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Lee NP, Pearson ES, Sanzo P, Klarner T. Exploring the personal stroke and rehabilitation experiences of older adults with chronic stroke during the COVID-19 pandemic: a qualitative descriptive study. Int J Qual Stud Health Well-being 2024; 19:2331431. [PMID: 38511399 PMCID: PMC10962289 DOI: 10.1080/17482631.2024.2331431] [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: 08/12/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE The purpose of this study was to explore the personal stroke and rehabilitation experiences of older adults with chronic stroke living in a mid-sized Northwestern Ontario city in Canada during the COVID-19 pandemic. METHODS A qualitative descriptive approach with a constructivist worldview was used. In addition, a semi-structured interview guide was used to gather the participants' perspectives on their experiences throughout stroke recovery. Ten participants were interviewed, including six males and four females. The interviews were completed, transcribed, and analysed using inductive and deductive content analysis. Multiple steps were taken to enhance data trustworthiness. RESULTS Six main themes and eight related subthemes emerged. These included: getting help is complex, the effects of stroke are multifaceted, losing rehabilitation services during the COVID-19 pandemic, overcoming hardships but not alone, "If you don't use it, you lost it": rehabilitative success is based on one's actions, and "look at me now": the importance of taking pride in one's successes. CONCLUSIONS One unique finding was that the participants used this study as an opportunity to teach and advocate for future stroke survivors which is not often seen in qualitative stroke rehabilitation research. Future stroke research should place emphasis on both the positive and negative experiences of this population.
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Affiliation(s)
- Nicole P. Lee
- CONTACT Nicole P. Lee School of Kinesiology, Lakehead University, 955 Oliver Rd, Thunder Bay, OntarioP7B5E1, Canada
| | | | - Paolo Sanzo
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Taryn Klarner
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
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Højgaard Nejst C, Glintborg C. Hope as experienced by people with acquired brain injury in a rehabilitation-or recovery process: a qualitative systematic review and thematic synthesis. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1376895. [PMID: 38807900 PMCID: PMC11131419 DOI: 10.3389/fresc.2024.1376895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024]
Abstract
Background There has been an increasing interest in the concept of hope within the field of brain injury rehabilitation. Existing reviews have nevertheless focused on stroke, leaving out the broad population of people with acquired brain injury (ABI). Furthermore a majority of the included studies in those reviews excluded the subgroup of people with communication difficulties, thus primarily giving voice to a select group of people with ABI. Methods A qualitative systematic review was conducted with the purpose of systematically reviewing and thematically synthesise findings about hope as experienced by adults with ABI in a rehabilitation or recovery process. The search strategy included peer-reviewed qualitative studies published after 2000 in English or Scandinavian languages. Searches of EBSCO databases incorporating CINAHL, MEDLINE, and PsycINFO were conducted together with SocINDEX, Social Work Abstracts, Eric and Web of Science. Ten qualitative studies were included, and the Critical Appraisal Skills Program (CASP) was used for assessing the quality and relevance of the ten studies. Qualitative findings were synthesized using Thomas and Harden's methodology. Results Through a thematic synthesis eleven subthemes were identified relating to experiences of hope. These were grouped into four analytical themes: (1) hope a two folded phenomenon; (2) time and temporality; (3) progress, goals and visibility and (4) the alliance; a balancing act requiring good communication skills. Conclusion This review has shown that even though hope has both a positive and negative side to it, it is necessary as a driving force for people with ABI in terms of supporting them to keep going and not give up. Rehabilitation professionals are advised to embrace the ambiguity of hope, customizing the support of hope to each person with ABI. Attention is needed on how to make progress visible for persons with ABI during their rehabilitation process just as rehabilitation professionals should acknowledge the alliance with the person with ABI as a core component of rehabilitation. This requires a focus on professionals' communication skills if hope promoting relationships between professionals and persons with ABI are to be achieved.
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Affiliation(s)
- Camilla Højgaard Nejst
- Neurorehabilitation Copenhagen, Municipality of Copenhagen, Copenhagen, Denmark
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Chalotte Glintborg
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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Lafiatoglou P, Ellis-Hill C, Gouva M, Ploumis A, Mantzoukas S. Older adults' lived experiences of physical rehabilitation for acquired brain injury and their perceptions of well-being: A qualitative phenomenological study. J Clin Nurs 2024; 33:1134-1149. [PMID: 38014630 DOI: 10.1111/jocn.16939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
AIM To explore the experiences of older adults (65+) living with acquired brain injury regarding their sense of well-being during physical rehabilitation within the Greek Healthcare System. BACKGROUND With the increasing ageing population and the life-changing effects of acquired brain injury, there is a need to focus on care for older people and their potential to live well. Rehabilitation systems deserve greater attention, especially in improving the well-being of those who are using them. DESIGN A qualitative study design with a hermeneutic phenomenological approach was used. METHODS Fourteen older adults living with acquired brain injury and undergoing physical rehabilitation in Greece were purposively sampled. Semi-structured interviews were conducted to collect data and were thematically analysed using van Manen's and Clarke and Braun's methods. The COREQ checklist was followed. RESULTS Four themes emerged from the analysis: (1) Challenges of new life situation, (2) Seeking emotional and practical support through social interaction, (3) Identifying contextual processes of rehabilitation, (4) Realising the new self. CONCLUSIONS The subjective experiences, intersubjective relations and contextual conditions influence the sense of well-being among older adults living with acquired brain injury, thus impacting the realisation of their new self. The study makes the notion of well-being a more tangible concept by relating it to the degree of adaptation to the new situation and the potential for older adults to create a future whilst living with acquired brain injury. RELEVANCE FOR CLINICAL PRACTICE Identifying the factors that impact older adults' sense of well-being during rehabilitation can guide healthcare professionals in enhancing the quality of care offered and providing more dignified and humanising care. PATIENT OR PUBLIC CONTRIBUTION Older adults living with acquired brain injury were involved in the study as participants providing the research data.
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Affiliation(s)
- Panagiota Lafiatoglou
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Mary Gouva
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Avraam Ploumis
- Department of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Stefanos Mantzoukas
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Corbin S, Damiolini E, Termoz A, Huchon L, Rode G, Schott AM, Haesebaert J. Rehabilitation professionals' views on individual peer support interventions for assisting stroke survivors with reintegration into the community: a qualitative study. Disabil Rehabil 2023; 45:4413-4423. [PMID: 36576210 DOI: 10.1080/09638288.2022.2152115] [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: 12/16/2021] [Accepted: 11/22/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE We aimed to explore stroke rehabilitation professionals' understanding and representations of peer support; the benefits they anticipated for patients; and the levers and barriers they perceived to implement the intervention in their practice. MATERIALS AND METHODS This qualitative study comprised four focus groups with 21 rehabilitation professionals and four semi-structured interviews. It was held in a French hospital. Interpretation was guided by the Consolidated Framework for Implementation Research. RESULTS Although professionals had poor knowledge on peer support, they identified many unmet needs of stroke survivors that peer support could meet such as social, emotional and informational support. Main barriers were the lack of human and financial resources, and of linkage between hospital and community professionals, and the fear that peer support would give false hope to survivors if not delivered properly. They showed ambivalence towards patient engagement, acknowledging its importance, but demonstrating top-down attitudes. They also identified potential avenues for the implementation of peer support for stroke survivors. CONCLUSIONS Our study supports the necessity to involve professionals in the construction of peer-support interventions and to sensitise them to provide patient-centred care. It delivers insights on effective implementation strategies to develop peer support interventions for stroke survivors reintegrating the community.
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Affiliation(s)
- Sara Corbin
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon 1, France
| | - Eleonore Damiolini
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon 1, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
| | - Laure Huchon
- Service de médecine physique et réadaptation, hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Equipe "Trajectoires", Centre de Recherche en Neurosciences de Lyon, Inserm UMR-S 1028, CNRS UMR 5292, Université de Lyon, Université Lyon 1, Bron, France
| | - Gilles Rode
- Service de médecine physique et réadaptation, hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Equipe "Trajectoires", Centre de Recherche en Neurosciences de Lyon, Inserm UMR-S 1028, CNRS UMR 5292, Université de Lyon, Université Lyon 1, Bron, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon 1, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon 1, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
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Elf M, Rasoal D, Zingmark M, Kylén M. The importance of context-a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke. BMC Health Serv Res 2023; 23:733. [PMID: 37415156 DOI: 10.1186/s12913-023-09735-7] [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: 10/18/2022] [Accepted: 06/22/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records. METHODS Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework. RESULTS The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home. CONCLUSIONS Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.
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Affiliation(s)
- Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Dara Rasoal
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Magnus Zingmark
- Department of Health Sciences, Lund University, Lund, Sweden
- Health and Social Care Administration, Östersund, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umåe, Sweden
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden.
- Department of Health Sciences, Lund University, Lund, Sweden.
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Lavis H, van Vliet P, Tavener M. Stroke survivor, caregiver and therapist experiences of home-based stroke rehabilitation: a thematic synthesis of qualitative studies. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2180710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Heidi Lavis
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Paulette van Vliet
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Meredith Tavener
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
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Connor EO, Dolan E, Horgan F, Galvin R, Robinson K. A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals' experiences of early supported discharge (ESD) after stroke. PLoS One 2023; 18:e0281583. [PMID: 36780444 PMCID: PMC9925006 DOI: 10.1371/journal.pone.0281583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. METHOD A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis. RESULTS Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. CONCLUSION The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.
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Affiliation(s)
- Elaine O. Connor
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
- Connolly Hospital, Blanchardstown, Dublin, Ireland
- * E-mail:
| | - Eamon Dolan
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
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Lo TLT, Lee JLC, Ho RTH. Recovery beyond functional restoration: a systematic review of qualitative studies of the embodied experiences of people who have survived a stroke. BMJ Open 2023; 13:e066597. [PMID: 36759032 PMCID: PMC9923291 DOI: 10.1136/bmjopen-2022-066597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To synthesise the qualitative evidence of embodied experiences of people who have survived a stroke, the experiences of making sense of oneself, others and the world in the poststroke bodies.DesignQualitative systematic review. DATA SOURCES Five electronic databases, PsycINFO, PubMed, MEDLINE, CINAHL Plus and Cochrane Library, were employed to search for qualitative studies published up to February 2022. INCLUSION CRITERIA Literature in English that employed qualitative methods to investigate the embodied experiences of people who have survived a stroke. QUALITY APPRAISAL Two reviewers independently appraised the quality of the included studies based on the tool developed by Salter et al in 2008. It consists of seven questions assessing the credibility and relevance of the studies. Discrepancies were resolved until a consensus was reached. DATA EXTRACTION AND SYNTHESIS Thematic synthesis was applied to synthesise the related findings from all the included studies. Two reviewers were involved in the process. RESULTS 1482 records were identified. After the screening process, 34 studies were included in this review. Three analytical themes and their related descriptive themes emerged. Analytical themes included 'disconnection between oneself, others and the world,' 'the transitional period: exploring and negotiating,' and 'reconnecting with oneself, others and the world'. CONCLUSION The findings demonstrated that the embodied experiences of people who have survived a stroke progressed from feeling disconnected to reconnecting with themselves, others and the world. Stroke recovery should not only be limited to functional restoration. Approaching 're-embodiment', the realignment between oneself and one's body, is crucial in reintegrating with others and the world on the trajectory toward recovery. PROSPERO REGISTRATION NUMBER CRD42020183125.
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Affiliation(s)
- Temmy Lee Ting Lo
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Janet Lok Chun Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong SAR
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR
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Murray CM, Weeks S, van Kessel G, Guerin M, Watkins E, Mackintosh S, Fryer C, Hillier S, Stanley M. Perspectives of choice and control in daily life for people following brain injury: A qualitative systematic review and meta‐synthesis. Health Expect 2022; 25:2709-2725. [DOI: 10.1111/hex.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Carolyn M. Murray
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Scott Weeks
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | | | - Michelle Guerin
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | | | - Shylie Mackintosh
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Caroline Fryer
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Susan Hillier
- Allied Health and Human Performance Academic Unit University of South Australia Adelaide South Australia Australia
| | - Mandy Stanley
- School of Medical and Health Sciences Edith Cowan University Joondalup Western Australia Australia
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Hall J, Kroll T, van Wijck F, Bassil-Morozow H. Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:877442. [PMID: 36189023 PMCID: PMC9397888 DOI: 10.3389/fresc.2022.877442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022]
Abstract
Background Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals. Methods This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions. Findings Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support. Conclusion Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.
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Affiliation(s)
- Joseph Hall
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
- *Correspondence: Joseph Hall
| | - Thilo Kroll
- UCD Centre for Education, Research and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Frederike van Wijck
- Research Centre for Health, School for Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Helena Bassil-Morozow
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
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Carlsson H, Lindgren I, Rosén B, Björkman A, Pessah-Rasmussen H, Brogårdh C. Experiences of SENSory Relearning of the UPPer Limb (SENSUPP) after Stroke and Perceived Effects: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063636. [PMID: 35329318 PMCID: PMC8955037 DOI: 10.3390/ijerph19063636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023]
Abstract
Recently, it was shown that sensory relearning of the upper limb (SENSUPP) is a promising intervention to improve sensorimotor function after stroke. There is limited knowledge, however, of how participants perceive the training. Here, we explored how persons with sensory impairments in the upper limb experienced the SENSUPP protocol (combined sensory- and motor training and home exercises for 5 weeks) and its effect. Fifteen persons (mean age 59 years; 10 men; >6 months post-stroke) were individually interviewed, and data were analyzed with qualitative content analysis. An overall theme ‘Sensory relearning was meaningful and led to improved ability to perform daily hand activities’ and two categories with six subcategories emerged. The outpatient training was perceived as meaningful, although the exercises were demanding and required concentration. Support from the therapist was helpful and training in small groups appreciated. The home training was challenging due to lack of support, time, and motivation. Small improvements in sensory function were perceived, whereas increased movement control and ability in performing daily hand activities were reported. In conclusion, the SENSUPP protocol is meaningful and beneficial in improving the functioning of the UL in chronic stroke. Improving compliance to the home training, regular follow-ups, and an exercise diary are recommended.
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Affiliation(s)
- Håkan Carlsson
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
- Correspondence:
| | - Ingrid Lindgren
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
| | - Birgitta Rosén
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden;
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
- Department of Clinical Sciences, Lund University, 221 00 Lund, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
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Man S, Bruckman D, Tang AS, Uchino K, Schold JD. The Association of Socioeconomic Status and Discharge Destination with 30-Day Readmission after Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:106146. [PMID: 34644664 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106146] [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: 06/12/2021] [Revised: 09/04/2021] [Accepted: 09/26/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES This study aimed to explore the association of socioeconomic status and discharge destination with 30-day readmission after ischemic stroke. MATERIALS AND METHODS We examined 30-day all-cause readmission among patients hospitalized for ischemic stroke in states of Arkansas, Iowa, and Wisconsin in 2016 and 2017 and New York in 2016 using Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases. RESULTS Among the 52301 patients included, 51.1% were female. The 30-day readmission rates were 10.2%, 8.2%, 9.3%, 10.4%, 11.6%, and 11.2% for age group 18-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years, respectively (p<0.001). In Generalized Estimating Equation analysis, patients with Medicare and Medicaid insurance were more likely to be readmitted, compared with private insurance, (adjusted Odds Ratio [aOR] 1.37, 95% CI 1.23-1.53; and aOR 1.26, 95% CI 1.09-1.45, respectively). Patients in the bottom quartile of zip code level median household income had higher 30-day readmission rate (12.4%) than those in the 2nd, 3rd and 4th quartile (10.3%, 10.1%, and 10.7%, respectively, p<0.001). Compared with those discharged home with self-care which had the lowest readmission rate (8.4%), patients who left against medical advice had the highest readmission rate (18.6%; aOR 2.23, 95% CI 1.75-2.83), followed by rehabilitation and skilled nursing facilities (13.2%; aOR 1.33, 95% CI 1.22-1.46), and home with home health care (11.3%, aOR 1.18, 95% CI 1.08-1.28). CONCLUSIONS Socioeconomic status and discharged destination affect readmission after stroke. These results provide evidence to inform vulnerable patient population as targets for readmission prevention.
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Affiliation(s)
- Shumei Man
- Department of Neurology, Neurological Institute, Cleveland Clinic, United States; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, United States.
| | - David Bruckman
- Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, United States
| | - Anne S Tang
- Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, United States
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, United States
| | - Jesse D Schold
- Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, United States
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Welch V, Mathew CM, Babelmorad P, Li Y, Ghogomu ET, Borg J, Conde M, Kristjansson E, Lyddiatt A, Marcus S, Nickerson JW, Pottie K, Rogers M, Sadana R, Saran A, Shea B, Sheehy L, Sveistrup H, Tanuseputro P, Thompson‐Coon J, Walker P, Zhang W, Howe TE. Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1175. [PMID: 37051456 PMCID: PMC8988637 DOI: 10.1002/cl2.1175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | | | | | - Yanfei Li
- Evidence‐Based Social Science Research Center, School of Public HealthLanzhou UniversityLanzhouChina
| | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership FieldFaroPortugal
| | | | | | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | | | - Morwenna Rogers
- NIHR ARC, South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | | | | | - Beverly Shea
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Lisa Sheehy
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Heidi Sveistrup
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
- Faculty of Health SciencesUniversity of OttawaOttawaCanada
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Peter Walker
- Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Wei Zhang
- Access to Medicines, Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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14
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Lafiatoglou P, Ellis-Hill C, Gouva M, Ploumis A, Mantzoukas S. A systematic review of the qualitative literature on older individuals' experiences of care and well-being during physical rehabilitation for acquired brain injury. J Adv Nurs 2021; 78:377-394. [PMID: 34397112 PMCID: PMC9291982 DOI: 10.1111/jan.15016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/24/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
Aims To acquire an in‐depth understanding of how older individuals diagnosed with acquired brain injury (ABI) experience their well‐being and care when undergoing physical rehabilitation. Design Systematic literature review. Data sources The electronic databases of PubMed, CINAHL, APA PsycInfo, ASSIA and SCOPUS were searched from 2005 to 2020. Extensive reference checking was also conducted. Review methods A systematic review was conducted following PRISMA guidelines, including predominantly qualitative studies. Studies’ quality was appraised using the critical apraisal skills programme (CASP) tool. Results Seventeen studies met the inclusion criteria. Following methods of thematic synthesis, four overarching interpretive themes were identified: (a) Rehabilitation processes and their impact on older individuals’ well‐being; (b) Identity and embodiment concerns of older individuals during rehabilitation; (c) Institutional factors affecting older individuals’ care and well‐being experiences; and (d) Older individuals’ participation in creative activities as part of rehabilitation. Conclusion Organizational and structural care deficiencies as well as health disparities can adversely impact older individuals’ autonomous decision‐making and goal‐setting potentials. The discrepancy between older individuals’ expectations and the reality of returning home along with the illusionary wish to return to a perceived normality, can further negatively affect older individuals’ sense of well‐being. Constructive communication, emotional support, family involvement in rehabilitation and creating a stimulating, enriching social environment can humanize and facilitate older individuals’ adjustment to their new reality following ABI. Impact There is a lack of qualitative research on older individuals’ ABI rehabilitation experiences, especially traumatic brain injury incidents. Further study should consider patients’ concerns over their involvement in decision‐making and goal setting about their care. Overall, this review reveals the need to examine further the significance of humanizing care and the factors that affect older individuals’ sense of well‐being.
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Affiliation(s)
| | | | - Mary Gouva
- Department of Nursing, University of Ioannina, Ioannina, Greece
| | - Avraam Ploumis
- Department of Medicine, University of Ioannina, Ioannina, Greece
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15
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Martinsen R, Kitzmüller G, Mangset M, Kvigne K, Evju AS, Bronken BA, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Nurses' and occupational therapists' experiences of conducting a home-based psychosocial intervention following stroke: a qualitative process evaluation. BMC Health Serv Res 2021; 21:791. [PMID: 34376188 PMCID: PMC8356405 DOI: 10.1186/s12913-021-06857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Persons with stroke are susceptible to psychosocial problems, and express disappointment at how health care professionals fail to meet their psychosocial needs following discharge to home. The responsibility of nurses and occupational therapists in stroke rehabilitation is to assist the persons and their families during the recovery and adjustment process. A home-based dialogical intervention aiming to enhance psychosocial support was therefore developed and tested in a randomized controlled trial. This study is a part of the process evaluation conducted alongside the trial. The aim was to explore the nurses’ and occupational therapists’ experiences of conducting the intervention. Methods Eighteen nurses and four occupational therapists participated in six focus groups to explore their experiences when providing the intervention. The themes discussed in the focus groups were the aspects that facilitated the delivering of the intervention and the challenges they encountered during the study period. The interviews were analysed using qualitative content analysis. Results The analysis generated two themes. The theme Developing a supportive relationship to facilitate the adjustment process following stroke had two subthemes: Getting personally involved and Handling challenges. This theme reveals how the nurses and occupational therapists experienced their relationship with the persons with stroke and potential threats which challenged them while conducting the intervention. The theme Developing professional skills in providing psychosocial support had two subthemes: Becoming confident in conducting dialogues and Integrating psychosocial topics. This theme reveals the aspects that the nurses and occupational therapists perceived as facilitating the development of their professional skills in conducting the dialogues. Conclusion Delivering the psychosocial intervention was perceived as deeply meaningful and increased the nurses’ and occupational therapists’ understanding of how to support stroke survivors to live with the consequences of stroke. However, balancing the professional and the personal relationship was challenging. A basic educational programme, training, supervision and having dedicated time were crucial elements to instil confidence in professionals conducting theme-based dialogues to promote post-stroke psychosocial well-being. Individual clinical experience and knowledge of stroke care were considering important to enable professionals to integrate psychosocial rehabilitation into community health care. Trial registration ClinicalTrials.gov, NCT 02338869, registered 10/04/2014.
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Affiliation(s)
- Randi Martinsen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway.
| | - Gabriele Kitzmüller
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kari Kvigne
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Anne Svelstad Evju
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Berit Arnesveen Bronken
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Line Kildal Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Gabrielsen Hjelle
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Geriatric Medicine and Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.
Method:
Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.
Results:
While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.
Conclusions:
Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.
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17
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van Dongen L, Hafsteinsdóttir TB, Parker E, Bjartmarz I, Hjaltadóttir I, Jónsdóttir H. Stroke survivors' experiences with rebuilding life in the community and exercising at home: A qualitative study. Nurs Open 2021; 8:2567-2577. [PMID: 33690972 PMCID: PMC8363348 DOI: 10.1002/nop2.788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 01/27/2023] Open
Abstract
Aim This study aimed to explore how stroke survivors deal with stroke‐related impairments when rebuilding their lives in the community and their experiences of exercising at home. Design An explorative and descriptive qualitative study. Methods A purposive sample of ten stroke survivors residing at home was recruited to explore experiences of rebuilding their lives in the community and exercising at home. One focus group interview was conducted followed by semi‐structured interviews. Data were analysed using thematic analysis. Results Three main themes were identified: “Framing exercise within the context of everyday life” describes how stroke survivors integrate exercise in everyday activities with varying success and the social importance of exercising; “Managing the challenges of physical impairment” describes the taxing undertakings in daily living, loss of concentration and identity; “Long‐term challenges of everyday life” describes how the stroke survivors manage depression and live with a sense of uncertainty.
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Affiliation(s)
- Lisa van Dongen
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ethna Parker
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Ingibjörg Hjaltadóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
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18
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Guo Y, Zhang Z, Lin B, Mei Y, Liu Q, Zhang L, Wang W, Li Y, Fu Z. The Unmet Needs of Community-Dwelling Stroke Survivors: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2140. [PMID: 33671734 PMCID: PMC7926407 DOI: 10.3390/ijerph18042140] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022]
Abstract
The unmet needs perceived by community-dwelling stroke survivors may truly reflect the needs of patients, which is crucial for pleasant emotional experiences and a better quality of life for community-dwelling survivors not living in institutionalized organizations. The purpose of the study is to identify the scope of unmet needs from the perspectives of stroke patients in the community. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. Six electronic databases were searched from inception to February 2020. A total of 24 articles were involved, providing data on 378 stroke survivors. Eight categories were derived from 63 findings, and then summarized into four synthesized findings based on the framework of ICF: (1) unmet needs regarding with the disease-related information; (2) unmet physical recovery and activity/participation needs; (3) unmet needs for social environmental resources; (4) unmet psycho-emotional support needs. We found the framework of ICF mostly complete, but unmet information needs still remain. The needs that are mainly unsatisfied include physical, psychosocial and informational, as well as the practical support from professional or environment resources. The ever-present unmet needs perceived by community-dwelling stroke survivors who do not live in institutions are discoverable and mitigable. Future studies should focus on quantifying unmet needs comprehensively derived from experiential domains, assessing the rationality of the unmet needs expressed by patients' perspectives and developing flexible strategies for long-term and changing needs.
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Affiliation(s)
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (Y.G.); (B.L.); (Y.M.); (Q.L.); (L.Z.); (W.W.); (Y.L.); (Z.F.)
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19
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Family Functioning Mediates the Relationship Between Activities of Daily Living and Poststroke Depression. Nurs Res 2021; 70:51-57. [PMID: 32956257 DOI: 10.1097/nnr.0000000000000472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poststroke depression is common and includes depressive and somatic symptoms. However, few studies have confirmed the influence of family functioning on poststroke depression or explored the association among daily activities, family functioning, and poststroke depression. OBJECTIVES We examined the independent risk factors of daily activities and family functioning for poststroke depression and identified the mediating effect of family functioning on the association between daily activities and poststroke depression. METHODS This cross-sectional study design used convenience sampling to recruit 422 stroke survivors from the neurology department of a hospital in Harbin, China, from February to July 2018. We assessed participants' demographic and clinical variables, including depression, daily activities, and family functioning. Pearson's correlations and multiple linear regression analyses were conducted, and a path analysis with bootstrapping was utilized to define direct/indirect effects. RESULTS Daily activities and family functioning had a significant and direct negative effect on participants' depression. The indirect effect of 1,000 bootstrap samples after bias correction with a 95% confidence interval was below zero, indicating that family function had a significant mediating effect on the association between depression and daily activities. DISCUSSION This study revealed the importance of family functioning in the association between depression and daily activities in stroke survivors. To the best of our knowledge, this study was the first to explore the mediating role of family functioning in poststroke depression, emphasizing the importance of family for the mental health of stroke patients. To reduce the incidence of poststroke depression, interventions that enhance daily activities and family functioning may include nurses, family therapists, rehabilitation physicians, and community workers.
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20
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Kjaerhauge Christiansen L, Rasmussen AM, Mouritzen HS, Østervig Buus AA, Grønkjaer M. Quickly home again: patients' experiences of early discharge after minor stroke. Scand J Caring Sci 2020; 35:1187-1195. [PMID: 33277947 DOI: 10.1111/scs.12937] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/25/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with minor stroke experience some of the same issues as patients experiencing stroke of increased severity such as fatigue, anxiety and cognitive symptoms. It is current practice that patients with minor stroke receive accelerated treatment and care, yet studies indicate that patients find it difficult to return to their everyday lives after being discharged. We aimed to explore how patients with minor stroke experience the transitional period from the hospital through the first 2-4 weeks after an accelerated care pathway with discharge within 72 hours after stroke onset. METHODS A qualitative study consisting of semi-structured interviews with 11 patients experiencing first-time stroke 2-4 weeks after discharge. RESULTS The patients struggled to identify themselves as having had a stroke. They strived to find a new everyday life, but were challenged by existential concerns, mental fatigue and the fear of having a stroke again. Unresolved questions and misunderstandings arose, and the patients expressed a need for health professionals to support them and discuss unclear issues after discharge. Patients searched for others with similar issues in order to find a new sense of self. CONCLUSION Patients with minor stroke struggle with everyday life after discharge. There is a need for support after discharge from healthcare professionals with specialised knowledge of stroke. Patients also requested an opportunity to meet other patients with minor stroke.
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Affiliation(s)
| | - Anitta M Rasmussen
- Acute Stroke Unit, Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Helle S Mouritzen
- Acute Stroke Unit, Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Mette Grønkjaer
- Clinical Nursing Research Unit, Department of Clinical Medicine, Aalborg University Hospital Aalborg University, Aalborg, Denmark
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21
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Gagin R, HaGani N, Levy I, Norman D. There Is No Place Like Home: A Survey on Satisfaction and Reported Outcomes of a Home-Based Rehabilitation Program Among Orthopedic Surgery Patients. J Patient Exp 2020; 7:1715-1723. [PMID: 33457635 PMCID: PMC7786787 DOI: 10.1177/2374373519892764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Home-based rehabilitation (HBR) was previously found to be associated with positive outcomes that are equal to inpatient rehabilitation. Few studies have examined the challenges patients are facing during rehabilitation and recovery and their satisfaction from HBR. OBJECTIVE The purpose of this study was to examine the overall satisfaction and reported outcomes of HBR. METHODS A telephone survey was conducted among 146 orthopedic surgery patients who participated in an HBR program, at the end of the HBR and 6 months after. The questionnaire included information about level of independence, satisfaction from HBR, and difficulties during HBR. FINDINGS The overall satisfaction was high (73.1%). Patients reported on improvements in level of independence between the time of hospital discharge, the end of the program (P = .0001), and the 6 months follow-up (P = .004). Long wait for beginning of HBR, being a widower, and residing in a facility or with a nonfamilial caregiver were associated significantly with less general well-being and independence. The repeated measures analysis showed age lower than 71 and private health insurance ownership were associated with a better recovery. The most common difficulties reported were physical difficulties, lack of function, and caregivers' burden. CONCLUSIONS Patients and families need more emotional, social, and physical support during HBR. The increase in health services delivered in community settings requires a more clear-cut policy and supervision for HBR and the follow-up services.
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Affiliation(s)
| | | | - Itay Levy
- Rambam Medical Center, Haifa, Israel
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22
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Hanna K, Mercer D, Rowe F. A qualitative exploration of the sociology of poststroke visual impairments and the associated health inequalities. Brain Behav 2020; 10:e01738. [PMID: 32588979 PMCID: PMC7428468 DOI: 10.1002/brb3.1738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Inequalities have been found to exist within the visually impaired stroke population on an individual level, in relation to demographic differences, unequal access to vision services, transport, employment, and financial repercussions. The long-term impact of living with poststroke visual impairments must be explored, in order to identify complications accessing NHS services and to inform possible changes to service planning and delivery in order to tackle such complications. AIM To explore the extent of health inequalities within visually impaired stroke survivors in the northwest of England and discuss potential solutions to these. METHODS Focus groups and individual interviews (n = 13 stroke survivors and n = 1 spouse) were conducted between October 2016 and January 2017. Transcription and thematic analysis of the transcripts was undertaken, using line-by-line coding, underpinned with social constructionism. RESULTS The findings draw on lived experiences of stroke survivors across their journey from prestroke to life after stroke. The three overarching experiences of stroke and visual impairment that emerged in respondent accounts were constructed in terms of "loss," concerning (a) the physical being, (b) the psychosocial being and, (c) the systematic organization of health care. CONCLUSION The stroke survivors frequently reported a complete lack of visual care, with many recounting apathetic experiences, often resonating power imbalance in the healthcare system. Where suitable care is being offered after stroke, a desire for a personalized approach to rehabilitation, with adapted communication methods specific to individual needs, featured strongly in many of the respondent accounts. The findings emphasize a need to ensure vision rehabilitation is offered to all stroke survivors suffering from poststroke visual impairment, and to educate stroke clinicians and patients of the bigger picture of life after stroke, highlighting all forms of available support.
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Affiliation(s)
- Kerry Hanna
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
| | - David Mercer
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
| | - Fiona Rowe
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
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23
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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: 37] [Impact Index Per Article: 9.3] [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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Experiences, needs, and preferences for follow-up after stroke perceived by people with stroke and healthcare professionals: A focus group study. PLoS One 2019; 14:e0223338. [PMID: 31574135 PMCID: PMC6772122 DOI: 10.1371/journal.pone.0223338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to explore the experiences, needs, and preferences regarding follow-up perceived by people with stroke and healthcare professionals. Methods This is a qualitative exploratory study using focus groups. Patients and healthcare professionals, participating in a clinical visit in primary care or specialised care, were purposively sampled. Data were analysed using a framework of analysis developed by Krueger. Results Focus groups were conducted with two patient groups (n = 10, range 45–78 years) and two multidisciplinary healthcare professional groups (n = 8, range 35–55 years). The overarching theme elucidates stroke as a long-term condition requiring complex follow-up. Three organisational themes and six subthemes were identified. People with stroke discovered feelings and changes after returning home. In daily life, problems and feelings of abandonment became evident. Participants expressed experiences of unequal access to health care services. Barriers for accessing appropriate treatment and support included difficulties in communicating one’s needs and lack of coherent follow-up. Follow-up activities were well functioning in certain clinics but did not provide continuity over the long term. Participants made suggestions for a comprehensive, planned, and tailored follow-up to meet patient needs. Conclusion Comprehensive long-term follow-up that is accessible to all patients is essential for equal support. Our findings raised awareness about problems discovered after returning home and the obstacles individuals face in communicating their needs. Structured follow-up, which is individually tailored, can empower patients.
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Bright FAS, McCann CM, Kayes NM. Recalibrating hope: A longitudinal study of the experiences of people with aphasia after stroke. Scand J Caring Sci 2019; 34:428-435. [PMID: 31487069 PMCID: PMC7432176 DOI: 10.1111/scs.12745] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
Background Hope is a critical resource for people with aphasia after stroke, sustaining people though times of distress and uncertainty and providing motivation. In the first months after stroke, hope is vulnerable to different influences, and people can struggle to identify and work towards hopes for the future. We have little knowledge about how people with aphasia experience hope in the longer term after stroke. Objectives To identify how people with aphasia experience hope 1 year after stroke and how hope may change in the year after stroke. Methods The study used an Interpretive Description methodology. Interviews were conducted with four people with aphasia who had been interviewed 1 year previously. These were analysed using content analysis. Results All people reported a broad sense of hope for the future. They described an active process of recalibrating their early poststroke hopes through a process of reflecting on past progress, current function and what they considered might be possible and desirable in the future. People were able to develop ‘new’ hopes that were meaningful and seemingly achievable when they had a sense of a possible, desirable future. Those who struggled to see a possible future maintained a hope that things will be good. Social supports, a sense of progress, engagement in meaningful activities and interactions appeared crucial in helping people (re)develop hopes for their future. Conclusions Hope and hopes for the future gradually changed after stroke. Hope, identity and social connectedness were closely entwined and could enable people to both dwell in the present and move towards desired futures. This research suggests clinicians should prioritise creating hope‐fostering environments which support people to develop hope for their future.
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Affiliation(s)
- Felicity A S Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Clare M McCann
- School of Psychology (Speech Science), University of Auckland, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Osborne CL, Neville M. Understanding the Experience of Early Supported Discharge from the Perspective of Patients with Stroke and Their Carers and Health Care Providers: A Qualitative Review. Nurs Clin North Am 2019; 54:367-384. [PMID: 31331624 DOI: 10.1016/j.cnur.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A systematic review of qualitative studies that examined the experience of early supported discharge (ESD) from the perspective of patients with stroke and their caregivers and health care providers revealed an emphasis on psychosocial aspects-the patient-provider relationship, the value of the home environment, and the ability to tailor treatment to meet patient-oriented goals. Patients, caregivers, and providers stressed the importance of clear and systematic communication throughout the ESD process to support transitions, prevent duplication of services, foster trust in relationships, and ensure that patients and caregivers have the knowledge and skills required to manage a chronic condition long term.
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Affiliation(s)
- Candice L Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, CS6.110 Charles Sprague Building, 5161 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Marsha Neville
- Department of Occupational Therapy, School of Occupational Therapy, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235, USA
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Bråndal A, Eriksson M, Glader EL, Wester P. Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry. BMC Neurol 2019; 19:40. [PMID: 30866844 PMCID: PMC6417172 DOI: 10.1186/s12883-019-1268-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD. METHODS Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD. RESULTS The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17-2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55-0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17-1.92), toileting (OR: 1.30, 95%CI: 1.05-1.61), and dressing (OR: 1.23, 95%CI: 1.02-1.48). CONCLUSION In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.
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Affiliation(s)
- Anna Bråndal
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden. .,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-901 87, Umeå, Sweden.
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business and Economics Umeå University, S-901 87, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden.,Department of Clinical Sciences, Karolinska Institute, Danderyd hospital, S-182 88, Stockholm, Sweden
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Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2018; 41:3025-3033. [DOI: 10.1080/09638288.2018.1483434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Maria Ranner
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Tham
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Health and Society, Malmö University, Malmö, Sweden
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Rizzo J, Bell A. Mental models of adherence: parallels in perceptions, values, and expectations in adherence to prescribed home exercise programs and other personal regimens. Disabil Rehabil 2018; 41:2412-2420. [PMID: 29739240 DOI: 10.1080/09638288.2018.1466923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Purpose: A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. Methods: The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Results: Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Conclusion: Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients customarily use to adhere to other activities may inform strategies to promote prescribed home exercise adherence.
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Affiliation(s)
- Jon Rizzo
- a Department of Kinesiology , University of Connecticut , Storrs , CT , USA
| | - Alexandra Bell
- b Department of Educational Leadership , University of Connecticut , Storrs , CT , USA
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Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, Mant J. Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography. PLoS One 2018; 13:e0192533. [PMID: 29466383 PMCID: PMC5821463 DOI: 10.1371/journal.pone.0192533] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/25/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services. Design Systematic review and meta-ethnography. Data sources Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015). Eligibility criteria Primary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services. Data synthesis A set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria. Results 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke. Limitations Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems. Conclusions Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services. Systematic review registration number PROSPERO 2015:CRD42015026602
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Affiliation(s)
- Dominika M. Pindus
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ricky Mullis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Lisa Lim
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - A. Viona Rundell
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Noor Azah Abd Aziz
- Department of Family Medicine, National University of Malaysia, Bandar Tun Razak Cheras, Kuala Lumpur, Malaysia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
- * E-mail:
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Bjornsdottir K. 'Holding on to life': An ethnographic study of living well at home in old age. Nurs Inq 2017; 25:e12228. [PMID: 29235234 DOI: 10.1111/nin.12228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Abstract
In recent years, much attention has been paid to how older people living at home can remain independent and manage their illness themselves, while less attention has been given to those who have become frail and need assistance with challenges of everyday life. In this article, I drew on Latimer's formulation of care for frail older people as relational and world-making and on Foucault's work related to the care of the self in developing an understanding of how frail older persons manage to live well at home in the final years of their lives. I use data from an ethnographic study of home care nursing in the homes of 15 frail older people to develop an understanding of how their care at home can be developed. The participants were holding on to life, which reflected their vitality and vulnerability as well as agency in continuing to explore ways to preserve and build their world at home. With declining ability and stamina relations with material things, relatives and official care workers become of central importance in holding on to life. Home care services can be thought of as part of life, as world-forming, where workers contribute to daily activities that support living well at home.
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Affiliation(s)
- Kristin Bjornsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disabil Rehabil 2017; 41:396-404. [DOI: 10.1080/09638288.2017.1393698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mia Ingerslev Loft
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
- Clinic of Neurorehabilitation, TBI unit, Rigshospitalet, Hvidovre, Denmark
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Mairami FF, Allotey P, Warren N, Mak JS, Reidpath DD. Adaptive invention: independence and mobility through modifications. Disabil Rehabil Assist Technol 2017; 13:658-664. [DOI: 10.1080/17483107.2017.1369586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fatima Fanna Mairami
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
| | - Narelle Warren
- School of Social Sciences, Clayton Campus, Monash University, Melbourne, Australia
| | - Jun Shin Mak
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Daniel Diamond Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
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Vansimaeys C, Zuber M, Pitrat B, Join-Lambert C, Tamazyan R, Farhat W, Bungener C. Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol. Front Psychol 2017; 8:1172. [PMID: 28747895 PMCID: PMC5506189 DOI: 10.3389/fpsyg.2017.01172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022] Open
Abstract
Context: Stroke has several consequences on survivors’ daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders. Although previous studies have brought promising perspectives, their designs based on retrospective tools involve some limits regarding their ecological validity. Ecological Momentary Assessment (EMA) is an alternative to conventional instruments that could be a key in research for understanding processes that underlined post-stroke depression and anxiety onset. We aim to evaluate the feasibility and validity of anxiety, depression and coping EMA for minor stroke patients. Methods: Patients hospitalized in an Intensive Neuro-vascular Care Unit between April 2016 and January 2017 for a minor stroke is involved in a study based on an EMA methodology. We use a smartphone application in order to assess anxiety and depression symptoms and coping strategies four times a day during 1 week at three different times after stroke (hospital discharge, 2 and 4 months). Participants’ self-reports and clinician-rates of anxiety, depression and coping are collected simultaneously using conventional and standard instruments. Feasibility of the EMA method will be assessed considering the participation and compliance rate. Validity will be the assessed by comparing EMA and conventional self-report and clinician-rated measures. Discussion: We expect this study to contribute to the development of EMA using smartphone in minor stroke population. EMA method offers promising research perspective in the assessment and understanding of post-stroke psychological disorders. The development of EMA in stroke population could lead to clinical implications such as remotely psychological follow-ups during early supported discharge. Trial registration: European Clinical Trials Database Number 2014-A01937-40
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Affiliation(s)
- Camille Vansimaeys
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Mathieu Zuber
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Benjamin Pitrat
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de ParisParis, France
| | - Claire Join-Lambert
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Ruben Tamazyan
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Wassim Farhat
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Catherine Bungener
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
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VanderKaay S, Moll SE, Gewurtz RE, Jindal P, Loyola-Sanchez A, Packham TL, Lim CY. Qualitative research in rehabilitation science: opportunities, challenges, and future directions. Disabil Rehabil 2016; 40:705-713. [PMID: 27973927 DOI: 10.1080/09638288.2016.1261414] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Qualitative research has had a significant impact within rehabilitation science over time. During the past 20 years the number of qualitative studies published per year in Disability and Rehabilitation has markedly increased (from 1 to 54). In addition, during this period there have been significant changes in how qualitative research is conceptualized, conducted, and utilized to advance the field of rehabilitation. The purpose of this article is to reflect upon the progress of qualitative research within rehabilitation to date, to explicate current opportunities and challenges, and to suggest future directions to continue to strengthen the contribution of qualitative research in this field. METHODS Relevant literature searches were conducted in electronic data bases and reference lists. Pertinent literature was examined to identify current opportunities and challenges for qualitative research use in rehabilitation and to identify future directions. RESULTS Six key areas of opportunity and challenge were identified: (a) paradigm shifts, (b) advancements in methodology, (c) emerging technology, (d) advances in quality evaluation, (e) increasing popularity of mixed methods approaches, and (f) evolving approaches to knowledge translation. Two important future directions for rehabilitation are posited: (1) advanced training in qualitative methods and (2) engaging qualitative communities of research. CONCLUSION Qualitative research is well established in rehabilitation and has an important place in the continued growth of this field. Ongoing development of qualitative researchers and methods are essential. Implications for Rehabilitation Qualitative research has the potential to improve rehabilitation practice by addressing some of the most pervasive concerns in the field such as practitioner-client interaction, the subjective and lived experience of disability, and clinical reasoning and decision making. This will serve to better inform those providing rehabilitation services thereby benefiting patients that are utilizing these services. Changes over time in how qualitative research is conceptualized, conducted, and utilized to advance rehabilitation science have resulted in a number of unique opportunities and challenges in using qualitative research that must be considered within this field. Advances in methodology and increased expectations for evaluation must be considered to ensure quality and credibility of qualitative rehabilitation research within rehabilitation. Improved quality and credibility may increase likelihood of research dissemination and use by clinicians intervening within the rehabilitation process in order to improve clinical practice. In order to maximize opportunities and mitigate challenges there are two principal future directions for rehabilitation scientists to consider: (1) advancing training in qualitative methods to adequately prepare future rehabilitation scientists and (2) engaging qualitative communities of research.
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Affiliation(s)
- Sandra VanderKaay
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Sandra E Moll
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Rebecca E Gewurtz
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Pranay Jindal
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | | | - Tara L Packham
- c Hamilton Health Sciences , Hand Therapy Clinic , Hamilton , Ontario , Canada
| | - Chun Y Lim
- d Department of Child Development , KK Women's And Children's Hospital , Singapore
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Lou S, Carstensen K, Møldrup M, Shahla S, Zakharia E, Nielsen CP. Early supported discharge following mild stroke: a qualitative study of patients' and their partners' experiences of rehabilitation at home. Scand J Caring Sci 2016; 31:302-311. [PMID: 27481568 DOI: 10.1111/scs.12347] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early supported discharge (ESD) allows mild-to-moderate stroke patients to return home as soon as possible and continue rehabilitation at their own pace in familiar surroundings. Thus, the main responsibility for continued rehabilitation is in the hands of patients and their partners, who must collaborate to adjust to poststroke everyday life. However, couples' joint experiences of stroke, early discharge and rehabilitation at home remain minimally investigated. AIM To investigate how mild stroke patients' and their partners' experience and manage everyday life in a context of ESD. METHODS We conducted qualitative interviews with a purposive sample of 22 ESD patients and 18 partners. Interviews were conducted 3-6 weeks after stroke, and we used thematic analysis to analyse the data. FINDINGS The analysis identified three themes. First, 'Home as a healing place' involved the couples' experiences of a well-informed discharge from hospital. They trusted the health professionals' assessment that the patient was ready to go home. They described home as a comforting and calm place, where recovery could meaningfully take place. The second theme, 'Flow of everyday life', comprised the experiences of adapting to and continuing everyday life. Most of the interviewees had relatively minor physical and cognitive impairments, and the patients and their partners were hopeful for a full recovery in the foreseeable future. Finally, 'Professional safety net' involved the much appreciated stroke team. Although most of the participants only had one visit from the team, knowing that they were an accessible resource was very important to the couples. CONCLUSION ESD was experienced as a meaningful and adequate rehabilitation service that allowed patients and partners to collaboratively reinvent and rebuild their flow of everyday life by jointly adjusting routines, activities and their relationship.
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Affiliation(s)
- Stina Lou
- CFK- Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | - Kathrine Carstensen
- CFK- Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | - Marie Møldrup
- Department of Rehabilitation, Horsens Regional Hospital, Horsens, Denmark
| | - Seham Shahla
- Department of Internal Medicine/Geriatrics, Randers Regional Hospital, Randers, Denmark
| | - Elias Zakharia
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
| | - Camilla Palmhøj Nielsen
- CFK- Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
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Lou S, Carstensen K, Jørgensen CR, Nielsen CP. Stroke patients’ and informal carers’ experiences with life after stroke: an overview of qualitative systematic reviews. Disabil Rehabil 2016; 39:301-313. [DOI: 10.3109/09638288.2016.1140836] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Stina Lou
- CFK – Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | - Kathrine Carstensen
- CFK – Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
| | | | - Camilla Palmhøj Nielsen
- CFK – Public Health & Quality Improvement, Central Denmark Region, Aarhus N, Denmark
- Institute of Public Health, Health, Aarhus University, Aarhus N, Denmark
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Nordin Å, Sunnerhagen KS, Axelsson ÅB. Patients' expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study. BMC Neurol 2015; 15:235. [PMID: 26572860 PMCID: PMC4647613 DOI: 10.1186/s12883-015-0492-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients' expectations of coming home very early after stroke with support and rehabilitations at home. METHOD This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0-5 days before discharge and the material was analyzed with qualitative content analysis. RESULTS Four main categories containing 11 subcategories were found. The VESD team was expected to provide "Support towards independency", by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to "A new and unknown situation", causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, "Returning to one's own setting" described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. "A new everyday life" waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. CONCLUSIONS The participants described mixed expectations such as insecurity and fear, and on the other hand, longing to come home. Moreover, they had a high degree of confidence in the expected support of the VESD team. The health professionals at the hospital may build on this trust to reduce the patients' insecurity for coming home. In addition, it may be beneficial to explore the patients' expectations thoroughly in front of discharge, as certain feelings and thoughts could complicate or support the home coming process. Thus, a greater attention on such expectations may facilitate the patient's transition from hospital to home after stroke.
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Affiliation(s)
- Åsa Nordin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Sunnaas Rehabilitation Hospital, Nesodden, Oslo, Norway.
| | - Åsa B Axelsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Taule T, Strand LI, Assmus J, Skouen JS. Ability in daily activities after early supported discharge models of stroke rehabilitation. Scand J Occup Ther 2015; 22:355-65. [PMID: 26005768 PMCID: PMC4673522 DOI: 10.3109/11038128.2015.1042403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
UNLABELLED More knowledge is needed about how different rehabilitation models in the municipality influence stroke survivors' ability in activities of daily living (ADL). OBJECTIVES To compare three models of outpatient rehabilitation; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke. METHODS A group comparison study was designed within a randomized controlled trial. Included participants were tested with the Assessment of Motor and Process Skills (AMPS) at baseline and discharged directly home. Primary and secondary outcomes were the AMPS and the modified Rankin Scale (mRS). RESULTS AND CONCLUSIONS Included were 154 participants (57% men, median age 73 years), and 103 participants completed the study. There were no significant group differences in pre-post changed ADL ability measured by the AMPS. To find the best rehabilitation model to improve the quality of stroke survivors' motor and process skills needs further research. Patients participating in the ESD rehabilitation models were, compared with traditional treatment, significantly associated with improved ADL ability measured by the mRS when controlling for confounding factors, indicating that patients with social needs and physical impairment after stroke may benefit from ESD rehabilitation models.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital (HUH) , Bergen , Norway
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