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Jacobi M, van der Schuur L, Seves BL, Brandenbarg P, Dekker R, Hettinga FJ, Hoekstra F, Krops LA, van der Woude LHV, Hoekstra T. Exploring experiences of people with stroke and health professionals on post-stroke fatigue guidance: getting the right people to the right care at the right time. Disabil Rehabil 2023:1-9. [PMID: 37950406 DOI: 10.1080/09638288.2023.2277398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This focus group study aimed to explore experiences and perceptions on post-stroke fatigue guidance in Dutch rehabilitation and follow-up care among people/patients with stroke and health professionals. METHODS Ten persons with stroke and twelve health professionals with different professions within stroke rehabilitation or follow-up care in the Netherlands were purposively sampled and included. Eight online focus group interviews were conducted. We analysed the data using reflexive thematic analysis. RESULTS Three themes were identified. Guidance in fatigue management did not always match the needs of people/patients with stroke. Professionals were positive about the provided fatigue guidance (e.g. advice on activity pacing), but found it could be better tailored to the situation of people/patients with stroke. Professionals believe the right time for post-stroke fatigue guidance is when people/patients with stroke are motivated to change physical activity behaviour to manage fatigue - mostly several months after stroke - while people/patients with stroke preferred information on post-stroke fatigue well before discharge. Follow-up care and suggestions for improvement described that follow-up support after rehabilitation by a stroke coach is not implemented nationwide, while people/patients with stroke and professionals expressed a need for it. CONCLUSIONS The study findings will help guide improvement of fatigue guidance in stroke rehabilitation programmes and stroke follow-up care aiming to improve physical activity, functioning, participation, and health.
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Affiliation(s)
- M Jacobi
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L van der Schuur
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B L Seves
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - F Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - L A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Hoekstra
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bhimani R, Xiong J, Anderson L. Fatigue Experiences in People With Stroke. Rehabil Nurs 2023; 48:200-208. [PMID: 37733016 DOI: 10.1097/rnj.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE Fatigue is a major symptom in patients with stroke. Because fatigue is an overarching multidimensional phenomenon, it is important to understand how the characteristics of fatigue change over time. The purpose of this study was to explore how fatigue characteristics change over time in patients with stroke. DESIGN This study used a mixed-method observational design. METHODS This study is a secondary analysis of data from a previous study, the results of which indicated fatigue to be a prominent symptom. Participants in that study were patients with stroke who met eligibility criteria and provided informed consent. This secondary analysis used data from numeric rating scale scores for fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue Scale scores, fatigue descriptors, and participant comments about fatigue gleaned from transcribed interviews. RESULTS Twenty-two patients participated in the study. Thirteen characteristics of fatigue were evaluated. Seven characteristics showed significant improvement ( p < .05) from admission to 1 month follow-up, and six characteristics did not change significantly. CONCLUSIONS Fatigue experiences vary over time and have both physical and mental aspects to them. CLINICAL RELEVANCE TO REHABILITATION NURSING Nurses may consider providing a quiet environment for physical rest, which may allow the brain to not be distracted by multiple stimuli.
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Affiliation(s)
- Rozina Bhimani
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Jiayue Xiong
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Lisa Anderson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
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Cabanas-Valdés R, García-Rueda L, Salgueiro C, Pérez-Bellmunt A, Rodríguez-Sanz J, López-de-Celis C. Assessment of the 4-meter walk test test-retest reliability and concurrent validity and its correlation with the five sit-to-stand test in chronic ambulatory stroke survivors. Gait Posture 2023; 101:8-13. [PMID: 36696822 DOI: 10.1016/j.gaitpost.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The 4-meter walk test (4-MWT) is a widely used measure to assess gait speed in the elderly but has not been validated for stroke survivors to date. OBJECTIVES To assess the test-retest reliability and concurrent validity of the 4-MWT compared to the 10-meter walk test (10-MWT) as a measure of gait speed in chronic post-stroke. SECONDARY OUTCOME MEASURE to assess the correlation of both gait measures with the 5 times sit-to-stand test (5TSTS). METHODS A cross-sectional observational study was conducted. Reliability was assessed by intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM) and minimal detectable change (MDC-95%). Bland & Altman analysis was used to quantify agreement between the 4-MWT and the 10-MWT. Two consecutive walking trials of the 4-MWT and 10-MWT followed by 5TSTS were performed all on the same day. A single researcher made all measurements. RESULTS Thirty-six chronic ambulatory post-stroke (average age 58.56 ± 11.28 years) were analyzed at their self-selected walking speed with a dynamic start. The 4-MWT showed excellent concurrent validity and test-retest reliability: ICC2.1 = 0.991 (95% CI: 0.983, 0.996); SEM= 0.032 and MDC- 95% = 0.090 m/second) with a strong positive correlation with the 10-MWT (r = 0.957, p < 0.001). The Bland & Altman analysis showed a concordance of -0.05 m/second bias (p = 0.039) (95% limits of agreement: 0.20 to -0.29 m/second). The paired t-test showed no statistically significant difference in the mean of both walking tests (p < 0.091). However, there was only moderate correlation between the two gait assessments and the 5TSTS. CONCLUSIONS This study indicates excellent test-retest reliability concurrent validity and strong correlation between 4-MWT and 10-MWT with a dynamic start at comfortable speed. The 4-MWT could be used as a measure of gait speed in both outpatients and home settings in chronic ambulatory stroke survivors.
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Affiliation(s)
- Rosa Cabanas-Valdés
- Universitat Internacional de Catalunya, Physiotherapy Department, Faculty of Medicine and Health Sciences, Sant Cugat del Vallés, Barcelona, Spain.
| | - Laura García-Rueda
- Universitat Internacional de Catalunya, PhD Program, Sant Cugat del Vallés, Barcelona, Spain.
| | - Carina Salgueiro
- Universitat Internacional de Catalunya, Physiotherapy Department, Faculty of Medicine and Health Sciences, Sant Cugat del Vallés, Barcelona, Spain; Clínica de Neurorehabilitación, Sant Cugat del Vallés, Barcelona, Spain.
| | - Albert Pérez-Bellmunt
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain.
| | - Jacobo Rodríguez-Sanz
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain.
| | - Carlos López-de-Celis
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
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Eriksson G, Larsson I, Guidetti S, Johansson U. Handling fatigue in everyday activities at five years after stroke: A long and demanding process. Scand J Occup Ther 2023; 30:228-238. [PMID: 35758254 DOI: 10.1080/11038128.2022.2089230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue is common and can be challenging after stroke. AIM To explore how post-stroke fatigue (PSF) was experienced and handled among people with stroke in their performance of everyday activities and in participation in social activities five years after stroke. METHODS Nine persons who perceived PSF one year after stroke onset were interviewed five years later. The interviews were analysed using qualitative content analysis. RESULTS Most participants experienced PSF even five years after stroke and reported longstanding difficulties in everyday activities. Handling fatigue-a long slow process with invisible adjustments in everyday life emerged as the theme. By implementing new strategies in everyday life their PSF lessened over time. Understanding among significant others as to how PSF appears and providing information about PSF early after stroke was perceived important. CONCLUSION This study adds new knowledge regarding experiences of PSF and long-term support needs. Even if PSF still was reported the participants experienced improvements in everyday life through the application of new strategies. Information about PSF and strategies for managing everyday life should be provided during rehabilitation. SIGNIFICANCE This study is one out of only a few focussing on long-term PSF and adjustment to its consequences in everyday life.
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Affiliation(s)
- Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ingrid Larsson
- Centre for Research & Development, Gävleborg - Uppsala University, Gävleborg, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ulla Johansson
- Centre for Research & Development, Gävleborg - Uppsala University, Gävleborg, Sweden
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Bicknell ED, Said CM, Haines KJ, Kuys S. “I Give It Everything for an Hour Then I Sleep for Four.” The Experience of Post-stroke Fatigue During Outpatient Rehabilitation Including the Perspectives of Carers: A Qualitative Study. Front Neurol 2022; 13:900198. [PMID: 35720087 PMCID: PMC9201517 DOI: 10.3389/fneur.2022.900198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fatigue is a debilitating post-stroke symptom negatively impacting rehabilitation. Lack of acknowledgment from carers can be additionally distressing. The purpose of this study was to describe the experience of post-stroke fatigue during outpatient rehabilitation, including the perspectives of carers. Methods This qualitative study was guided by descriptive phenomenology within a constructivist paradigm. Semi-structured interviews were conducted with stroke survivors experiencing fatigue (Fatigue Assessment Scale >23) and attending outpatient rehabilitation. Carers were also interviewed where identified, providing insight into their own and stroke survivor experiences. Data were analyzed according to Colaizzi's analytic method. Results Fourteen stroke survivors (50% culturally and linguistically diverse), and nine carers participated. Six themes were identified: 1. The unpredictable and unprepared uncovering of fatigue; 2. Experience and adjustment are personal 3. Being responsible for self-managing fatigue; 4. The complex juggle of outpatient stroke rehabilitation with fatigue; 5. Learning about fatigue is a self-directed problem-solving experience; 6. Family and carers can support or constrain managing fatigue. Conclusion Despite engaging in outpatient rehabilitation, stroke survivors largely learnt to manage fatigue independent of healthcare professionals. Carers often facilitated learning, monitoring rehabilitation, daily routines and fatigue exacerbation. Conversely, family could be dismissive of fatigue and possess unrealistic expectations. Post-stroke fatigue must be considered by clinicians when delivering outpatient rehabilitation to stroke survivors. Clinicians should consistently screen for fatigue, provide flexible session scheduling, and educate about individual indicators and strategies for management. Clinicians should also explicitly engage carers who play a critical role in the management of fatigue.
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Affiliation(s)
- Erin D. Bicknell
- School of Allied Health, Australian Catholic University, Brisbane, QLD, Australia
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia
- *Correspondence: Erin D. Bicknell
| | - Catherine M. Said
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science, St Albans, VIC, Australia
| | | | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Brisbane, QLD, Australia
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Ulrichsen KM, Kolskår KK, Richard G, Alnæs D, Dørum ES, Sanders AM, Tornås S, Sánchez JM, Engvig A, Ihle-Hansen H, de Schotten MT, Nordvik JE, Westlye LT. Structural brain disconnectivity mapping of post-stroke fatigue. NEUROIMAGE-CLINICAL 2021; 30:102635. [PMID: 33799271 PMCID: PMC8044723 DOI: 10.1016/j.nicl.2021.102635] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/15/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
We tested for associations between post stroke fatigue (PSF) and both lesion characteristics and brain structural disconnectome in 84 S patients. Results provided no evidence supporting a simple association between PSF severity and lesion characteristics or disconnectivity. PSF was strongly correlated with depression. Further studies including patients with more severe symptoms are needed to generalize the findings across a wider clinical spectrum.
Stroke patients commonly suffer from post stroke fatigue (PSF). Despite a general consensus that brain perturbations constitute a precipitating event in the multifactorial etiology of PSF, the specific predictive value of conventional lesion characteristics such as size and localization remains unclear. The current study represents a novel approach to assess the neural correlates of PSF in chronic stroke patients. While previous research has focused primarily on lesion location or size, with mixed or inconclusive results, we targeted the extended structural network implicated by the lesion, and evaluated the added explanatory value of a structural disconnectivity approach with regards to the brain correlates of PSF. To this end, we estimated individual structural brain disconnectome maps in 84 S survivors in the chronic phase (≥3 months post stroke) using information about lesion location and normative white matter pathways obtained from 170 healthy individuals. PSF was measured by the Fatigue Severity Scale (FSS). Voxel wise analyses using non-parametric permutation-based inference were conducted on disconnectome maps to estimate regional effects of disconnectivity. Associations between PSF and global disconnectivity and clinical lesion characteristics were tested by linear models, and we estimated Bayes factor to quantify the evidence for the null and alternative hypotheses, respectively. The results revealed no significant associations between PSF and disconnectome measures or lesion characteristics, with moderate evidence in favor of the null hypothesis. These results suggest that symptoms of post-stroke fatigue among chronic stroke patients are not simply explained by lesion characteristics or the extent and distribution of structural brain disconnectome, and are discussed in light of methodological considerations.
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Affiliation(s)
- Kristine M Ulrichsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway; Sunnaas Rehabilitation Hospital HT, Nesodden, Norway.
| | - Knut K Kolskår
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway; Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Geneviève Richard
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Dag Alnæs
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Bjørknes College, Oslo, Norway
| | - Erlend S Dørum
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway; Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Anne-Marthe Sanders
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway; Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | | | - Jennifer Monereo Sánchez
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Netherlands
| | - Andreas Engvig
- Department of Nephrology, Oslo University Hospital, Ullevål, Norway
| | | | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut Des Maladies Neurodégénératives- UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | | | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Norway.
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Bragstad LK, Lerdal A, Gay CL, Kirkevold M, Lee KA, Lindberg MF, Skogestad IJ, Hjelle EG, Sveen U, Kottorp A. Psychometric properties of a short version of Lee Fatigue Scale used as a generic PROM in persons with stroke or osteoarthritis: assessment using a Rasch analysis approach. Health Qual Life Outcomes 2020; 18:168. [PMID: 32503548 PMCID: PMC7275526 DOI: 10.1186/s12955-020-01419-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom associated with a wide range of diseases and needs to be more thoroughly studied. To minimise patient burden and to enhance response rates in research studies, patient-reported outcome measures (PROM) need to be as short as possible, without sacrificing reliability and validity. It is also important to have a generic measure that can be used for comparisons across different patient populations. Thus, the aim of this secondary analysis was to evaluate the psychometric properties of the Norwegian 5-item version of the Lee Fatigue Scale (LFS) in two distinct patient populations. METHODS The sample was obtained from two different Norwegian studies and included patients 4-6 weeks after stroke (n = 322) and patients with osteoarthritis on a waiting list for total knee arthroplasty (n = 203). Fatigue severity was rated by five items from the Norwegian version of the LFS, rating each item on a numeric rating scale from 1 to 10. Rasch analysis was used to evaluate the psychometric properties of the 5-item scale across the two patient samples. RESULTS Three of the five LFS items ("tired", "fatigued" and "worn out") showed acceptable internal scale validity as they met the set criterion for goodness-of-fit after removal of two items with unacceptable goodness-of-fit to the Rasch model. The 3-item LFS explained 81.6% of the variance, demonstrated acceptable unidimensionality, could separate the fatigue responses into three distinct severity groups and had no differential functioning with regard to disease group. The 3-item version of the LFS had a higher separation index and better internal consistency reliability than the 5-item version. CONCLUSIONS A 3-item version of the LFS demonstrated acceptable psychometric properties in two distinct samples of patients, suggesting it may be useful as a brief generic measure of fatigue severity. TRIAL REGISTRATION Clinicaltrials.gov: NCT02338869; registered 10/04/2014 (stroke study).
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Affiliation(s)
- Line Kildal Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, P.O Box 4956, Ullevaal, Nydalen, 0424, Oslo, Norway. .,Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, Faculty of Medicine, Institute of Health and Society, P.O. Box 1130, Blindern, N-0318, Oslo, Norway.
| | - Anners Lerdal
- Department of Nursing Science, University of Oslo, Faculty of Medicine, Institute of Health and Society, P.O. Box. 1130, Blindern, N-0318, Oslo, Norway.,Department for Patient Safety and Research, Lovisenberg Diaconal Hospital, P.O. Box 04970, Nydalen, N-0440, Oslo, Norway
| | - Caryl L Gay
- Department for Patient Safety and Research, Lovisenberg Diaconal Hospital, P.O. Box 04970, Nydalen, N-0440, Oslo, Norway.,Department of Family Health Care Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Marit Kirkevold
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, Faculty of Medicine, Institute of Health and Society, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Maren Falch Lindberg
- Department of Nursing Science, University of Oslo, Faculty of Medicine, Institute of Health and Society, P.O. Box. 1130, Blindern, N-0318, Oslo, Norway.,Department for Surgery, Lovisenberg Diaconal Hospital, P.O. Box 04970, Nydalen, N-0440, Oslo, Norway
| | - Ingrid Johansen Skogestad
- Department for Medicine, Lovisenberg Diaconal Hospital, P.O. Box 04970, Nydalen, N-0440, Oslo, Norway
| | - Ellen Gabrielsen Hjelle
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, Faculty of Medicine, Institute of Health and Society, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, P.O Box 4956, Ullevaal, Nydalen, 0424, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424, Oslo, Norway
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden
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Abstract
OBJECTIVE Assistive technology (AT) can help carers (family, friends and neighbours) and people with dementia to stay well and safely at home. There are important gaps in what we know about experience of using AT from the perspective of carers of persons with dementia. This study investigates carers' experience of using AT in supporting and caring for persons with dementia who live at home. DESIGN Qualitative phenomenological study with semi-structured interviews to achieve data saturation and thematic analysis to identify key themes. SETTING Community-based within the UK. PARTICIPANTS Twenty-three (14 women, 9 men) adult carers of persons with dementia who have used at least one AT device. RESULTS All participants reported benefiting to varying degrees from using AT. There were 5 themes and 18 subthemes that highlighted reasons for using AT and use of AT over time. Providing care for a person with dementia, motivation for using AT, changes to roles and routines, carer knowledge and skills for using AT and social, environmental and ethical considerations were the main themes. This study showed that AT can provide reassurance and support for carers of persons with dementia but there are difficulties with acquiring and continued use of AT as dementia progresses. CONCLUSIONS Carers consider AT as an adjunct to care they provided in caring for a person with dementia. Use of AT should be considered in the personal, social and environmental context of persons with dementia and their carers. Further research and policy interventions are needed to address best use of resources and guidance on data sharing and data protection while using AT.
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Affiliation(s)
- Vimal Sriram
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
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Thomas K, Hjalmarsson C, Mullis R, Mant J. Conceptualising post-stroke fatigue: a cross-sectional survey of UK-based physiotherapists and occupational therapists. BMJ Open 2019; 9:e033066. [PMID: 31826895 PMCID: PMC6924719 DOI: 10.1136/bmjopen-2019-033066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED With survival after stroke improving, more people are discharged into the community with multiple and persistent deficits. Fatigue is a common unmet need for stroke survivors, but there are no evidence-based guidelines for its assessment and management. This study explored how UK-based therapists conceptualise post-stroke fatigue (PSF) in current practice. OBJECTIVE To describe current understanding of PSF among physiotherapists (PT) and occupational therapists (OT). DESIGN A cross-sectional online survey using Qualtrics software (a survey creation and analysis programme) was sent to therapists working with stroke survivors in 2019. Responses to the open ended question, 'How would you describe PSF if approached by another healthcare professional?' were analysed thematically by two independent researchers. PARTICIPANTS 137 survey respondents (71 PT and 66 OT) from a range of clinical settings (25 acute care, 24 sub-acute rehabilitation care, 3 primary care and 85 community care) with 7 months-36 years of experience working with stroke survivors completed the survey. RESULTS Respondents stated that PSF should be regarded as an important medical condition because it is common and can be associated with severe symptoms. Symptoms were perceived to be highly variable and the syndrome was difficult to define objectively. It was felt to have both physical and cognitive components. A variety of different opinions were expressed with regard to causation, conceptualisation and best management. CONCLUSION Therapists working with stroke survivors conceptualise and manage PSF in different ways. Clinical practice is hampered by a lack of a widely adopted definition, and a small evidence base. Research into causes and management of PSF is a priority.
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Affiliation(s)
- Karen Thomas
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clarissa Hjalmarsson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ricky Mullis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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