Recovery from stroke: does rehabilitation counselling have a role to play?

Conceptualizing Disability

Empirical analysis of disability identity has great potential to improve understanding of the role of disability status in identity politics. Despite ongoing discussions of the relevance of disability identity in the disability rights movement and political actions related to disability, there is limited research into its nature and its underlying psychological, social, and political constructs. This may in part be caused by the lack of a theoretical model to guide analysis. This article proposes a conceptual framework to guide empirical analysis of disability identity, outlining six potential construct domains and their sub-domains based on a review of scholarly discussions and empirical research.

Study Protocol of the Restore4Stroke Self-Management Study: A Multicenter Randomized Controlled Trial in Stroke Patients and Their Partners

Rationale

Many stroke patients and their partners report long-term negative consequences of stroke on their health-related quality of life. Adequate self-management abilities may help manage the consequences of the stroke, but it is unknown what specific intervention might be effective to enhance self-management abilities of stroke patients and their partners.

Aim

The study aims to investigate the effectiveness of a 10-week group self-management intervention addressing proactive coping strategies compared with a group education intervention in stroke patients and their partners.

Design

The study is a multicenter randomized controlled trial. A total of 106 stroke patients with, if applicable, their partners are randomly assigned to the self-management intervention or the education intervention within each of the 10 participating hospitals and rehabilitation centers. The main inclusion criteria are a symptomatic stroke at least six-weeks ago, living at home, and reporting at least two participation restrictions on the Utrecht Scale for Evaluation of Rehabilitation-Participation's restriction scale. Measurements are performed at baseline, immediately after intervention, three-months, and nine-months postintervention.

Study outcomes

Primary outcome measures are stroke patients' and partners' proactive coping competencies (Proactive Competence Inventory) and societal participation (Utrecht Scale for Evaluation of Rehabilitation-Participation's restriction scale).

Discussion

If effective, the results of this study will enable stroke patients and their partners to deal better with the lasting consequences of stroke. In the context of the growing number of people returning home after stroke, a large number of people may profit from this intervention.

The impact of early stroke on identity: A discourse analytic study

This article examines the ways in which sufferers talk about early stroke and the effects this chronic condition has on identity. Traditional research into chronic illness has largely used medical, psychiatric or cognitive models. We adopt a social constructionist perspective and use a discourse analytic methodology to study data collected via focus group interaction. Analysis of the data collected shows that participants displayed sensitivity about having acquired a potentially 'damaged' sense of self by mitigating negative features of their experiences. Participants also attended to the issue of whether their accounts were persuasive or believable. Some carers were present in these discussions. As a consequence, participants who had suffered a stroke displayed sensitivity to the way that carers might respond to mitigation of the negative aspects of stroke.

Psychosocial predictors of quality of life in a sample of community-dwelling stroke survivors: a longitudinal study

BACKGROUND

Stroke research and rehabilitation has traditionally focussed on the physical impact of a stroke, with less attention given to associated psychosocial factors. This study aimed to identify psychosocial predictors of health-related quality of life (HRQoL) in chronic stroke survivors and examine differences between nondepressed and depressed participants.

METHOD

Participants were recruited primarily from six major metropolitan hospital databases. A total of 135 first-ever stroke survivors aged 25-96 years who were 6 to 24 months post stroke and community-dwelling were studied longitudinally over 6 months. HRQoL and psychosocial factors (optimism, self-esteem, perceived control, depressive status, and social support) were measured at baseline, 10 weeks, and 6 months.

RESULTS

Psychosocial factors were significantly associated with HRQoL at every time point, accounting for 33% to 53% of the variance after controlling for demographic and clinical characteristics. At least 26% of all participants reported clinically significant depressive symptoms throughout the study. Compared to nondepressed participants, depressed participants had significantly poorer scores for HRQoL, social support, optimism, self-esteem, perceived control, and physical functioning. There were improvements in participants' physical health, social participation, depressive status, and optimism over the course of the study.

CONCLUSION

These findings highlight the important role that psychosocial factors play in chronic stroke survivors' HRQoL and have implications for stroke rehabilitation programs: rehabilitation that targets poststroke depression and psychosocial adjustment to stroke has the potential to improve HRQoL for chronic stroke survivors, independent of functional impairment.

Coping with the challenges of recovery from stroke: long term perspectives of stroke support group members

Recovery from stroke poses significant physical and psychological challenge. To develop appropriate psychological support interventions, increased understanding of the challenge and coping behaviours that promote adjustment is critical. This study presents results from a series of focus groups with stroke support group members. The evolution of challenges faced during hospitalization, rehabilitation and into the longer term is described. The active, social and cognitive coping strategies reported as helpful are explored. In the long term, acceptance of life changes, engagement in new roles and activities and the presence of social support appear to be key factors in post-stroke adjustment.

Recovery following stroke: The role of self-management education

Current stroke rehabilitation tends to focus on the bio-medical course of disability, often responding to psychological and social issues only when they have been implicated in crises. Although this situation is costly, little evidence exists in relation to how psychological and social outcomes can be facilitated or how psychosocial decline can be prevented. In the area of adjustment following traumatic injury, there has been some suggestion that rehabilitation should focus on the expansion of resources, skills and self-efficacy as this will enable individuals to cope more effectively with their medical condition and circumstances. The current study was a longitudinal randomised controlled trial involving 100 people with stroke, 58 of whom were randomly allocated to an intervention based on the notion of psychosocial skill expansion. All were patients of a major hospital in Queensland, Australia. An existing self-management intervention (The Chronic Disease Self-Management Course, Lorig et al., 2001) was used to operationalise the concept of psychosocial skill expansion. The control group reported declines in functioning during the first year following stroke in the areas of family roles, activities of daily living, self-care and work productivity, that were not reported by the intervention group. Although the groups had reached similar levels by one year post-stroke, this intervention may have a protective function, presumably by improving capacity to manage the functional requirements of daily life. However, the intervention did not appear to have its impact through self-efficacy, as was expected, and failed to influence outcomes such as mood or social participation. Nevertheless, the intervention warrants further investigation, given that it appears to improve rehabilitation outcomes, at least in the short-term.

Informal stroke rehabilitation: what do Thai caregivers perform?

Our aim was to explore the informal rehabilitation activities performed by Thai caregivers for stroke survivors at home. Twenty primary informal caregivers were individually interviewed, using semi-structured questions developed by researchers, to investigate the informal rehabilitation activities provided for the stroke survivors at their homes. All interviews were audiotape recorded and some pictures of rehabilitation activities were taken during data collection. The data collected underwent content analysis. Findings revealed three major categories of rehabilitation activities - biological, psychological and social rehabilitation. Biological rehabilitation was the most frequently undertaken by all Thai caregivers. Several methods were used to rehabilitate the stroke survivors in each category, based on the scientific background and cultural beliefs of the caregivers and survivors. In conclusion, informal caregivers always have in mind all activities, thus providing a holistic approach for informal rehabilitation. This plays a very significant role in minimizing residual disabilities, preventing related complications and sustaining the well-being of stroke survivors. Health professionals should motivate caregivers of stroke survivors to maintain informal rehabilitation activity at home. Additionally, health care providers should be concerned about the coordination between institutional and informal rehabilitation in order to better optimize the quality of care provided at home.

A review and commentary of the social factors which influence stroke care: issues of inequality in qualitative literature

Stroke is the third most common cause of death in the UK and a major cause of adult disability. Stroke services have long been criticised for being deficient and there is evidence that some aspects of care provision vary across different population groups. While there is information about the patterns of service provision, questions remain about processes which might underlie these variations. The present paper sought to assess how well the processes which might lead to inequity in the delivery and uptake of stroke services are currently understood by reviewing the qualitative literature in the area. The review was carried out by systematically searching online literature databases, using keyword and bibliographical searches, within a particular time frame. In total, 55 articles were reviewed, including studies related to primary and secondary clinical care, as well as social care. Articles focused on both professionals' and patients' perspectives. The review reports the cultural factors and processes which have been identified as possible causes of barriers to professionals' delivering stroke services, as well as issues which influence patients' uptake of services. Issues identified in the literature were categorised into four broad thematic areas: conceptualisations of stroke illness and ageing, socio-economic factors, resource allocation and information provision. These themes are then revisited through the hypothesis that the concept of social and personal identity could cast new light on our understanding of how inequity in stroke care provision might arise. It is argued that the ways in which professionals and patients view themselves and each other influences their interaction, and in turn, the delivery and demand for services. Finally, the authors suggest areas where further research is warranted.