1
|
Chiu V, Fields BE, Lin YN, Kang JH, Han DS, Wu YH, Su Y, Skidmore ER, Chang FH. Implementing strategy training in Taiwan: perspectives of individuals with Acquired brain injury. Disabil Rehabil 2024; 46:1121-1129. [PMID: 36970997 DOI: 10.1080/09638288.2023.2191013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity-related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training. MATERIALS AND METHODS Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis. RESULTS This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training. CONCLUSIONS All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts.IMPLICATIONS FOR REHABILITATIONStrategy training provides clients the opportunity to actively engage in their own goal setting and decision making.Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities.Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community.Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training.
Collapse
Affiliation(s)
- Valeria Chiu
- Department of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Beth E Fields
- Occupational Therapy Program, Department of Kinesiology, University of Wisconsin-Madison, Madison, MI, USA
| | - Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu Su
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
2
|
Lin YN, Hung TH, Rodakowski J, Kang JH, Han DS, Liou TH, Wu YH, Chang FH. Development of a Dyad-Focused Intervention for Stroke Survivors and Their Family Caregivers: A Feasibility Study. Am J Occup Ther 2024; 78:7802180230. [PMID: 38422433 DOI: 10.5014/ajot.2024.050571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
IMPORTANCE Transitioning from the hospital to the community poses significant challenges for stroke survivors and their caregivers. OBJECTIVE To examine the feasibility and preliminary effects of a dyad-focused strategy training intervention. DESIGN Single-arm trial with data collection at baseline, postintervention, and 3-mo follow-up. SETTING Rehabilitation settings in Taiwan. PARTICIPANTS Sixteen stroke survivor-caregiver dyads. INTERVENTIONS Dyad-focused strategy training was provided to stroke survivor-caregiver dyads twice a week over 6 wk. The training included shared decision-making, goal setting, performance evaluation, strategy development and implementation, and therapeutic guided discovery. OUTCOMES AND MEASURES Feasibility indicators were Goal Attainment Scaling, Dyadic Relationship Scale, Participation Measure-3 Domains, 4 Dimensions, Activity Measure for Post-Acute Care, Montreal Cognitive Assessment, Trail Making Test, Stroop Color and Word Test, Preparedness for Caregiving Scale, and Zarit Burden Interview. RESULTS In total, 15 dyads completed all intervention sessions with full attendance. Both stroke survivors and their caregivers demonstrated high engagement and comprehension and reported moderate to high satisfaction with the intervention. From baseline to postintervention, the effects on goal attainment, frequency and perceived difficulty of community participation, executive function, mobility function, and caregiver preparedness were significant and positive. CONCLUSIONS AND RELEVANCE Our study supports the feasibility and preliminary efficacy of dyad-focused strategy training for stroke survivor-caregiver dyads transitioning from the hospital to the community in Taiwan. Our preliminary evidence indicates that dyads who receive strategy training exhibit advancement toward their goals and experience considerable enhancements in their individual outcomes. Plain-Language Summary: This study addresses the scarcity of interventions catering to both stroke survivors and their caregivers. By demonstrating the feasibility of our dyad-focused intervention, the research offers preliminary evidence that supports the potential advantages of involving both stroke survivors and their caregivers in the intervention process.
Collapse
Affiliation(s)
- Yen-Nung Lin
- Yen-Nung Lin, MD, MS, is Professor, Graduate Institute of Injury Prevention and Control, College of Public Health, and Director and Visiting Staff, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Te-Hsun Hung
- Te-Hsun Hung, BS, is Master's Student, Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Juleen Rodakowski
- Juleen Rodakowski, OTD, MS, OTR/L, FAOTA, is Associate Professor and Chair, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jiunn-Horng Kang
- Jiunn-Horng Kang, MD, PhD, is Dean, College of Biomedical Engineering, and Professor, Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, and Visiting Staff, Taipei Medical University Hospital, Taipei, Taiwan
| | - Der-Sheng Han
- Der-Sheng Han, MD, PhD, is Professor, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan, and Director and Visiting Staff, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan
| | - Tsan-Hon Liou
- Tsan-Hon Liou, MD, PhD, is Superintendent, Wan Fang Hospital, Taipei, Taiwan, and Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei, Taiwan
| | - Yi-Hsuan Wu
- Yi-Hsuan Wu, MS, OTR/L, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Hang Chang
- Feng-Hang Chang, ScD, OTR/L, is Professor, Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei, Taiwan, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;
| |
Collapse
|
3
|
Chang FH, Fields BE, Kersey JM, Wu CY, Shih M, Skidmore ER. How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States. Disabil Rehabil 2021; 44:5612-5622. [DOI: 10.1080/09638288.2021.1946604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Beth E. Fields
- Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison, Madison, MI, USA
| | - Jessica M. Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chao-Yi Wu
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA
| | - Minmei Shih
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
4
|
Chang FH, Chiu V, Ni P, Lin YN, Kang JH, Liou TH, Lu L, Han DS, Skidmore ER. Enhancing community participation for stroke survivors with cognitive impairment: study protocol for a randomised controlled trial in Taiwan. BMJ Open 2020; 10:e040241. [PMID: 33293312 PMCID: PMC7722819 DOI: 10.1136/bmjopen-2020-040241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Stroke can lead to life-long disability and constitutes a huge financial burden on the family and society. Stroke survivors with cognitive impairment often experience considerable challenges in the process of recovery and returning to society. Interventions that effectively help individuals resume essential daily activities and return to active participation in their communities are lacking. This study examines the efficacy of a newly-developed intervention programme, the Optimising Participation after Stroke through Strategy-training (OPASS) programme, for improving community participation among stroke survivors with cognitive impairment. METHODS AND ANALYSIS A single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding will be implemented to assess the efficacy of the OPASS programme. An expected 210 adults with cognitive impairment following stroke will be randomly assigned to either the experimental intervention (OPASS) group or the attention control group. In addition to their usual rehabilitation, both groups will receive 45 min sessions, twice weekly for a total of 12-15 sessions. The primary outcome is change in participation performance, which will be measured using the participation measure-three domains, four dimensions scale. Additional measures include the Activity Measure for Post-Acute Care generic outpatient short forms, Montreal Cognitive Assessment, Stroop Test, Trail Making Test and General Self-Efficacy Scale. These scales will be administered at baseline, post-intervention, 3-month follow-up, 6-month follow-up and 12-month follow-up. Their results will be analysed using multiple linear regression models and mixed-effects regression models. Further assessment of feasibility and acceptability of the intervention will be conducted through structured interviews with participants, caregivers and therapists. These interviews will be transcribed and thematically analysed. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N201804055). The findings will be disseminated through presentations at scientific conferences and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03792061; pre-results.
Collapse
Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Valeria Chiu
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Pengsheng Ni
- Health Law, Policy & Management; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei, Taiwan
| | - Lu Lu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|