Unpacking community mobility: a preliminary study into the embodied experiences of stroke survivors

The needs and difficulties during the return to work after a stroke: a systematic review and meta-synthesis of qualitative studies

PURPOSE

To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers.

MATERIALS AND METHODS

A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital.

RESULTS

Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients' group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges.

CONCLUSIONS

Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process.

Recovery beyond functional restoration: a systematic review of qualitative studies of the embodied experiences of people who have survived a stroke

OBJECTIVE

To synthesise the qualitative evidence of embodied experiences of people who have survived a stroke, the experiences of making sense of oneself, others and the world in the poststroke bodies.DesignQualitative systematic review.

DATA SOURCES

Five electronic databases, PsycINFO, PubMed, MEDLINE, CINAHL Plus and Cochrane Library, were employed to search for qualitative studies published up to February 2022.

INCLUSION CRITERIA

Literature in English that employed qualitative methods to investigate the embodied experiences of people who have survived a stroke.

QUALITY APPRAISAL

Two reviewers independently appraised the quality of the included studies based on the tool developed by Salter et al in 2008. It consists of seven questions assessing the credibility and relevance of the studies. Discrepancies were resolved until a consensus was reached.

DATA EXTRACTION AND SYNTHESIS

Thematic synthesis was applied to synthesise the related findings from all the included studies. Two reviewers were involved in the process.

RESULTS

1482 records were identified. After the screening process, 34 studies were included in this review. Three analytical themes and their related descriptive themes emerged. Analytical themes included 'disconnection between oneself, others and the world,' 'the transitional period: exploring and negotiating,' and 'reconnecting with oneself, others and the world'.

CONCLUSION

The findings demonstrated that the embodied experiences of people who have survived a stroke progressed from feeling disconnected to reconnecting with themselves, others and the world. Stroke recovery should not only be limited to functional restoration. Approaching 're-embodiment', the realignment between oneself and one's body, is crucial in reintegrating with others and the world on the trajectory toward recovery.

PROSPERO REGISTRATION NUMBER

CRD42020183125.

The health equity characteristics of research exploring the unmet community mobility needs of older adults: a scoping review

BACKGROUND

Unmet community mobility needs of older adults, published since the announcement of the UN sustainable development goals was synthesised to describe the health equity characteristics of research identifying unmet community mobility needs of older adults.

METHODS

Searches were conducted in March and April 2020, 2275 articles were screened and 100 identified for data extraction.

RESULTS

Findings showed underrepresentation of articles considering rural settings [9%] and originating in the global South [14%]. Gender, disability, education, and transport / driving were identified as key health equity characteristics and only 10 articles provided detail on all four of these. External factors inhibiting community mobility included built environments, service availability, and societal attitudes. Internal factors included finances, fear and apprehension, and functional limitations.

CONCLUSIONS

The need for standardised reporting of participant characteristics in the community mobility of older adults was highlighted. These characteristics are required by research consumers to judge equity dimensions, and the extent to which findings represent minority or marginalised groups. 15 after the UN pledge to reduce inequalities, peer reviewed primary research does not reflect a global drive to end discrimination, exclusion and reduce the inequalities and vulnerabilities that leave people behind.

"Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany

Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.

Examining the factors associated with community ambulation in an older adult day hospital population

PURPOSE

The ability of an older adult to walk independently in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. In clinical practice, outdoor mobility is often one of the first activities, where a decline is observed. The aim of this study was to examine the factors associated with community ambulation in community dwelling older adults attending a day hospital.

METHODS

This was a cross-sectional observational study design. Inclusion criteria were community dwelling older adults, over 65 years, attending a day hospital and able to ambulate at least 10 m with or without an assistive device. The primary outcome measure was a community ambulation questionnaire. A range of other outcome measures were completed assessing motor, cognitive, executive function and behavioural domains. Multivariate logistic regression was employed to identify independent predictors of community ambulation.

RESULTS

161 participants completed this study. The median age was 83 years (IQR 9), 64% were female and 49.1% lived alone. 55.3% of participants were classified as independent community ambulators. Mean gait speed was 0.8 m/s, median TUG score was 16.6 s and median frailty was 4 (IRQ 2) using the Clinical Frail Scale. Self-efficacy (p < 0.001) and gait speed (p = 0.030) were independently associated with community ambulation.

CONCLUSIONS

The findings demonstrate the complexity and multifactorial nature of community ambulation in older adults. This suggests the need to adopt a broader approach to the management of older adults, to promote the achievement of independent community ambulation.

Living with the aftermaths of a stroke in the era of the COVID-19 pandemic; the significance of home and close surroundings

Stay-at-home recommendations to reduce the spread of the COVID-19 virus have had a major impact on people's everyday lives. However, while the evidence indicates that such recommendations have caused distress, anxiety, and fear among the public, little is known about how persons living with complex health conditions, e.g., disability after stroke, have experienced and handled the situation. We interviewed fourteen participants (7 women, 7 men) aged 61–91 years living in ordinary housing during summer 2020 to explore how people who recovered after a stroke experienced their everyday lives in their homes and close surroundings during the COVID-19 pandemic recommendations. Three intertwined themes were constructed from the narrative data and the iterative thematic analysis: (1) Places within and out of reach, (2) Upholding activities–strategies and structures, and (3) Adapting to new circumstances. The findings suggest that places within reach were important to maintain activities and provide structure in daily life. The participants seemed to make use of their previous experiences of adjusting to new circumstances after stroke when adapting to living under the stay-at-home recommendations. In addition, feeling that they now shared the restrictions with all other people in society seemed to ease their situations. Access to nature and spaces in the close surroundings was essential for staying socially connected and receiving support in daily life. The significance of the home and the neighbourhood for health experiences among people who recently have had a stroke should inform rehabilitation interventions both during and after pandemics and environmental planning.

Reliability of activity monitors for physical activity assessment in patients with musculoskeletal disorders: A systematic review

BACKGROUND

Activity monitors have been introduced in the last years to objectively measure physical activity to help physicians in the management of musculoskeletal patients.

OBJECTIVE

This systematic review aimed at describing the assessment of physical activity by commercially available portable activity monitors in patients with musculoskeletal disorders.

METHODS

PubMed, Embase, PEDro, Web of Science, Scopus and CENTRAL databases were systematically searched from inception to June 11th, 2020. We considered as eligible observational studies with: musculoskeletal patients; physical activity measured by wearable sensors based on inertial measurement units; comparisons performed with other tools; outcomes consisting of number of steps/day, activity/inactivity time, or activity counts/day.

RESULTS

Out of 595 records, after removing duplicates, title/abstract and full text screening, 10 articles were included. We noticed a wide heterogeneity in the wearable devices, that resulted to be 10 different types. Patients included suffered from rheumatoid arthritis, osteoarthritis, juvenile idiopathic arthritis, polymyalgia rheumatica, and fibromyalgia. Only 3 studies compared portable activity trackers with objective measurement tools.

CONCLUSIONS

Taken together, this systematic review showed that activity monitors might be considered as useful to assess physical activity in patients with musculoskeletal disorders, albeit, to date, the high device heterogeneity and the different algorithms still prevent their standardization.

Comparative Study on Overground Gait of Stroke Survivors With a Conventional Cane and a Haptic Cane

The conventional cane (single cane) is widely used to promote gait ability of stroke survivors as it provides postural stability by extending the base of support. However, its use can reduce muscle activity in the user's paretic side and cause upper limb neuropathies due to the intermittent and excessive loading of the upper limb. The provision of low magnitude support and speed regulation may result in collective improvement of gait parameters such as symmetry, balance and muscle activation. In this paper, we developed a robotic Haptic Cane (HC) that is composed of a tilted structure with motorized wheels and sensors to allow continuous haptic contact with the ground while moving at a regulated speed, and carried out gait experiments to compare the HC with an Instrumented conventional Cane (IC). The results show that use of the HC involved more continuous ground support force of a comparatively lesser magnitude than the IC, and resulted in greater improvements in the swing symmetry ratio and significant improvements in the step length symmetry ratio. Percentage of Non-Paretic Activity (%NPA) of paretic muscles (vastus medialis obliquus (VMO), semitendinosus (SMT), tibialis anterior (TBA) and gastrocnemius medialis (GCM)) in swing phase was significantly improved by the use of either device at fast speed. However, the use of HC improved %NPA of paretic VMO and SMT more than the use of IC at both preferred and fast speeds. It also significantly improved %NPA of paretic GCM in stance phase. Furthermore, comfortable speed with the HC was higher than with the IC and exhibited better RMS of anteroposterior (AP) tilt. Thus, the developed device with a simple and intuitive mechanism can provide efficient assistance for overground gait of stroke patients with a high possibility of widespread use.

Using an Accelerometer-Based Step Counter in Post-Stroke Patients: Validation of a Low-Cost Tool

Monitoring the real-life mobility of stroke patients could be extremely useful for clinicians. Step counters are a widely accessible, portable, and cheap technology that can be used to monitor patients in different environments. The aim of this study was to validate a low-cost commercial tri-axial accelerometer-based step counter for stroke patients and to determine the best positioning of the step counter (wrists, ankles, and waist). Ten healthy subjects and 43 post-stroke patients were enrolled and performed four validated clinical tests (10 m, 50 m, and 6 min walking tests and timed up and go tests) while wearing five step counters in different positions while a trained operator counted the number of steps executed in each test manually. Data from step counters and those collected manually were compared using the intraclass coefficient correlation and mean average percentage error. The Bland–Altman plot was also used to describe agreement between the two quantitative measurements (step counter vs. manual counting). During walking tests in healthy subjects, the best reliability was found for lower limbs and waist placement (intraclass coefficient correlations (ICCs) from 0.46 to 0.99), and weak reliability was observed for upper limb placement in every test (ICCs from 0.06 to 0.38). On the contrary, in post-stroke patients, moderate reliability was found only for the lower limbs in the 6 min walking test (healthy ankle ICC: 0.69; pathological ankle ICC: 0.70). Furthermore, the Bland–Altman plot highlighted large average discrepancies between methods for the pathological group. However, while the step counter was not able to reliably determine steps for slow patients, when applied to the healthy ankle of patients who walked faster than 0.8 m/s, it counted steps with excellent precision, similar to that seen in the healthy subjects (ICCs from 0.36 to 0.99). These findings show that a low-cost accelerometer-based step counter could be useful for measuring mobility in select high-performance patients and could be used in clinical and real-world settings.

Factors which Influence Risk Taking and the Evolution of Social-Identity in Stroke Narratives: A Thematic Synthesis

Background: The disruption of a stroke can impact an individual’s sense of social identity. A comprehensive review is required to understand the factors and processes that influence changes in social identity following a stroke. Aims: To undertake a review of literature to discover a process of social identity evolution for people with stroke and identify the factors which influence it. Methods: A meta-ethnographic approach to review was undertaken and a subtle realist viewpoint was assumed. Studies were included if they documented experiences and perceptions relating to stroke. Eight electronic databases were searched from January 2009 until January 2019. Quality assessment and synthesis techniques were applied. Findings: Out of the 18 papers included, a total of 251 (141/251, 56% male, 109/251, 43% female, 1/251, 0.4% undisclosed) individuals were included within the synthesis. The evolution of social-identity model was developed and identified with five key stages to represent a process that individuals with stroke can experience. Factors which influence the process were identified and direct implications for clinical practice are given. Conclusion: This review has highlighted the major themes within the evolution of social identity and management strategies for risk taking to achieve a desired future. Further research is required to consider how these findings may be tested in clinical practice.

Perceived barriers and facilitators for gait-related participation in people after stroke: From a patients' perspective

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.

Towards meaningful mobility: a research agenda for movement within and between places in later life

Mobility or physical movement contributes to health and wellbeing in later life. Most studies have focused on the contribution of outdoor mobility to active ageing, but physical and cognitive impairments restrict the mobility of many older adults. This article aims to explore the gaps in the current literature on mobility in later life, and identify required innovations in the field through laying out key areas for future research. It discusses two, largely separate, areas of research, namely on mobility patterns and mobility experiences. The first focuses on quantitative and spatial research on outdoor mobility patterns in terms of routes, timing and transport modes. The second mainly concerns qualitative research on how older adults perceive mobility in their everyday lives. This article identifies three areas for future research on mobility in later life: (a) beyond outdoor movement; (b) diversity in mobility; and (c) the role of time in mobility. To conclude, addressing these areas jointly will contribute to further unpacking the concept of mobility as meaningful practice and to integrating quantitative and qualitative methods when studying mobility in later life. This will result in policy inputs on the mobility and wellbeing of our ageing population.