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Souza FRD, Sales M, Laporte LR, Melo A, Ribeiro NMDS. Discharge outcomes as predictors of social participation in the community after a stroke: a cohort study. Int J Rehabil Res 2023; 46:325-330. [PMID: 37535004 DOI: 10.1097/mrr.0000000000000599] [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: 08/04/2023]
Abstract
The mapping of possible predictors of restrictions in the social participation of people after stroke in the community can be an essential tool to support the development of rehabilitation strategies even in the hospital environment. This study aimed to identify whether mobility, functional balance and dependence on functionality at hospital discharge can predict restrictions on social participation 1 year after stroke in the community. This is a hospital-based cohort study, with individuals over 18 years old admitted with a diagnosis of acute stroke included. People with dementia, previous functional limitations and cancer patients were omitted. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed 1 year after a stroke in the community. Forty-eight patients were included after a 1-year follow-up. The degree of functional independence at hospital discharge ( β = 0.813; P < 0.01) was the independent predictor of social participation, specifically the locomotion ( β = 0.452; P < 0.001) and social cognition ( β = 0.462; P < 0.001) related to functional independence. Mobility ( β = 0.040; P = 0.777) and functional balance ( β = 0.060; P = 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities ( β = 0.786; P < 0.001), social roles ( β = 0.390; P = 0.014) and satisfaction ( β = 0.564; P < 0.001) of social participation. The degree of functional independence of people after a stroke at hospital discharge was able to predict the level of social involvement in the community one year after the stroke.
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Affiliation(s)
- Flaviane Ribeiro de Souza
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - Matheus Sales
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | | | - Ailton Melo
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brasil
| | - Nildo Manoel da Silva Ribeiro
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
- Departamento de fisioterapia, Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brasil
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Chavda K, Prakash V. Transport use limitations and its association with social participation among patients with stroke living in rural India. Disabil Rehabil 2023:1-5. [PMID: 37728331 DOI: 10.1080/09638288.2023.2260740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE This study aimed to investigate the limitations in transport use among stroke survivors in rural India and examine its impact on their social participation. MATERIALS AND METHODS A cross-sectional survey assessed transport patterns, post-stroke changes, and limitations among patients with stroke (N = 77). Social participation was measured with the Stroke Impact Scale (SIS 3.0). RESULTS Following stroke, there was a significant decrease (28-41%) in the proportion of participants who could use various modes of transport unassisted, particularly in driving a motorbike or scooter and using a bus or train. Post-stroke changes in transport use showed that many participants ceased or decreased their use of different modes of transport. Independent users consistently had higher social participation scores than dependent users across all transport modes, indicating better social participation. The mean differences in various transport modes ranged from 6 to 11 points (p < 0.01). CONCLUSIONS Independent use of different modes of transport, particularly public transportation, reduced among rural Indian stroke survivors. These transport limitations are significantly associated with reduced social participation, highlighting the need for interventions to improve accessibility and fostering greater community engagement for stroke survivors in this population.IMPLICATIONS FOR REHABILITATIONLimited transportation access limits social participation for stroke survivors in rural India.Study results show a significant decrease in independent transport use among stroke survivors, affecting their social participation.Rehabilitation interventions should focus on improving transportation accessibility to enhance social engagement for rural stroke survivors.
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Affiliation(s)
- Kajal Chavda
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, India
| | - V Prakash
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, India
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Hoyle M, Gustafsson L, Meredith P. Personal factors, participation, and satisfaction post-stroke: A qualitative exploration. Scand J Occup Ther 2022; 30:572-584. [PMID: 36537995 DOI: 10.1080/11038128.2022.2154708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Decreased participation and life satisfaction are common post-stroke. Exploratory studies have indicated associations between these outcomes and personal factors. Information remains limited and experiences of people with stroke are not well-represented or understood. AIMS/OBJECTIVES The aim of this study was to explore how personal factors influence experiences of participation and life satisfaction for people with stroke living in the community. MATERIAL AND METHODS Qualitative in-depth semi-structured interviews were conducted with eight participants living in the community post-stroke, chosen purposively based on participation and life satisfaction levels. Data were interrogated using interpretative phenomenological analysis. RESULTS Three themes were identified: (1) What does participation mean to me? (2) Looking forward or looking back, and (3) Appraisals, avoidance, and "getting on with it". The first acknowledged the multifaceted nature of participation, although it was typically viewed as incorporating active involvement and social interaction. The additional two themes explored impacts of pre/post-stroke self-discrepancies and threat appraisals on participation and life satisfaction outcomes. CONCLUSIONS AND SIGNIFICANCE Relationships between participation and personal factors seem to be bidirectional. Life satisfaction appeared to be influenced by rumination on negative self-discrepancies based on difference in pre/post-stroke participation. Findings suggest there may be value in examining the influence of personal factor-related interventions on post-stroke outcomes.
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Affiliation(s)
- Melanie Hoyle
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Pamela Meredith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
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Calder A, Sole G, Mulligan H. Co-Design of an Educational Resource with Female Partners of Male Stroke Survivors to Support Physical Activity Participation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16856. [PMID: 36554747 PMCID: PMC9779113 DOI: 10.3390/ijerph192416856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Many male stroke survivors find it challenging to meet the recommended physical activity (PA) guidelines for health benefits. The spouse/partner is an important source of self-management for stroke survivor PA participation; however, they feel unsupported by health professionals. This study aimed to co-design an educational resource prototype to guide and empower female partners in supporting male stroke survivors' participation in PA. We used a participatory action research (PAR) methodology. Thirteen support persons of male stroke survivors from Canterbury, New Zealand participated in four PAR cycles. The data were collected using individual interviews and focus groups and analyzed inductively using the general inductive approach. Three themes were reflected in the data and informed the prototype content: (1) managing an unwanted and challenging new life, (2) inconsistent access to meaningful information, and (3) considerations for successful stroke survivor PA participation. If partners are to be an essential source in supporting stroke survivors' self-management of PA, they require resources that are meaningful and credible to enhance their confidence and self-efficacy. Further research is needed to explore the acceptability and usability of the educational resource with a wider audience and evaluate the co-design process. An inclusive and collaborative approach where support persons were valued for their expertise was essential in co-designing a meaningful resource intended to support stroke survivors and support persons' self-management of their PA.
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van der Veen DJ, Jellema S, van der Wees PJ, Graff MJL, de Swart BJM, Steultjens EMJ. Enhancing the role of the social network in activity (re)engagement post-stroke: a focus group study with rehabilitation professionals. BMC PRIMARY CARE 2022; 23:285. [PMID: 36397003 PMCID: PMC9673324 DOI: 10.1186/s12875-022-01897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND People post-stroke are at risk of not being able to participate in valued activities. It is important that rehabilitation professionals prepare people post-stroke for the transition home and provide needed support when they live at home. Several authors have suggested that members of the broad social network should play an active role in rehabilitation. This includes informing them about the importance of activity (re)engagement post-stroke and learning strategies to provide support. It is not clear when and how the broad social network can best be equipped to provide adequate activity support. This study aimed to explore stroke professionals' perspectives on strategies that establish a social network that supports activity (re)engagement of people post-stroke, when strategies are best implemented, and the factors that influence the implementation of these strategies. METHODS Two focus groups were executed. Content analysis was used to analyze the transcripts of the recorded conversations. RESULTS Eighteen professionals with various professional backgrounds and roles in treating people post-stroke participated. Strategies to establish a supportive social network included identifying, expanding, informing, and actively engaging network members. Working with the network in the immediate post-stroke phase was regarded as important for improving long-term activity outcomes. Participants expressed that most strategies to equip the social network to support people post-stroke need to take place within community care. However, the participants experienced difficulties in implementing network strategies. Perceived barriers included interprofessional collaboration, professional knowledge, self-efficacy, and financial structures. CONCLUSIONS Strategies to involve the social network of people post-stroke are not fully implemented. Although identifying members of a social network should begin during inpatient rehabilitation, the main part of actively engaging the network will have to take place when the people post-stroke return home. Implementing social network strategies requires a systematic process focusing on collaboration, knowledge, attitude, and skill development.
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Affiliation(s)
- Dinja J van der Veen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
- HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Sandra Jellema
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Maud J L Graff
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Bert J M de Swart
- HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Esther M J Steultjens
- HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Harrison J, Thetford C, Reeves MJ, Brown C, Joshi M, Watkins C. Returning to Leisure Activity Post-Stroke: Barriers and Facilitators to Engagement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14587. [PMID: 36361466 PMCID: PMC9657985 DOI: 10.3390/ijerph192114587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To identify barriers and facilitators to engagement when returning to, or participating in, leisure activity post-stroke or Transient Ischemic Attack (TIA). DESIGN Sequential explanatory, mixed methods study. SETTING 21 hospital sites across England, Wales and Northern Ireland. PARTICIPANTS Adults with a clinical diagnosis of first/recurrent stroke or TIA. Patients approaching end of life were excluded. Participants were recruited as in-patients or at first clinic appointment and a baseline questionnaire was completed. A 6-month follow-up questionnaire was sent to participants for self-completion. Open-text questions were asked about barriers and facilitators when returning to, or participating in, leisure activity. Responses were thematically analysed and explored by participant characteristics, including type of leisure activity undertaken. Characteristics also included measures of socioeconomic deprivation, mood, fatigue and disability. RESULTS 2000 participants returned a 6-month follow-up questionnaire (78% stroke, 22% TIA); 1045 participants responded to a question on barriers and 820 on facilitators. Twelve themes were identified and the proportion of responses were reported (%). Barriers: physical difficulties (69%), lower energy levels (17%), loss of independence (11%), psychological difficulties (10%), hidden disabilities (7%), and delay or lack of healthcare provision (3%). Facilitators: family support (35%), healthcare support (27%), well-being and fitness (22%), friendship support (20%), self-management (19%), and returning to normality (9%). 'Physical difficulties' was the most reported barrier across all participant characteristics and activity types. Family support was the most reported facilitator except for those with greater disability, where it was healthcare support and those without fatigue where it was well-being and exercise. CONCLUSIONS Physical difficulties and lack of energy are problematic for stroke and TIA survivors who want to return to or participate in leisure activity. Healthcare support alone cannot overcome all practical and emotional issues related to leisure activity engagement. Family support and improving well-being are important facilitators and future research should explore these mechanisms further.
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Affiliation(s)
- Joanna Harrison
- Synthesis, Economic Evaluation and Decision Science (SEEDS), Applied Health Research hub (AHRh), University of Central Lancashire, Preston PR1 2HE, UK
| | - Clare Thetford
- Stroke Research Team, Faculty of Health and Care, University of Central Lancashire, Preston PR1 2HE, UK
| | - Matthew J. Reeves
- UCLan Research Centre for Sport, Physical Activity & Performance, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
| | - Christopher Brown
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Miland Joshi
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Caroline Watkins
- Stroke Research Team, Faculty of Health and Care, University of Central Lancashire, Preston PR1 2HE, UK
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
- Lancashire Institute for Global Health and Well-being, University of Central Lancashire, Preston PR1 2HE, UK
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Stevens E, Clarke SG, Harrington J, Manthorpe J, Martin FC, Sackley C, McKevitt C, Marshall IJ, Wyatt D, Wolfe C. The provision of person-centred care for care home residents with stroke: An ethnographic study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5186-e5195. [PMID: 35869786 PMCID: PMC10084099 DOI: 10.1111/hsc.13936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Care home residents with stroke have higher levels of disability and poorer access to health services than those living in their own homes. We undertook observations and semi-structured interviews (n = 28 participants) with managers, staff, residents who had experienced a stroke and their relatives in four homes in London, England, in 2018/2019. Thematic analysis revealed that residents' needs regarding valued activity and stroke-specific care and rehabilitation were not always being met. This resulted from an interplay of factors: staff's lack of recognition of stroke and its effects; gaps in skills; time pressures; and the prioritisation of residents' safety. To improve residential care provision and residents' quality of life, care commissioners, regulators and providers may need to re-examine how care homes balance safety and limits on staff time against residents' valued activity, alongside improving access to specialist healthcare treatment and support.
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Affiliation(s)
- Eleanor Stevens
- School of Life Course & Population SciencesKing's College LondonLondonUK
| | - Stephanie G. Clarke
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
- University Hospitals BirminghamDepartment of PhysiotherapyBirminghamUK
| | - Jean Harrington
- School of Life Course & Population SciencesKing's College LondonLondonUK
| | - Jill Manthorpe
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Health & Social Care Workforce, King's College LondonLondonUK
| | - Finbarr C. Martin
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Catherine Sackley
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
| | - Christopher McKevitt
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Iain J. Marshall
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
| | - David Wyatt
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Charles Wolfe
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
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Reeves MJ, Thetford C, McMahon N, Forshaw D, Brown C, Joshi M, Watkins C. Life and Leisure Activities following Stroke or Transient Ischaemic Attack (TIA): An Observational, Multi-Centre, 6-Month Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13848. [PMID: 36360725 PMCID: PMC9655688 DOI: 10.3390/ijerph192113848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine changes in leisure participation following stroke/transient ischaemic attack (TIA) and explore its relationship to modifiable and non-modifiable participant characteristics. DESIGN An observational study design with self-report questionnaires collected at two time points (baseline and 6-months). SETTING The study was conducted across 21 hospital sites in England, Wales, and Northern Ireland. PARTICIPANTS Participants were aged 18+ and had experienced a first or recurrent stroke or TIA and had a post-stroke/TIA modified Rankin score (mRS) of ≤3. PROCEDURE Research practitioners at each site approached potential participants. Individuals who agreed to participate completed a baseline questionnaire whilst an inpatient or at a first post-stroke/TIA clinic appointment. A follow-up questionnaire was posted to participants with a freepost return envelope. Two questionnaires were developed that collected demographic information, pre-stroke/TIA mRS, social circumstances (e.g., employment situation) and incorporated the shortened Nottingham Leisure Questionnaire (sNLQ). RESULTS The study recruited eligible participants (N = 3295); 2000 participants returned questionnaires at follow-up. Data showed three participant variables were significant predictors of engagement in leisure activities post-stroke/TIA: age, sex, and deprivation decile. There was an overall decline in the number and variety of leisure activities, with an average loss of 2.2 activities following stroke/TIA. Only one activity, "exercise/fitness" saw an increase in engagement from baseline to follow-up; watching TV remained stable, whilst participation in all other activities reduced between 10% and 40% with an average activity engagement reduction of 22%. CONCLUSIONS Some groups experienced a greater reduction in activities than others-notably older participants, female participants, and those living in a low socioeconomic area. REGISTRATION researchregistry4607. STRENGTHS AND LIMITATIONS OF THIS STUDY 1. This is the largest-ever study to survey life and leisure activity engagement following stroke/TIA. 2. Survey responses were self-reported retrospectively and, therefore, may have been misreported, or misremembered. 3. Despite the large cohort, there were few participants, and so respondents, from ethnic minority groups.
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Affiliation(s)
- Matthew J. Reeves
- UCLan Research Centre for Sport, Physical Activity & Performance, University of Central Lancashire, Preston PR1 2HE, UK
- Lancashire Institute for Global Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
| | - Clare Thetford
- Stroke Research Team, University of Central Lancashire, Preston PR1 2HE, UK
| | - Naoimh McMahon
- Division of Health Research, University of Lancaster, Lancaster LA1 4YW, UK
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Chris Brown
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Miland Joshi
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
| | - Caroline Watkins
- Lancashire Institute for Global Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
- Stroke Research Team, University of Central Lancashire, Preston PR1 2HE, UK
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston PR1 2HE, UK
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Perceived Community Participation and Associated Factors in People With Stroke. Arch Rehabil Res Clin Transl 2022; 4:100210. [PMID: 36123973 PMCID: PMC9482037 DOI: 10.1016/j.arrct.2022.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To examine individual- and environmental-level factors associated with perceived participation performance and satisfaction in people with chronic stroke. Design Cross-sectional study using secondary data analysis of baseline data from a randomized controlled trial. Setting Community-based setting. Participants Community-dwelling adults with mild to moderate stroke (N=113; mean age=57 years; 58 males). Interventions Not applicable. Main Outcome Measures Main outcomes were measured with the Reintegration to Normal Living Index (perceived participation performance) and Patient-Reported Outcome Measure Information System satisfaction with participation in social roles (perceived participation satisfaction). Other variables collected included personal (eg, age, perceived recovery), health-related (eg, time since stroke, number of comorbidities), body function–related (eg, Stroke Impact Scale, Center for Epidemiologic Studies Depression Scale), and environmental (eg, World Health Organization Quality of Life Short Form Environmental subscale) data. Results Depression, fatigue, mobility, and environmental support showed moderate to strong, statistically significant associations with participation performance and satisfaction in people with stroke. Perceived recovery was moderately associated with participation performance but not with participation satisfaction. Conclusions Returning to participation is a complex process after stroke. Results suggest that various personal, body function–related, and environmental factors are associated with participation performance and satisfaction.
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Courtney-Harris M, Jolly N, Rowe F, Rose K. Validation of a vision-screening tool for use by nurses and other non-eye care health practitioners on stroke survivors. Contemp Nurse 2022; 58:276-284. [PMID: 35861106 DOI: 10.1080/10376178.2022.2104334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Neryla Jolly
- Graduate School of Health, Orthoptics, University of Technology Sydney, Australia
| | - Fiona Rowe
- Department of Primary care & Mental Health, University of Liverpool, United Kingdom
| | - Kathryn Rose
- Graduate School of Health, Orthoptics, University of Technology Sydney, Australia
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11
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Twardzik E, Colabianchi N, Duncan L, Lisabeth LD, Brown SH, Clarke PJ. "Well in in this neighborhood I have walked, not at all": Stroke survivors lived experience in the outdoor environment. Soc Sci Med 2022; 305:115107. [PMID: 35690031 PMCID: PMC9310555 DOI: 10.1016/j.socscimed.2022.115107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 04/05/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Stroke survivors face unique challenges in the outdoor environment when returning to their home community following a stroke. Challenges include navigating uneven terrain, social stigma, and adapting to changes in functioning. Outdoor environments may serve as potential points of intervention to promote independence and participation post stroke. This study aimed to understand lived post-stroke experience in the outdoor environment as it pertains to independent mobility. METHODS Qualitative semi-structured interviews were conducted with 20 stroke survivors (8 males, 12 females; mean age 64.2 years: range 45 years-90 years). Participants were eligible if they were over the age of 45, could communicate in English, lived outside a nursing home, able to walk safely outdoors, were a minimum of six-months post stroke, and had no severe cognitive impairment. Interviews with participants were tape recorded, audio files were transcribed verbatim, codes were created and applied to transcripts, and themes were generated using interpretative phenomenological analysis. RESULTS Post-stroke experiences in the outdoor environment were multidimensional. Three themes emerged from the stroke survivors' description of personal experiences in the outdoor environment. These themes included feelings of vigilance, employing adaptation strategies, and management of dynamic relations between the self and context. DISCUSSION The findings highlight the post-stroke experience traversing the outdoor environment. Investing in the public outdoor environment to remove barriers and install facilitators could reduce feelings of apprehension and hypervigilance while walking in the outdoor environment. Future research is needed to evaluate the role of environmental interventions on hypervigilance in the outdoor environment post stroke.
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Affiliation(s)
- Erica Twardzik
- School of Kinesiology, University of Michigan, 830 N University Ave, Ann Arbor, MI, 48109, USA; Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, Ann Arbor, MI, USA.
| | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, 830 N University Ave, Ann Arbor, MI, 48109, USA; Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104-1248, USA
| | - Lilia Duncan
- School of Kinesiology, University of Michigan, 830 N University Ave, Ann Arbor, MI, 48109, USA
| | - Lynda D Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, Ann Arbor, MI, USA
| | - Susan H Brown
- School of Kinesiology, University of Michigan, 830 N University Ave, Ann Arbor, MI, 48109, USA
| | - Philippa J Clarke
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104-1248, USA
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Huber SK, Knols RH, Arnet P, de Bruin ED. Motor-cognitive intervention concepts can improve gait in chronic stroke, but their effect on cognitive functions is unclear: A systematic review with meta-analyses. Neurosci Biobehav Rev 2021; 132:818-837. [PMID: 34815131 DOI: 10.1016/j.neubiorev.2021.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Abstract
Motor-cognitive intervention concepts are promising to counteract residual gait and cognitive impairments in chronic stroke. There is, however, considerable variation in motor-cognitive intervention types, which may lead to different effects. This systematic review strived to summarize and compare the effects of different motor-cognitive intervention concepts on gait and cognitive functions in chronic stroke. The systematic search identified twenty-nine articles, which were allocated to three types of motor-cognitive training concepts; SEQUENTIAL, SIMULTANEOUS-ADDITIONAL, and SIMULTANEOUS-INCORPORATED. Random-effects meta-analyses revealed that motor-cognitive interventions may be better than non-combined training approaches for improving gait function in chronic stroke (e.g. gait speed: g = 0.43, 95 % CI [0.22, 0.64], p < 0.0001). SIMULTANEOUS-INCORPORATED motor-cognitive training seems the most promising concept. As very few articles measured both, spatiotemporal gait parameters and cognitive outcomes, future studies are warranted to investigate the effects of motor-cognitive intervention concepts on gait control and cognitive functions in chronic stroke.
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Affiliation(s)
- Simone K Huber
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland; Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland; Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Physiotherapy Occupational Therapy, Nursing and Allied Health Professions Office, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Arnet
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland; Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; OST - Eastern Swiss University of Applied Sciences, Department of Health, St.Gallen, Switzerland
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13
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Larsson-Lund M, Månsson Lexell E, Nyman A. Strategies for Empowering activities in Everyday life (SEE 1.0): study protocol for a feasibility study of an Internet-based occupational therapy intervention for people with stroke. Pilot Feasibility Stud 2021; 7:187. [PMID: 34656173 PMCID: PMC8520220 DOI: 10.1186/s40814-021-00924-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background Rehabilitation after stroke seldom focuses on needs related to an active everyday life and the process of change that people must undergo to adapt to an altered capacity and life situation. In particular, occupational therapy in the late phase needs to support clients in adopting sustainable self-initiated management strategies to regain daily activities and an active everyday life. To improve access to rehabilitation, the use of digital solutions has been suggested. This study aims to evaluate the feasibility of the Internet-based occupational therapy intervention “Strategies for Empowering activities in Everyday life” (SEE, version 1.0). We will investigate the feasibility of the intervention process in terms of acceptability and adherence as well as the most suitable outcome measures to evaluate SEE and improve the knowledge about the potential changes and outcomes of SEE for clients with stroke. Methods This feasibility study is based on a pretest posttest design without a control group. Quantitative and qualitative data will be collected from clients and staff concurrently embedded in a mixed-method design during the entire study. Discussion The project is a first test of a novel Internet-based occupational therapy intervention, and the research will contribute to the continued development and evaluation of the SEE programme. SEE can provide people with strategies in daily activities that can support them to live an active everyday life despite changed capacity and to improve access to rehabilitation interventions. Trial registration NCT04588116. Name of the registry: Strategies Empowering Activities in Everyday Life (SEE 1.0). A Web-based Occupational Therapy Intervention. URL of trial registry record. Date of registry: Trial first posted: October 19, 2020; first submitted: October 2, 2020
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Affiliation(s)
- Maria Larsson-Lund
- Department of Health, Education and Technology, Luleå University of Technology, 971 87, Luleå, Sweden.
| | - Eva Månsson Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Malmö, Sweden
| | - Anneli Nyman
- Department of Health, Education and Technology, Luleå University of Technology, 971 87, Luleå, Sweden
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14
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Swanson VA, Chan V, Cruz-Coble B, Alcantara CM, Scott D, Jones M, Zondervan DK, Khan N, Ichimura J, Reinkensmeyer DJ. A Pilot Study of a Sensor Enhanced Activity Management System for Promoting Home Rehabilitation Exercise Performed during the COVID-19 Pandemic: Therapist Experience, Reimbursement, and Recommendations for Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10186. [PMID: 34639494 PMCID: PMC8508164 DOI: 10.3390/ijerph181910186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
Adherence to home exercise programs (HEPs) during physical rehabilitation is usually unmonitored and is thought to be low from self-reports. This article describes exploratory implementation of a Sensor Enhanced Activity Management (SEAM) system that combines HEP management software with a movement sensor for monitoring and motivating HEP adherence. The article also presents results from attempting to gain reimbursement for home use of the system with therapist oversight using Remote Physiologic Monitoring (RPM) codes. Four therapists used the system in their regular practice during the first six months of the COVID-19 pandemic. Therapists filled out surveys, kept notes, and participated in interviews. Billing and reimbursement data were obtained from the treatment facility. Exercise data from the SEAM system were used to understand HEP adherence. Patients were active for a mean of 40% (26% SD) of prescribed days and completed a mean of 25% (25% SD) of prescribed exercises. The therapists billed 23 RPM codes (USD 2353), and payers reimbursed eight of those instances (USD 649.21). The therapists reported that remote monitoring and the use of a physical movement sensor was motivating to their patients and increased adherence. Sustained technical support for therapists will likely improve implementation of new remote monitoring and treatment systems. RPM codes may enable reimbursement for review and program management activities, but, despite COVID-19 CMS waivers, organizations may have more success if these services are billed under supervision of a physician.
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Affiliation(s)
- Veronica A. Swanson
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
| | - Vicky Chan
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Betsaida Cruz-Coble
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Celeste M. Alcantara
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Douglas Scott
- Division of Rehabilitative Services, University of California, Irvine, CA 92868, USA;
| | - Mike Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA;
| | | | | | - Jan Ichimura
- Department of Physical Therapy, Acute Rehabilitation Unit, University of California, Irvine, CA 92868, USA;
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
- Department of Anatomy and Neurobiology, UC Irvine School of Medicine, University of California, Irvine, CA 92697, USA
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15
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Ganesh A, Ospel JM, Marko M, van Zwam WH, Roos YBWEM, Majoie CBLM, Goyal M. From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke. Front Neurol 2021; 12:713738. [PMID: 34381418 PMCID: PMC8350336 DOI: 10.3389/fneur.2021.713738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond. Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT. Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability. Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | - Martha Marko
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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16
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Larsson Lund M, Månsson Lexell E, Nyman A. Optimising the development of sustainable internet-based occupational therapy interventions: Important key actions and perspectives to consider. Scand J Occup Ther 2021; 29:259-269. [PMID: 34280329 DOI: 10.1080/11038128.2021.1950206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND By examining the health needs of the general population and utilising the potential of digitalisation as a driving force, new internet-based services need to be developed in occupational therapy. However, existing guidelines for the development of complex interventions provide scant information on how to develop internet-based interventions. AIM The aim of this paper is to share experiences and illustrate important key actions and new perspectives to consider during the innovation process of developing and designing an internet-based occupational therapy intervention. METHOD AND MATERIALS International guidelines for intervention development was reviewed to add important perspectives in the innovation process. RESULTS The illustration focuses on five key actions in the development phase to highlight new perspectives and questions important to consider when designing new internet-based occupational therapy interventions. CONCLUSION The new perspectives can complement existing guidelines to enhance the development of more effective and sustainable internet-based interventions. SIGNIFICANCE The illustration provided has potential to improve the sustainability in innovation processes of new internet-based occupational therapy interventions.
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Affiliation(s)
- Maria Larsson Lund
- Department of Health, Learning and Technology, Luleå University of Technology, Luleå, Sweden
| | - Eva Månsson Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Anneli Nyman
- Department of Health, Learning and Technology, Luleå University of Technology, Luleå, Sweden
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17
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Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, Farrin A. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified.
Objectives
The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations).
Design
Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales.
Setting
The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales.
Participants
Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services.
Data sources
Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified.
Intervention
Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks.
Results
A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains.
Conclusions
We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation.
Future work
Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation.
Trial registration
Current Controlled Trials ISRCTN38920246.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, School of Medicine, University of Leeds, Leeds, UK
| | | | - Josie Dickerson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gill Carter
- Patient and public involvement contributor, York, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robbie Foy
- Division of Primary Care, Palliative Care and Public Health, School of Medicine, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Arvin Prashar
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ross Atkinson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca J Hawkins
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicola Cornwall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Laetitia Schmitt
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Speed
- Patient and public involvement contributor, York, UK
| | - Katie Grenfell
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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18
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Espernberger KR, Fini NA, Peiris CL. Personal and social factors that influence physical activity levels in community-dwelling stroke survivors: A systematic review of qualitative literature. Clin Rehabil 2021; 35:1044-1055. [PMID: 33586479 DOI: 10.1177/0269215521993690] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the personal and social factors perceived to influence physical activity levels in stroke survivors. DATA SOURCES Four electronic databases (MEDLINE, CINAHL, PubMed and Embase) were searched from inception to November 2020, including reference and citation list searches. STUDY SELECTION The initial search yielded 1499 papers, with 14 included in the review. Included articles were peer-reviewed, qualitative studies, reporting on the perceived factors influencing physical activity levels of independently mobile community-dwelling adults, greater than 3 months post stroke. DATA EXTRACTION Data extracted included location, study aim, design, participant and recruitment information and how data were collected and analysed. DATA SYNTHESIS Thematic analysis was undertaken to identify meanings and patterns, generate codes and develop themes. Five main themes were identified: (i) Social networks are important influencers of physical activity; (ii) Participation in meaningful activities rather than 'exercise' is important; (iii) Self-efficacy promotes physical activity and physical activity enhances self-efficacy; (iv) Pre-stroke identity related to physical activity influences post-stroke physical activity; and (v) Formal programmes are important for those with low self-efficacy or a sedentary pre-stroke identity. CONCLUSIONS Physical activity levels in stroke survivors are influenced by social activities and support, pre-stroke identity, self-efficacy levels and completion of activities that are meaningful to stroke survivors.
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Affiliation(s)
- Karl R Espernberger
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.,Donvale Rehabilitation Hospital, Donvale, VIC, Australia
| | - Natalie A Fini
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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19
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Jellema S, Bakker K, Nijhuis-van der Sanden MWG, van der Sande R, Steultjens EM. The role of the social network during inpatient rehabilitation: A qualitative study exploring the views of older stroke survivors and their informal caregivers. Top Stroke Rehabil 2021; 29:30-39. [PMID: 33427602 DOI: 10.1080/10749357.2020.1871285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND After discharge, stroke survivors and their informal caregivers need support from their social networks to resume their most valued activities. Rehabilitation professionals could help them establish a strong support system. OBJECTIVE Explore how older stroke survivors and their primary informal caregivers expect to resume their valued activities after discharge, and discover their ideas about involving, informing and educating their family members, friends and important others during inpatient rehabilitation so that, once home, they will have adequate support. METHODS We conducted semi-structured interviews with stroke survivors from three geriatric rehabilitation centres and their primary informal caregivers, used the pictures of daily activities to elicit their perspectives, and applied a descriptive and interpretive design to data analysis. RESULTS Many participants had no concrete idea about how to resume their activities after discharge but nevertheless were optimistic they would. They expected help to be available and saw no need for professionals to involve their network during inpatient rehabilitation. However, once they had insight into the challenges to expect after discharge, they often appreciated the idea of professionals contacting their network. To better understand the challenges after discharge, it was helpful if professionals provided concrete, honest information about the stroke's consequences for daily life. Actually doing daily activities also helped gain better insights. CONCLUSIONS To enhance insight in the need of social support after discharge, we suggest that rehabilitation professionals are honest about what to expect and let stroke survivors explore their valued activities in a realistic context more often.
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Affiliation(s)
- Sandra Jellema
- IQ Healthcare, Radboud university medical center, Nijmegen, The Netherlands.,School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Kim Bakker
- Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- IQ Healthcare, Radboud university medical center, Nijmegen, The Netherlands.,School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands
| | - Rob van der Sande
- School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Esther Mj Steultjens
- School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
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20
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Simpson DB, Jose K, English C, Gall SL, Breslin M, Callisaya ML. "Factors influencing sedentary time and physical activity early after stroke: a qualitative study". Disabil Rehabil 2021; 44:3501-3509. [PMID: 33399023 DOI: 10.1080/09638288.2020.1867656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to understand from the perspective of stroke survivors and their carers (1) factors contributing to sedentary time and physical activity during inpatient rehabilitation and the transition home, and (2) actual and perceived opportunities to reduce sedentary time and increase physical activity. MATERIAL AND METHODS Qualitative study with 7 stroke survivor/carer dyads and 8 stroke survivors. Semi-structured interviews were conducted 2-4 weeks after hospital discharge, audio recorded and transcribed prior to thematic analysis. RESULTS Stroke survivors were mean age 69 [SD15] years (53% male). Carers were mean age 62 [SD15] years (86% were female). Five themes were identified: (1) Education and guidance about physical activity and sedentary behaviour after stroke is important to build understanding of recovery and secondary prevention, (2) Stroke survivors need clear communication about safety and risk, (3) Return to life participation supports motivation for and engagement in physical activity, 4) Social and professional influences and 5) Opportunities to be physically active. CONCLUSION Stroke survivors and their carers need a clearer understanding of the role of physical activity and risks of sedentary time during stroke recovery. Physical activity enablers included consistent communication, building confidence and skills to self-manage activity before discharge.Implications for RehabilitationInpatient rehabilitation and early after discharge may be an important time-point to support stroke survivors to establish long term physical activity behaviours before contact with healthcare professionals reduces.To reduce sedentary behaviour, people need to understand the health benefits of breaking up sedentary time and people who need physical support to stand up will need greater support from health professionals.Being able to imagine a future post-stroke self is important motivation to get up and move. Rehabilitation should help develop a person's vision of their post-stroke self.Managing potential risks in hospital without overly restricting physical activity is important and requires consistent communication from the multi-disciplinary team.Building a person's confidence and skills to self-manage physical activity in the community prior to discharge home may be another key enabler for activity.
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Affiliation(s)
- Dawn B Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Institute for the Study of Social Change, University of Tasmania, Hobart, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
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21
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Tse T, Lentin P, Douglas J, Carey LM. Understanding activity participation 3-months after stroke: a mixed methodology study. Disabil Rehabil 2020; 44:2868-2878. [PMID: 33353413 DOI: 10.1080/09638288.2020.1849429] [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: 10/22/2022]
Abstract
PURPOSE To investigate stroke survivors' activity participation 3-months after stroke, reasons for activity participation and the change in reason for activity participation. METHOD Thirty stroke survivors were administered the Activity Card Sort-Australia concurrent with a semi-structured interview about their activity participation. Data were analyzed using descriptive statistics and spiral content analysis. RESULTS Participants had returned, in part, to 96% of their previous leisure, social/educational and household activities 3-months after-stroke; retaining more sedentary and home-based activities but fewer physically demanding and community-based activities. Thirteen participants described a change in their reasons for their activity participation. Personal, environmental and temporal dimensions explained these reasons for activity participation, as well as the changes in reason for activity participation. Full activity participation involved participants' orchestrating a dynamic mix of fulfilling their personal desires according to their current physical, mental and emotional capacity; their social, organizational and physical environmental demands and obligations; and their routines, available time and future plans. CONCLUSION Qualitative interviews extend our understanding of the process of returning to participation in life activities and occupations following stroke to reveal that it involves the stroke survivor in a dynamic adaptation process of synchronizing personal, environmental and temporal dimensions in their daily lives.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals need to recognize the unique knowledge and ability stroke survivors have to manage their capacities, activities, occupations and environments.Client-centered practice involving true collaborative partnerships are needed to ensure stroke survivors return more satisfactorily to their activities and occupations.Rehabilitation professionals need to continually consider the ongoing changing relationships that occur between the person, their capacities, social, organizational and physical environments, and the person's activity/occupational participation during recovery from stroke.Returning to full activity/occupational participation after stroke is a dynamic and continuous process.Rehabilitation needs to be provided in different forms at different stages beyond the immediate post-stroke time so that stroke survivors benefit from the "right rehabilitation" at the "right time" throughout their recovery journey.
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Affiliation(s)
- Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,Occupational Therapy Department, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Primrose Lentin
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Summer Foundation, Blackburn, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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22
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Aderonmu JA. Emerging challenges in meeting physiotherapy needs during COVID-19 through telerehabilitation. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2020. [PMCID: PMC7725645 DOI: 10.1186/s43161-020-00018-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Physiotherapy plays a significant role in rehabilitation. However, the emergence of the coronavirus disease 2019 (COVID-19) has posed a big challenge to its practice, especially regarding the level of contact with patients. There is a dire need for the exploration of rehabilitation options, other than in-person contacts, to limit the spread of the virus. This article explores telerehabilitation, its outcomes, and the challenges involved in the continuum of care of patients by physiotherapists in the face of the pandemic. Body Telerehabilitation is a vital tool which utilizes technology to link practitioners to patients. With its previous history of favorable outcomes for the rehabilitation of certain conditions, telerehabilitation has been widely recommended. However, issues exist on how well it can bridge the gap of physical touch in physiotherapy, its effectiveness in terms of outcomes and satisfaction across various conditions and large population sizes, and finally, its cost and effects, especially in developing countries. Conclusion Telerehabilitation is a necessary adaptation to ensure continued physiotherapy service delivery during the pandemic. However, more quality studies are recommended to evaluate its effectiveness and outcomes. Also, measures to ensure that developing countries are catered for in meeting the rising demands for physiotherapy services using telerehabilitation should be carried out.
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23
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de Graaf JA, Schepers VPM, Nijsse B, van Heugten CM, Post MWM, Visser-Meily JMA. The influence of psychological factors and mood on the course of participation up to four years after stroke. Disabil Rehabil 2020; 44:1855-1862. [DOI: 10.1080/09638288.2020.1808089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. A. de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - V. P. M. Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
| | - B. Nijsse
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - C. M. van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - M. W. M. Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J. M. A. Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
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24
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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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25
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de Rooij IJM, van de Port IGL, van der Heijden LLM, Meijer JWG, Visser-Meily JMA. Perceived barriers and facilitators for gait-related participation in people after stroke: From a patients' perspective. Physiother Theory Pract 2019; 37:1337-1345. [PMID: 31793365 DOI: 10.1080/09593985.2019.1698085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: An important focus of post-stroke physical therapy is to improve walking and walking capacity. However, many people after stroke experience difficulties with gait-related participation, which includes more than walking capacity alone. Gait-related participation involves walking with a participation goal and requires to deal with changes in the environment during walking and perform dual tasks, for example.Objective: To explore barriers and facilitators for gait-related participation from the perspective of people after stroke. This knowledge can contribute to the development of effective interventions to improve gait-related participation.Methods: Semi-structured interviews were conducted to investigate how people after stroke experience gait-related participation. Audio-recorded interviews were transcribed, anonymized, and analyzed thematically. Barriers and facilitators were categorized according to the International Classification of Functioning, Disability and Health (ICF) framework.Results: Twenty-one people after stroke participated. Median age was 65 years, median time since stroke 16 weeks. Barriers were reported in movement-related functions, cognitive functions, mobility, personal factors, and environmental factors. Facilitators were found on participation level and in personal and environmental factors, such as motivation and family support.Conclusion: People after stroke who were physically able to walk independently still described multiple barriers to gait-related participation in all components of the ICF framework.
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Affiliation(s)
- Ilona J M de Rooij
- Revant Rehabilitation Centres, Breda, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | | | - Jan-Willem G Meijer
- Revant Rehabilitation Centres, Breda, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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26
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Spreij LA, Sluiter D, Gosselt IK, Visser-Meily JMA, Nijboer TCW. CoCo - participation: The development and clinical use of a novel inventory measuring cognitive complaints in daily life. Neuropsychol Rehabil 2019; 31:255-277. [PMID: 31790631 DOI: 10.1080/09602011.2019.1691017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cognitive difficulties can be subtle and only come to light when patients return home from inpatient care and start to participate in society. Subjective cognitive complaints often interfere with participation, hence capturing cognitive complaints systematically is important. We developed a patient- and relative-reported measure to assess cognitive complaints during daily life activities across the memory, attention and executive domain for patients with acquired brain injury (ABI). The inventory Cognitive Complaints - Participation (CoCo-P) was created based on a literature review, consultations with experts, semi-structured interviews with patients, and a quantitative study. The inventory was administered to patients with ABI (n = 46), their relatives (n = 33) and healthy controls (n = 102) to finalize the inventory. We examined the reported complaints per daily life activity and cognitive domain of patients and healthy controls, and we compared the patients' and relatives' reports. The majority of patients (87-96%) experienced cognitive complaints, mostly related to attention, at work/education, during leisure activities, and in contact with family/friends and community. Patients reported more cognitive complaints than relatives. The CoCo-P seems appropriate to capture cognitive complaints in daily life in patients with mild ABI. Additional research is needed in terms of reliability and validity.
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Affiliation(s)
- Lauriane A Spreij
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - David Sluiter
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Netherlands
| | - Isabel K Gosselt
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Netherlands
| | - Tanja C W Nijboer
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
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Della Vecchia C, Viprey M, Haesebaert J, Termoz A, Giroudon C, Dima A, Rode G, Préau M, Schott AM. Contextual determinants of participation after stroke: a systematic review of quantitative and qualitative studies. Disabil Rehabil 2019; 43:1786-1798. [PMID: 31646906 DOI: 10.1080/09638288.2019.1679897] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE From a patient's perspective, participation is a major determinant of quality of life. We aimed to review contextual factors, both personal and environmental, potentially associated with post-stroke participation. METHODS PubMed, PsycINFO, and Web of Science were searched for original quantitative and qualitative studies that investigated contextual factors of post-stroke participation, measured participation as the primary outcome, and met inclusion criteria. RESULTS Socio-demographic determinants were mostly unrelated with participation or showed discordant and inconclusive results. Although less investigated, psychosocial/psychological factors, particularly self-esteem and acceptance, were associated with participation in most studies. Motivation was found in qualitative studies, but discordant in quantitative ones. Environmental factors were even less investigated and mainly in qualitative studies among patients with communication disabilities. Among these, social support and attitude of others appeared to be major determinants of participation as well as physical environment and societal environment (services and polices). CONCLUSIONS Personal factors, particularly psychological and psychosocial factors, were identified as positively associated with post-stroke participation. Environmental factors such as support, relationships, and positive attitudes towards patients were major facilitators of participation as well as physical environment and accessibility to appropriate services. Most of these factors are modifiable and should be addressed to improve patient participation.Implications for RehabilitationPsychosocial factors (motivational aspects, acceptance of a new condition, self-esteem) and environmental factors (social support, attitudes towards the patient, physical environment, access to health, social services and policies) were identified as determinants of post-stroke participation.A structured evaluation of determinants of participation may be used in clinical practice to propose appropriate support and then improve patients' recoveryPrograms to improve patients' psychosocial skills such as self-esteem, acceptance, motivation should be tested and implemented, and policies to develop appropriate services accessibility should be encouraged.
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Affiliation(s)
- Claire Della Vecchia
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Bron, France
| | - Marie Viprey
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Anne Termoz
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Caroline Giroudon
- Central Documentation Department, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Dima
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Gilles Rode
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron, France.,Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Marie Préau
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Bron, France.,INSERM UMR 912 SESSTIM, Aix-Marseille Université, Marseille, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
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Débora Pacheco B, Guimarães Caetano LC, Amorim Samora G, Sant'Ana R, Fuscaldi Teixeira-Salmela L, Scianni AA. Perceived barriers to exercise reported by individuals with stroke, who are able to walk in the community. Disabil Rehabil 2019; 43:331-337. [PMID: 31180726 DOI: 10.1080/09638288.2019.1624396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify the perceived barriers to exercise, which could be modified, as well as the associated factors in people at the sub-acute post-stroke stages, who were able to walk in the community. METHODS For this exploratory study, barriers to exercise were identified by the Exercise Barrier sub-scale of the Exercise Benefits/Barriers Scale. Step-wise multiple linear regression analysis was employed to identify which of the clinical and sociodemographic variables, that is, age, walking speed, levels of physical activity, socioeconomic status, and depressive symptoms, could significantly predict the Exercise Barrier sub-scale scores. RESULTS Ninety-five individuals, who had a mean age of 63 (13) years and a mean time since the onset of the stroke of 4 (1) months participated. The main reported barriers to exercise were related to fatigue, as well as availability and distance from the exercise places. Additional reported barriers were "lack of a person to help" and "knowledge on how to practice exercise." Perceived barriers were associated with depressive symptoms and socioeconomic status. Together, they explained 9% of the variance in the Exercise Barrier sub-scale scores (p < 0.01). CONCLUSIONS Fatigue, reduced number of places, and long distances to exercise places were the main reported barriers to exercise. Depressive symptoms and socioeconomic status were the only variables that explained the variance in the Exercise Barrier sub-scale scores. Rehabilitation interventions should include strategies to reduce fatigue during and after exercise, provide guidance regarding both structured and unstructured exercise venues, in addition to screening and managing depressive symptoms. Implications for Rehabilitation Stroke survivors, who are able to walk in the community, should be referred and instructed on how to reduce fatigue through the practice of exercise. Health professionals should guide stroke survivors about the existing places for practice of exercise and how to exercise without structured environments. It is necessary to create or reformulate environments for exercise and provide orientation to practice through qualified professionals. Health professionals should also be able to assess the presence of depressive symptoms and address proper referral and management of the potential barriers to exercise.
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Affiliation(s)
- Bruna Débora Pacheco
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lívia Cristina Guimarães Caetano
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Giane Amorim Samora
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Romeu Sant'Ana
- Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Luci Fuscaldi Teixeira-Salmela
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Alvim Scianni
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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29
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Yoshida HM, Barreira J, Fernandes PT. Habilidade motora, sintomas depressivos e função cognitiva em pacientes pós-AVC. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17001026012019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Os objetivos deste estudo foram (1) caracterizar pacientes pós-AVC em relação à habilidade motora (HM), sintomas depressivos (SD) e função cognitiva (FC); (2) realizar comparações desses aspectos entre sexo, idade, nível de atividade física; e (3) correlacioná-los com o tempo pós-AVC. Avaliamos 135 sujeitos com idade média de 60 (±15) anos e tempo médio pós-AVC de 17 meses. Foram usados os seguintes instrumentos: questionário sociodemográfico, Protocolo de Habilidade Motora de Fugl-Meyer (HM), Inventário de Depressão de Beck (SD) e Mini Exame do Estado Mental (FC). O teste Mann-Whitney foi utilizado para comparação entre sexo, idade e prática de atividade física. O coeficiente de Spearman para verificar a correlação entre o tempo pós-AVC e as variáveis analisadas (HM, SD e FC). O grupo obteve uma média de 118,19 (±30,45) para HM, 9,93 (±7,14) para SD e de 21,7 (±5,43) para FC. Além disso, nossos resultados mostram que as mulheres apresentam maiores níveis de sintomas depressivos do que os homens, pacientes maiores de 50 anos apresentaram pior escore para FC. Não houve diferenças significativas entre pacientes praticantes e não praticantes de atividade física em relação à habilidade motora, sintomas depressivos e função cognitiva. Não foram encontradas correlações significativas entre o tempo pós-AVC e as variáveis analisadas. Nossos resultados contribuem para o planejamento e ações que busquem a melhora da qualidade de vida dos pacientes.
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30
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Skrastins O, Tsotsos S, Aqeel H, Qiang A, Renton J, Howe JA, Tee A, Moller J, Salbach NM. Fitness coordinators' and fitness instructors' perspectives on implementing a task-oriented community exercise program within a healthcare-recreation partnership for people with balance and mobility limitations: a qualitative study. Disabil Rehabil 2019; 42:2687-2695. [PMID: 30739500 DOI: 10.1080/09638288.2019.1570357] [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: 12/12/2022]
Abstract
Background: Healthcare organizations are partnering with recreation organizations to support the delivery of community-based exercise programs for people with balance and mobility limitations. The value and impact of support strategies provided by healthcare organizations, however, have not been examined.Objective: Study objectives were to explore fitness coordinators' and fitness instructors' experiences with implementing a task-oriented community-based exercise program for people with balance and mobility limitations within the context of a healthcare-recreation partnership.Methods: A qualitative descriptive study was conducted. Fitness coordinators and instructors involved with delivering a licensed, group, task-oriented community-based exercise program for people with balance and mobility limitations supported by a healthcare-recreation partnership were interviewed by telephone. Interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed.Results: Eight fitness coordinators and 8 fitness instructors from 14 recreation centres were interviewed. Findings showed that healthcare-recreation partnerships help to optimize exercise program quality and safety through multiple strategies. Fitness coordinators and instructors still face challenges with program implementation at start-up and over time. Recommendations to address these challenges included increased training content related to adjusting exercises to accommodate participant abilities, 1-2 visits from a healthcare professional each program after initial program implementation, suggestions to increase exercise variety, and ongoing education.Conclusions: Findings clarify the role of healthcare organizations, ongoing challenges, and directions for improvement in this program delivery model.Implications for rehabilitationCommunity recreation centres can provide task-oriented exercise programs to help people with balance and mobility limitations safely engage in regular exerciseHealthcare organizations should provide specific supports to help increase the safety and quality of task-oriented exercise programs in recreation centresSupports include providing clear exercise guidelines, and a healthcare professional who trains fitness instructors, visits the program, answers questions between visits, promotes collaboration and information exchange between recreation centres, and provides ongoing education.
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Affiliation(s)
- Olivia Skrastins
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Tsotsos
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hammad Aqeel
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anthony Qiang
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica Renton
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Alda Tee
- Royal Victoria Regional Health Centre, Ontario Central East Stroke Network, Barrie, ON, Canada
| | - Jason Moller
- British Columbia Fraser Health Authority, Chilliwack, BC, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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31
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Olofsson A, Larsson Lund M, Nyman A. Everyday activities outside the home are a struggle: Narratives from two persons with acquired brain injury. Scand J Occup Ther 2018; 27:194-203. [DOI: 10.1080/11038128.2018.1495762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alexandra Olofsson
- Department of Health Science, Occupational Therapy, Luleå University of Technology, Luleå, Sweden
| | - Maria Larsson Lund
- Department of Health Science, Occupational Therapy, Luleå University of Technology, Luleå, Sweden
| | - Anneli Nyman
- Department of Health Science, Occupational Therapy, Luleå University of Technology, Luleå, Sweden
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32
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Ushio M, Kanaoka M, Kinoshita Y, Maeno S, Fujita K. Moderate-to-vigorous physical activity and the risk of stroke recurrence in patients with a history of minor ischemic stroke in Japan: a retrospective analysis. Top Stroke Rehabil 2018; 25:591-598. [PMID: 30207894 DOI: 10.1080/10749357.2018.1507309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Physical activity (PA) is beneficial for stroke prevention; in particular, moderate-to-vigorous physical activity (MVPA). However, few studies have investigated its relationship with recurrent ischemic stroke (RIS). OBJECTIVES To clarify the relationship between MVPA and RIS and the burden of risk factors after a first-ever ischemic stroke. METHODS A total of 45 outpatients (mean age 67.1 ± 10.2 years) who had previously experienced a transient ischemic attack or a minor non-cardioembolic ischemic stroke at a single hospital in Japan (mean 6.4 ± 4.2 years previously), were enrolled between March and June 2016. All patients wore an accelerometer around their hips for 10 days, and their percentage body fat (%BF) and visceral fat level (VFL) were measured by bioelectrical impedance. Retrospective information about the history of RIS and risk factors (blood pressure, lipoprotein cholesterol and estimated glomerular filtration rate) were extracted from the clinical records. Binary logistic regression models were used to estimate the relevance of the RIS history to MVPA and potential risk factors such as sociodemographic and clinical variables (obesity, smoking and hypertension). RESULTS RIS occurred in 9 patients; they had significantly higher VFL (p = 0.007) and %BF (p = 0.007) values and lower MVPA (p = 0.011) values than patients without recurrence. A multivariate analysis of these factors indicated that age, VFL and MVPA were significant independent predictors of RIS. CONCLUSIONS Patients with a history of mild ischemic stroke had low MVPA and high VFL values, which together may be a risk factor for RIS.
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Affiliation(s)
- Miyuki Ushio
- a Department of Health Sciences , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Maki Kanaoka
- b Department of Clinical Nursing , School of Health Sciences, University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Yumiko Kinoshita
- a Department of Health Sciences , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Satoko Maeno
- a Department of Health Sciences , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Kimie Fujita
- a Department of Health Sciences , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
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Engel-Yeger B, Tse T, Josman N, Baum C, Carey LM. Scoping Review: The Trajectory of Recovery of Participation Outcomes following Stroke. Behav Neurol 2018; 2018:5472018. [PMID: 30271506 PMCID: PMC6151208 DOI: 10.1155/2018/5472018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Participation is a central concept in health and well-being and healthcare, yet operationalizing this concept has been difficult. Its definition, uses in healthcare, and impacts on recovery require ongoing research. Our review question goes like this: from the longitudinal evidence investigating participation among stroke survivors, what are the patterns of participation recovery in stroke survivors over time, and what interventions are used to improve participation? To fully understand these questions, we also ask, how is participation defined in the stroke literature, and what are the measures of participation used in the stroke literature? A systematic scoping review was undertaken using the search terms "stroke," "longitudinal," "participation," and "outcome" in seven databases. Articles included were published until April 2017, written in English, and had at least two longitudinal assessments of participation. Fifty-nine articles met the inclusion criteria. The International Classification of Functioning, Disability and Health was the most frequent definition of participation used (34%). There were 22 different measures of participation. Eight of ten studies demonstrated significant improvements in participation up to 12 months poststroke. Efficacy of interventions and their impact on participation varied. The various definitions, measures, and intervention efficacies of participation highlight the need for further research worldwide into achieving meaningful participation and quality of life among stroke survivors. Future practice should include participation as a main outcome measure.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamara Tse
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Occupational Therapy Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Naomi Josman
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Leeanne M. Carey
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Nicholson CM, Wilson M. Experiences of a group creative music-making intervention to support multidisciplinary stroke rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.6.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Clare Marie Nicholson
- Advanced practitioner occupational therapist, Humber NHS Foundation Trust, Willerby, Hull, UK
| | - Michelle Wilson
- Senior clinical psychologist, Humber NHS Foundation Trust, Willerby, Hull, UK
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Living Life After Traumatic Brain Injury: Phase 1 of a Longitudinal Qualitative Study. J Head Trauma Rehabil 2018; 33:E44-E52. [DOI: 10.1097/htr.0000000000000321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Worthington E, Hawkins L, Lincoln N, Drummond A. The day-to-day experiences of people with fatigue after stroke: Results from the Nottingham Fatigue After Stroke study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.10.449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esme Worthington
- Research Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Louise Hawkins
- Stroke Association Postgraduate Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Nadina Lincoln
- Professor of Clinical Psychology, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Avril Drummond
- Professor of Healthcare Research, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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Hawkins RJ, Jowett A, Godfrey M, Mellish K, Young J, Farrin A, Holloway I, Hewison J, Forster A. Poststroke Trajectories: The Process of Recovery Over the Longer Term Following Stroke. Glob Qual Nurs Res 2017; 4:2333393617730209. [PMID: 28932766 PMCID: PMC5600296 DOI: 10.1177/2333393617730209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/18/2017] [Accepted: 07/02/2017] [Indexed: 11/17/2022] Open
Abstract
We adopted a grounded theory approach to explore the process of recovery experienced by stroke survivors over the longer term who were living in the community in the United Kingdom, and the interacting factors that are understood to have shaped their recovery trajectories. We used a combination of qualitative methods. From the accounts of 22 purposively sampled stroke survivors, four different recovery trajectories were evident: (a) meaningful recovery, (b) cycles of recovery and decline, (c) ongoing disruption, (d) gradual, ongoing decline. Building on the concept of the illness trajectory, our findings demonstrate how multiple, interacting factors shape the process and meaning of recovery over time. Such factors included conception of recovery and meanings given to the changing self, the meanings and consequences of health and illness experiences across the life course, loss, sense of agency, and enacting relationships. Awareness of the process of recovery will help professionals better support stroke survivors.
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Affiliation(s)
| | - Adam Jowett
- Coventry University, Coventry, United Kingdom
| | | | | | - John Young
- University of Leeds, Leeds, United Kingdom.,Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | | | | | | | - Anne Forster
- University of Leeds, Leeds, United Kingdom.,Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
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Soeker MS, Olaoye OA. Exploring the experiences of rehabilitated stroke survivors and stakeholders with regard to returning to work in South- West Nigeria. Work 2017; 57:595-609. [DOI: 10.3233/wor-172590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dunn A, Marsden DL, Barker D, Van Vliet P, Spratt NJ, Callister R. Cardiorespiratory fitness and walking endurance improvements after 12 months of an individualised home and community-based exercise programme for people after stroke. Brain Inj 2017; 31:1617-1624. [PMID: 28872360 DOI: 10.1080/02699052.2017.1355983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the immediate and longer-term effects of an individually tailored, home- and community-based exercise programme with ongoing remote support in people with stroke on cardiorespiratory fitness (CRF), ambulation and health-related quality of life (HRQoL). METHODS Twenty people 5.3 ± 3.5 months post stroke completed the 12-week HowFITSS? exercise programme aimed at increasing CRF and daily physical activity. Support was provided by phone and email, which decreased in frequency over time. Participants were assessed at baseline, then at 3, 6 and 12 months after initiation of the intervention. CRF (VO2peak) was evaluated using a portable metabolic system during the 6-minute walk test (6MWT), the Shuttle Walk Test (SWT) and the cycle graded exercise test (cGXT). Walking speed, balance, body composition, fatigue, depression and HRQoL were also measured. RESULTS CRF improved significantly from pre-intervention to 12-month follow-up on the 6MWT (Effect Size, ES = 0.87; p = 0.002) and cGXT (ES = 0.60; p < 0.001), with more modest improvements on the SWT (ES = 0.52; p = 0.251). From baseline to 12 months, significant within-participant improvements were found for self-selected walking speed, balance and HRQoL. Performances on the remaining tests were maintained over the post-intervention period. CONCLUSION There may be health benefits of providing people with stroke an exercise intervention with long-term support that encourages increased regular physical activity.
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Affiliation(s)
- Ashlee Dunn
- a Priority Research Centre for Physical Activity and Nutrition, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
| | - Dianne L Marsden
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia.,e Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights , New Lambton Heights , New South Wales , Australia
| | - Daniel Barker
- c School of Medicine and Population Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Paulette Van Vliet
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
| | - Neil J Spratt
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia.,e Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights , New Lambton Heights , New South Wales , Australia
| | - Robin Callister
- a Priority Research Centre for Physical Activity and Nutrition, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
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Ganesh S, Mohapatra S, Mohanty P, Pattnaik M, Mishra C. Identification of the components associated with functioning using the international classification of functioning, disability and health comprehensive core set for stroke in Indian stroke survivors. Top Stroke Rehabil 2017; 24:517-526. [PMID: 28545344 DOI: 10.1080/10749357.2017.1330231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Rehabilitation interventions are expected to ensure best possible recovery and minimize functional disability in stroke survivors. However, not many studies have investigated patterns of recovery and outcomes after stroke in low-income countries. The objective of this study is to identify the biological, psychological, and social components associated with functioning over time in Indian stroke patients using the International Classification of Functioning, Disability and Health (ICF)-based tools and the Functional Independence Measure (FIM). METHODS The functioning profile of stroke survivors who received a standard multi-disciplinary rehabilitation was prospectively assessed using the ICF and the FIM at admission (baseline), at 12 & 24 weeks. Descriptive analyses were performed to identify changes in the frequencies of ICF categories and qualifiers from admission to follow-up. RESULTS One hundred and twenty-seven participants (mean age of 56 years) with mean FIM score 68 at baseline participated and completed the study. The mean FIM score at follow-up was 108. The numbers and frequency of ICF categories for activities and participation reduced after rehabilitation. More numbers of environmental factors were identified as barriers at follow-up (15 out of 33) compared to baseline. Within the components of Activities and Participation, significant improvement in functioning was found in 43 out of 51 categories. CONCLUSION The results show a reduction in frequencies in ICF activities and participation categories corresponding to basic activities of daily living. Categories corresponding to employment and social integration showed little or no improvement.
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Affiliation(s)
- Shankar Ganesh
- a Department of Physiotherapy, Demonstrator in Physiotherapy , SVNIRTAR , Cuttack , India
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Budhdeo S, Kolias AG, Clark DJ, Chari A, Hutchinson PJ, Warburton EA. A Retrospective Cohort Study to Assess Patient and Physician Reported Outcome Measures After Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke. Cureus 2017; 9:e1237. [PMID: 28620567 PMCID: PMC5467774 DOI: 10.7759/cureus.1237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Decompressive hemicraniectomy for malignant middle cerebral artery (MCA) infarction is known to reduce mortality. However, there are on-going concerns in terms of the quality of life in survivors. We aimed to examine the correlation between patient and physician reported outcome measures in decompressive hemicraniectomy. Patients and methods We analyzed outcomes in 21 patients who underwent decompressive hemicraniectomy for malignant MCA infarction between September 2003 and August 2013 within a regional health system. Patient and physician reported outcome measures were collected at follow-up. These were Stroke Impact Scale (SIS) Version 3, modified Rankin Scale (mRS), National Hospital Seizure Severity Scale, Headache Impact Test and Patient Health Questionnaire for depression. Results There was a good correlation between physician and patient reported outcome measures. The Spearman's rank correlation coefficient between mRS and structured SIS Version 3 was -0.887 (p < 0.001); with unstructured SIS results, the correlation coefficient was -0.663 (p = 0.001). There was no statistically significant correlation between life worth and modified Rankin Scale: r = -0.3383 (p = 0.087). Discussion Our findings of a statistically significant correlation between mRS and SIS have not previously been reported in patients with this condition. These findings provide further information to inform patient and next of kin discussions regarding outcomes from decompressive hemicraniectomy in malignant MCA infarction.
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Affiliation(s)
- Sanjay Budhdeo
- Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge
| | - Angelos G Kolias
- Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge
| | - David J Clark
- Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge
| | - Aswin Chari
- Division of Brain Sciences, Faculty of Medicine, Imperial College London
| | - Peter J Hutchinson
- Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge
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Babin N, Theux G, Sibon I, Dehail P, Prouteau A, Bélio C, Joseph PA, Aly F, Mazaux JM, Glize B. Patient and general practitioner perceptions of post-stroke difficulties may not always agree. Ann Phys Rehabil Med 2017; 60:117-119. [DOI: 10.1016/j.rehab.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 11/28/2022]
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Törnbom K, Sunnerhagen KS, Danielsson A. Perceptions of physical activity and walking in an early stage after stroke or acquired brain injury. PLoS One 2017; 12:e0173463. [PMID: 28273158 PMCID: PMC5342245 DOI: 10.1371/journal.pone.0173463] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical activity has been established as being highly beneficial for health after stroke. There are considerable global efforts to find rehabilitation programs that encourage increased physical activity for persons with stroke. However, many persons with stroke or acquired brain injury do not reach recommended levels of physical activity and increased knowledge about why is needed. We aimed to explore views and experiences of physical activity and walking among persons with stroke or acquired brain injury. METHOD A qualitative study was conducted, among persons with stroke (n = 8) or acquired brain injury (n = 2) from a rehabilitation unit at Sahlgrenska University Hospital in Sweden. Semi-structured in-depth interviews were held about perceptions and experiences of walking and physical activity in general. Data were analyzed using qualitative content analysis, with categories that were determined inductively. RESULTS Physical activity in general and walking ability more specifically were considered very important by the participants. However, physical activity was, regardless of exercising habits pre-injury, associated with different kinds of negative feelings and experiences. Commonly reported internal barriers in the current study were; fatigue, fear of falling or getting hurt in traffic, lack of motivation and depression. Reported external barriers were mostly related to walking, for example; bad weather, uneven ground, lack of company or noisy or too busy surroundings. CONCLUSION Persons with stroke or acquired brain injury found it difficult to engage in and sustain an eligible level of physical activity. Understanding individual concerns about motivators and barriers surrounding physical activity may facilitate the work of forming tailor-made rehabilitation for these groups, so that the levels of physical activity and walking can increase.
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Affiliation(s)
- Karin Törnbom
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Anna Danielsson
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Unit of physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Yoo SD, Jeong YS, Kim TW. Medical rehabilitation system for patients in acute rehabilitation units. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.11.864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | | | - Tae-Woo Kim
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
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Jackson S, Mercer C, Singer BJ. An exploration of factors influencing physical activity levels amongst a cohort of people living in the community after stroke in the south of England. Disabil Rehabil 2016; 40:414-424. [PMID: 28029070 DOI: 10.1080/09638288.2016.1258437] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore factors influencing physical activity (PA) reported by people living in rural/semi-rural communities in the south of England post-stroke, and to understand relationships between personal, interpersonal and environmental barriers and self-reported levels of PA. METHOD A survey was mailed to patients of NHS Trusts who were identified as potential participants. Self-reported PA levels, type, and frequency of reported barriers were tabulated. Spearman's rank correlation coefficient was used to explore associations between self-reported PA level and: age, gender, level of physical function, fear of falling, beliefs regarding PA, available supports, and socioeconomic status. RESULTS Seventy-six of 322 questionnaires distributed were returned (24%). Only 55.2% of respondents reported undertaking PA of sufficient intensity to meet current guidelines. Personal barriers included fear of falling, stroke-related disability, pain, and fatigue. Interpersonal and environmental barriers included lack of social support, transport, and inclement weather. Significant relationships existed between self-reported PA and fear of falling, functional mobility, and beliefs relating to PA. CONCLUSIONS Almost half of the survey cohort reported PA levels insufficient to meet current guidelines. Similar to barriers reported in previous studies in USA and other parts of the UK, numerous interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA were identified. Implications for Rehabilitation This study found that although more than 60% of the survey population were able to ambulate >200 m, only 55.2% reported undertaking sufficient PA to meet current guidelines, putting them at increased risk of further stroke and other co-morbidities. Participants reported a number of interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA, which may explain this discrepancy between mobility status and self reported activity levels. Rehabilitation professionals and primary care providers are well positioned to address the barriers identified in this survey, such as providing interventions to reduce fear of falling, pain, and fatigue, providing support and education about safely increasing physical activity and addressing unhelpful beliefs about PA. Behaviour change strategies, such as increasing self-efficacy, and partnering with the person with stroke to problem solve strategies to address the barriers identified by this, and related research, are likely to be more successful in increasing PA than providing information alone.
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Affiliation(s)
- Sharon Jackson
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia.,b Portsmouth Hospitals NHS Foundation Trust , Portsmouth , UK
| | | | - Barbara Jennifer Singer
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia
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Satink T, Josephsson S, Zajec J, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. Self-management develops through doing of everyday activities-a longitudinal qualitative study of stroke survivors during two years post-stroke. BMC Neurol 2016; 16:221. [PMID: 27846820 PMCID: PMC5111179 DOI: 10.1186/s12883-016-0739-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/29/2016] [Indexed: 12/04/2022] Open
Abstract
Background A description of the complexity of the process of self-management and the way stroke survivors give meaning to their process of self-management post-stroke is lacking. This study explores how stroke survivors managed their lives, gave meaning to their self-management post-stroke and how this evolved over time. Methods Data was generated through participant observations and interviews of 10 stroke survivors at their homes at 3, 6, 9, 15 and 21 months post-discharge. A constant comparative method was chosen to analyse the data. Results ‘Situated doing’ was central in stroke survivors’ simultaneous development of self-management and their sense of being in charge of everyday life post-stroke. Doing everyday activities provided the stroke survivors with an arena to explore, experience, evaluate, develop and adapt self-management and being in charge of everyday activities and daily life. The influence of stroke survivors’ partners on this development was sometimes experienced as empowering and at other times as constraining. Over time, the meaning of self-management and being in charge changed from the opinion that self-management was doing everything yourself towards self-managing and being in charge, if necessary, with the help of others. Moreover, the sense of self-management and being in charge differed among participants: it ranged from managing only at the level of everyday activities to full role management and experiencing a meaningful and valuable life post-stroke. Conclusions The findings of this study indicate the doing of activities as an important arena in which to develop self-management and being in charge post-stroke. Stroke self-management programs could best be delivered in stroke survivors’ own environment and focus on not only stroke survivors but also their relatives. Furthermore, the focus of such interventions should be on not only the level of activities but also the existential level of self-management post-stroke.
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Affiliation(s)
- Ton Satink
- Department of Occupational, Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands. .,Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health, Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands. .,Research Group, Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Staffan Josephsson
- Division of Occupational Therapy, Department of Neurobiology, Caring Science and Society, Karolinska Institute, Stockholm, Sweden.,Department of Applied Social Sciences, NTNU, Norwegian University og Technology and Science, Trondheim, Norway
| | - Jana Zajec
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert J M de Swart
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Group, Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health, Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
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Sit JW, Chair SY, Choi KC, Chan CW, Lee DT, Chan AW, Cheung JL, Tang SW, Chan PS, Taylor-Piliae RE. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. Clin Interv Aging 2016; 11:1441-1450. [PMID: 27789938 PMCID: PMC5072569 DOI: 10.2147/cia.s109560] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. PURPOSE To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. METHODS This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. RESULTS A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. CONCLUSION Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.
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Affiliation(s)
- Janet Wh Sit
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Carmen Wh Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Diana Tf Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Aileen Wk Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Jo Lk Cheung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Siu Wai Tang
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong Hospital Authority, Causeway Bay, Hong Kong, People's Republic of China
| | - Po Shan Chan
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong Hospital Authority, Causeway Bay, Hong Kong, People's Republic of China
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48
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Jellema S, van Hees S, Zajec J, van der Sande R, Nijhuis-van der Sanden MW, Steultjens EM. What environmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings. Clin Rehabil 2016; 31:936-947. [PMID: 27681480 PMCID: PMC5482381 DOI: 10.1177/0269215516671013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Identify the environmental factors that influence stroke-survivors' reengagement in personally valued activities and determine what specific environmental factors are related to specific valued activity types. DATA SOURCES PubMed, CINAHL and PsycINFO were searched until June 2016 using multiple search-terms for stroke, activities, disability, and home and community environments. REVIEW METHODS An integrated mixed-method systematic review of qualitative, quantitative and mixed-design studies was conducted. Two researchers independently identified relevant studies, assessed their methodological quality and extracted relevant findings. To validly compare and combine the various findings, all findings were classified and grouped by environmental category and level of evidence. RESULTS The search yielded 4024 records; 69 studies were included. Most findings came from low-evidence-level studies such as single qualitative studies. All findings were consistent in that the following factors facilitated reengagement post-stroke: personal adapted equipment; accessible environments; transport; services; education and information. Barriers were: others' negative attitudes and behaviour; long distances and inconvenient environmental conditions (such as bad weather). Each type of valued activity, such as mobility or work, had its own pattern of environmental influences, social support was a facilitator to all types of activities. Although in many qualitative studies others' attitudes, behaviour and stroke-related knowledge were seen as important for reengagement, these factors were hardly studied quantitatively. CONCLUSION A diversity of environmental factors was related to stroke-survivors' reengagement. Most findings came from low-evidence-level studies so that evidence on causal relationships was scarce. In future, more higher-level-evidence studies, for example on the attitudes of significant others, should be conducted.
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Affiliation(s)
- Sandra Jellema
- 1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands
| | - Suzanne van Hees
- 3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Jana Zajec
- 3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Rob van der Sande
- 2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.,4 Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- 1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.,3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Esther Mj Steultjens
- 2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands
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49
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Outermans J, Pool J, van de Port I, Bakers J, Wittink H. What's keeping people after stroke from walking outdoors to become physically active? A qualitative study, using an integrated biomedical and behavioral theory of functioning and disability. BMC Neurol 2016; 16:137. [PMID: 27527603 PMCID: PMC4986174 DOI: 10.1186/s12883-016-0656-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In general people after stroke do not meet the recommendations for physical activity to conduct a healthy lifestyle. Programs to stimulate walking activity to increase physical activity are based on the available insights into barriers and facilitators to physical activity after stroke. However, these programs are not entirely successful. The purpose of this study was to comprehensively explore perceived barriers and facilitators to outdoor walking using a model of integrated biomedical and behavioral theory, the Physical Activity for people with a Disability model (PAD). METHODS Included were community dwelling respondents after stroke, classified ≥ 3 at the Functional Ambulation Categories (FAC), purposively sampled regarding the use of healthcare. The data was collected triangulating in a multi-methods approach, i.e. semi-structured, structured and focus-group interviews. A primarily deductive thematic content analysis using the PAD-model in a framework-analysis' approach was conducted after verbatim transcription. RESULTS 36 respondents (FAC 3-5) participated in 16 semi-structured interviews, eight structured interviews and two focus-group interviews. The data from the interviews covered all domains of the PAD model. Intention, ability and opportunity determined outdoor walking activity. Personal factors determined the intention to walk outdoors, e.g. negative social influence, resulting from restrictive caregivers in the social environment, low self-efficacy influenced by physical environment, and also negative attitude towards physical activity. Walking ability was influenced by loss of balance and reduced walking distance and by impairments of motor control, cognition and aerobic capacity as well as fatigue. Opportunities arising from household responsibilities and lively social constructs facilitated outdoor walking. CONCLUSION To stimulate outdoor walking activity, it seems important to influence the intention by addressing social influence, self-efficacy and attitude towards physical activity in the development of efficient interventions. At the same time, improvement of walking ability and creation of opportunity should be considered.
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Affiliation(s)
- Jacqueline Outermans
- Research Group Lifestyle and Health, Research Centre for Innovations in Healthcare, Hogeschool Utrecht University of Applied Sciences, Heidelberglaan 7, 3584CS, Utrecht, The Netherlands.
| | - Jan Pool
- Research Group Lifestyle and Health, Research Centre for Innovations in Healthcare, Hogeschool Utrecht University of Applied Sciences, Heidelberglaan 7, 3584CS, Utrecht, The Netherlands
| | | | - Japie Bakers
- Utrecht University Medical Centre, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, Research Centre for Innovations in Healthcare, Hogeschool Utrecht University of Applied Sciences, Heidelberglaan 7, 3584CS, Utrecht, The Netherlands
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50
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Fryer K, Baxter S, Brumfitt S. The meaning of participation to stroke survivors: a qualitative study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.8.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The effect of stroke can be all encompassing, and has an impact on significant roles in life. Assessing someone's level of participation is seen as essential to understanding the social impact of a disability on a person's life, and tailoring support accordingly. This study aimed to examine the meaning of participation to stroke survivors, in order to provide insight into the meaning of participation in the context of a stroke. Methods: A qualitative approach drawing on methods of phenomenology was used, with data collected via semi-structured interviews and a follow-up focus group. Analysis was undertaken using techniques of interpretative phenomenological analysis. Findings: Six stroke survivors and six carers were interviewed, and four stroke survivors attended a focus group. Three main themes in relation to the meaning of participation were identified in the data: ‘being actively involved’; ‘making meaningful choices’; and ‘being me’. Conclusions: The work confirms the findings of previous studies on participation, and adds to current understandings by developing the meaning of ‘involvement’ beyond a social concept. It highlights that ‘involvement’ can include active engagement in life through being alone. It also identifies a specific link between stroke survivors’ sense of self, and participation.
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Affiliation(s)
- Kate Fryer
- PhD candidate, Department of Human Communication Sciences, University of Sheffield, Sheffield, UK
| | - Susan Baxter
- Research fellow, Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shelagh Brumfitt
- Emeritus professor, Department of Human Communication Sciences, University of Sheffield, Sheffield, UK
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