLICATIONS Stroke survivors and their family members develop personally meaningful and context-specific strategies to adjust to and manage life after stroke. Future interventions should recognize, support and build upon the active work already undertaken by stroke survivors with communication difficulties and their families. Further support before and around the point of discharge from community services may be needed to help build confidence and skills to manage in the longer term. The benefit of a supported self-management approach for stroke survivors with communication difficulties should be further investigated.
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Affiliation(s)
- Faye Wray
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Clarke
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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19
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Fletcher S, Kulnik ST, Demain S, Jones F. The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation. PLoS One 2019; 14:e0218517. [PMID: 31216337 PMCID: PMC6584009 DOI: 10.1371/journal.pone.0218517] [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: 10/26/2018] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
Self-management is a concept which is now firmly established in Western healthcare policy and practice. However, the term remains somewhat ambiguous, multi-faceted and contentious. This is evident in stroke care and rehabilitation, in which a self-management approach is increasingly adopted and advocated, yet interpreted in different ways, resulting in contradictions and tensions around control, responsibility, power and discipline. This paper aims to further our understanding of tensions and contradictions in stroke self-management, by critically examining contemporary self-management practices. We use a Foucauldian theoretical lens to explore the various power dynamics in the operationalisation of self-management, in addition to the complexity of the term self-management itself. Conducting a secondary analysis of interview and focus group data from the Self-Management VOICED study, supplemented with analysis of relevant documentary evidence from policy and practice, we describe the multiple aspects of power in operation. These include rhetorical, hierarchical, personal and mutual forms of power, representing interweaving dynamics evident in the data. These aspects of power demonstrate underlying agendas and tacit and explicit understandings of self-management which exist in clinical practice. These aspects of power also give insight into the multiple identities of ‘self-management’, acting as a simultaneous repressor and liberator, directly in keeping with Foucauldian thinking. The findings are also consistent with Foucault’s notions of bodily docility, discussions around governance and biopower, and contemporary discipline. Our analysis positions self-management as a highly nuanced and complex concept, which can fluctuate in its conceptualisation depending on the structures, routines, and the individual. We encourage healthcare professionals, policymakers and commissioners in the field of self-management to reflect on these complexities, to make transparent their assumptions and to explicitly position their own practice accordingly.
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Affiliation(s)
- Simon Fletcher
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom
| | - Sara Demain
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom.,Bridges Self-Management Limited, London, United Kingdom
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20
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Sørensen SL, Pedersen SKS, Pallesen H. Social psychological mechanisms and processes in a novel, health professional-led, self-management intervention for older stroke individuals: a synthesis and phenomenological study. BMC Health Serv Res 2019; 19:320. [PMID: 31113442 PMCID: PMC6530065 DOI: 10.1186/s12913-019-4150-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A good portion of stroke patients in Western countries are over 65 of age. Because of sequelae, they often lead more isolated lives after the stroke. In terms of social reintegration, this group of patients is especially vulnerable. Reintegration into the community post-stroke greatly depends on support from family. However, the stroke individual's closest relatives are at risk of becoming overburdened. The objectives are to describe the social psychological mechanisms and processes involved in a novel self-management intervention, and to evaluate their feasibility and acceptability from the stroke individuals', the informal caregivers' and the mentors' perspectives, before implementation into a randomised controlled trial. METHODS Qualitative interviews were conducted and analysed using a phenomenological approach. Informants comprised four stroke individuals, three informal caregivers and two mentors. The UK Medical Research Council Framework for developing and evaluating complex interventions was used in the evaluation design of the intervention. RESULTS Six social psychological mechanisms were revealed as the mentors' focus areas in their interaction with stroke individuals and informal caregivers: a) Tailored approach - by individual preferences, b) Dialogue-based communication, c) Development of a good relationship, d) Transfer of activities to everyday and social contexts, e) Involvement of relatives and social networks, and f) Supporting tools - to optimise actions and communication. Furthermore, interaction processes between the stroke individual and the informal caregiver and the mentors occurred, and generated processes of change and learning in the stroke individual and the informal caregiver. The mechanisms and processes described were perceived as feasible and acceptable to the informants - with the exception of the technological supporting tool. CONCLUSION The social psychological mechanisms and processes involved in the intervention indicated a positive association to self-management behaviour from the informants' perspectives. The informants evaluated them to be relevant and meaningful in the novel self-management intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT03183960. Reg. June 15, 2017.
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Affiliation(s)
- Susanne Lillelund Sørensen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Aarhus, Denmark.
| | - Sedsel Kristine Stage Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Aarhus, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Aarhus, Denmark
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21
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Kerstens HCJW, Satink T, Nijkrake MJ, De Swart BJM, Van Lith BJH, Geurts ACH, Nijhuis-van der Sanden MWG. Stumbling, struggling, and shame due to spasticity: a qualitative study of adult persons with hereditary spastic paraplegia. Disabil Rehabil 2019; 42:3744-3751. [PMID: 31079503 DOI: 10.1080/09638288.2019.1610084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose: Little is known concerning the impact of chronic spasticity on physical activities, social participation, and well-being, and whether patients' needs are addressed by current treatments. This study aims to investigate these lacunas in persons with a pure form of hereditary spastic paraplegia (HSP), in whom spasticity is a prominent symptom.Methods: Fourteen patients with a pure form of HSP were interviewed. These interviews were recorded, verbally transcribed, and thematically analyzed.Results: Four themes were identified which can be reflected by the phrases: (1) 'I stumble', (2) 'I struggle', (3) 'I feel ashamed', and (4) 'I need support'. Balance and gait problems led to limitations in domestic activities, employment, and recreation. 'Stumbling' also occurred due to pain, stiffness, and fatigue. Struggling was related to the continuous need for adaptation strategies, including the abandonment of some activities. Participants further reported feelings of shame, fear, and frustration. Lastly, they needed more support in daily activities than currently provided.Conclusion: Besides treating spasticity-related motor impairments, patients with HSP need practical support for optimizing their physical activities and social participation. They also seek attention for the non-motor consequences of their chronic spasticity to improve their well-being. Patient-reported outcomes might help to address these needs.Implications for rehabilitationAccording to patients with hereditary spastic paraplegia, interventions for spasticity should not only be aimed at reducing motor impairments, but also on reducing pain and fatigue, improving nighttime rest and general well-being, and optimizing the performance of relevant personal activities.Medical, role and emotional management in patients with hereditary spastic paraplegia can be improved only when individual needs are identified and monitored over the course of the disease.Besides assessment of bodily functions and physical capacities, systematic evaluation of patient-reported outcomes will help both patients and professionals to monitor the functional impact of disease progression and to evaluate the effects of interventions aimed at retarding this progression.
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Affiliation(s)
- Hans C J W Kerstens
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maarten J Nijkrake
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Bert J M De Swart
- HAN University of Applied Sciences, Nijmegen, The Netherlands.,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Bas J H Van Lith
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
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22
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Egan MY, Laliberté-Rudman D, Rutkowski N, Lanoix M, Meyer M, McEwen S, Collver M, Linkewich E, Montgomery P, Quant S, Donnelly B, Fearn J. The implications of the Canadian Stroke Best Practice Recommendations for design and allocation of rehabilitation after hospital discharge: a problematization. Disabil Rehabil 2019; 42:3403-3415. [PMID: 30973029 DOI: 10.1080/09638288.2019.1592244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Introduction: Implementation of the Canadian Stroke Best Practice Recommendations has improved inpatient rehabilitation. As attention is turned to the design and allocation of rehabilitation after hospitalization, examination of their implications for post-discharge rehabilitation could help optimize service planningMethods: Critical discourse analysis modeled on Alvesson and Sandberg's method of problematization was conducted to determine how the Canadian Stroke Best Practice Recommendations envision and shape post-discharge rehabilitation, and identify any tensions and potential ways to resolve them.Results: Within the Canadian Stroke Best Practice Recommendations post-discharge rehabilitation is implicitly viewed as a continuation of inpatient rehabilitation. Rehabilitation is largely envisioned as a set of biomedical procedures aimed at normalization through correction of impairment. There is potential tension between this implicit goal and the explicit goal of providing patient and family-centered care and promoting reengagement in valued activities and roles.Conclusion: An alternate vision of post-discharge rehabilitation could help resolve this tension. Post-discharge rehabilitation could be envisioned as a self-management intervention. Rather than primarily an expert-driven process of measuring impairment and applying procedures aimed at normalization, rehabilitation would be considered facilitation of self-management with the goal of reengaging in forms of participation that comprise a satisfying life.Implications for RehabilitationImplicit assumptions within best practice guidelines powerfully influence recommendations. These ideas are difficult to examine because they seem self-evident.Implicit assumptions in the Canadian Stroke Best Practice Guidelines envision post-discharge stroke rehabilitation as an expert-driven, impairment-focused biomedical procedure.This biomedical image makes it difficult to provide care that meets the guideline's explicit goals of client- and family-centeredness.Reimagining post-discharge stroke rehabilitation as a chronic self-care management intervention aimed at developing a satisfying life after stroke could improve patient care.
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Affiliation(s)
- Mary Y Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyere Research Institute, Ottawa, ON, Canada
| | | | | | - Monique Lanoix
- Faculty of Philosophy, Saint Paul University, Ottawa, ON, Canada
| | - Matthew Meyer
- London Health Sciences Centre, Matthew Meyer, London, ON, Canada
| | - Sara McEwen
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Margo Collver
- London Health Sciences Centre, Southwestern Ontario Stroke Network, London, ON, Canada
| | - Elizabeth Linkewich
- North and East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sylvia Quant
- North and East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Beth Donnelly
- Champlain Stroke Network, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jennifer Fearn
- Health Sciences North, Northeastern Ontario Stroke Network, Sudbury, ON, Canada
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23
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Pallesen H, Næss-Schmidt ET, Kjeldsen SS, Pedersen SKS, Sørensen SL, Brunner I, Nielsen JF. "Stroke - 65 Plus. Continued Active Life": a study protocol for a randomized controlled cross-sectoral trial of the effect of a novel self-management intervention to support elderly people after stroke. Trials 2018; 19:639. [PMID: 30454014 PMCID: PMC6245630 DOI: 10.1186/s13063-018-2961-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Elderly people represent the majority of stroke cases worldwide. Post-stroke sequelae frequently lead to a more isolated life. Restricted social relations render older individuals with stroke a vulnerable group, especially in terms of social reintegration. Reintegration into the community after a stroke largely depends on support from the family. However, close relatives are at risk of becoming overburdened. The aim of this study is to investigate the effect of a novel self-management intervention to support elderly people after stroke. Methods/Design Randomized controlled trial. Two weeks before discharge from a rehabilitation hospital/center, individuals with stroke aged > 65 years will be randomized either to a group receiving conventional neurorehabilitation (control) or to an additional novel self-management intervention. In the intervention group, patients with stroke will be offered eight self-management sessions of 45–60 min duration by a physiotherapist or an occupational therapist during a period of nine months after discharge. Inclusion will continue until at least 35 individuals in each group have been recruited. Study outcome measurements: Stroke Self-efficacy Questionnaire, a short version of Stroke Specific Quality of Life Scale, Impact on Participation and Autonomy and Caregiver Burden Scale. Furthermore, physical activity will be assessed using accelerometers. All outcomes except “impact on participation” and “autonomy” will be assessed at baseline, three months, and nine months after discharge. Impact on participation and autonomy will be assessed at three and nine months after discharge. Patient, informal caregiver, and therapist satisfaction will be examined by way of questionnaires and interviews. Discussion Self-management interventions are promising strategies for rehabilitation, potentially increasing self-efficacy, quality of life, as well as participation and autonomy. The introduction of a novel self-management intervention in combination with traditional physical and occupational therapy may enhance recovery after stroke and quality of life and lessen the burden on relatives. This trial “Stroke - 65 Plus. Continued Active Life,” will provide further evidence of self-management strategies to clinicians, patients, and health economists. Trial registration ClinicalTrials.gov, NCT03183960. Registered on 12 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2961-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark.
| | | | - Simon Svanborg Kjeldsen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Sedsel Kristine Stage Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Susanne Lillelund Sørensen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Iris Brunner
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Denmark
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Olofsson A, Larsson Lund M, Nyman A. Everyday activities outside the home are a struggle: Narratives from two persons with acquired brain injury. Scand J Occup Ther 2018; 27:194-203. [DOI: 10.1080/11038128.2018.1495762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alexandra Olofsson
- Department of Health Science, Occupational Therapy, Luleå University of Technology, Luleå, Sweden
| | - Maria Larsson Lund
- 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
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25
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Singer B, Jones F, Lennon S. Adapting the Bridges stroke self-management programme for use in Australia. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.8.414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Barbara Singer
- Adjunct Professor, School of Surgery, Faculty of Medicine, Dentistry and Health Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona Jones
- Professor of rehabilitation research, Faculty of Health Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Sheila Lennon
- Professor, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia
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26
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Packer TL, Fracini A, Audulv Å, Alizadeh N, van Gaal BGI, Warner G, Kephart G. What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:579-595. [PMID: 29239734 DOI: 10.1016/j.pec.2017.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/10/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific). METHODS A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures. RESULTS Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains. CONCLUSIONS Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care. PRACTICE IMPLICATIONS In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.
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Affiliation(s)
- Tanya L Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Canada; Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - America Fracini
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Åsa Audulv
- Department of Nursing Science, Mid Sweden University, Sundsvall, Sweden.
| | - Neda Alizadeh
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Betsie G I van Gaal
- Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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27
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Jones F, McKevitt C, Riazi A, Liston M. How is rehabilitation with and without an integrated self-management approach perceived by UK community-dwelling stroke survivors? A qualitative process evaluation to explore implementation and contextual variations. BMJ Open 2017; 7:e014109. [PMID: 28373253 PMCID: PMC5387947 DOI: 10.1136/bmjopen-2016-014109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Self-management programmes could support long-term needs after stroke and using methods integrated into rehabilitation is one option. To explore theoretical assumptions and possible mechanisms of implementation a process evaluation was delivered alongside a cluster trial which has demonstrated feasibility of an integrated self-management programme (Bridges SMP) in community-dwelling stroke survivors. This paper aims to show the extent to which experiences from stroke survivors receiving rehabilitation in control (usual care) and intervention (integrated self-management) sites reflected the differences in rehabilitation received and whether their understandings aligned with the self-management approach employed. DESIGN Semistructured qualitative interviews carried out as part of a process evaluation analysed thematically. SETTING Study was based in South London; all interviews were carried out in participants' home setting. PARTICIPANTS 22 stroke participants recruited; 12 from integrated self-management sites and 10 from usual care sites. RESULTS All participants revealed shared appreciation of knowledge and support from therapists but subtle differences emerged between sites in respect to perceptions about responsibility, control and how previous experiences were used. Accounts depicted a variance regarding who had structured and planned their rehabilitation, with greater flexibility about content and involvement perceived by participants from the integrated self-management sites. They also provided accounts and experiences which aligned with principles of the intervention, such as self-discovery and problem-solving. CONCLUSIONS The findings reflect our theoretical assumptions and possible mechanisms of implementation that rehabilitation with a focus on supporting self-management is reflected in accounts and understandings of stroke survivors. Taken together with our previous research this justifies evaluating the effectiveness of Bridges SMP in a larger sample to further contribute to an understanding of the functioning of the intervention, implementation, contextual factors and mechanisms of impact. TRIAL REGISTRATION NUMBER ISRCTN42534180; Post-results.
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Affiliation(s)
- Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
- National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care South London, London, UK
| | - Christopher McKevitt
- National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care South London, London, UK
- Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, UK
- National Institute for Health Research (NIHR), Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Afsane Riazi
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Matthew Liston
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
- School of Science and Health, University of Western Sydney, Australia
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28
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Atler KE, Van Puymbroeck M, Portz JD, Schmid AA. Participant-perceived outcomes of merging yoga and occupational therapy: Self-management intervention for people post stroke. Br J Occup Ther 2017. [DOI: 10.1177/0308022617690536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction There is a need for development and validation of post-stroke fall-prevention programs. This qualitative study provides an inside look into participant-perceived outcomes of a new and innovative self-management intervention: Merging Yoga and Occupational Therapy. Method A qualitative approach was employed. Thirteen participants, who were more than 6 months post stroke and self-reported falling or a fear of falling, engaged in focus groups and individual interviews following participation in the intervention twice weekly for 8 weeks. Data from focus groups and individual interviews were analyzed using an iterative, inductive approach. Findings Five outcomes emerged from the line-by-line analysis: (1) improved abilities and capacities, (2) gained new knowledge, (3) enhanced engagement in activities, (4) improved relaxation, and (5) increased confidence and inspiration. Conclusion Participants experienced positive outcomes from engagement in a community-based multimodal fall-prevention self-management program for people post stroke.
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Affiliation(s)
- Karen E Atler
- Assistant Professor, Department of Occupational Therapy, Colorado State University, Fort Collins, USA
| | - Marieke Van Puymbroeck
- Professor, Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, USA
| | - Jennifer D Portz
- Assistant Professor, School of Social Work, Colorado State University, Fort Collins, USA
| | - Arlene A Schmid
- Associate Professor, Department of Occupational Therapy, Colorado State University, Fort Collins, USA
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29
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Sadler E, Wolfe CDA, Jones F, McKevitt C. Exploring stroke survivors' and physiotherapists' views of self-management after stroke: a qualitative study in the UK. BMJ Open 2017; 7:e011631. [PMID: 28283483 PMCID: PMC5353340 DOI: 10.1136/bmjopen-2016-011631] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 12/30/2016] [Accepted: 01/26/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Stroke is a sudden-onset condition with long-term consequences. Self-management could help address long-term consequences of stroke. Stroke survivors' and health professionals' views of self-management may vary, limiting the successful introduction of self-management strategies. This paper explores stroke survivors' and physiotherapists' views of self-management, focusing on what self-management means, and factors perceived to enable and hinder self-management after stroke, to draw out implications for policy, practice and future research. DESIGN Qualitative study using semistructured interviews and a thematic analysis approach. SETTING Stroke unit and community stroke-rehabilitation services in London, UK. PARTICIPANTS 13 stroke survivors (8 men and 5 women; aged 53-89 years) admitted to a London stroke unit. 13 physiotherapists: 8 working in an inpatient stroke unit and 5 in community rehabilitation. RESULTS Key differences were evident in how self-management was understood between these groups. Stroke survivors were unfamiliar with the term self-management, but most could provide their own definition and relate to the term, and understood it as care of the self: 'doing things for yourself' and 'looking after yourself'. They did not recognise self-management as part of their care, but valued therapists as encouraging experts in supporting their recovery after stroke. Physiotherapists commonly understood self-management as a process in which stroke survivors were expected to take an active role in their rehabilitation and manage their recovery and health, with different understandings of self-management among physiotherapists shaped by the context in which they worked. They reported that individual, social and organisational factors enable and hinder self-management after stroke, with individual and organisational barriers particularly evident in the early stages. CONCLUSIONS If self-management support approaches are to be used, further work is required to explore the language and strategies used by professionals to support self-management, and the barriers to supporting self-management at different time points after stroke.
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Affiliation(s)
- Euan Sadler
- Health Service and Population Research Department, King's Improvement Science, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Charles D A Wolfe
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas’ NHS Foundation Trust and King's College London, Tower Wing Guy's Hospital, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Christopher McKevitt
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas’ NHS Foundation Trust and King's College London, Tower Wing Guy's Hospital, London, UK
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30
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Satink T, Cup EH, de Swart BJ, Nijhuis-van der Sanden MW. The perspectives of spouses of stroke survivors on self-management – a focus group study. Disabil Rehabil 2017; 40:176-184. [DOI: 10.1080/09638288.2016.1247920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ton Satink
- Department of Occupational Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Edith H.C. Cup
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
| | - Bert J.M. de Swart
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria W.G. Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
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31
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Clark E, Bennett K, Ward N, Jones F. One size does not fit all – Stroke survivor’s views on group self-management interventions. Disabil Rehabil 2016; 40:569-576. [DOI: 10.1080/09638288.2016.1268653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ella Clark
- The National Hospital for Neurology and Neurosurgery, Queen Square, London & Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Kate Bennett
- The Institute of Psychology and Health and Society, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Nick Ward
- The National Hospital for Neurology and Neurosurgery, Queen Square, London & Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St Georges University of London, London, United Kingdom of Great Britain and Northern Ireland
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32
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Satink T, Josephsson S, Zajec J, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. Self-management develops through doing of everyday activities-a longitudinal qualitative study of stroke survivors during two years post-stroke. BMC Neurol 2016; 16:221. [PMID: 27846820 PMCID: PMC5111179 DOI: 10.1186/s12883-016-0739-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/29/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A description of the complexity of the process of self-management and the way stroke survivors give meaning to their process of self-management post-stroke is lacking. This study explores how stroke survivors managed their lives, gave meaning to their self-management post-stroke and how this evolved over time. METHODS Data was generated through participant observations and interviews of 10 stroke survivors at their homes at 3, 6, 9, 15 and 21 months post-discharge. A constant comparative method was chosen to analyse the data. RESULTS 'Situated doing' was central in stroke survivors' simultaneous development of self-management and their sense of being in charge of everyday life post-stroke. Doing everyday activities provided the stroke survivors with an arena to explore, experience, evaluate, develop and adapt self-management and being in charge of everyday activities and daily life. The influence of stroke survivors' partners on this development was sometimes experienced as empowering and at other times as constraining. Over time, the meaning of self-management and being in charge changed from the opinion that self-management was doing everything yourself towards self-managing and being in charge, if necessary, with the help of others. Moreover, the sense of self-management and being in charge differed among participants: it ranged from managing only at the level of everyday activities to full role management and experiencing a meaningful and valuable life post-stroke. CONCLUSIONS The findings of this study indicate the doing of activities as an important arena in which to develop self-management and being in charge post-stroke. Stroke self-management programs could best be delivered in stroke survivors' own environment and focus on not only stroke survivors but also their relatives. Furthermore, the focus of such interventions should be on not only the level of activities but also the existential level of self-management post-stroke.
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Affiliation(s)
- Ton Satink
- Department of Occupational, Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health, Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
- Research Group, Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Staffan Josephsson
- Division of Occupational Therapy, Department of Neurobiology, Caring Science and Society, Karolinska Institute, Stockholm, Sweden
- Department of Applied Social Sciences, NTNU, Norwegian University og Technology and Science, Trondheim, Norway
| | - Jana Zajec
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith H. C. Cup
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert J. M. de Swart
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Group, Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health, Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
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Brasier C, Ski CF, Thompson DR, Cameron J, O'Brien CL, Lautenschlager NT, Gonzales G, Hsueh YSA, Moore G, Knowles SR, Rossell SL, Haselden R, Castle DJ. The Stroke and Carer Optimal Health Program (SCOHP) to enhance psychosocial health: study protocol for a randomized controlled trial. Trials 2016; 17:446. [PMID: 27612562 PMCID: PMC5018183 DOI: 10.1186/s13063-016-1559-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of disability and distress, and often profoundly affects the quality of life of stroke survivors and their carers. With the support of carers, many stroke survivors are returning to live in the community despite the presence of disability and ongoing challenges. The sudden and catastrophic changes caused by stroke affects the mental, emotional and social health of both stroke survivors and carers. The aim of this study is to evaluate a Stroke and Carer Optimal Health Program (SCOHP) that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of stroke survivors and their carers. METHODS This study is a prospective randomised controlled trial. It will include a total of 168 stroke survivors and carers randomly allocated into an intervention group (SCOHP) or a control group (usual care). Participants randomised to the intervention group will receive nine (8 + 1 booster) sessions guided by a structured workbook. The primary outcome measures for stroke survivors and carers will be health-related quality of life (AQoL-6D and EQ-5D) and self-efficacy (GSE). Secondary outcome measures will include: anxiety and depression (HADS); coping (Brief COPE); work and social adjustment (WSAS); carer strain (MCSI); carer satisfaction (CASI); and treatment evaluation (TEI-SF and CEQ). Process evaluation and a health economic cost analysis will also be conducted. DISCUSSION We believe that this is an innovative intervention that engages the stroke survivor and carer and will be significant in improving the psychosocial health, increasing independence and reducing treatment-related costs in this vulnerable patient-carer dyad. In addition, we expect that the intervention will assist carers and stroke survivors to negotiate the complexity of health services across the trajectory of care and provide practical skills to improve self-management. TRIAL REGISTRATION ACTRN12615001046594 . Registered on 7 October 2015.
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Affiliation(s)
- Catherine Brasier
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Chantal F Ski
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia. .,Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia. .,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia.
| | - David R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Jan Cameron
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Casey L O'Brien
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Nicola T Lautenschlager
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, VIC, 3052, Australia
| | - Graeme Gonzales
- Department of Neurology, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Ya-Seng Arthur Hsueh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Gaye Moore
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Simon R Knowles
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia.,Department of Psychology, Swinburne University, Melbourne, VIC, 3122, Australia
| | - Susan L Rossell
- Department of Psychology, Swinburne University, Melbourne, VIC, 3122, Australia
| | - Rachel Haselden
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - David J Castle
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
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34
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Lou S, Carstensen K, Møldrup M, Shahla S, Zakharia E, Nielsen CP. Early supported discharge following mild stroke: a qualitative study of patients' and their partners' experiences of rehabilitation at home. Scand J Caring Sci 2016; 31:302-311. [PMID: 27481568 DOI: 10.1111/scs.12347] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early supported discharge (ESD) allows mild-to-moderate stroke patients to return home as soon as possible and continue rehabilitation at their own pace in familiar surroundings. Thus, the main responsibility for continued rehabilitation is in the hands of patients and their partners, who must collaborate to adjust to poststroke everyday life. However, couples' joint experiences of stroke, early discharge and rehabilitation at home remain minimally investigated. AIM To investigate how mild stroke patients' and their partners' experience and manage everyday life in a context of ESD. METHODS We conducted qualitative interviews with a purposive sample of 22 ESD patients and 18 partners. Interviews were conducted 3-6 weeks after stroke, and we used thematic analysis to analyse the data. FINDINGS The analysis identified three themes. First, 'Home as a healing place' involved the couples' experiences of a well-informed discharge from hospital. They trusted the health professionals' assessment that the patient was ready to go home. They described home as a comforting and calm place, where recovery could meaningfully take place. The second theme, 'Flow of everyday life', comprised the experiences of adapting to and continuing everyday life. Most of the interviewees had relatively minor physical and cognitive impairments, and the patients and their partners were hopeful for a full recovery in the foreseeable future. Finally, 'Professional safety net' involved the much appreciated stroke team. Although most of the participants only had one visit from the team, knowing that they were an accessible resource was very important to the couples. CONCLUSION ESD was experienced as a meaningful and adequate rehabilitation service that allowed patients and partners to collaboratively reinvent and rebuild their flow of everyday life by jointly adjusting routines, activities and their relationship.
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Affiliation(s)
- Stina Lou
- CFK- Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | - Kathrine Carstensen
- CFK- Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | - Marie Møldrup
- Department of Rehabilitation, Horsens Regional Hospital, Horsens, Denmark
| | - Seham Shahla
- Department of Internal Medicine/Geriatrics, Randers Regional Hospital, Randers, Denmark
| | - Elias Zakharia
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
| | - Camilla Palmhøj Nielsen
- CFK- Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
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Lou S, Carstensen K, Jørgensen CR, Nielsen CP. Stroke patients’ and informal carers’ experiences with life after stroke: an overview of qualitative systematic reviews. Disabil Rehabil 2016; 39:301-313. [DOI: 10.3109/09638288.2016.1140836] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Stina Lou
- CFK – Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | - Kathrine Carstensen
- CFK – Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | | | - Camilla Palmhøj Nielsen
- CFK – Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
- Institute of Public Health, Health, Aarhus University, Aarhus N, Denmark
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Satink T, Josephsson S, Zajec J, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. Negotiating role management through everyday activities: narratives in action of two stroke survivors and their spouses. Disabil Rehabil 2016; 38:2354-64. [PMID: 26854923 DOI: 10.3109/09638288.2015.1129442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To manage social roles is a challenging part of self-management post-stroke. This study explored how stroke survivors act as role managers with their spouses in the context of everyday activities. METHOD Two stroke survivors with a first time stroke living at home with a spouse were included. Data were generated through participant observations at their own environment at 3, 6, 9, 15 and 21 months post-discharge. The narrative analysis focused on the actions of participants. RESULTS Daily activities can be understood as an arena where role management and a meaningful live is negotiated and co-constructed with others. Everyday activities gave stroke survivors and their spouses insight into stroke survivors' capacities in daily situations. This was sometimes empowering, and other times conflicting when a spouse had negative perceptions of the abilities of the stroke survivors. CONCLUSION The findings add to the current understanding of self-management and role management with regard to how these are situated in everyday activities. Daily activities can help both spouses to reflect and understand about self-management, role management and comanagement in daily life. Moreover, observing stroke survivors in everyday situations provides professionals with concrete pictures of stroke survivors' performance and self-management in interaction with their spouses. Implications for Rehabilitation Self-management is a dynamic process in which individuals actively manage a chronic condition and finally live a meaningful life with a long-term chronic condition; self-management can be divided into medical, role, and emotional management; comanagement is when individuals activate resources and use the capacities of other persons to manage a situation together. Self-management is situated in everyday activities. Everyday activities give stroke survivors ánd their partners impressions about stroke survivors' self-management abilities post-stroke in an everyday context. Everyday activities give stroke survivors ánd their partners an arena where role management and a meaningful life are negotiated and coconstructed through doing. Observing stroke survivors in everyday situations provides professionals a concreter picture of stroke survivors' self-management and comanagement with their partners than can be obtained from an informal interview.
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Affiliation(s)
- Ton Satink
- a Department of Occupational Therapy and Research Group Neurorehabilitation , HAN University of Applied Sciences , Nijmegen , The Netherlands ;,b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Staffan Josephsson
- c Department of Neurobiology, Division of Occupational Therapy , Caring Science and Society, Karolinska Institute , Stockholm , Sweden ;,d Department of Occupational Therapy, Faculty of Health Science , Sør-Trøndelag University College , Trondheim , Norway
| | - Jana Zajec
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Edith H C Cup
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Bert J M de Swart
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands ;,e Research Group Neurorehabilitation , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
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