Exploring community-dwelling stroke survivors' experiences of receiving a nurse-led theory-based stroke self-management programme: A qualitative study

Comparisons between group- and individual-based interventions to support recovery from stroke and ischaemic heart disease in the community: a scoping review

PURPOSE

To map and summarise available literature on the effectiveness or other benefits of group- and individual-based interventions provided for adults living with stroke or ischaemic heart disease (IHD) in the community.

MATERIAL AND METHODS

The review was conducted based on JBI methodology and reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Articles were retrieved from: Medline, PsychInfo, Embase, Scopus, and CINAHL from 2002-2022. Extracted data from eligible studies included type of health outcomes (e.g., impairments), retention and adherence, social connectedness, and the costs associated with group- and individual-based interventions.

RESULTS

After screening, five articles (representing 4 unique studies) comparing a group- and individual-based intervention were included (total sample size n = 87). Three types of interventions were assessed: exercise (3/5), communication (1/5), and occupational therapy (1/5). Effectiveness of group- and individual-based interventions at improving health outcomes (i.e. physical ability, communication, motivation, and quality of life) is unclear. Currently there is insufficient evidence to guide clinical practice.

CONCLUSIONS

There is limited evidence comparing interventions delivered in a group and individual modality for adults living with stroke or IHD. Adequately powered studies are needed to determine if mode of delivery is equivalent or more cost effective.

Effects of "two-heart" nursing mode on the psychological state and quality of life of stroke patients

BACKGROUND

Evidence-based nursing (EBN) intervention is a nursing approach that uses credible scientific research findings as evidence, in conjunction with patient needs, to provide personalized nursing care tailored to the specific needs of patients. EBN has been widely applied in clinical practice and has achieved remarkable results. However, there are limited studies evaluating the efficacy of EBN on cognitive impairment, psychological disorders, and quality of life in stroke patients. This study aims to explore the clinical effects of the EBN, which we call "two-heart" nursing mode on cognitive function, limb function, mental state, and quality of life of stroke patients.

METHODS

A total of 92 stroke patients were divided into two groups: the traditional group (n = 46) and the two-heart group (n = 46). The traditional group received conventional nursing care, while the two-heart group received the double-heart nursing mode in addition to conventional nursing care. The cognitive function, limb function, living ability, mental state, quality of life, and nursing satisfaction of both groups were compared.

RESULTS

The cognitive function in the two-heart group (26.81 ± 3.15 points) was better than the traditional group (23.61 ± 3.74 points; P = 001); limb function in the two-heart group (86.16 ± 6.73 points) was improved compared to the traditional group (79.57 ± 5.19 points; P = 0.002), and the living ability of patients in the two-heart group (68.53 ± 5.87 points) was superior to the traditional group (60.79 ± 5.96 points; P = 0.003). Similarly, the quality of life of patients in the two-heart group (81.13 ± 6.69 points) was higher than the traditional group (70.78 ± 6.63 points; P = 0.003), and the mental state of patients in the two-heart group (43.61 ± 4.13 points, 43.19 ± 4.16 points) was better than that in the traditional group (50.59 ± 3.76 points, 51.49 ± 4.43 points; P = 0.003). However, the nursing satisfaction score in the two-heart group (97.83%) was slightly higher than the traditional group (95.65%; P = 0.068).

CONCLUSIONS

The two-heart nursing mode can improve cognitive function, limb function, and mental state, as well as enhance the quality of life of stroke patients. This approach is worthy of clinical promotion and application.

Virtual Multidisciplinary Stroke Care Clinic for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial

BACKGROUND

Stroke survivors constantly feel helpless and unprepared after discharge from hospitals. More flexible and pragmatic support are needed for their optimized recovery. We examined the effects of a virtual multidisciplinary stroke care clinic on survivors' health and self-management outcomes.

METHODS

A randomized controlled trial was conducted. Survivors were recruited from 10 hospitals and randomized at 1:1 ratio into the intervention or the control groups. Intervention group participants received the Virtual Multidisciplinary Stroke Care Clinic service (monthly online consultations with a nurse, follow-up phone calls, and access to an online platform). Control group participants received the usual care. Outcomes of self-efficacy (stroke self-efficacy questionnaire; primary), self-management behaviors (Stroke Self-Management Behaviors Performance Scale), social participation (reintegration to normal living index), and depression (Geriatric Depression Scale; secondary) were measured at baseline, and 3 and 6 months after commencing the intervention (post-randomization). A generalized estimating equations model was used to compare the differential changes in outcomes at 3 and 6 months with respect to baseline between 2 groups.

RESULTS

Between July 2019 and June 2022, 335 eligible participants were enrolled in the study. Participants (intervention group; n=166) showed significantly greater improvements in outcomes of self-efficacy (group-by-time interaction regression coefficient, B=4.60 [95% CI, 0.16 to 9.05]), social participation (B=5.07 [95% CI, 0.61 to 9.53]), and depression (B=-2.33 [95% CI, -4.06 to -0.61]), and no significant improvement in performance of self-management behaviors (B=3.45, [95% CI, -0.87 to 7.77]), compared with the control group (n=169) right after the intervention (6 months after its commencement). Hedges' g effect sizes of the intervention on outcomes: 0.19 to 0.36.

CONCLUSIONS

The results provide some positive evidence on the usefulness of the Virtual Multidisciplinary Stroke Care Clinic service. The effect sizes are regarded as small to medium, which may not be of clinical relevance. The baseline levels in outcomes were in favor of the control group, the intervention effects might be overestimated. The service must be tested further to determine its effectiveness.

REGISTRATION

URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800016101.

Exploring Nursing Strategies to Engage Community in Cardiovascular Care

PURPOSE OF REVIEW

This review aims to highlight some of the strategies nurses use to engage community members in cardiovascular care. We also elaborate on opportunities for improving community engagement.

RECENT FINDINGS

Community engagement occurs across a continuum of progressive levels of community involvement, impact, trust, and flow of communication. Successful community engagement has been shown to improve both patient-centered care and intervention design, implementation, and dissemination. Nurse strategies used for engaging community in cardiovascular care included more examples of outreach, consult, and involvement than collaboration and shared leadership. More attention is needed toward strategies that embrace collaboration and enhance trusting relationships to advance to shared leadership. Nurses must intentionally work in partnership with communities to improve cardiovascular health for all. Furthermore, assessing meaningful community engagement is necessary to achieve the desired outcomes, including optimal cardiovascular health and thriving communities.

Health Professional- and Volunteer-partnered Self-management Support (COMBO-KEY) to Promote Self-efficacy and Self-management Behaviors in People with Stroke: A Randomized Controlled Trial

BACKGROUND

Multiple systematic reviews have reported that self-management interventions are associated with positive impacts on self-efficacy and health-related quality of life (HRQoL) of people with stroke.

PURPOSE

This article reports the effects of an enhanced stroke self-management program.

METHODS

Eligible adults with stroke were recruited from community-based organizations and a support group for a two-arm, assessor-blinded randomized controlled trial. Participants in the control group received usual care, while those in the intervention group also received the 8-week self-management program, Coaching Ongoing Momentum Building On stroKe rEcovery journeY (COMBO-KEY), consisting of four individual home visits and five follow-up phone calls, delivered by healthcare professionals and trained volunteers. Assessments were conducted at baseline and after the intervention, for outcomes of self-efficacy, satisfaction with the performance of self-management behaviors, HRQoL, and community reintegration, which were analyzed using generalized estimating equations (GEEs).

RESULTS

134 Participants were recruited [mean age = 64.1 years, standard deviation (SD) = 12.7]. Over 80% of the participants had a first-ever stroke [mean years after first stroke: 4.2 (SD = 5.1)]. The GEE analysis revealed that the intervention group participants showed significantly greater improvements in self-efficacy, satisfaction with their performance of self-management behaviors, HRQoL, and community reintegration at 8-week follow-up with respect to their baseline levels.

CONCLUSIONS

The COMBO-KEY program showed effective improvements in recovery outcomes of people with stroke. Future research should explore the inclusion of virtual/hybrid sessions, strategies to assess health conditions of people with stroke via online modes, and assessment of goal attainment and actual performance of self-management behaviors.

Rehabilitation models that support transitions from hospital to home for people with acquired brain injury (ABI): a scoping review

BACKGROUND

Research shows a lack of continuity in service provision during the transition from hospital to home for people with acquired brain injuries (ABI). There is a need to gather and synthesize knowledge about services that can support strategies for more standardized referral and services supporting this critical transition phase for patients with ABI. We aimed to identify how rehabilitation models that support the transition phase from hospital to home for these patients are described in the research literature and to discuss the content of these models.

METHODS

We based our review on the "Arksey and O`Malley framework" for scoping reviews. The review considered all study designs, including qualitative and quantitative methodologies. We extracted data of service model descriptions and presented the results in a narrative summary.

RESULTS

A total of 3975 studies were reviewed, and 73 were included. Five categories were identified: (1) multidisciplinary home-based teams, (2) key coordinators, (3) trained family caregivers or lay health workers, (4) predischarge planning, and (5) self-management programs. In general, the studies lack in-depth professional and contextual descriptions.

CONCLUSIONS

There is a wide variety of rehabilitation models that support the transition phase from hospital to home for people with ABI. The variety may indicate a lack of consensus of best practices. However, it may also reflect contextual adaptations. This study indicates that health care service research lacks robust and thorough descriptions of contextual features, which may limit the feasibility and transferability to diverse contexts.

Stroke survivors' preferences for post-stroke self-management programs: A discrete choice experiment

BACKGROUND AND PURPOSE

Self-management programs enhance survival in stroke patients. However, they require patient-centered designs to be effective. The aim of this study was therefore to investigate the type of post-stroke self-management programs that appeal to stroke survivors, and to estimate their willingness to participate in such programs.

METHODS

A Discrete Choice Experiment was administered to patients who had either a transient ischemic attack (TIA) or stroke within the past 3 years and were cognitively intact (i.e., stroke survivors). Stroke survivors were presented with eight choice tasks and asked to choose between 'No Program' and two hypothetical post-stroke management programs that varied by six attributes: Topics covered by the program; schedule of the program; frequency and duration of the sessions; number of participants; out-of-pocket registration fee for the whole program; and rewards for completing the program.

RESULTS

The analysis involved 146 stroke survivors. Based on the mixed logit model, the predicted willingness to participate ranged from 53% to 76%. The most popular characteristics in a program were topics on health education and risk management, being scheduled during weekends as four sessions that are each 2 hours long and involve four participants, a registration fee of SGD50 (∼USD36), and SGD500 (∼USD359) reward for program completion.

CONCLUSIONS

Interest in post-stroke self-management programs was high, with at least half of the sample showing interest in participating in these programs. Program features such as focusing on health education and risk management, charging a low registration fee, and offering incentives helped to increase the demand.

An Evidence-Based Nursing Intervention Decreases Anxiety, Depression, Sleep Quality and Somatic Symptoms of Patients with Acute Ischemic Stroke

PURPOSE

This study aimed to explore the effects of evidence-based nursing (EBN) intervention on anxiety, depression, sleep quality and somatic symptoms of patients with acute ischemic stroke (AIS).

METHODS

The eligible AIS patients were randomized into the intervention group and control group in a 1:1 ratio. Patients in both groups received routine nursing care. On the basis of routine nursing, patients in the intervention group also received EBN. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were used to assess patients' anxiety, depression, sleep quality, and somatic symptoms at baseline (T0) and 6 months after intervention (T1), respectively.

RESULTS

There was no difference in SAS, SDS, PSQI, and PHQ-15 scores at T0 between the 2 groups (all P > 0.05). Comparing to the control group, the intervention group had significantly lower SAS and SDS scores at T1 (P = 0.002, P < 0.001, respectively). The SAS and SDS score changes (T1-T0) were more evident in the intervention group than in the control group (all P < 0.001). No difference of PSQI or PHQ-15 score between the 2 groups was observed at T1. However, the PSQI and PHQ-15 score changes were more evident in the intervention group than in the control group (P = 0.044 and P = 0.007, respectively).

CONCLUSION

EBN invention significantly improved anxiety, depression, sleep quality and somatic symptoms of patients with AIS.