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Chin LF, Rosbergen ICM, Hayward KS, Brauer SG. A self-directed upper limb program during early post-stroke rehabilitation: A qualitative study of the perspective of nurses, therapists and stroke survivors. PLoS One 2022; 17:e0263413. [PMID: 35120167 PMCID: PMC8815971 DOI: 10.1371/journal.pone.0263413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
This study aimed to explore the perspective of nurses, therapists and stroke survivors on the performance of upper limb self-exercise and use outside therapy during early inpatient stroke rehabilitation.
Methods
A descriptive qualitative approach was used in focus groups with nurses (n = 21) and therapists (n = 8), as well as in-depth semi-structured interviews with stroke survivors (n = 8) who were undergoing subacute inpatient stroke rehabilitation. Inductive thematic analysis of data was performed according to participant group.
Results
Nurses and therapists perceived that stroke survivors played a central role in determining the success of a self-directed upper limb program. Nurses perceived that stroke survivors needed a lot of prompting to be motivated to perform self-directed upper limb therapy outside therapy. Therapists perceived that not all stroke survivors would be able to perform self-directed upper limb therapy and deemed it important to consider stroke survivor factors before commencing a program. Although some stroke survivors expressed initial reservations with performing self-practice, many indicated that they would participate in the self-directed upper limb program because they wanted to recover faster.
Conclusion
A difference between the perspective of nurses/therapists and stroke survivors towards self-directed upper limb performance outside therapy was found. Deeper stroke survivor engagement and a shift in rehabilitation culture to encourage stroke survivor autonomy are important considerations for a self-directed upper limb program. Teamwork amongst healthcare professionals and families is essential to support stroke survivors to participate in a self-directed upper limb program during early inpatient stroke rehabilitation.
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Affiliation(s)
- Lay Fong Chin
- Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- * E-mail:
| | - Ingrid C. M. Rosbergen
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- STARS Surgical Treatment and Rehabilitation Service, The University of Queensland, Brisbane, Australia
- STARS Surgical Treatment and Rehabilitation Service, Metro North Health, Brisbane, Australia
| | - Kathryn S. Hayward
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Sandra G. Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Levy T, Killington M, Laver K, Lannin NA, Crotty M. Developing and implementing an exercise-based group for stroke survivors and their carers: the Carers Count group. Disabil Rehabil 2021; 44:3982-3991. [PMID: 33730949 DOI: 10.1080/09638288.2021.1897693] [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: 10/21/2022]
Abstract
PURPOSE Guidelines recommend that carers of stroke survivors should be engaged early in rehabilitation. There has been limited research implementing exercise programs that include carers. The aims of this study were to develop, facilitate, and evaluate an intervention, the Carers Count group, an exercise-based group for stroke survivors and their carers. METHODS Over a 5-month period, a staged approach was used to design the intervention and implementation strategies which would maximise the chances of embedding the intervention within an inpatient stroke ward. Implementation strategies included planning, educating, restructuring, financing, and managing quality. Following development and facilitation of the intervention, outcomes were evaluated through collecting data about therapy time, surveys (n = 30) and interviews (n = 18) with participants, and a focus group with staff. RESULTS Thirty stroke survivors and their carers participated in the Carers Count group. Analysis of time spent in therapy showed that participation led to increased dose of physiotherapy time (service outcome). Survey and interview data suggested that participation in the group was a rewarding and engaging experience for participants (client outcomes). CONCLUSION Using multifaceted strategies, a group designed to include carers was implemented on a stroke rehabilitation ward. The intervention provided positive outcomes in terms of increased therapy dose and satisfaction according to participant feedback. CLINICAL TRIALS REGISTRATION NUMBER ANZCTR12620000708954Implications for rehabilitationIt is possible to develop modes of delivery in rehabilitation that include the carers of stroke survivors and these interventions are considered enjoyable and beneficial.Health professionals should consider interventions that are engaging and fun for stroke survivors and their carers.Health professionals should carefully plan and utilise appropriate implementation strategies when aiming to introduce a new intervention into an established health service.Health professionals should ensure stroke survivors and their carers have an understanding of recovery following stroke and how to maximise outcomes through increasing amount of practice.
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Affiliation(s)
- Tamina Levy
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Flinders Medical Centre, Rehabilitation and Palliative Services, Adelaide, SA, Australia
| | - Maggie Killington
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,South Australia Brain Injury Rehabilitation Services, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia
| | - Kate Laver
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Flinders Medical Centre, Rehabilitation and Palliative Services, Adelaide, SA, Australia
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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: 3] [Impact Index Per Article: 0.8] [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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Olafsdottir SA, Jonsdottir H, Bjartmarz I, Magnusson C, Caltenco H, Kytö M, Maye L, McGookin D, Arnadottir SA, Hjaltadottir I, Hafsteinsdottir TB. Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study. BMC Health Serv Res 2020; 20:562. [PMID: 32571316 PMCID: PMC7310069 DOI: 10.1186/s12913-020-05432-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality. Methods A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings. Results Ten stroke survivors aged 55–79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (− 4.2) and 5xSST (− 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying − 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES. Conclusions ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.
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Affiliation(s)
- Steinunn A Olafsdottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland.
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ingibjörg Bjartmarz
- Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Mikko Kytö
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland.,Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Laura Maye
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - David McGookin
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - Solveig Asa Arnadottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thora B Hafsteinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Olafsdottir SA, Jonsdottir H, Magnusson C, Caltenco H, Kytö M, Maye L, McGookin D, Bjartmarz I, Arnadottir SA, Hjaltadottir I, Hafsteinsdottir TB. Developing ActivABLES for community-dwelling stroke survivors using the Medical Research Council framework for complex interventions. BMC Health Serv Res 2020; 20:463. [PMID: 32450854 PMCID: PMC7249380 DOI: 10.1186/s12913-020-05198-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/07/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Novel technical solutions are called for to promote home-based exercise among community-dwelling stroke survivors supported by their caregivers. Lack of resources and knowledge about how to accomplish it, has been demonstrated. The objective of this study is to describe in detail the development of ActivABLES, a technical intervention to promote home-based exercise and physical activity engagement of community-dwelling stroke survivors with support from their caregivers. METHODS The technical development process of ActivABLES was guided by the Medical Research Council (MRC) framework for development and evaluation of complex interventions as well as by principles of human-centred design and co-design. The main steps included: (1) Synthesis of evidence supporting the inclusion of balance exercises, mobility and walking exercises and exercises for the upper arm; (2) Implementation of initial user studies with qualitative data collection from individual interviews with stroke survivors, and focus group interviews with caregivers and health professionals; (3) Preliminary testing of eight prototypes with seven stroke survivors and their caregivers. RESULTS After the preliminary testing of eight prototypes, four prototypes were not further developed whereas four prototypes were modified further. In addition, two new prototypes were developed, leaving six prototypes for further modification: 1) ActivFOAM for balance exercises, 2) WalkingSTARR to facilitate walking, 3) ActivBALL for hand exercises, 4) ActivSTICKS for upper arm exercises, and 5) ActivLAMP and 6) ActivTREE which both give visual feedback on progress of daily exercise and physical activities. ActivFOAM, ActivBALL and ActivSTICKS are all connected to a tablet where exercise instructions are given. All the exercise prototypes can be connected to ActivLAMP and ActivTREE to give feedback on how much exercise the user has done. Settings can be individualised and recommended daily time and/or repetition can easily be changed as the user progresses to higher activity levels. CONCLUSIONS The development process of ActivABLES was guided by the principles of human-centred design, with iterative testing of future users, and by the MRC framework of complex intervention, with a repeated process of development and testing. This process resulted in six prototypes which are available for feasibility testing among a small group of community-dwelling stroke survivors.
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Affiliation(s)
- Steinunn A. Olafsdottir
- School of Health Sciences, University of Iceland, Stapi v/Hringbraut, 102 Reykjavík, Iceland
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | - Mikko Kytö
- Department of Computer Science, Aalto University in Helsinki, Helsinki, Finland
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Laura Maye
- Department of Computer Science, Aalto University, Espoo, Finland
| | - David McGookin
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Ingibjörg Bjartmarz
- Grensasdeild Rehabilitation, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Solveig Asa Arnadottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Emergency, Geriatrics, Rehabilitation Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thora B. Hafsteinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bezmez D, Shakespeare T, Yardimci S. Family role in in-patient rehabilitation: the cases of England and Turkey. Disabil Rehabil 2019; 43:559-567. [PMID: 31257955 DOI: 10.1080/09638288.2019.1632941] [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: 10/26/2022]
Abstract
PURPOSE This article explores the differences between experiences of family role in in-patient rehabilitation in Turkey and England. BACKGROUND The literature predominantly assumes family presence in rehabilitation as positive, because it draws upon Western cases, where care is delivered fully by professionals, and patients may feel isolated during hospital stays. Analyses of other contexts provide a more nuanced view. METHOD This qualitative research included in-depth interviews (Turkey: 42, England: 18) with people with disabilities (n = 39), their families (n = 8) and hospital staff (n = 13); hospital ethnography (Turkey), focus groups (England: 3 groups involving 4 doctors, 5 nurses, 6 therapists), and participant-observation (England: 5 families). Thematic analysis highlights experiences of family involvement across different contexts. RESULTS Families are differently integrated in rehabilitation in England and Turkey. In England, where family presence is regulated and relatively limited, people with disabilities feel more isolated and see family as a major form of support. In Turkey, where family presence is unregulated and intense, they enjoy family as an agent of intra-hospital socialising, but find it disabling when it implies a loss of privacy and individuality. CONCLUSION Family involvement in rehabilitation should support social interaction but allow people with disabilities to remain independent.Implications for rehabilitationFamily involvement in rehabilitation can be both enabling and disabling.Existing literature draws upon rehabilitation practices, where family presence is limited and perceived as positive. An analysis of cases, where families are integral to the health care system (e.g., Turkey), can provide a nuanced view of family integration, which can be both enabling and disabling.Rehabilitation processes and health professionals need to integrate families in ways that will enrich social interaction, but still allow people with disabilities to retain their independence.
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Affiliation(s)
- Dikmen Bezmez
- Sociology Department, Koç University, Istanbul, Turkey
| | | | - Sibel Yardimci
- Sociology Department, Mimar Sinan University of Fine Arts, Istanbul, Turkey
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Levy T, Killington M, Lannin N, Crotty M. Viability of using a computer tablet to monitor an upper limb home exercise program in stroke. Physiother Theory Pract 2019; 37:331-341. [PMID: 31172867 DOI: 10.1080/09593985.2019.1625092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: To evaluate the feasibility of using a tablet computer to monitor the amount of upper limb practice completed by stroke patients prescribed with a home program and to explore factors that influence adherence. Method: Ten consecutive participants randomized to the intervention arm of a randomized controlled trial investigating therapy after spasticity management for stroke patients (ACTRN 12615000616572) were recruited for this sub-study. Participants were asked to perform and record a prescribed 60-min upper limb program, based on the Graded Arm Supplementary Program, on a tablet computer daily. Four randomly selected recorded sessions for each participant were analyzed by the physiotherapist to assess adherence to the amount of exercise and content. Results: Mean score for the System Usability Scale was 85.5 (range 47.5-100) indicating that participants were accepting of the technology. Participants performed exercises on average for 50.32 min (range 26.42-68.37). Self-reported practice time was 59.44 min (range 48-67.5). Conclusion: Monitoring of patient practice using a tablet computer is feasible and may prove more reliable than self-report. There is variability in the amount of upper limb exercise stroke patients do at home.
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Affiliation(s)
- Tamina Levy
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Maggie Killington
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Natasha Lannin
- School of Allied Health, La Trobe University , Bundoora, Australia.,Occupational Therapy, Alfred Health , Prahran, Australia
| | - Maria Crotty
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
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Scorrano M, Ntsiea V, Maleka D. Enablers and barriers of adherence to home exercise programmes after stroke: caregiver perceptions. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.7.353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maryke Scorrano
- MSc Physiotherapy student, Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Associate Professor, Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Douglas Maleka
- Associate Professor Department of Physiotherapy, Sefako Makgatho University of Health Sciences, Pretoria, South Africa
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Lee MJ, Yoon S, Kang JJ, Kim J, Kim JM, Han JY. Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation. Ann Rehabil Med 2018; 42:406-415. [PMID: 29961738 PMCID: PMC6058591 DOI: 10.5535/arm.2018.42.3.406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/04/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy. Methods Acute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures. Results There were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p<0.0001). There were no significant (p=0.0755) differences in changes in TIS-S scores at 4 weeks from baseline between the two groups. MBI, FAC, BBS, and TIS scores showed significantly inverse correlations with FES-I scores in patients receiving CME. There were no TEAEs in our series. Conclusion CME was effective and safe in improving the degree of independence, ambulation status, dynamic and static balance, trunk function, and concerns about post-stroke falls in stroke survivors.
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Affiliation(s)
- Min Jun Lee
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Seihee Yoon
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jung Joong Kang
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jun Young Han
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
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French H, Galvin R. Musculoskeletal services in primary care in the Republic of Ireland: an insight into the perspective of physiotherapists. Physiotherapy 2017; 103:214-221. [DOI: 10.1016/j.physio.2016.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
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11
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Role of Family in the Process of Rehabilitation of Older Adults Hospitalized in a Nursing Home. TOPICS IN GERIATRIC REHABILITATION 2017. [DOI: 10.1097/tgr.0000000000000147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Caregiver Factors in Stroke: Are They the Missing Piece of the Puzzle? Arch Phys Med Rehabil 2016; 97:1223-5. [DOI: 10.1016/j.apmr.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/21/2022]
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13
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Prout EC, Mansfield A, McIlroy WE, Brooks D. Patients’ perspectives on aerobic exercise early after stroke. Disabil Rehabil 2016; 39:684-690. [DOI: 10.3109/09638288.2016.1161833] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erik C. Prout
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
| | - Avril Mansfield
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - William E. McIlroy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
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14
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Lawler K, Taylor NF, Shields N. Involving family members in physiotherapy for older people transitioning from hospital to the community: a qualitative analysis. Disabil Rehabil 2015; 37:2061-9. [DOI: 10.3109/09638288.2014.996673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Warner G, Stadnyk R. What is the Evidence and Context for Implementing Family-Centered Care for Older Adults? PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2014. [DOI: 10.3109/02703181.2014.934942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Morris JH, Oliver T, Kroll T, Joice S, Williams B. From physical and functional to continuity with pre-stroke self and participation in valued activities: A qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke. Disabil Rehabil 2014; 37:64-77. [DOI: 10.3109/09638288.2014.907828] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mohd Nordin NA, Aziz NAA, Abdul Aziz AF, Ajit Singh DK, Omar Othman NA, Sulong S, Aljunid SM. Exploring views on long term rehabilitation for people with stroke in a developing country: findings from focus group discussions. BMC Health Serv Res 2014; 14:118. [PMID: 24606911 PMCID: PMC3975304 DOI: 10.1186/1472-6963-14-118] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 02/28/2014] [Indexed: 11/18/2022] Open
Abstract
Background The importance of long term rehabilitation for people with stroke is increasingly evident, yet it is not known whether such services can be materialised in countries with limited community resources. In this study, we explored the perception of rehabilitation professionals and people with stroke towards long term stroke rehabilitation services and potential approaches to enable provision of these services. Views from providers and users are important in ensuring whatever strategies developed for long term stroke rehabilitations are feasible and acceptable. Methods Focus group discussions were conducted involving 15 rehabilitation professionals and eight long term stroke survivors. All recorded conversations were transcribed verbatim and analysed using the principles of qualitative research. Results Both groups agreed that people with stroke may benefit from more rehabilitation compared to the amount of rehabilitation services presently provided. Views regarding the unavailability of long term rehabilitation services due to multi-factorial barriers were recognised. The groups also highlighted the urgent need for the establishment of community-based stroke rehabilitation centres. Family-assisted home therapy was viewed as a potential approach to continued rehabilitation for long term stroke survivors, given careful planning to overcome several family-related issues. Conclusions Barriers to the provision of long term stroke rehabilitation services are multi-factorial. Establishment of community-based stroke rehabilitation centres and training family members to conduct home-based therapy are two potential strategies to enable the continuation of rehabilitation for long term stroke survivors.
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Affiliation(s)
- Nor Azlin Mohd Nordin
- School of Rehabilitation Sciences, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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van der Linden J, Waights V, Rogers Y, Taylor C. A blended design approach for pervasive healthcare: bringing together users, experts and technology. Health Informatics J 2013; 18:212-8. [PMID: 23011816 DOI: 10.1177/1460458212442934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pervasive healthcare is beginning to investigate how novel sensory technologies can be used to measure body movements and provide various forms of feedback. This position paper reflects on a blended design approach that uses a combination of technology inspiration, consultation with experts and user-centred design for the development of a personalized pervasive healthcare system to support stroke rehabilitation.
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The importance of psychological and social factors in influencing the uptake and maintenance of physical activity after stroke: a structured review of the empirical literature. Stroke Res Treat 2011; 2012:195249. [PMID: 21918730 PMCID: PMC3170904 DOI: 10.1155/2012/195249] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 07/12/2011] [Indexed: 11/18/2022] Open
Abstract
Background. People with stroke are not maintaining adequate engagement in physical activity (PA) for health and functional benefit. This paper sought to describe any psychological and social factors that may influence physical activity engagement after stroke. Methods. A structured literature review of studies indexed in MEDLINE, CinAHL, P&BSC, and PsycINFO using search terms relevant to stroke, physical disabilities, and PA. Publications reporting empirical findings (quantitative or qualitative) regarding psychological and/or social factors were included. Results. Twenty studies from 19 publications (9 surveys, 1 RCT, and 10 qualitative studies) were included. Seventeen studies reported findings pertinent to psychological factors and fourteen findings pertinent to social factors. Conclusion. Self-efficacy, physical activity beliefs, and social support appear particularly relevant to physical activity behaviour after stroke and should be included in theoretically based physical interventions. The Transtheoretical Model and the Theory of Planned Behaviour are candidate behavioural models that may support intervention development.
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Abstract
BACKGROUND Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation. Initial severity of motor impairment, however, is not modifiable by rehabilitation, and increased one-on-one treatment is not always feasible. Alternative methods to increase intensity and improve upper-limb function are needed. OBJECTIVE The purpose of this study was to examine caregiver involvement in upper-limb treatment as a method to improve upper-limb function. DESIGN This study was a secondary analysis of a multi-site randomized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation. METHODS Data from 50 individuals with subacute stroke who were randomly assigned to the experimental group (upper-limb exercise) were used for the analysis. Outcome variables were measured at baseline and at completion of the 4-week intervention. Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance. Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment (intensity) as covariates, a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function, as measured by change scores on the Chedoke Arm and Hand Activity Inventory and the Motor Activity Log. RESULTS Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise. The multiple regression analysis showed that Fugl-Meyer score, treatment intensity, and caregiver support were significant predictors of upper-limb improvement (R(2)=.240-.292). In the regression models, caregiver support accounted for 5% to 9% of upper-limb improvement. LIMITATIONS Support was coded as a dichotomous variable, and thus the degree of support or qualitative nature of support was not captured. CONCLUSIONS Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity. Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results.
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