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Takashi N, McCarthy MJ, Ono-Kihara M, Kihara M, Nakayama T. Disagreement about perceptions of patient disability between the stroke patient and caregiver: a cross sectional study exploring the association to patient and caregiver quality of life. Aging Ment Health 2023; 27:1729-1737. [PMID: 36036267 PMCID: PMC9339023 DOI: 10.1080/13607863.2022.2116400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study explored the association of disagreement in the perception of patient disability between patients and family caregivers with physical and psychological quality of life (QOL) in both parties. METHODS A cross-sectional analysis of data collected from male stroke patients and family caregivers was conducted. Physical and psychological QOL in patients and caregivers were measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule 2.0 (DAS). Using DAS scores reported independently by patients and caregivers, dyads were categorized into one of four groups representing agreement or disagreement about patient disability. Generalized estimating equations were used to examine the associations between WHOQOL scores in patients and caregivers and these four groups. RESULTS Among 56 dyads enrolled, approximately 52% were categorized into 'agreement' groups and 48% were categorized into 'disagreement' groups. The disagreement in perception about patient disability were significantly associated with poor patient physical QOL. However, the disagreement in perception were not significantly associated with caregiver QOL. CONCLUSION Findings suggest the association of disagreement with QOL differs between patients and caregivers. Further research is needed to carefully appraise the relationship and interaction between patient and caregiver.
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Affiliation(s)
- Naoki Takashi
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan
| | - Michael J McCarthy
- College of Social and Behavioral Sciences, Department of Social Work, Northern Arizona University, Flagstaff, AZ, USA
| | - Masako Ono-Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Masahiro Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Takeo Nakayama
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
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Connor EO, Dolan E, Horgan F, Galvin R, Robinson K. A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals' experiences of early supported discharge (ESD) after stroke. PLoS One 2023; 18:e0281583. [PMID: 36780444 PMCID: PMC9925006 DOI: 10.1371/journal.pone.0281583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. METHOD A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis. RESULTS Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. CONCLUSION The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.
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Affiliation(s)
- Elaine O. Connor
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
- Connolly Hospital, Blanchardstown, Dublin, Ireland
- * E-mail:
| | - Eamon Dolan
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
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Cheraghifard M, Akbarfahimi M, Azad A, Eakman AM, Taghizadeh G. Validation of the Persian Version of the Engagement in Meaningful Activities Survey (EMAS) in an Iranian Stroke Population: Predictors of Participation in Meaningful Activities. Am J Occup Ther 2022; 76:23317. [PMID: 35771732 DOI: 10.5014/ajot.2022.046623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The inability to participate in meaningful activities is one of stroke survivors' main difficulties and has a negative effect on their satisfaction and quality of life. OBJECTIVE To assess the reliability and validity of the Persian version of the Engagement in Meaningful Activities Survey (EMAS-P) and predictors of participation in meaningful activity among chronic stroke survivors. DESIGN Cross-sectional. SETTING Medical and rehabilitation centers. PARTICIPANTS One hundred twenty-three people (75 men, 48 women) with chronic stroke. OUTCOMES AND MEASURES Participants were evaluated with the EMAS-P, Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies Depression Scale, Purpose in Life Test-Short Form (PIL-SF), 36-Item Short Form Health Survey (SF-36), and Life Satisfaction Index-Z (LSI-Z). RESULTS The EMAS-P showed good internal consistency (Cronbach's α = .95) and test-retest reliability (intraclass correlation coefficient = .87 for EMAS-P total score). Test-retest reliability for each EMAS-P item was moderate (κ = .40-.65). A significant correlation between the EMAS-P and PIL-SF (r = .86), SWLS (r = .83), LSI-Z (r = .75), and SF-36 subscales (rs = .52-.83) indicated the appropriate convergent validity. The EMAS-P's discriminative validity was also confirmed for age, depression level, and disability level among people with chronic stroke. Depression, disability level, gender, and fatigue were significant predictors of EMAS-P score. CONCLUSIONS AND RELEVANCE The results indicate that the EMAS-P has acceptable reliability and validity among Iranian people with chronic stroke. Moreover, the EMAS-P showed good discriminant validity for age, depression, and disability level among them. What This Article Adds: The EMAS-P is a reliable and valid scale for assessing the engagement of Iranian chronic stroke survivors in meaningful activities and thus should be helpful in both clinical research and practice.
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Affiliation(s)
- Moslem Cheraghifard
- Moslem Cheraghifard, PhD, is Occupational Therapist, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Malahat Akbarfahimi
- Malahat Akbarfahimi, PhD, is Associate Professor, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Akram Azad
- Akram Azad, PhD, is Associate Professor, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Aaron M Eakman
- Aaron M. Eakman, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins
| | - Ghorban Taghizadeh
- Ghorban Taghizadeh, PhD, is Assistant Professor, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran; or
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Lin BL, Mei YX, Wang WN, Wang SS, Li YS, Xu MY, Zhang ZX, Tong Y. Unmet care needs of community-dwelling stroke survivors: a systematic review of quantitative studies. BMJ Open 2021; 11:e045560. [PMID: 33879490 PMCID: PMC8061855 DOI: 10.1136/bmjopen-2020-045560] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Understanding the unmet needs of community-dwelling stroke survivors is essential for further intervention. This systematic review was performed to summarise their unmet needs from a quantitative viewpoint. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES A comprehensive search of six databases was conducted from inception to February 2020: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and CBM. The methodological quality of the studies was assessed. Unmet needs were categorised, and a pooled analysis of the main outcomes was conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included quantitative studies focused on the unmet needs of stroke survivors who live at homes rather than in any other institutionalised organisation. RESULTS In total, 32 of 2660 studies were included, and 1980 unmet needs were identified. The prevalence of patients with unmet needs ranged from 15.08% to 97.59%, with a median of 67.20%; the median number of unmet needs per patient ranged from 2 to 8 (0-31). The prevalence of unmet needs was high at 6 months post-stroke (62.14%) and 2 years post-stroke (81.37%). After categorisation, the main concerns among these patients were revealed to be information support, physical function and mental health; a few studies reported unmet needs related to leisure exercise, return to work and so on. Additionally, differences in the measurement tools used across studies affect what unmet needs participants report. CONCLUSIONS Sufficient, accurate, individualised and dynamic information support is a priority among community-dwelling stroke survivors. Physical function and mental health are also the most significant concerns for re-achieving social participation. It is essential to design and disseminate standard, effective and time-saving tools to assess unmet needs. TRIAL REGISTRATION NUMBER CRD42018112181.
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Affiliation(s)
- Bei-Lei Lin
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yong-Xia Mei
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
| | - Wen-Na Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
| | - Shan-Shan Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
- The Hong Kong Polytechnic University, Hong Kong, China
| | - Ying-Shuang Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng-Ya Xu
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen-Xiang Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
| | - Yao Tong
- School of Information Engineering, Zhengzhou University, Zhengzhou, China
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5
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Wassenius C, Claesson L, Blomstrand C, Jood K, Carlsson G. Integrating consequences of stroke into everyday life - Experiences from a long-term perspective. Scand J Occup Ther 2020; 29:126-138. [PMID: 33307938 DOI: 10.1080/11038128.2020.1857433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Occupational engagement encompasses both objective and subjective aspects of occupation. Long-term follow-up studies indicate that stroke can have a negative impact on the ability to perform IADL. Less is known about the subjective experiences of occupational engagement and how engagement may evolve after stroke. OBJECTIVE To explore stroke survivors' experiences of occupational engagement and how engagement changed over time and across contexts. MATERIAL AND METHODS Repeat, semi-structured interviews 15-18 years post-stroke, analysed using thematic analysis. Eight out of nine participants were classified as having had a mild stroke at onset. RESULTS The analysis resulted in five themes that together formed the main theme 'It takes time - integrating consequences of stroke into everyday life by engaging in occupation, using internal resources and adapting to context'. This illustrated how occupational outcome was the result of a continuous process in which occupational engagement was a way of gradually integrating consequences of stroke into everyday life. CONCLUSION AND SIGNIFICANCE Occupational engagement plays an important part in the process of moving on with life and can serve as both goal and means of achieving desired outcomes after stroke. Interventions that focus on enabling opportunities for occupational engagement in valued occupations and support the use of abilities and internal resources can reduce the impact of stroke in everyday life.
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Affiliation(s)
- Charlotte Wassenius
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Occupational therapy and Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden
| | - Lisbeth Claesson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Stroke Centre West, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Neurology, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Carlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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6
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Understanding people’s experiences of using the SaeboFlex® following a stroke. Br J Occup Ther 2020. [DOI: 10.1177/0308022620943781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction This qualitative interpretive phenomenological study sought to understand the experiences of people using the SaeboFlex®, within an outpatient setting, following a stroke. Method Five adults who had experienced a stroke and had received the SaeboFlex® from occupational therapists in one outpatient service within the previous 12 months were recruited using convenience sampling. Semi-structured interviews were conducted, recorded, transcribed verbatim, and analysed using Braun and Clarke’s thematic analysis. Results Three themes emerged from the data: (a) hope for upper limb recovery: ‘you have got nothing to lose’; (b) the everyday experience of the SaeboFlex®: ‘just keeping it in a routine’; (c) the self-reported outcomes: ‘I can do more things you know … but there haven’t been any miracles’. Conclusion The findings highlight the important role of hope in the recovery of people following a stroke, and that participants continue to use the device despite limited goal achievement. The reports of limited transfer of training into everyday occupations, either with or without the device, is something that should be carefully considered. The SaeboFlex® is a tool that is promoted for upper limb rehabilitation, but which has limited evidence of effectiveness and mixed client experiences. Further research is required.
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Purton J, Sim J, Hunter SM. The experience of upper-limb dysfunction after stroke: a phenomenological study. Disabil Rehabil 2020; 43:3377-3386. [PMID: 32223456 DOI: 10.1080/09638288.2020.1743775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Stroke can bring about a profound disruption to people's lives, but what is less understood is the effect that specific dysfunctions can have. The aim of this study was to explore stroke survivors' experiences of upper-limb dysfunction over time. METHODS 13 adult stroke survivors engaged in a series of up to four semi-structured interviews over an 18-month period after stroke. Data were interpreted through a method based on framework analysis. An interpretive phenomenological approach guided the research. RESULTS Upper-limb dysfunction brought substantial challenges for people, identified in a main theme of an altered way of life. Subordinate themes that contributed to this alteration were challenges in personal care, participating in meaningful and valued activities, and managing life roles and relationships. The second main theme was the disrupted self, with subordinate themes of feeling devalued, disrupted self-image and changes in identity. CONCLUSION The impact of upper-limb dysfunction on people's lives after stroke should be understood and acknowledged by rehabilitation professionals. Restoring some functional upper-limb activity could play an important role in enabling a person to regain a meaningful life and a coherent sense of self after stroke.IMPLICATIONS FOR REHABILITATIONUpper-limb dysfunction after stroke, and the loss of bimanual hand function, can profoundly alter a person's life, rendering them unable to manage simple tasks of personal care, participate in valued activities and fulfil important life roles.These functional and social limitations can then disrupt their sense of self, with feelings of low self-worth, and changes in self-image and identity.It is important that these changes in stroke survivors' lives are acknowledged and understood by rehabilitation professionals. More prolonged periods of therapy for recovery of upper-limb function, or for developing compensatory strategies, should be considered so that people can regain some meaning in life and maintain a coherent sense of self.
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Affiliation(s)
- Judy Purton
- School of Science, Technology and Health, York St John University, York, UK.,School of Allied Health Professions, Keele University, Keele, UK
| | - Julius Sim
- School of Allied Health Professions, Keele University, Keele, UK.,School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Susan M Hunter
- School of Allied Health Professions, Keele University, Keele, UK
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Harel-Katz H, Adar T, Milman U, Carmeli E. Examining the feasibility and effectiveness of a culturally adapted participation-focused stroke self-management program in a day-rehabilitation setting: A randomized pilot study. Top Stroke Rehabil 2020; 27:577-589. [DOI: 10.1080/10749357.2020.1738676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hagit Harel-Katz
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamar Adar
- Department of Family Medicine, Haifa and West Gallilee District, Clalit Health Services, Israel
| | - Uzi Milman
- Department of Family Medicine, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Eli Carmeli
- Faculty of Social Welfare and Health Sciences, Department of Physical Therapy, University of Haifa, Haifa, Israel
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Walder K, Molineux M. Listening to the client voice - A constructivist grounded theory study of the experiences of client-centred practice after stroke. Aust Occup Ther J 2019; 67:100-109. [PMID: 31840290 DOI: 10.1111/1440-1630.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Collaboration, choice and power-sharing are cornerstones of practice as occupational therapists support individuals to re-establish an occupational identity and reintegrate into the community following stroke. Yet evidence of unmet client needs suggests client-centred care is not optimal, and little is known of client perspectives of client-centred practice. A deeper understanding of the client experience of therapeutic relationships during adjustment following stroke, will help facilitate client-centred practice. This paper reports on a study exploring the research question: how do stroke survivors perceive their relationship with their health care team as they adjust to life following stroke? METHODS In this constructivist grounded theory study, in-depth interviews were conducted with six adult stroke survivors from South-East Queensland, Australia. Transcribed interviews were analysed using a constant comparative approach, identifying emerging concepts and patterns, to construct a theoretical understanding of the experience and meaning of adjustment and reintegration back into the community, with a specific focus on perceptions of therapeutic relationships and client-centred practice. RESULTS Participant perspectives of client-centred care during their rehabilitation following stroke were revealed and implications of this for their recovery identified. Themes of being understood; out of the driver's seat; knowing what's going on; and what I need when I need it emerged. Participants described not being: involved in decision making, provided with information, or receiving services aligned to their needs. Periods of frustration, loss of hope and fluctuating motivation were also common. CONCLUSION Findings shed further light on previously reported health service and discharge experiences. The insight gained into individual experiences of client-centred care following stroke suggest ways therapists can understand and address each client's adjustment experience and the impact this has on their needs, goal-setting, motivation, and confidence. Client-centred care must be grounded in client reality.
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Affiliation(s)
- Kim Walder
- School of Allied Health Sciences, Griffith University, Nathan, QLD, Australia
| | - Matthew Molineux
- School of Allied Health Sciences, Griffith University, Nathan, QLD, Australia
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Walder K, Molineux M, Bissett M, Whiteford G. Occupational adaptation - analyzing the maturity and understanding of the concept through concept analysis. Scand J Occup Ther 2019; 28:26-40. [PMID: 31786968 DOI: 10.1080/11038128.2019.1695931] [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: 10/25/2022]
Abstract
Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement.Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation.Methods: Four databases were searched using the term 'occupational adaptation' and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept's evolution and analysis of the maturity of its structural features also occurred.Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility.Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility.
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Affiliation(s)
- Kim Walder
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Matthew Molineux
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Michelle Bissett
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Gail Whiteford
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
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11
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Martin-Saez MM, James N. The experience of occupational identity disruption post stroke: a systematic review and meta-ethnography. Disabil Rehabil 2019; 43:1044-1055. [PMID: 31373246 DOI: 10.1080/09638288.2019.1645889] [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: 12/21/2022]
Abstract
PURPOSE After a stroke, most individuals cannot participate in some of their valued occupations, disrupting their occupational identity. The aim of this interpretive synthesis is to systematically review the existing body of research to develop an understanding of the experience of occupational identity disruption post-stroke. METHODS A systematic review of the literature that included nine electronic databases, reference lists screening and grey literature checking was completed. Ten studies published between January 2012 and October 2018 were included. Meta-ethnography was used for the interpretive synthesis. FINDINGS A three-staged process model was created. Stage 1 illustrates the four factors involved in occupational identity disruption: "A fragmented and externalized body", "losing control, freedom and independence", "changed social and familial interactions", and "occupational participation loss". Stage two explains the experience of occupational identity disruption: "Occupational identity loss", "a de-valued self", and "threat to identity continuity". Stage three shows the individual's coping strategies: "protecting one's self", "social isolation", and "re-inventing one's occupational self". CONCLUSIONS Stroke impacts on an individual's occupational identity, compromising the continuity of a stroke survivor's sense of self. However, occupational identity is fluid; this can be used to support individuals to re-invent the occupational self. A conceptual model was developed to support the application of these results in clinical practice.Implications for rehabilitationOccupational identity disruption impacts on stroke survivors' self-value and sense of self continuity.Health care professionals' understanding of stroke survivors experience of occupational identity disruption could contribute to realign stroke survivors and clinicians' rehabilitation goals.Occupational participation and social interaction should be core aspects of stroke rehabilitation.Occupation-focus rehabilitation could provide opportunities for stroke survivors to pursue their desired occupational identity.
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Affiliation(s)
- Maria M Martin-Saez
- Occupational Therapy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil James
- School of Health Sciences, University of East Anglia, Norwich, UK
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12
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Lin B, Ding C, Mei Y, Wang P, Ma F, Zhang ZX. Unmet care needs of community-dwelling stroke survivors: a protocol for systematic review and theme analysis of quantitative and qualitative studies. BMJ Open 2019; 9:e029160. [PMID: 31230030 PMCID: PMC6596939 DOI: 10.1136/bmjopen-2019-029160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/30/2019] [Accepted: 05/28/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Stroke is a leading cause of disability worldwide. The average hospital length of stay ranges from 3 to 28 days, and after discharge home the stroke survivors will live with physical, cognitive, even psychological disorders for the rest of their lives. It is essential to review the unmet needs of stroke survivors. METHODS AND ANALYSIS A systematic review of previous quantitative and qualitative studies reporting the unmet needs of stroke survivors in their homes will be conducted. The following six databases will be searched from inception to December 2018 for relevant articles: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and China Biology Medicine. We will include studies limited to human and published in English or Chinese, and the patients with stroke should discharge home rather than any other professional organisations including nursing homes or community rehabilitation units and so on. Data of quantitative research will be standardised for comparison, thematic analysis will be used for qualitative data and a narrative synthesis and pooled analysis of the main outcomes will be reported. ETHICS AND DISSEMINATION This review will be submitted to an international professional journal, and the detailed search strategies and analysis flowchart will be openly included as supplements. This study does not require ethical approval as no patient's identifiable data will be used. Our findings will give a new look at the aspect of stroke survivors' unmet needs in their long-term recovery stage, especially the trajectories of unmet needs at different timepoints. What is more, this review will demonstrate the long-term unmet needs of stroke survivors from different countries, will compare any variations between high-income and low-income regions, and the geographical differences of needs will be mapped if necessary. We will endeavour to provide as much information as possible to healthcare professionals and public health policy makers in order to promote further medical reform. TRIAL REGISTRATION NUMBER CRD42018112181.
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Affiliation(s)
- Beilei Lin
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Chunge Ding
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongxia Mei
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Panpan Wang
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Fayang Ma
- China-US (Henan) Hormel Cancer Institute, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen-Xiang Zhang
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
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13
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Black MH, Milbourn B, Desjardins K, Sylvester V, Parrant K, Buchanan A. Understanding the meaning and use of occupational engagement: Findings from a scoping review. Br J Occup Ther 2019. [DOI: 10.1177/0308022618821580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction It is theorized that occupational therapy practice is underpinned by the construct of occupational engagement, with a focus on examining the subjective meaning of occupation. The theoretical definition of occupational engagement presents significant challenges to its use, evaluation, and measurement within evidence-based contemporary occupational therapy practice. Method A scoping review was conducted to examine how occupational engagement is defined within occupational therapy literature and how occupational engagement is evaluated. Results Twenty-six journal articles were identified. Definitions were fragmented and inconsistent across studies. Key themes relating to definitions of occupational engagement included active involvement in occupation, finding value and meaning, balanced engagement, subjective experience of engagement, developing identity through occupation, and social and environmental interactions. Measures seeking to understand occupational engagement were varied across studies, with a consistent measure applied only in the area of mental health. Conclusion The lack of consistency in definitions and measurement of occupational engagement presents significant issues for occupational therapy practice and evaluation. There is a need for a common definition of occupational engagement to be applied in the literature. Outcome measures seeking to understand occupational engagement are also required; however, these rely on a clearly defined construct.
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Affiliation(s)
- Melissa H Black
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Ben Milbourn
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Kyle Desjardins
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Victoria Sylvester
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Kimberley Parrant
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Angus Buchanan
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
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14
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Walder K, Molineux M. Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience. Br J Occup Ther 2017. [DOI: 10.1177/0308022617722711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Annually, approximately five million people worldwide are left with a permanent disability following a stroke, often with ongoing occupational issues. A deeper understanding of the emerging picture of occupational disruption and identity reconstruction after stroke is needed to inform client-centred practice. Method In-depth interviews using constructivist grounded theory methodology were conducted with six Queensland (Australia) adult stroke survivors. Data analysis identified themes which were woven into an overarching theory about the process of reintegration back into the community and living a meaningful life. Findings The central process of adjustment for all participants was reconstruction of an occupational identity, facilitated through connections within and across three domains – self, others and reality. Connecting with self involved emotional management; motivation; confidence; occupational engagement; and seizing control. Connecting with others included being understood; belonging; receiving help; and interactions. Connecting with reality meant confronting the impact on daily life and one's unfolding life story according to three realities: past reality, the reality of the stroke and future reality. Conclusion Exploring how stroke survivors form and maintain connections across the domains of self, reality and others provides a framework to ground occupational therapy services in the reality of individual needs from an occupational perspective.
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Affiliation(s)
- Kim Walder
- Lecturer and Higher Degree Research Student, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Gold Coast campus, Australia
| | - Matthew Molineux
- Head, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Gold Coast campus, Australia
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15
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Charlton K, Murray CM, Kumar S. Perspectives of older people about contingency planning for falls in the community: A qualitative meta-synthesis. PLoS One 2017; 12:e0177510. [PMID: 28562596 PMCID: PMC5451003 DOI: 10.1371/journal.pone.0177510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/30/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Despite consistent evidence for the positive impact of contingency planning for falls in older people, implementation of plans often fail. This is likely due to lack of recognition and knowledge about perspectives of older people about contingency planning. The objective of this research was to explore the perspectives of older people living in the community about use of contingency planning for getting help quickly after a fall. Method A systematic literature search seeking qualitative research was conducted in April 2014, with no limit placed on date of publication. Medline, EMBASE, Ageline, CINAHL, HealthSource- Nursing/Academic Edition, AMED and Psych INFO databases were searched. Three main concepts were explored and linked using Boolean operators; older people, falls and contingency planning. The search was updated until February 2016 with no new articles found. After removal of duplicates, 562 articles were assessed against inclusion and exclusion criteria resulting in six studies for the meta-synthesis. These studies were critically appraised using the McMaster critical appraisal tool. Bespoke data extraction sheets were developed and a meta-synthesis approach was adopted to extract and synthesise findings. Findings Three themes of ‘a mix of attitudes’, ‘careful deliberations’ and ‘a source of anxiety’ were established. Perspectives of older people were on a continuum between regarding contingency plans as necessary and not necessary. Levels of engagement with the contingency planning process seemed associated with acceptance of their risk of falling and their familiarity with available contingency planning strategies. Conclusion Avoiding a long lie on the floor following a fall is imperative for older people in the community but there is a lack of knowledge about contingency planning for falls. This meta-synthesis provides new insights into this area of health service delivery and highlights that implementation of plans needs to be directed by the older people rather than the health professionals.
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Affiliation(s)
- Kimberly Charlton
- Domiciliary Care, Department of Communities and Social Inclusion, South Australian Government, Northfield, South Australia, Australia
| | - Carolyn M. Murray
- School of Health Sciences, University of South Australia, Sansom Institute for Health Research, Adelaide, South Australia, Australia
- * E-mail:
| | - Saravana Kumar
- School of Health Sciences, University of South Australia, Sansom Institute for Health Research, Adelaide, South Australia, Australia
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16
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Taylor J, Jones V. The development of a workbook to explore meaningful occupations after life-changing events. Br J Occup Ther 2017. [DOI: 10.1177/0308022617698168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Following serious illness or other traumatic events, individuals can experience a disruption of identity. This is related to an altered ability to engage in the routines, interactions and occupations of everyday life. The meaningfulness of occupations and of life itself can be changed or diminished. Because engagement in occupations contributes to identity construction, a practical tool to systematically explore the unique meanings of particular occupations to an individual could be of value in helping to re-establish a positive way forward. The aim of this study was to develop such a therapeutic tool, based on a framework of ‘the occupied self’. Method A participatory design approach was employed to engage the expertise of potential end-users of the tool: six occupational therapists in cancer services and nine people living with cancer. The prototype ‘What Now?’ Workbook and associated Guidance Notes were incrementally developed over a period of 8 months. Results The workbook was judged by the expert advisers to be relevant, useful and user-friendly, with the potential to benefit carers, retirees and those recovering from life-changing events. Conclusion The final version of the ‘What Now?’ Workbook is now ready to be tested in practice.
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17
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Pearce G, Pinnock H, Epiphaniou E, Parke HL, Heavey E, Griffiths CJ, Greenhalgh T, Sheikh A, Taylor SJC. Experiences of Self-Management Support Following a Stroke: A Meta-Review of Qualitative Systematic Reviews. PLoS One 2015; 10:e0141803. [PMID: 26657458 PMCID: PMC4682853 DOI: 10.1371/journal.pone.0141803] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/13/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Supporting self-management in stroke patients improves psychological and functional outcomes but evidence on how to achieve this is sparse. We aimed to synthesise evidence from systematic reviews of qualitative studies in an overarching meta-review to inform the delivery and development of self-management support interventions. METHODS We systematically searched eight electronic databases including MEDLINE, EMBASE and CINAHL for qualitative systematic reviews (published January 1993 to June 2012). We included studies exploring patients', carers' or health care professionals' experiences relevant to self-management support following a stroke, including studies describing the lived experience of surviving a stroke. We meta-synthesised the included review findings using a meta-ethnographic framework. RESULTS Seven reviews, reporting 130 unique studies, were included. Themes emerging from the reviews were pertinent, consistent and showed data saturation; though explicit mention of self-management support was rare. Our meta-review highlighted the devastating impact of stroke on patients' self-image; the varying needs for self-management support across the trajectory of recovery; the need for psychological and emotional support throughout recovery particularly when physical recovery plateaus; the considerable information needs of patients and carers which also vary across the trajectory of recovery; the importance of good patient-professional communication; the potential benefits of goal-setting and action-planning; and the need for social support which might be met by groups for stroke survivors. CONCLUSIONS The observed data saturation suggests that, currently, no further qualitative research simply describing the lived experience of stroke is needed; we propose that it would be more useful to focus on qualitative research informing self-management support interventions and their implementation. Our findings demonstrate both the on-going importance of self-management support and the evolving priorities throughout the stages of recovery following a stroke. The challenge now is to ensure these findings inform routine practice and the development of interventions to support self-management amongst stroke survivors.
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Affiliation(s)
- Gemma Pearce
- Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, United Kingdom
| | - Hilary Pinnock
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Eleni Epiphaniou
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Hannah L. Parke
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Emily Heavey
- Social Policy Research Unit, University of York, York, United Kingdom
| | - Christopher J. Griffiths
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, Medical Sciences division, University of Oxford, Oxford, United Kingdom
| | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Stephanie J. C. Taylor
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- * E-mail:
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18
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Yong ASL, Price L. The Human Occupational Impact of Partner and Close Family Caregiving in Dementia: A Meta-Synthesis of the Qualitative Research, Using a Bespoke Quality Appraisal Tool. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14071472109879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: In 2009, the United Kingdom Department of Health identified the need to assist families so that people with dementia can remain living at home. Occupational therapists could support families and their loved ones at home by understanding the human occupational impact of caregiving. This impact includes how one is influenced by values and motivated to perform activities shaped by experiences and life roles. The purpose of this review was to synthesize qualitative research related to family dementia caregiving, extrapolating information about the human occupational impact on the caregiver. The aim was to inform occupational therapy practice. Method: A search was conducted across a range of electronic databases. A quality appraisal tool was specifically developed for the study appraisal and data extraction process. Data were extracted and analysed within the Model of Human Occupation framework. Findings: Twenty studies were included in this review. Five themes emerged: adapting to dementia; staying motivated and in control; preserving occupational balance and wellbeing; gaining meaning from the caregiver role; and losses and burden. Conclusion: The human occupational impact of caregiving affects the quality and decision-making of care for families. Occupational therapists are well placed to support families through the stages of dementia.
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Affiliation(s)
- Audrey Su Lin Yong
- Advanced Occupational Therapist, Sussex Partnership NHS Foundation Trust, Eastbourne Downs and Weald Community Learning Disability Service, East Sussex
| | - Lee Price
- Principal Lecturer, University of Brighton, School of Health Sciences, Eastbourne, East Sussex
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