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Tsang WN, Lee JJ, Yang SC, Poon JCY, Lau EYY. Stroke caregivers' perception on instant messaging application use for psychological intervention: a qualitative study. PSYCHOL HEALTH MED 2024; 29:1208-1221. [PMID: 38528430 DOI: 10.1080/13548506.2024.2332925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/15/2024] [Indexed: 03/27/2024]
Abstract
In caring for patients with stroke, the leading cause of death and disability affecting over 80 million people worldwide, caregivers experience substantial psychological and physical burdens and difficulties in help-seeking owing to physical and time-constraints. Social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic further restricted them from using caregiver support services. While the use of telehealth emerged as a global prevailing trend during the COVID-19 pandemic, evidence for utilising instant messaging (IM) applications for psychological intervention is scanty. This study aimed to explore stroke caregivers' perceived potential utility of IM-delivered psychological intervention. Between January and August 2020, 36 adult family stroke caregivers in Hong Kong were recruited to individual telephone semi-structured interviews using purposive sampling. The interviews were audio-recorded, transcribed verbatim and analysed using an interpretive description approach. Three themes of caregivers' perceptions towards IM-delivered psychological intervention emerged: perceived high convenience and ease of use, perceived advantages that overcome existing barriers to services and message delivery tailored to individual needs. Our findings suggested that there is an imminent need among stroke caregivers for personalised psychological interventions and that IM is a potential modality for overcoming existing barriers in delivering accessible support to caregivers in real-time, real-world settings. Our study highlighted caregivers' acceptance and perceived benefits of IM-delivered psychological intervention and provided practical insights into the design of IM-delivered psychological interventions.
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Affiliation(s)
- Wing Nga Tsang
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Sook Ching Yang
- Department of Medicine, St Vincent's Hospital, Sydney, Australia
| | - Joan Chung Yan Poon
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
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Li X, Zhang X, Liu J, Cao Y, Pi Z, Peng H. Is matching or discrepancy between filial piety expectation and filial support better? The role of filial support of children and social support. Psych J 2024. [PMID: 38618758 DOI: 10.1002/pchj.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/28/2024] [Indexed: 04/16/2024]
Abstract
Filial piety in traditional Chinese culture is an essential variable in explaining intergenerational interaction. However, previous studies have not clarified whether older adults' filial responsibility expectations matched children's filial support and the effects of the filial discrepancy on their life satisfaction and loneliness. The latent profile analysis showed that older adults were divided into two groups: (1) high expectations and support, and (2) low expectations and support. The results showed that compared with older adults with low expectations and low support, those with high expectations and high support reported higher life satisfaction and lower loneliness. Additionally, social support played a moderating role in the effect of the groups of older adults on life satisfaction and loneliness. Our conclusion shows that filial support is an essential factor influencing older adult life satisfaction and loneliness, and social support is an effective supplement to filial support.
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Affiliation(s)
- Xiying Li
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, China
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
| | - Xingyu Zhang
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, China
| | - Jing Liu
- Department of Educational and Psychological Science, Yuncheng University, Yuncheng, China
| | - Yuxiang Cao
- School of Educational Science, Anhui Normal University, Anhui, China
| | - Zhongling Pi
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, China
| | - Huamao Peng
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
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Thiengtham S, Chiang-Hanisko L, D'Avolio D, Sritanyarat W. Experience of Transitional Care Among Thai-Isan Older Stroke Survivors and Their Family Caregivers. QUALITATIVE HEALTH RESEARCH 2024:10497323241232937. [PMID: 38482851 DOI: 10.1177/10497323241232937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The transitional care model for people who have suffered brain injuries is a relatively recent addition to the Thai healthcare system. The aim of this study was to explore experience of Thai Isan older stroke survivors and their family caregivers across different points of transition from hospital to home. Fifteen dyads of older stroke survivors and their family caregivers were recruited following the inclusion and exclusion criteria. Data were collected through participant observations and semi-structured interviews. Forty-seven participation observation field notes and twenty-four interview transcriptions were analyzed using the Four Phases of the Data Analysis Enabler and the Leininger-Templin-Thompson Ethnoscript Coding Enabler. Three themes emerged: I feel lost with managing care at home; it has been challenging for our family to maintain continuity of care; and it is a matter of who fits in and is convenient for family care responsibilities. The findings of this study have highlighted the dispersion of care among Thai-Isan people during the patient's transition to home. Therefore, a transitional care plan should be developed that specifies who is responsible for monitoring and supporting patients and families throughout this period.
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Affiliation(s)
- Supavadee Thiengtham
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Lenny Chiang-Hanisko
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Deborah D'Avolio
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Wanapa Sritanyarat
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
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Taheri Kondar R, Hassani L, Ghanbarnejad A. The effect of educational intervention based on social support theory on the perceived stress caused by the covid-19 pandemic in patients with diabetes in hormozgan (2020-2021). BMC Public Health 2024; 24:691. [PMID: 38438887 PMCID: PMC10913277 DOI: 10.1186/s12889-024-18180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND People with diabetes are more at risk of covid-19. Perceived social support plays an important role in maintaining people's health and reducing the negative effects of stress caused by the environment and society. The present study was designed and implemented with the purpose of determining the effect of educational intervention based on social support theory in reducing stress caused by the covid-19 pandemic in people with diabetes. METHODS The current investigation was an interventional and semi-experimental study conducted on 212 patients diagnosed with type 2 diabetes. Eligible participants were diabetic individuals capable of utilizing virtual platforms and not afflicted with COVID-19. Exclusion criteria encompassed unwillingness to continue study participation, absence from multiple training sessions, and development of a specific illness during the study period. Random allocation placed patients into either the control or intervention group. The intervention group received educational materials via WhatsApp, while the control group did not receive any intervention. The researcher administered a questionnaire to collect demographic information and assess perceived social support among the patients. Data analysis involved the use of chi-square tests, independent and paired t-tests, as well as ANCOVA. RESULTS This study revealed that the mean age of patients in the control and intervention groups was 46.35 ± 14.15 and 51.72 ± 11.57, respectively. Most of the diabetic patients in both groups were female, married, had a diploma, were housekeepers, and had an income between 2 and 5 million Tomans. According to the results obtained in all subscales of social support theory as well as the perceived stress score due to the corona pandemic after the educational intervention, a statistically significant difference was observed between the two groups (P < 0.05), so that the score of all subscales of social support theory in the intervention group was higher than the control group. But the perceived stress score caused by Corona in the intervention group was significantly lower than the control group. CONCLUSION The results of this study illustrate the noteworthy influence of social support training in lessening perceived stress among patients with diabetes during the COVID-19 pandemic. Consequently, healthcare providers are encouraged to integrate social support education programs into comprehensive care initiatives for diabetic patients, particularly during periods of heightened stress like the current coronavirus pandemic.
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Affiliation(s)
- Reihaneh Taheri Kondar
- MSc of Health Education and Promotion HUMS, Hormozgan University of Medical Sciences (HUMS), BandarAbbas, Iran
| | - Laleh Hassani
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, BandarAbbas, Iran.
| | - Amin Ghanbarnejad
- Department of community medicine, research institute for health, Hormozgan University of medical sciences, BandarAbbas, Iran
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İnan-Budak M, Zonp Z, Köse AM, Saint-Arnault DM. Psychometric evaluation of the Social Support Questionnaire for Transactions in Turkish gender-based violence sample. Arch Psychiatr Nurs 2023; 45:184-191. [PMID: 37544697 DOI: 10.1016/j.apnu.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/07/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023]
Abstract
AIM This study aims to investigate the reliability and predictive validity of the Social Support Questionnaire for Transactions (SSQT) scale. DESIGN A psychometric design using cross-sectional data. METHOD This cross-sectional descriptive study was conducted between February-June 2021 using snowball sampling through an online survey panel. 204 Turkish survivors of gender-based violence (GBV) participated in the research. RESULTS The mean age of participants was 35.66 ± 12.50. Exploratory and confirmatory factor analysis examined the construct validity of the SSQT scale. The principle axis factoring (PAF) estimation method was performed, including oblique rotation (Promax) for EFA, and the diagonally weighted least squares (DWLS) estimation method was used for CFA. Test-retest reliability coefficients (r) were moderate to excellent, ranging from 0.48 to 0.88. The analyzes supported the 5-factor solution, and the reliability was evaluated with Cronbach's Alpha coefficients for Social Friendship, Daily Emotional Support, Problem-Oriented Emotional Support, Daily Instrumental Support, and Problem-Focused Instrumental Support sub-dimensions, and the total score of SSQT showing 0.87, 0.84, 0.90, 0.73, 0.83, and 0.93, respectively. The relationships between sub-dimensions of SSQT showed moderate positive correlations ranging from 0.40 to 0.60. There were weak negative correlations between SSQT and PHQ-9, PHQ-15 and GAD-7, ranging from -0.20 to -0.34, which shows the external validity of the SSQT. CONCLUSION The relationships between sub-dimensions of SSQT and PHQ-9, PHQ-15, GAD-7 are given in the results support using the SSQT scale as a research and clinical instrument for assessing women who had experienced GBV and have/have not received social support in Turkish culture.
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Affiliation(s)
- Merve İnan-Budak
- Department of Psychiatric Nursing, Istanbul Medeniyet University, Faculty of Health Sciences, Turkey.
| | - Zeynep Zonp
- Acibadem University, the Faculty of Health Science, Nursing Department, Turkey; University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States of America.
| | - Ali Mertcan Köse
- Istanbul Ticaret University, Vocational School, Department of Computer Programming, PO Box 34840, Istanbul, Turkey.
| | - Denise M Saint-Arnault
- University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States of America.
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Liu H, Cook A, Ding J, Lu H, Jiao J, Bai W, Johnson CE. Palliative care needs and specialist services post stroke: national population-based study. BMJ Support Palliat Care 2023:spcare-2023-004280. [PMID: 37500566 DOI: 10.1136/spcare-2023-004280] [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: 03/20/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES (1) To compare palliative care needs of patients admitted primarily with stroke and (2) to determine how the care needs of these patients affect their use of different types of specialist palliative care services. METHODS Observational study based on point-of-care data from the Australian Palliative Care Outcomes Collaboration. Multivariate logistic regression models were used to explore the association between patients' palliative care needs and use of community versus inpatient specialist palliative care services. RESULTS The majority of patients who had a stroke in this study population had mild or no symptom distress, but experienced a high degree of functional impairment and needed substantial help with basic tasks of daily living. A lower Australia-modified Karnofsky Performance Status score (OR=1.82, 95% CI 1.06 to 3.13) and occurrence of an 'unstable' palliative care phase (OR=28.34, 95% CI 9.03 to 88.94) were associated with use of inpatient versus community palliative care, but otherwise, no clear association was observed between the majority of symptoms and use of different care services. CONCLUSIONS Many people with stroke could potentially have been cared for and could have experienced the terminal phases of their condition in a community setting if more community support services were available for their families.
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Affiliation(s)
- Huiqin Liu
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Yale School of Internal Medicine, New Haven, Connecticut, USA
| | - Hongwei Lu
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingjing Jiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wenhui Bai
- Department of Nursing, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Claire E Johnson
- AHSRI, University of Wollongong Faculty of Business, Wollongong, New South Wales, Australia
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He F, Blackberry I, Yao L, Xie H, Rasekaba T, Mnatzaganian G. Pooled incidence and case-fatality of acute stroke in Mainland China, Hong Kong, and Macao: A systematic review and meta-analysis. PLoS One 2022; 17:e0270554. [PMID: 35759497 PMCID: PMC9236238 DOI: 10.1371/journal.pone.0270554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Stroke incidence and case-fatality in Mainland China, Hong Kong, and Macao vary by geographic region and rates often differ across and within regions. This systematic review and meta-analysis (SR) estimated the pooled incidence and short-term case-fatality of acute first ever stroke in mainland China, Hong Kong, and Macao.
Methods
Longitudinal studies published in English or Chinese after 1990 were searched in PubMed/Medline, EMBASE, CINAHL, Web of Science, SinoMed and CQVIP. The incidence was expressed as Poisson means estimated as the number of events divided by time at risk. Random effect models calculated the pooled incidence and pooled case-fatality. Chi-squared trend tests evaluated change in the estimates over time. When possible, age standardised rates were calculated. Percent of variation across studies that was due to heterogeneity rather than chance was tested using the I2 statistic.The effect of covariates on heterogeneity was investigated using meta-regressions. Publication bias was tested using funnel plots and Egger’s tests.
Results
Overall, 72 studies were included. The pooled incidences of total stroke (TS), ischaemic stroke (IS) and haemorrhagic stroke (HS) were 468.9 (95% confidence interval (CI): 163.33–1346.11), 366.79 (95% CI: 129.66–1037.64) and 106.67 (95% CI: 55.96–203.33) per 100,000 person-years, respectively, varied according to the four economic regions (East Coast, Central China, Northeast and Western China) with the lowest rates detected in the East Coast. Increased trends over time in the incidence of TS and IS were observed (p<0.001 in both). One-month and three-to-twelve-month case-fatalities were 0.11 (95% CI: 0.04–0.18) and 0.15 (95% CI: 0.12–0.17), respectively for IS; and 0.36 (95% CI: 0.26–0.45) and 0.25 (95% CI: 0.18–0.32), respectively for HS. One-month case-fatality of IS and HS decreased over time for both (p<0.001). Three-to-twelve-month fatalities following IS increased over time (p<0.001). Publication bias was not found.
Conclusions
Regional differences in stroke incidence were observed with the highest rates detected in less developed regions. Although 1-month fatality following IS is decreasing, the increased trends in 3-12-month fatality may suggest an inappropriate long-term management following index hospital discharge.
Registration
Registration-URL: https://www.crd.york.ac.uk/prospero/; Reference code: CRD42020170724
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Affiliation(s)
- Fan He
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
- * E-mail:
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
| | - Liqing Yao
- Department of Rehabilitation, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Haiyan Xie
- Department of Healthcare, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tshepo Rasekaba
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
| | - George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Lu Q, Mårtensson J, Zhao Y, Johansson L. Needs of family members caring for stroke survivors in china: A deductive qualitative content analysis study by using the caregiver task inventory-25. BMC Geriatr 2022; 22:96. [PMID: 35114940 PMCID: PMC8812361 DOI: 10.1186/s12877-022-02774-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background In China, family caregivers are usually the main carers of relatives after stroke due to traditional Chinese culture and the limited development of the primary healthcare system. This responsibility often results in burdens and negative health outcomes. However, family caregivers seldom receive support. To improve informal care, as well as the health and well-being of family caregivers, it is important to identify their needs. Objective This study aimed to deductively explore the needs of family members caring for stroke survivors in China. Methods Twenty-six semi-structured interviews were performed with family caregivers of stroke survivors who were selected from one city and three communities by purposive sampling. A deductive qualitative content analysis method was performed by using the Caregiver Task Inventory-25 (CTI-25), an instrument measuring the needs of family caregivers, as a framework. Results All subscales, as well as all belonging items in the CTI-25, were identified in the present study, meaning that the family caregivers had needs related to learning to cope with new role, providing care according to care-receiver’s needs, managing own emotional needs, appraising supportive resources, and balancing caregiving needs and one’s own needs. Moreover, needs related to financial support, both direct and indirect, were identified but not part of the CTI-25. Conclusion These findings identified that family caregivers of stroke survivors in China had various needs, which is important knowledge when assessing needs and improving health care for family caregivers. Cultural adjustments and modifications should be made if CTI-25 is used in mainland China. This study also indicated a comprehensive and holistic perspective (individual, community, and social level) when identifying, assessing needs or implementing interventions to support family caregivers.
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Affiliation(s)
- Qi Lu
- School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,School of Nursing, Tianjin Medical University, Tianjin, China.
| | - Jan Mårtensson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Linda Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Wang J, Cui J, Tu S, Yang R, Zhao L. Resilience and caregiving ability among caregivers of people with stroke: The mediating role of uncertainty in illness. Front Psychiatry 2022; 13:788737. [PMID: 36483138 PMCID: PMC9723154 DOI: 10.3389/fpsyt.2022.788737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In China, stroke survivors are usually cared for by their family members. However, the caregiving ability of these informal caregivers remain inadequate during the hospitalization of their family members following a sudden onset of a stroke, and this sudden need for care overwhelms caregivers even after the hospital discharge. Therefore, research is required to identify predictors of caregiving ability that could be targeted in future interventions aimed at improving caregiving skills and reducing the burden on caregivers who care for stroke survivors. MATERIALS AND METHODS From August 2019 to February 2020, stroke survivors were hospitalized for the first time, and their family caregivers were registered via convenience sampling. Caregiver demographic information, resilience status, uncertainty in illness, caregiving ability, and patients' severity of stroke were measured using standardized questionnaires. Structural equation modeling was used to test the proposed model, where caregiver resilience and stroke severity predicted caregiving ability directly, and uncertainty in illness mediated the association between caregiver resilience and caregiving ability. RESULTS A total of 306 dyads were included in the study. The tested model fit the data well (χ2 = 118.2, df = 64, RMSEA = 0.053, CFI = 0.946, TLI = 0.923). Statistically significant pathways linked caregivers' resilience status to uncertainty in illness (β = -0.558, S.E. = 0.022, P < 0.01), caregivers' resilience to the status of caregiving ability (β = -0.269, S.E. = 0.013, P < 0.01) and caregivers' uncertainty about the illness to caregiving ability (β = 0.687, S.E. = 0.051, P < 0.01). We also found that caregivers' uncertainty in illness mediated the association between caregivers' resilience and caregiving ability (β = -0.384, S.E. = 0.061, P < 0.01). CONCLUSIONS Our structural equation modeling result identified resilience and uncertainty about the illness as predictors of the caregiving ability of informal family caregivers who suffered from care burdens. Supporting family caregivers to build their resilience and reduce illness uncertainty may improve caregiving for stroke survivors.
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Affiliation(s)
- Jinyao Wang
- West China School of Nursing, Sichuan University, Chengdu, China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Cui
- West China Hospital, Sichuan University, Chengdu, China
| | - Shuangyan Tu
- West China School of Nursing, Sichuan University, Chengdu, China.,Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Yang
- West China Hospital, Sichuan University, Chengdu, China
| | - Lihong Zhao
- West China School of Nursing, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Ahn S, Logan JG. Perceived role overload and physical symptom experience among caregivers of older adults: The moderating effect of social support. Geriatr Nurs 2021; 43:197-205. [PMID: 34922280 DOI: 10.1016/j.gerinurse.2021.11.021] [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] [Received: 09/21/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
We investigated the association between perceived role overload and physical symptom experience, and the potential moderating effect of social support among caregivers of older adults. We analyzed data of 1,471 caregivers obtained from the 2017 National Study of Caregiving. In the survey, participants were assessed for physical symptoms (pain, limited leg strength, and low energy), symptom-related activity limitations, perceived role overload, and informal/formal support sources. We performed multiple logistic regression analyses with interaction terms. Caregivers who perceived higher role overload were more likely to experience the physical symptoms and frequent limited activities due to the symptoms. The associations of perceived role overload with pain and low energy, respectively, were attenuated among caregivers with high informal support. The moderating effect of formal support appeared to be the opposite in relation to pain. Caregivers who perceived high burden may benefit from their informal support to prevent detrimental effects of caregiving on physical health.
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Affiliation(s)
- Soojung Ahn
- Doctoral Student, School of Nursing, University of Virginia, Charlottesville, VA, USA.
| | - Jeongok G Logan
- Associate Professor, School of Nursing, University of Virginia, Charlottesville, VA, USA
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11
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Chow EOW, Wong YY, Fok DYH, Liao X, Li C. Positive life stories of Stroke-Survivor's spousal caregiving in Hong Kong: Lessons for policy and practice. Soc Sci Med 2021; 291:114476. [PMID: 34700116 DOI: 10.1016/j.socscimed.2021.114476] [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: 04/17/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Advances in medical-care for immediately post-stroke mean that many stroke-survivors now live a normal lifespan, although they may suffer residual disability. They are often cared for at home by their spouse, who may be ill-prepared for this task, and may also have health concerns. As demands on formal services increase with population aging in Hong Kong, equipping spousal-caregivers with positive effective caring strategies is increasingly important. OBJECTIVE To understand what constitutes positive spousal-caregiving for stroke-survivors in Hong Kong within the cultural lens of 'Zhong (Loyalty)' METHOD: Naturalistic qualitative research was employed to hear stories about positive caregiving from Hong Kong couples living with stroke sequelae. Three in-depth face-to-face semi-structured interviews were undertaken with eleven dyads (stroke-survivor alone, spousal-caregiver alone, then the couple together). Data validation was by member-checking, further questions, and feedback at a second interview, and corroboration by field-notes. FINDINGS A strength-based interactive model of positive spousal-caregiving was described, whose core tenet was Zhong (Loyalty). This fostered, and in turn was nurtured by, three paired key behaviours (1. Learning new skills linked with satisfaction when efforts paid off; 2. Utilizing formal and informal resources linked with supporting others; 3. Cherishing and bringing out the best linked with managing life- and self-care). Couples' capacity to develop these behaviours reflected their inner strengths. CONCLUSIONS Couples who practiced positive caring and were resilient in the face of adversity were likely to optimise dyadic health and deal constructively with unexpected challenges. To address a looming shortfall between client need, and formal health and social services in Hong Kong, evidence-based policies are required to support effective, positive community-based spousal-caregiving.
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Affiliation(s)
- Esther O W Chow
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong.
| | - Yuk Yi Wong
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong
| | - Doris Y H Fok
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong
| | - Xu Liao
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong
| | - Chaoyu Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong
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12
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A scoping review on studies about the quality of life of informal caregivers of stroke survivors. Qual Life Res 2021; 31:1013-1032. [PMID: 34515916 DOI: 10.1007/s11136-021-02988-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the available evidence regarding the quality of life (QoL) of informal caregivers of stroke survivors, by identifying the instruments used to assess QoL, and its associated characteristics. METHODS A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the characteristics influencing the QoL of informal caregivers of stroke survivors. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized, and qualitative data were explored by thematic content analysis. RESULTS The included studies, 56 quantitative, 1 qualitative, and 1 mixed methods, were published between 1999 and 2020. A high heterogeneity was found regarding the assessment of QoL, and the characteristics influencing it. Only one study used an instrument specifically designed to assess the stroke caregivers' QoL. The QoL of informal caregivers was inversely associated with physical and mental health of stroke survivors and caregivers, while stroke characteristics with a better prognosis, caregivers' positive relationships, and a more supportive and participative social context were positively associated to QoL. CONCLUSION There is a need for standardizing the assessment of the QoL of informal caregivers of stroke survivors, as well as for investing in cross-country/cultural studies with robust mixed methods designs to allow a deeper understanding of the experiences of caregivers. Further research, policies, and practices should consider the diversity and complexity of the characteristics influencing QoL, to empower informal caregivers and improve their QoL.
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Lee JJ, Tsang WN, Yang SC, Kwok JYY, Lou VWQ, Lau KK. Qualitative Study of Chinese Stroke Caregivers' Caregiving Experience During the COVID-19 Pandemic. Stroke 2021; 52:1407-1414. [PMID: 33588588 DOI: 10.1161/strokeaha.120.032250] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The coronavirus disease 2019 (COVID-19) outbreak has led to disruptions in health care service delivery worldwide, inevitably affecting stroke survivors requiring ongoing rehabilitation and chronic illness management. To date, no published research has been found on stroke caregiving during the COVID-19 pandemic. This study aimed to explore Hong Kong stroke caregivers' caregiving experiences in the midst of this difficult time. METHODS Individual semistructured interviews were conducted with 25 Chinese adult primary stroke caregivers from May to June 2020 via telephone. Interviews were transcribed verbatim and analyzed using an interpretive description approach and constant comparison strategy. RESULTS Five themes of the stroke caregiving experience during the COVID-19 pandemic emerged: care service adversities, additional caregiving workload and strain, threatened relationship between caregiver and stroke survivors, threats to caregivers' physical and psychological well-being, and needs for continuing caregiving roles. Our findings suggested that caregivers have worsened physical and psychological well-being because of increases in care burden with simultaneously reduced formal and informal support. The relationship between caregiver and stroke survivor was subsequently affected, placing some survivors at heightened risk of abuse. CONCLUSIONS Our study provides valuable findings about stroke caregiving experiences and needs during the pandemic. Delivery of psychological support, telemedicine, and household hygiene resources would be useful to mitigate caregivers' psychological distress during the COVID-19 pandemic.
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Affiliation(s)
- Jung Jae Lee
- School of Nursing (J.J.L., W.N.T., J.Y.Y.K.), The University of Hong Kong, Hong Kong SAR
| | - Wing Nga Tsang
- School of Nursing (J.J.L., W.N.T., J.Y.Y.K.), The University of Hong Kong, Hong Kong SAR
| | - Sook Ching Yang
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (S.C.Y.).,Now with Central Coast Local Health District, New South Wales Health, Australia (S.C.Y)
| | - Jojo Yan Yan Kwok
- School of Nursing (J.J.L., W.N.T., J.Y.Y.K.), The University of Hong Kong, Hong Kong SAR
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, Department of Social Work and Social Administration (V.W.Q.L.), The University of Hong Kong, Hong Kong SAR
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine (K.K.L.), The University of Hong Kong, Hong Kong SAR
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Babbitt EM, Worrall L, Cherney LR. "It's like a lifeboat": stakeholder perspectives of an intensive comprehensive aphasia program (ICAP)". APHASIOLOGY 2021; 36:10.1080/02687038.2021.1873905. [PMID: 38529517 PMCID: PMC10961968 DOI: 10.1080/02687038.2021.1873905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/05/2021] [Indexed: 03/27/2024]
Abstract
Background Intensive comprehensive aphasia programs (ICAPs) have gained popularity in recent years. Outcomes from ICAPs have demonstrated measurable improvements for most who take part, but how do people with aphasia and their family members experience an ICAP? Aim The aim of this paper was to explore, through qualitative interviews, the experiences of persons with aphasia and their family members who took part in an ICAP. Methods & Procedures Twelve interviews were conducted with persons with aphasia and family members regarding their experiences with the ICAP that they had just completed. Nine persons with aphasia were interviewed with their family members and three chose to take part in the interview alone. The Framework Analysis method was used to identify themes from the transcribed interviews. Outcomes & Results The interviewees discussed four themes related to treatment, psychosocial environments, physical environments, and outcomes. The interviewees remarked on the challenges that were provided by the treatment and how the treatment was different from previous treatment. Comments were made related to the relationships the participants and families developed within the context of the program. The physical environment allowed for relationships to develop. The interviewees discussed the physical and social environment as important additional factors that contribute to the overall therapeutic effect of the ICAP. Positive outcomes were noted in language skills and psychosocial contexts. Conclusions Based on interviewees' descriptions of this one ICAP, the concept of a therapeutic milieu was developed to describe how the intersection of the treatment, psychosocial interactions, and physical setting related to outcomes. Interviewees described how the therapeutic milieu of the ICAP was interwoven with the intensive therapy to create a "package" of therapy that led to improved outcomes. Implications for non-ICAP clinical practice is that participants linked more intensive therapy and greater social interactions with better outcomes.
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Affiliation(s)
- Edna M. Babbitt
- Center for Aphasia Research & Treatment, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leora R. Cherney
- Center for Aphasia Research & Treatment, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
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Rezaei Z, Jalali A, Jalali R, Sadeghi M. Haemodialysis patients' experience with fatigue: a phenomenological study. ACTA ACUST UNITED AC 2020; 29:684-690. [PMID: 32579460 DOI: 10.12968/bjon.2020.29.12.684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fatigue is one of the main and serious problems that affects haemodialysis patients' quality of life. It should be actively evaluated and, in this process, cooperation between the patient, their family, and healthcare staff is needed to examine fatigue and improve the quality of healthcare and the patient's life. The aim of the present research was to investigate haemodialysis patients' experiences of fatigue. In this qualitative phenomenological study, 12 participants were selected from haemodialysis patients in two health centres in Iran through purposeful sampling. Data were collected through semi-structured in-depth interviews and the collected data were analysed using Colaizzi's method. Two main themes, the nature of fatigue and the perception of fatigue, were found. In addition, the results revealed six secondary themes: physical problems, psychosocial problems, behavioural problems, limitations, need for support, and burnout. The results help to clarify the concept and nature of fatigue for this group of haemodialysis patients.
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Affiliation(s)
- Zahra Rezaei
- Psychiatric nurse, Psychiatric Nursing Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Associate Professor (Faculty member), Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Associate Professor (Faculty member), Nursing Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Sadeghi
- Assistant Professor (Faculty member), Medical Ethics Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
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The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
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Abstract
Nearly 40% of British self-employees are homeworkers. Using a large representative sample of the UK longitudinal survey data, we explore the determinants of self-employed homeworking, distinguishing between genders. We reject the notion that homeworking is a transitional entrepreneurial state that the self-employed "grow out of", while establishing that both employer status and business structure play an important role in predicting which self-employed become homeworkers. Our findings also shed light on two outstanding puzzles in entrepreneurship scholarship: why so few of the self-employed create jobs for others, and why on average the self-employed suffer an earnings penalty compared with employees.
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Affiliation(s)
- Nam Kyoon N. Kim
- Ivey Business School, Western University, London, Ontario Canada
| | - Simon C. Parker
- Ivey Business School, Western University, London, Ontario Canada
- University of Aberdeen, Aberdeen, UK
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Zhou DHR, Hung SL, Lo TLT. Can We Hit Two Birds with One Stone: An Effectiveness Study of Peer-support Groups for Low-income Spousal and Adult Children Caregivers of Hong Kong Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:227-249. [PMID: 32264770 DOI: 10.1080/01634372.2020.1746722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
This study aims to assess the effectiveness of peer support groups for low-income older adults' caregivers in the Hong Kong community. It compares the effectiveness of peer support groups on spouse and adult children caregivers. The peer support program was structured into three stages, including six training sessions for peer specialists, eight caregiver support group sessions, and non-structured informal contact. The study adopted a quasi-experiment design supplemented with qualitative data collected from focused group interviews. It involved a user group of 58 participants and a control group of 42 participants. Both quantitative and qualitative data were collected before, after the peer support groups, and at a three-month follow-up. The quantitative results showed that the peer support program was more effective in promoting social support for adult children caregivers but not for spousal caregivers. Three focus group interviews suggested that the community-based peer-support group could be helpful to improve stress management, emotional regulation skills, and social networks of the caregivers. Based on the research findings, we discuss the various needs of spousal and adult children caregivers, provide recommendations for service providers and practitioners to consider homogenous group services to address the diverse needs of spousal and adult children caregivers.
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Affiliation(s)
- De-Hui Ruth Zhou
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong, China
| | - Suet-Lin Hung
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China
| | - Temmy Lee Ting Lo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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Systematic Review and Meta-Analysis of Home-Based Rehabilitation on Improving Physical Function Among Home-Dwelling Patients With a Stroke. Arch Phys Med Rehabil 2019; 101:359-373. [PMID: 31689417 DOI: 10.1016/j.apmr.2019.10.181] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effects of home-based rehabilitation on improving physical function in home-dwelling patients after a stroke. DATA SOURCES Various electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health, Embase, the Cochrane Central Register of Controlled Trials, and 2 Chinese data sets (ie, Chinese Electronic Periodical Services and China Knowledge Resource Integrated) were searched for studies published before March 20, 2019. STUDY SELECTION Randomized controlled trials conducted to examine the effect of home-based rehabilitation on improving physical function in home-dwelling patients with a stroke and published in English or Chinese were included. In total, 49 articles in English (n=23) and Chinese (n=26) met the inclusion criteria. DATA EXTRACTION Data related to patient characteristics, study characteristics, intervention details, and outcomes were extracted by 2 independent reviewers. DATA SYNTHESIS A random-effects model with a sensitivity analysis showed that home-based rehabilitation exerted moderate improvements on physical function in home-dwelling patients with a stroke (g=0.58; 95% CI, 0.45∼0.70). Moderator analyses revealed that those patients with stroke of a younger age, of male sex, with a first-ever stroke episode, in the acute stage, and receiving rehabilitation training from their caregiver showed greater improvements in physical function. CONCLUSIONS Home rehabilitation can improve functional outcome in survivors of stroke and should be considered appropriate during discharge planning if continuation care is required.
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Effect of a Passive Intervention on Carers of Stroke Survivors During the Early Poststroke Period. J Neurosci Nurs 2019; 51:299-304. [PMID: 31626078 DOI: 10.1097/jnn.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Care partners of stroke survivors are often characterized by high burden levels and depression. Passive and active interventions have been proposed to help reduce burden and depression. The aim of this quality improvement report was to evaluate the effects of a single passive intervention on reported burden and depression in carers of stroke survivors. METHODS A quality improvement report was conducted on carers who participated in a short passive intervention (n = 56) and a control group (n = 44). The Family Strain Questionnaire-Short Form (FSQ-SF) and the Beck Depression Inventory II were administered in both groups at patients' admission and before discharge, with the intervention taking place between the 2 data collection periods. RESULTS No significant difference between groups was observed in FSQ-SF score and prevalence of depression at admission and in FSQ-SF at discharge. However, compared with admission, FSQ-SF at discharge was significantly reduced only in the intervention group (pre: 14, and interquartile range, 12-15; post: 9, and interquartile range, 9-13; P < .01). Moreover, a smaller proportion of carers classified as "depression" was found at discharge in the intervention group compared with controls (4% vs 28%, respectively; P < .01). CONCLUSION Results encourage the development and use of short passive intervention to reduce burden and depression in care partners of stroke survivors.
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Li X, Tan Z, Guo N, Qi S, Shao J. The impact of effort-reward imbalance on loneliness of the elderly: the multiple mediation effect of social support and control belief in social domain. J Elder Abuse Negl 2019; 31:294-306. [PMID: 31507252 DOI: 10.1080/08946566.2019.1663332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The empirical studies of loneliness have experienced unprecedented growth in the past decades. As such, there is now a growing body of research showing that loneliness is negatively related to physical and mental health. More recently, one of the most widely tested models of effort-reward imbalance (ERI) posits that the imbalance between high effort and low reward elicits strong negative emotions and sustained stress responses. Despite these developments, the mechanism between ERI and loneliness of the elderly remains unclear. In the current study, we explored how ERI influences loneliness via social support and control belief in social domain. Method: We selected a convenience sample aged 53-84 years old (N = 231) to complete a series of standard psychological assessments. Results: Multiple mediation analysis showed that (1) the positive effect of ERI on loneliness was partially mediated by social support (95% IC = -.001 to .078) and control belief in social domain (95% IC = .028 to .154), and (2) the chain mediating effect of both mediators was also significant (95% IC = .037 to .112). Discussion: The study suggests that ERI can influence loneliness through decreasing social support and subsequently reducing control belief in social domain.
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Affiliation(s)
- Xiying Li
- MOE Key laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, P. R. China
| | - Zuyu Tan
- MOE Key laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, P. R. China
| | - Ning Guo
- School of Education, Saint Louis University, St Louis, MO, USA
| | - Senqing Qi
- MOE Key laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, P. R. China
| | - Jingjin Shao
- Faculty of Psychology, Southeast University, Chongqing, P. R. China
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van der Veen DJ, Döpp CME, Siemonsma PC, Nijhuis-van der Sanden MWG, de Swart BJM, Steultjens EM. Factors influencing the implementation of Home-Based Stroke Rehabilitation: Professionals' perspective. PLoS One 2019; 14:e0220226. [PMID: 31344103 PMCID: PMC6657875 DOI: 10.1371/journal.pone.0220226] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background Stroke has a major impact on survivors and their social environment. Care delivery is advocated to become more client-centered and home-based because of their positive impact on client outcomes. The objective of this study was to explore professionals’ perspectives on the provision of Home-Based Stroke Rehabilitation (HBSR) in the Netherlands and on the barriers and facilitators influencing the implementation of HBSR in daily practice. Methods Semi-structured focus groups were conducted to explore the perspectives of health and social care professionals involved in stroke rehabilitation. Directed content analysis was performed to analyze the transcripts of recorded conversations. Results Fourteen professionals participated in focus groups (n = 12) or, if unable to attend, an interview (n = 2). Participants varied in professional backgrounds and roles in treating Dutch clients post stroke. Barriers and facilitators influencing the implementation of HBSR in daily practice were identified in relation to: the innovation, the user, the organization and the socio-political context. Participants reported that HBSR can be efficient and effective to most clients because it facilitates client- and caregiver-centered rehabilitation within the clients’ own environment. However, barriers in implementing HBSR were perceived in a lack of (structured) inter-professional collaboration and the transparency of expertise of primary care professionals. Also, the current financial structures for HBSR in the Netherlands are viewed as inappropriate. Discussion In line with previous studies, we found that HBSR is recognized by professionals as a promising alternative to institution-based rehabilitation for clients with sufficient capabilities (e.g. their own health and informal support). Conclusion Multiple factors influencing the implementation of HBSR were identified. Our study suggests that, in order to implement HBSR in daily practice, region specific implementation strategies need to be developed. We recommend developing strategies concerning: organized and coordinated inter-professional collaboration, transparency of the expertise of primary care professionals, and the financial structures of HBSR.
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Affiliation(s)
- Dinja J. van der Veen
- Institute of Health Studies, University of Applied Sciences HAN, Nijmegen, the Netherlands
- * E-mail:
| | | | - Petra C. Siemonsma
- Healthy Living, TNO Leiden, Leiden, the Netherlands
- University of Applied Sciences THIM, Nieuwegein, the Netherlands
- Faculty of Health, University of Applied Sciences Leiden, Leiden, the Netherlands
| | | | - Bert J. M. de Swart
- Institute of Health Studies, University of Applied Sciences HAN, Nijmegen, the Netherlands
- Department of Neurorehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esther M. Steultjens
- Institute of Health Studies, University of Applied Sciences HAN, Nijmegen, the Netherlands
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Zhou B, Zhang J, Zhao Y, Li X, Anderson CS, Xie B, Wang N, Zhang Y, Tang X, Prvu Bettger J, Chen S, Gu W, Luo R, Zhao Q, Li X, Sun Z, Lindley RI, Lamb SE, Wu Y, Shi J, Yan LL. Caregiver-Delivered Stroke Rehabilitation in Rural China. Stroke 2019; 50:1825-1830. [DOI: 10.1161/strokeaha.118.021558] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke disability is a major health burden in rural China where rehabilitation services are inadequate. We aimed to determine the effectiveness of a novel nurse-led, caregiver-delivered model of stroke rehabilitation in rural China.
Methods—
A multicenter prospective, randomized open, blinded outcome assessed, controlled trial was conducted in 3 rural county hospitals in China: Zhangwu, Liaoning Province (Northeast); Qingtongxia, Ningxia Hui Autonomous Region (Northwest); and Dianjiang, Chongqing Municipality (Southwest). Adult patients (age 18–79 years) with residual disability (Barthel Index score ≤80/100) after a recent acute stroke were randomized to a new service model or usual care. The new intervention was multifaceted and was based on a task-shifting / training-the-trainers model, supported by a custom-designed smartphone application, where patients and caregivers received evidence-based in-hospital education and stroke rehabilitation training (focus on mobility, self-care, and toileting), delivered by trained nurses before hospital discharge, and 3 postdischarge support telephone calls. Outcome assessments were undertaken before hospital discharge and at 3 and 6 months. Primary outcome was physical functioning (Barthel Index scores) at 6 months, assessed by research staff blind to treatment allocation, adjusted for baseline covariates in an intention-to-treat analysis. Secondary outcomes included measures of mobility, health-related quality of life, mood, and caregiver burden. The study included a process evaluation that assessed intervention fidelity.
Results—
From November 2014 to December 2016, 246 stroke patients were randomized to intervention (n=118) or control (n=128) groups. There was no statistically significant difference in adjusted 6-month Barthel Index scores between groups (70.1 versus 74.1, mean difference, −4.0 [95% CI, −10.0 to 2.9]), nor any differences across the other outcome measures. Process evaluation interviews revealed that the intervention was desirable and positively accepted by nurses, caregivers, and patients but was considered too complex despite efforts to simplify materials for the rural context. Key strategies identified for future studies included the use of community health workers, smartphone application enhancement, and simpler and more frequent training for nurses, caregivers, and patients.
Conclusions—
A novel nurse-led, digital supported, caregiver-delivered stroke rehabilitation program did not improve patient physical functioning after stroke in rural China. Further stroke rehabilitation research suitable for resource-poor settings is required, with several components being suggested through stakeholder interviews in our study.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02247921.
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Affiliation(s)
- Bo Zhou
- From the Department of Clinical Epidemiology, First Hospital of China Medical University, Shenyang (B.Z., Q.Z., J.S.)
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China (J.Z., Xian Li, C.S.A., R.L., Y.W., L.L.Y.)
| | - Yi Zhao
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China (Y. Zhao, Y. Zhang, Xiaoxia Li)
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China (J.Z., Xian Li, C.S.A., R.L., Y.W., L.L.Y.)
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, Australia (Xian Li, C.S.A.)
| | - Craig S. Anderson
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China (J.Z., Xian Li, C.S.A., R.L., Y.W., L.L.Y.)
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, Australia (Xian Li, C.S.A.)
| | - Bin Xie
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China (B.X., N.W.)
| | - Ninghua Wang
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China (B.X., N.W.)
| | - Yuhong Zhang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China (Y. Zhao, Y. Zhang, Xiaoxia Li)
| | - Xiaojun Tang
- School of Public Health and Management, Chongqing Medical University, China (X.T., Z.S.)
| | - Janet Prvu Bettger
- Duke Clinical Research Institutea (J.P.B.), Duke University, Durham, NC
- Duke Global Health Institute (J.P.B., L.L.Y.), Duke University, Durham, NC
| | - Shu Chen
- Global Health Research Center, Duke Kunshan University, China (S.C., W.G., L.L.Y.)
| | - Wanbing Gu
- Global Health Research Center, Duke Kunshan University, China (S.C., W.G., L.L.Y.)
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China (J.Z., Xian Li, C.S.A., R.L., Y.W., L.L.Y.)
| | - Qiongrui Zhao
- From the Department of Clinical Epidemiology, First Hospital of China Medical University, Shenyang (B.Z., Q.Z., J.S.)
| | - Xiaoxia Li
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China (Y. Zhao, Y. Zhang, Xiaoxia Li)
| | - Zhenxing Sun
- School of Public Health and Management, Chongqing Medical University, China (X.T., Z.S.)
| | - Richard I. Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia (R.I.L.)
| | - Sarah E. Lamb
- Oxford Clinical Trials Research Unit, University of Oxford, United Kingdom (S.E.L.)
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China (J.Z., Xian Li, C.S.A., R.L., Y.W., L.L.Y.)
- Peking University Clinical Research Institute, Beijing, China (Y.W.)
- School of Public Health, Peking University Health Science Center, Beijing, China (Y.W.)
| | - Jingpu Shi
- From the Department of Clinical Epidemiology, First Hospital of China Medical University, Shenyang (B.Z., Q.Z., J.S.)
| | - Lijing L. Yan
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China (J.Z., Xian Li, C.S.A., R.L., Y.W., L.L.Y.)
- Duke Global Health Institute (J.P.B., L.L.Y.), Duke University, Durham, NC
- Global Health Research Center, Duke Kunshan University, China (S.C., W.G., L.L.Y.)
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Halvorsen I, Rø Ø. User satisfaction with family-based inpatient treatment for adolescent anorexia nervosa: retrospective views of patients and parents. J Eat Disord 2019; 7:12. [PMID: 31069078 PMCID: PMC6495500 DOI: 10.1186/s40337-019-0242-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Research is scarce on patient and parent satisfaction with family-based treatment for adolescent anorexia nervosa (AN), especially family-based treatment adapted to inpatient settings. The purpose of this study was to describe and compare patient and parent satisfaction with an inpatient family-based treatment program for adolescent AN, and to investigate whether the level of satisfaction with treatment was associated with eating disorder outcome. METHODS Former patients and their parents were contacted approximately five years (4.5 ± 1.7, range: 1.3-7.0) after discharge from family-based inpatient treatment. Ninety-four participants (patients: n = 34, mothers: n = 40, fathers: n = 20) from 46/58 (79.3%) families took part in the study. Former patients and both parents completed treatment satisfaction questionnaires. Outcome at follow-up was assessed by the Eating Disorder Examination Questionnaire and body mass index (kg/m2). RESULTS Overall, mothers and fathers reported a high level of satisfaction with treatment, while the former patients' satisfaction was moderate. There were no significant differences between treatment satisfaction scores for mothers and fathers. However, the former patients' treatment satisfaction scores were significantly lower than the parents' scores on several of the items. Correlations between eating disorder outcome parameters and treatment satisfaction were small, except for fathers' satisfaction with treatment and weight outcome at follow-up. DISCUSSION Family-based treatment adapted to inpatient settings is a novel treatment approach for adolescents with AN that require hospitalization. Inclusion and empowerment of parents are considered crucial in outpatient family-based treatment, but may be just as important in inpatient programs. Mothers and fathers alike reported high levels of satisfaction with treatment, which may constitute an important factor in the success of family-based treatment. CONCLUSION Family-based inpatient treatment for adolescents with severe AN who have failed to respond to outpatient treatment seemed to be highly valued by parents and viewed by adolescents as acceptable. Parental satisfaction with their child's treatment is likely to be an important factor for treatment implementation and adherence both in outpatient and inpatient settings.
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Affiliation(s)
- Inger Halvorsen
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital - Ullevål Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital - Ullevål Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zhu W, Jiang Y. Determinants of caregiver burden of patients with haemorrhagic stroke in China. Int J Nurs Pract 2018; 25:e12719. [PMID: 30561838 DOI: 10.1111/ijn.12719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/08/2018] [Accepted: 11/09/2018] [Indexed: 02/05/2023]
Abstract
AIM The aim of this study was to assess the caregiver burden over time of patients with haemorrhagic stroke and the determinants of this. BACKGROUND Identification of the predictors for caregiver burden can be used to improve the outcomes of stroke survivors and caregivers. Few studies focus on the caregiver burden of patients with haemorrhagic stroke and how this changes over time. DESIGN This was a prospective longitudinal study. METHODS A convenience sample of 202 stroke survivor/caregiver pairs were recruited in the neurosurgery unit from March 2015 to March 2016. The participants were assessed at three different times by face to face or telephone interview. Caregiver burden was assessed using the Bakas Caregiver Outcomes Scale. Sociodemographic data and other characteristics of the pairs were also collected. Multiple linear regression was performed to identify the determinants. RESULTS Caregiver burden decreased from T1 to T3 significantly. The physical function, depression of stroke survivors, and self-rated burden of caregivers were the most important determinants for overall caregiver burden. The factors identified explained 41.6% to 67.4% of overall burden. CONCLUSION Caregiver burden decreased over time, affected by factors from patients and caregivers. More professional caregivers are needed to support informal carers.
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Affiliation(s)
- Wei Zhu
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
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An Examination of a Simplified Stroke Rehabilitation Program for Reducing Family Caregiver’s Burden for Stroke Patients in Rural China. CONTEMPORARY FAMILY THERAPY 2018. [DOI: 10.1007/s10591-018-9482-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vincent-Onabajo G, Daniel H, Lawan A, Ali MU, Masta MA, Modu A. Musculoskeletal Symptoms among Family Caregivers of Community-Dwelling Stroke Survivors in Nigeria. J Caring Sci 2018; 7:59-66. [PMID: 29977875 PMCID: PMC6029650 DOI: 10.15171/jcs.2018.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 03/17/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Caring for stroke survivors may be burdensome with adverse consequences on caregivers' physical health. This study examined the prevalence of musculoskeletal symptoms and associated factors among family caregivers of stroke survivors in Nigeria. Methods: A hospital-based cross-sectional study involving 90 stroke caregiver and stroke survivor dyads was conducted. Data on the participants' demographics and post-stroke duration were obtained. Seven-day prevalence of musculoskeletal symptoms among the caregivers and level of stroke survivors' disability were respectively assessed using the Nordic Musculoskeletal Questionnaire and Modified Rankin Scale. Prevalence of musculoskeletal symptoms was presented as percentages while participants' characteristics associated with prevalence of musculoskeletal symptoms were examined using inferential statistics. Results: Mean (SD) age of caregivers and stroke survivors was 33.2 (10.7) years and 58.9 (9.7) years respectively. Majority of the caregivers were females (61.1%), and children of the stroke survivors (58.9%). Prevalence of musculoskeletal symptoms was 82.2%. The low back was the most affected body region (72.2%) followed by the upper back (40%) while musculoskeletal symptoms in the wrist was least prevalent (3.3%). Female caregivers, caregivers of female stroke survivors and spousal caregivers had significantly higher prevalence of musculoskeletal symptoms compared to other categories of caregivers. Only 5 (5.6%) caregivers had however received any training on safe care giving methods while only 21 (28.4%) caregivers with musculoskeletal symptoms had received treatment. Conclusion: With the high prevalence of musculoskeletal symptoms among family caregivers of stroke survivors, effective preventive strategies including training and education as well as timely access to treatment would be required.
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Affiliation(s)
- Grace Vincent-Onabajo
- Department of Medical Rehabilitation (Physiotherapy), College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
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Effects of Home-Based Supportive Care on Improvements in Physical Function and Depressive Symptoms in Patients With Stroke: A Meta-Analysis. Arch Phys Med Rehabil 2017; 98:1666-1677.e1. [DOI: 10.1016/j.apmr.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/04/2017] [Accepted: 03/16/2017] [Indexed: 12/29/2022]
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Han Y, Liu Y, Zhang X, Tam W, Mao J, Lopez V. Chinese family caregivers of stroke survivors: Determinants of caregiving burden within the first six months. J Clin Nurs 2017; 26:4558-4566. [PMID: 28252843 DOI: 10.1111/jocn.13793] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe the family caregivers' caregiving experience for stroke survivors and to identify the determinants of caregiving burden over 6 months. BACKGROUND Sociocultural factors influence the caregiving experience in China. However, little is known about the dynamic changes occurring in Chinese caregivers' burden and its determinants. DESIGN This is a prospective longitudinal study. METHODS A total of 328 participants (164 stroke survivors and 164 family caregivers) from the neurological units of three hospitals in Shiyan were examined during a 6-month period at 1-2 days before discharge (T1) and 3 weeks (T2), 3 months (T3) and 6 months (T4) postdischarge using the Short Portable Mental Status Questionnaire, Multidimensional Scale of Perceived Social Support, Caregiver Strain Index and the Center for Epidemiological Studies-Depression. RESULTS Of the 209 dyads recruited, 164 completed all data collection phases, with 69% of the female caregivers aged 56.04 (SD = 4.0; range = 22-80) years. Caregivers reported higher mean burden at T1 (7.35 ± 2.9) but slightly decreased over time at T4 (6.34 ± 3.4), had borderline mean depressive symptoms only in T1 (9.71 ± 3.2) and T2 (9.02 ± 3.8) and had moderate mean social support throughout the 6-month period. Determinants of caregiving burden were stroke survivors' physical dependence, caregivers' age, caring hours per day, depressive symptoms and social support, which explained 46.8%-55.0% of the total variance (p < .05). CONCLUSION Caregivers' burden remains a serious problem in the first 6 months. It is an increasing hazard, especially for those at an advanced age who have depressive symptoms and care for severely dependent stroke survivors requiring more caring hours. RELEVANCE TO CLINICAL PRACTICE Nurses need to be aware of and understand caregivers' cultural values and beliefs about family obligations when considering an intervention to support them in their role at home.
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Affiliation(s)
- Yanhong Han
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.,Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yilan Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuelin Zhang
- School of Nursing, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Park EY, Kim JH. An analysis of depressive symptoms in stroke survivors: verification of a moderating effect of demographic characteristics. BMC Psychiatry 2017; 17:132. [PMID: 28390402 PMCID: PMC5385085 DOI: 10.1186/s12888-017-1292-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/30/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The rehabilitation of depressed stroke patients is more difficult because poststroke depression is associated with disruption of daily activities, functioning, and quality of life. However, research on depression in stroke patients is limited. The aim of our study was to evaluate the interaction of demographic characteristics including gender, age, education level, the presence of a spouse, and income status on depressive symptoms in stroke patients and to identify groups that may need more attention with respect to depressive symptoms. METHODS We completed a secondary data analysis using data from a completed cross-sectional study of people with stroke. Depression was measured using the Center for Epidemiologic Studies Depression Scale. RESULTS In this study, depressive symptoms in women living with a spouse were less severe than among those without a spouse. For those with insufficient income, depressive symptom scores were higher in the above high school group than in the below high school group, but were lower in patients who were living with a spouse than in those living without a spouse. CONCLUSION Assessing depressive symptoms after stroke should consider the interaction of gender, economic status, education level, and the presence/absence of a spouse. These results would help in comprehensive understanding of the importance of screening for and treating depressive symptoms during rehabilitation after stroke.
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Affiliation(s)
- Eun-Young Park
- grid.411845.dDepartment of Secondary Special Education, College of Education, Jeonju University, PO Box 560-759, 45 Baengma-gil, Wansan-gu, Jeonju, Korea
| | - Jung-Hee Kim
- Department of Clinical Nursing, College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
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Sato A, Okuda Y, Fujita T, Kimura N, Hoshina N, Kato S, Tanaka S. Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients. Phys Ther Res 2017; 19:32-38. [PMID: 28289579 DOI: 10.1298/ptr.e9904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/26/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability. METHOD This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIMⓇ instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables. RESULT The multiple logistic regression analysis showed that the FIMⓇ instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points. CONCLUSION Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients.
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Affiliation(s)
- Atsushi Sato
- Department of Physical Therapy, Yachiyo Rehabilitation College
| | - Yutaka Okuda
- Department of Physical Therapy, Yachiyo Rehabilitation College
| | - Takaaki Fujita
- Department of Rehabilitation, Tohoku Fukushi University; Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences
| | - Norihiko Kimura
- Department of Physical Therapy, Yachiyo Rehabilitation College
| | - Noriyuki Hoshina
- Department of Rehabilitation, Chiba minato Rehabilitation Hospital
| | - Sayaka Kato
- Department of Rehabilitation, Yachiyo Rehabilitation Hospital
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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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Yan LL, Chen S, Zhou B, Zhang J, Xie B, Luo R, Wang N, Lindley R, Zhang Y, Zhao Y, Li X, Liu X, Peoples N, Bettger JP, Anderson C, Lamb SE, Wu Y, Shi J. A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale. Int J Stroke 2016; 11:823-30. [PMID: 27462096 DOI: 10.1177/1747493016654290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/04/2016] [Indexed: 11/16/2022]
Abstract
RATIONALE Stroke is the leading cause of death and disability in rural China. For stroke patients residing in resource-limited rural areas, secondary prevention and rehabilitation are largely unavailable, and where present, are far below evidence-based standards. AIM This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery, and evaluate its feasibility and effectiveness in rural China. METHODS AND DESIGN This 2-year randomized controlled trial is being conducted in 2-3 county hospitals located in northwest, northeast, and southwest China. Eligible and consenting stroke inpatients (200 in total) have been recruited and randomized into either a control or intervention group. Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group. They also provide telephone follow-up care three times post discharge. The recruitment, baseline, intervention, follow-up care, and evaluation are guided by the RECOVER mobile phone app specifically designed for this study. STUDY OUTCOME The primary outcome is patients' Barthel Index (activities of daily living: mobility, self-care, and toileting) at 6 months. Process and economic evaluation will also be conducted. DISCUSSION The results of our study will generate initial high-quality evidence to improve stroke care in resource-scarce settings. If proven effective, this innovative care delivery model has the potential to improve the health and function of stroke patients, relieve caregiver burden, guide policy-making, and advance translational research in the field of stroke care.
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Affiliation(s)
- Lijing L Yan
- Global Health Institute, Duke University, Durham, USA Global Health Research Center, Duke Kunshan University, Kunshan, China The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Shu Chen
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Bo Zhou
- Department of Clinical Epidemiology, China Medical University, Shenyang, China
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Bin Xie
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Ninghua Wang
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China
| | | | - Yuhong Zhang
- School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Yi Zhao
- School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Xiao Liu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | | | - Janet Prvu Bettger
- Global Health Institute, Duke University, Durham, USA School of Nursing, Duke Clinical Research Institute, Duke University, Durham, USA
| | - Craig Anderson
- The George Institute for Global Health, Sydney, Australia
| | - Sarah E Lamb
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China Peking University Clinical Research Institute, Beijing, China
| | - Jingpu Shi
- Department of Clinical Epidemiology, China Medical University, Shenyang, China
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Brereton L, Carroll C, Barnston S. Interventions for adult family carers of people who have had a stroke: a systematic review. Clin Rehabil 2016; 21:867-84. [DOI: 10.1177/0269215507078313] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: A systematic review of the effectiveness of interventions for adult family carers of people with stroke, and an exploratory examination of the relationship between the conceptual basis of these interventions and their effectiveness. Data sources: Seventeen electronic databases and grey literature sources were searched, including ASSIA, BNI, Cochrane Library, CINAHL, EMBASE, MEDLINE, PsycINFO, Social Science Citation Index and the Science Citation Index, HMIC and the National Research Register. Authors of unpublished material were contacted for data and additional publications. Reference and citation tracking was performed on included publications. Review methods: Inclusion criteria: randomized controlled trials of interventions aimed primarily at adult family carers of people post stroke; carers were the primary sample; primary outcomes reported were for carers. Two independent reviewers screened titles and abstracts to identify publications and extract data. Quality assessment was performed to weight study findings. Results: Eight papers were found reporting on six complex, generally heterogeneous, interventions: caregiver training; education and counselling; social problem-solving partnerships, delivered principally by telephone; a psycho-educational telephone support group; a nurse-led support and education programme; and a support programme, delivered either to groups in hospital or individuals during home visits. Half of the interventions were based on stress-coping theories; the remainder did not identify a conceptual basis for the intervention. Conclusions: Some benefits were reported for all interventions, although trials were generally of low quality, preventing firm conclusions being drawn. The presence of a conceptual basis for interventions does not appear to influence effectiveness.
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Affiliation(s)
- Louise Brereton
- Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield
| | - Christopher Carroll
- Information Resources, School of Health and Related Research (ScHARR), University of Sheffield,
| | - Sue Barnston
- Sheffield Teaching Hospital NHS Foundation Trust, Stroke Unit, Royal Hallamshire Hospital, Sheffield, UK
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Williams A, Sethi B, Duggleby W, Ploeg J, Markle-Reid M, Peacock S, Ghosh S. A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective. Int J Equity Health 2016; 15:40. [PMID: 26936057 PMCID: PMC4774090 DOI: 10.1186/s12939-016-0328-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/23/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A little-studied issue in the provision of care at home by informal caregivers is the increase in older adult patients with chronic illness, and more specifically, multiple chronic conditions (MCC). We know little about the caregiving experience for this population, particularly as it is affected by social location, which refers to either a group's or individual's place/location in society at a given time, based on their intersecting demographics (age, gender, education, race, immigration status, geography, etc.). We have yet to fully comprehend the combined influence of these intersecting axes on caregivers' health and wellbeing, and attempt to do this by using an intersectionality approach in answering the following research question: How does social location influence the experience of family caregivers of older adults with MCC? METHODS The data presented herein is a thematic analysis of a qualitative sub-set of a large two-province study conducted using a repeated-measures embedded mixed method design. A survey sub-set of 20 survey participants per province (n = 40 total) were invited to participate in a semi-structured interview. In the first stage of data analysis, Charmaz's (2006) Constructivist Grounded Theory Method (CGTM) was used to develop initial codes, focused codes, categories and descriptive themes. In the second and the third stages of analysis, intersectionality was used to develop final analytical themes. RESULTS The following four themes describe the overall study findings: (1) Caregiving Trajectory, where three caregiving phases were identified; (2) Work, Family, and Caregiving, where the impact of caregiving was discussed on other areas of caregivers' lives; (3) Personal and Structural Determinants of Caregiving, where caregiving sustainability and coping were deliberated, and; (4) Finding Meaning/Self in Caregiving, where meaning-making was highlighted. CONCLUSIONS The intersectionality approach presented a number of axes of diversity as comparatively more important than others; these included gender, age, education, employment status, ethnicity, and degree of social connectedness. This can inform caregiver policy and programs to sustain health and well-being.
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Affiliation(s)
- Allison Williams
- McMaster University, School of Geography and Earth Sciences, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Bharati Sethi
- McMaster University, School of Geography and Earth Sciences, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Wendy Duggleby
- University of Alberta, Faculty of Nursing, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada.
| | - Jenny Ploeg
- McMaster University, School of Geography and Earth Sciences, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Maureen Markle-Reid
- McMaster University, School of Geography and Earth Sciences, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Shelley Peacock
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada.
| | - Sunita Ghosh
- University of Alberta, Faculty of Nursing, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada.
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Satink T, Josephsson S, Zajec J, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. Negotiating role management through everyday activities: narratives in action of two stroke survivors and their spouses. Disabil Rehabil 2016; 38:2354-64. [PMID: 26854923 DOI: 10.3109/09638288.2015.1129442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To manage social roles is a challenging part of self-management post-stroke. This study explored how stroke survivors act as role managers with their spouses in the context of everyday activities. METHOD Two stroke survivors with a first time stroke living at home with a spouse were included. Data were generated through participant observations at their own environment at 3, 6, 9, 15 and 21 months post-discharge. The narrative analysis focused on the actions of participants. RESULTS Daily activities can be understood as an arena where role management and a meaningful live is negotiated and co-constructed with others. Everyday activities gave stroke survivors and their spouses insight into stroke survivors' capacities in daily situations. This was sometimes empowering, and other times conflicting when a spouse had negative perceptions of the abilities of the stroke survivors. CONCLUSION The findings add to the current understanding of self-management and role management with regard to how these are situated in everyday activities. Daily activities can help both spouses to reflect and understand about self-management, role management and comanagement in daily life. Moreover, observing stroke survivors in everyday situations provides professionals with concrete pictures of stroke survivors' performance and self-management in interaction with their spouses. Implications for Rehabilitation Self-management is a dynamic process in which individuals actively manage a chronic condition and finally live a meaningful life with a long-term chronic condition; self-management can be divided into medical, role, and emotional management; comanagement is when individuals activate resources and use the capacities of other persons to manage a situation together. Self-management is situated in everyday activities. Everyday activities give stroke survivors ánd their partners impressions about stroke survivors' self-management abilities post-stroke in an everyday context. Everyday activities give stroke survivors ánd their partners an arena where role management and a meaningful life are negotiated and coconstructed through doing. Observing stroke survivors in everyday situations provides professionals a concreter picture of stroke survivors' self-management and comanagement with their partners than can be obtained from an informal interview.
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Affiliation(s)
- Ton Satink
- a Department of Occupational Therapy and Research Group Neurorehabilitation , HAN University of Applied Sciences , Nijmegen , The Netherlands ;,b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Staffan Josephsson
- c Department of Neurobiology, Division of Occupational Therapy , Caring Science and Society, Karolinska Institute , Stockholm , Sweden ;,d Department of Occupational Therapy, Faculty of Health Science , Sør-Trøndelag University College , Trondheim , Norway
| | - Jana Zajec
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Edith H C Cup
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
| | - Bert J M de Swart
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands ;,e Research Group Neurorehabilitation , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- b Department of Rehabilitation Radboud University Medical Centre , Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care , Nijmegen , The Netherlands
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Oral health related quality of life and it’s related factors of stroke patients at home in Korea. Arch Gerontol Geriatr 2015; 61:523-8. [DOI: 10.1016/j.archger.2015.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 06/27/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022]
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Newell JM, Lyons R, Martin-Misener R, Shearer CL. Creating a Supportive Environment for Living with Stroke in Rural Areas: Two Low-Cost Community-Based Interventions. Top Stroke Rehabil 2015; 16:147-56. [DOI: 10.1310/tsr1602-147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Teasell R, Mehta S, Pereira S, McIntyre A, Janzen S, Allen L, Lobo L, Viana R. Time to Rethink Long-Term Rehabilitation Management of Stroke Patients. Top Stroke Rehabil 2014. [DOI: 10.1310/tsr1906-457] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Teasell R, Rice D, Richardson M, Campbell N, Madady M, Hussein N, Murie-Fernandez M, Page S. The next revolution in stroke care. Expert Rev Neurother 2014; 14:1307-14. [DOI: 10.1586/14737175.2014.968130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Shao J, Zhang Q, Lin T, Shen J, Li D. Well-being of elderly stroke survivors in Chinese communities: mediating effects of meaning in life. Aging Ment Health 2014; 18:435-43. [PMID: 24188409 DOI: 10.1080/13607863.2013.848836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study aims to examine the role of meaning in life as a mediator for the relationship of physical functioning, social support, and optimism with well-being among elderly Chinese stroke survivors. METHOD A cross-sectional study was conducted on 214 community-dwelling older stroke survivors (128 men and 86 women), ranging from 60 to 88 years. The physical functioning, social support, optimism, meaning in life, and subjective well-being of the participants were measured. RESULTS Structural equation modeling revealed that meaning in life fully mediates the relationship of physical functioning, social support, and optimism with subjective well-being. CONCLUSION This study examines the role of meaning in life in stroke experience from an existential perspective. The modifiable features of meaning in life may offer an intervening angle for improving the well-being of elderly stroke survivors.
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Affiliation(s)
- Jingjin Shao
- a Research Center of Mental Health Education , Southwest University , Chongqing , China
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Cheng HY, Chair SY, Chau JPC. The effectiveness of psychosocial interventions for stroke family caregivers and stroke survivors: a systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2014; 95:30-44. [PMID: 24485756 DOI: 10.1016/j.pec.2014.01.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/17/2013] [Accepted: 01/07/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of psychosocial interventions for family caregivers on their psychosocial and physical wellbeing, quality of life, and the use of healthcare resources by stroke survivors. METHODS Electronic English and Chinese bibliographic databases were searched (inception to January 2012) for clinical trials. Two reviewers independently selected and appraised study quality. When possible, data from randomized controlled trials (RCTs) were statistically pooled. Otherwise, a narrative summary was used. RESULTS Eighteen studies (psychoeducation and social support group) were included. Pooled analysis of two individual psychoeducation programs showed a small effect on improving family functioning (SMD: -0.12; 95% CI: -0.23 to -0.01; p=0.03). Caregivers receiving psychoeducation that aimed at equipping caregivers with the skills of problem-solving, caregiving, and stress-coping appeared to have a more positive influence on the caregivers' psychosocial wellbeing and a reduced use of healthcare resources by stroke survivors. CONCLUSION Evidence on the effects of psychosocial interventions was limited. More RCTs of multifaceted psychoeducation programs are needed to further examine the optimal dose and format. PRACTICAL IMPLICATIONS To support caregivers across the stroke trajectory, the core skills of problem-solving and stress-coping should be included in the psychosocial interventions.
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Affiliation(s)
- Ho Yu Cheng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Janita Pak-Chun Chau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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Teasell RW, Murie Fernandez M, McIntyre A, Mehta S. Rethinking the continuum of stroke rehabilitation. Arch Phys Med Rehabil 2014; 95:595-6. [PMID: 24529594 DOI: 10.1016/j.apmr.2013.11.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/23/2013] [Accepted: 11/01/2013] [Indexed: 10/25/2022]
Abstract
Suffering a stroke can be a devastating and life-changing event. Although there is a large evidence base for stroke rehabilitation in the acute and subacute stages, it has been long accepted that patients with stroke reach a plateau in their rehabilitation recovery relatively early. We have recently published the results of a systematic review designed to identify all randomized controlled trials (RCTs) where a rehabilitation intervention was initiated more than 6 months after the onset of the stroke. Of the trials identified, 339 RCTs met inclusion criteria, demonstrating an evidence base for stroke rehabilitation in the chronic phase as well. This seems at odds with the assumption that further recovery is unlikely and the subsequent lack of resources devoted to chronic stroke rehabilitation and management.
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Affiliation(s)
- Robert W Teasell
- Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, ON, Canada; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; St. Joseph's Healthcare, St. Joseph's Parkwood Hospital, London, ON, Canada.
| | - Manuel Murie Fernandez
- Department of Neurology and Neurosurgery, University of Navarra, Pamplona, Navarra, Spain
| | - Amanda McIntyre
- Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, ON, Canada
| | - Swati Mehta
- Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, ON, Canada
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Yu Y, Hu J, Efird JT, McCoy TP. Social support, coping strategies and health-related quality of life among primary caregivers of stroke survivors in China. J Clin Nurs 2013; 22:2160-71. [DOI: 10.1111/jocn.12251] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Yunhong Yu
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology; Wuhan China
| | - Jie Hu
- University of North Carolina at Greensboro; Greensboro NC USA
| | - Jimmy T Efird
- Center for Health Disparities (Biostatistics Unit) and Department of Public Health; Brody School of Medicine; Eastern Carolina University; Greenville NC USA
| | - Thomas P McCoy
- University of North Carolina at Greensboro; Greensboro NC USA
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Pringle J, Drummond JS, McLafferty E. Revisioning, reconnecting and revisiting: the psychosocial transition of returning home from hospital following a stroke. Disabil Rehabil 2013; 35:1991-9. [PMID: 23614358 DOI: 10.3109/09638288.2013.770081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to investigate and improve understanding of the experiences of patients and their carers during the first month at home following discharge from hospital, thereby enhancing appropriate care from a more informed perspective. METHOD In-depth interviews and self-report diaries were used to capture data from 12 patient/carer dyads. Four survivors with marked communication problems were included in this number, two requiring the use of pictures and diagrams to express their views. Interpretative phenomenological analysis (IPA) was used to capture and interpret survivor and carer experiences. FINDINGS Three superordinate themes were derived from the data. Stroke survivors and their carers described the first month at home as a very dynamic time, recounting a process that involved revisioning (re-examining their identity and the reality of their new situation, including an awareness of their own mortality), reconnecting (with important relationships and previous activities) and revisiting (their past lives, and the stroke event and hospital experience). These three activities assisted in making and finding sense in their new situation; participants' vision of their lives was revised and revisited as they attempted to reconnect with as much of their past selves and past activities as possible. CONCLUSIONS This study contributes to understandings through in-depth individual accounts of the psychosocial transition of returning home. Details of how people make sense of their altered situation can make a valuable contribution to research, and the knowledge base for care provision. Implications for Rehabilitation Supporting people to revision their future can assist with psychosocial transition following a stroke. Assisting patients to reconnect and reintegrate in a way that is meaningful to them is an important part of the rehabilitation support that can be offered by professionals, and can be informed by awareness of their vision of what the future may now hold. Offering people the opportunity to reflect on what has occurred, either verbally or in the form of a diary, can assist adjustment and help people to make sense of their changed situation.
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Affiliation(s)
- Jan Pringle
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , UK and
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Cheng H, Sit JWH, Chan CWH, So WKW, Choi KC, Cheng KKF. Social support and quality of life among Chinese breast cancer survivors: findings from a mixed methods study. Eur J Oncol Nurs 2013; 17:788-96. [PMID: 23587632 DOI: 10.1016/j.ejon.2013.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/09/2013] [Accepted: 03/10/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Social support has been identified as a significant factor positively influencing quality of life (QOL) in breast cancer survivors. However, less is known about whether and how social support remains important among cancer survivors over the course of the survivorship trajectory. AIM To explore social support and its relationship with QOL in breast cancer survivors in China. METHODS This was a sequential mixed methods study. In Phase I, 100 breast cancer survivors were surveyed using standardized questionnaires. A multivariate regression analysis was performed to examine the relationship between social support and QOL after controlling for annual household income and length of survivorship. In Phase II, individual in-depth interviews were conducted to understand social support experience from 29 survivors selected from Phase I. Interview data were transcribed and analyzed using qualitative content analysis. RESULTS Survivors reported a median support network size of 2.2 persons (interquartile range = 1.2-3.8) and a median support satisfaction score of 5.5 (interquartile range = 5-6). While support satisfaction was found to be associated with QOL, no association was found between support network size and QOL. Interview findings revealed that close family members and peer survivors constituted the major source of breast cancer survivors' support, especially in emotional and informational support aspects. Cultural factors played a role in the perception and utilization of support of the breast cancer survivors. CONCLUSIONS This study has indicated that support satisfaction is more critical than support network size in influencing various aspects of survivors' QOL through the underlying different types of situation-specific support.
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Affiliation(s)
- Huilin Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
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Haghgoo HA, Pazuki ES, Hosseini AS, Rassafiani M. Depression, activities of daily living and quality of life in patients with stroke. J Neurol Sci 2013; 328:87-91. [PMID: 23522526 DOI: 10.1016/j.jns.2013.02.027] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/31/2013] [Accepted: 02/28/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Stroke patients are dealing with a wide variety of physical and psychological problems influencing their ability to carry out activities of daily living (ADL). The aim of the present study was to examine the relationship between the activity of daily living performances and degree of after stroke depression (ASD), as well as, the quality of life (QOL) in Iranian stroke survivors. MATERIALS AND METHOD In a cross sectional study, 40 patients with stroke in two Rehabilitation Centers for Stroke Patients, were recruited consecutively. They were assessed using the Modified Barthel Index, the Beck Depression Inventory-II (BDI-II), and a quality of life questionnaire (SF-36). Data were analyzed using Pearson and Spearman correlation coefficient. RESULTS Sixty five and one-half percent (65.5%) of the studied participants were either fully dependent or needed help in ADL. Also, 72.5% of the participants showed mild to severe ASD. There was a significant negative correlation between ADL performances and ASD and also between QOL and ASD. Furthermore a strong correlation was found between ADL and QOL. CONCLUSION ADL have a strong relationship with both level of depression and QOL in patients with stroke. It appears that motivating to perform ADL may enhance QOL. Further investigation with a larger sample size is required to better understand the causal relationship of these factors.
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Affiliation(s)
- Hojjat Allah Haghgoo
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Science, Tehran, Iran
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Balhara YPS, Verma R, Sharma S, Mathur S. A study of predictors of anxiety and depression among stroke patient-caregivers. J Midlife Health 2012; 3:31-5. [PMID: 22923977 PMCID: PMC3425146 DOI: 10.4103/0976-7800.98815] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Context: Caregivers play an important role in supporting people with illness either acute or chronic. It is important to explore caregiver's emotional turmoil as it helps in exploring their burden which can have impact on the patient's illness and functioning apart from their own. Aims: The current study aimed at assessing the predictors of anxiety and depression among caregivers of patients with stroke. Settings and Design: Seventy-five consecutive patient-caregiver dyads were recruited in the study. Materials and Methods: Patients and caregivers were assessed using a semi-structured proforma for the sociodemographic details. Subsequently these dyads were assessed for anxiety and depression levels using the Hospital Anxiety and Depression Scale. Statistical Analysis Used: Chi-square tests (for categorical variables) were used to find difference between the patients and the caregivers on different variables. Additionally Cramer's V-test and phi test were used for 2*4 contingency tables. Linear regression model was used. Results: Linear regression revealed that anxiety level in caregivers was predicted by the sex of care giver. Conclusions: Caring for the patients with stroke presents increased burden to the care givers which manifests as increased rate of anxiety and depression among them. It is important to assess the care givers along with the patients for emergence of these negative affective states. One needs to be extra cautious if the patient happens to be the primary earning member of the family.
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Affiliation(s)
- Yatan Pal Singh Balhara
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Plank A, Mazzoni V, Cavada L. Becoming a caregiver: new family carers’ experience during the transition from hospital to home. J Clin Nurs 2012; 21:2072-82. [DOI: 10.1111/j.1365-2702.2011.04025.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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