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Jacobs M, Evans E, Ellis C. Exploring the association between social determinants and aphasia impairment: A retrospective data integration approach. PLoS One 2024; 19:e0299979. [PMID: 38512886 PMCID: PMC10956803 DOI: 10.1371/journal.pone.0299979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Traditionally, the study of aphasia focused on brain trauma, clinical biomarkers, and cognitive processes, rarely considering the social determinants of health. This study evaluates the relationship between aphasia impairment and demographic, socioeconomic, and contextual determinants among people with aphasia (PWA). METHODS PWA indexed within AphasiaBank-a database populated by multiple clinical aphasiology centers with standardized protocols characterizing language, neuropsychological functioning, and demographic information-were matched with respondents in the Medical Expenditure Panel Survey based on response year, age, sex, race, ethnicity, time post stroke, and mental health status. Generalized log-linear regression models with bootstrapped standard errors evaluated the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and demographic, economic, and contextual characteristics accounting for clustering of respondents and the stratification of data collection. Region, age, and income specific models tested the sensitivity of results. RESULTS PWA over age 60 had 2.4% (SE = 0.020) lower WAB-R AQ scores compared with younger PWA. Compared to White PWA, Black and Hispanic PWA had 4.7% (SE = 0.03) and 0.81% (SE = 0.06) lower WAB-R AQ scores, respectively, as did those and living in the Southern US (-2.2%, SE = 0.03) even after controlling for age, family size, and aphasia type. Those living in larger families (β = 0.005, SE = 0.008), with income over $30,000 (β = 0.017, SE = 0.022), and a college degree (β = 0.030, SE = 0.035) had higher WAB-R AQ relative to their counterparts. Region-specific models showed that racial differences were only significant in the South and Midwest, while ethnic differences are only significant in the West. Sex differences only appeared in age-specific models. Racial and ethnic differences were not significant in the high-income group regression. CONCLUSION These findings support evidence that circumstances in which individuals live, work, and age are significantly associated with their health outcomes including aphasia impairment.
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Affiliation(s)
- Molly Jacobs
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, Communication Equity and Outcomes Laboratory, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, Communication Equity and Outcomes Laboratory, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
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Wang CY, Petriello M, Chou J, Zorowitz RD. Comparison of Functional Outcomes After Acute Inpatient Rehabilitation After Acquired Brain Injury Before and During the COVID-19 Pandemic. Am J Phys Med Rehabil 2023; 102:896-900. [PMID: 37026824 DOI: 10.1097/phm.0000000000002243] [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: 04/08/2023]
Abstract
OBJECTIVE The objective of this study was to characterize and compare functional outcomes of acquired brain injury patients in an inpatient rehabilitation facility in the year before (April 2019-March 2020) and during the first year (April 2020-March 2021) of the COVID-19 pandemic, when the most drastic changes in the delivery of health care occurred. DESIGN In this retrospective single-center chart review study, functional outcomes, based on the Center for Medicare and Medicaid Services Inpatient Rehabilitation Facility-Patient Assessment Instrument, were obtained and analyzed for patients in acute inpatient rehabilitation with acquired brain injury. RESULTS Data from 1330 patients were included for analysis. Functional outcomes of average self-care, bed mobility, and transfer scores were statistically, but not clinically, different between groups. More patients in the pandemic group were discharged home (prepandemic n = 454 [65.4%]; pandemic n = 461 [72.6%]; P = 0.011), although they had significantly longer lengths of stay (prepandemic median = 14.0 [interquartile range = 9.0-23.0]; pandemic = 16.0 [10.0-23.0]; P = 0.037). CONCLUSIONS Despite the impact of hospital policies due to the COVID-19 pandemic, similar functional outcomes were obtained for those with acquired brain injury after inpatient rehabilitation.
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Affiliation(s)
- Christine Yunjae Wang
- From the Department of Physical Medicine and Rehabilitation, Georgetown University/Medstar National Rehabilitation Hospital, Washington, DC (CYW, MP); Department of Physical Medicine and Rehabilitation, Lifebridge Health: Sinai Hospital of Baltimore, Baltimore, Maryland (CYW); Department of Orthopaedic Surgery, Stanford University, Stanford, California (MP); Center of Biostatistics, Informatics and Data Science (CBIDS), Medstar Health Research Institute, Hyattsville, Maryland (JC); Georgetown University School of Medicine, Washington, DC (RDZ); and MedStar National Rehabilitation Network, Washington, DC (RDZ)
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Deepradit S, Powwattana A, Lagampan S, Thiangtham W. Effectiveness of a family-based program for post-stroke patients and families: A cluster randomized controlled trial. Int J Nurs Sci 2023; 10:446-455. [PMID: 38020842 PMCID: PMC10667323 DOI: 10.1016/j.ijnss.2023.09.020] [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: 05/22/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To examine the effectiveness of a family-based program for post-stroke patients and their families. Methods A cluster randomized controlled trial design was used. Participants were randomly selected in the experimental group (3 districts) and the comparison group (3 districts), with 62 families recruited. Sixty-two persons with new stroke and families (family caregivers and family members) who met the inclusion criteria were assigned to two groups, 31 in each group. Using the Neuman System Model as a framework, we implemented the stressors assessment and family-based intervention into the program. Participants in the comparison group received usual care, and those in the experimental group underwent a stressors assessment and received the family-based program. Measurement of functional status, depression, and complications in post-stroke patients and family function in family caregivers and family members, as well as caregiver burden and caregiver stress in family caregivers, were assessed at baseline, 4 weeks, and 12 weeks after enrollment. Data analysis included descriptive statistics, the chi-square test, Bonferroni test, and repeated measures analysis of variance. Results After participating in a 12-week family-based program, post-stroke patients in the experimental group showed statistically significant improvements in their functional status and decreased depression compared to the comparison group (P < 0.05). The family function of the experimental group was significantly improved, and caregivers' burden and stress were decreased compared to the comparison group (P < 0.05). Three patients in the experimental group and seven in the comparison group experienced complications. Conclusions The study findings suggest that the present family-based program improved family function in family caregivers and family members and decreased caregiver burden and stress in family caregivers. The program also improved functional status and reduced depression in post-stroke patients. It is suggested the duration of the program be extended to assess its sustainable effectiveness.
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Affiliation(s)
- Saisunee Deepradit
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Arpaporn Powwattana
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Sunee Lagampan
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Weena Thiangtham
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
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Jacobs M, Evans E, Ellis C. Intersectional sociodemographic and neurological relationships in the naming ability of persons with post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106352. [PMID: 37331326 DOI: 10.1016/j.jcomdis.2023.106352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 05/16/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Significant attention has been given to the role of brain function and disruption in determining performance on naming tasks among individuals with aphasia. However, scholarly pursuit of a neurological explanation has overlooked the fundamental cornerstone of individual health-the underlying social, economic, and environmental factors that shape how they live, work, and age, also known as the social determinants of health (SDOH). This study examines the correlation between naming performance and these underlying factors. METHODS Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database (MAPPD) was matched with the 2009-2011 Medical Expenditure Panel Survey (MEPS) using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between the Boston Naming Test (BNT) percentile score and age, income, sex, race, household size, marital status, aphasia type, and region of residence. Poisson regression models with bootstrapped standard errors were used to estimate these relationships RESULTS: Discrete dependent variable estimation with non-normal prior specification included individual level (age, marital status, years of education), socioeconomic (family income), health (aphasia type), household (family size), and environmental (region of residence) characteristics. Regression results indicated that, relative to individuals with Wernicke's, individuals with Anomic (0.74, SE = 0.0008) and Conduction (0.42, SE = 0.0009) aphasia performed better on the BNT. While age at the time of testing was not significantly correlated, higher income level (0.15, SE = 0.0003) and larger family size (0.002, SE = 0.002) was associated with higher BNT score percentiles. Finally, Black persons with aphasia (PWA) (-0.0124, SE = 0.0007) had lower average score percentiles when other factors were held constant. CONCLUSIONS The findings reported here suggest higher income and larger family size are associated with better outcomes. As expected, aphasia type was significantly associated with naming outcomes. However, poorer performance by Black PWA and individuals with low income suggests that SDOH can play a critical role (positive and negative) in naming impairment in some populations with aphasia.
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Affiliation(s)
- Molly Jacobs
- Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, United States
| | - Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States.
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Lawler K, Taylor NF, Shields N. Let families decide: Barriers and enablers to participation in family-assisted therapy for older people in transition care. Australas J Ageing 2023; 42:499-507. [PMID: 36527306 DOI: 10.1111/ajag.13167] [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: 08/12/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To understand the barriers and enablers to participation in family-assisted therapy for older people in Transition Care. METHODS A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members, who either participated in or chose not to participate in a family-assisted therapy trial. Semi-structured interviews were conducted, transcribed verbatim and analysed thematically. RESULTS Forty-four participants were interviewed (17 patients and 27 family members). The unifying theme was to let families decide about participation in family-assisted therapy. The unifying theme was illustrated by three subthemes. The first, what is possible for the family now, described practical considerations including geography, paid and unpaid work structure and commitments and the presence of fit and willing social networks. The second, what is important to the family now, recognised the role of family priorities in deciding. Physical rehabilitation and extra therapy were of high importance to some families. For others, emotional support or searching for a residential aged care bed were more important at the time. Finally, how the family functions described the complexity of relationships and family history that impacted the decision to participate. CONCLUSIONS The decision to participate in family-assisted therapy is complex and is best made by patients and their families. Clinicians offering family-assisted therapy are encouraged to avoid assuming what will or will not work for families and instead, to let families decide.
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Affiliation(s)
- Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Vaalburg AM, Boersma P, Wattel EM, Ket JCF, Hertogh CMPM, Gobbens RJJ. Supporting older patients in working on rehabilitation goals: A scoping review of nursing interventions. Int J Older People Nurs 2023:e12542. [PMID: 37082887 DOI: 10.1111/opn.12542] [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: 01/20/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Nurses are consistently present throughout the rehabilitation of older patients but are apprehensive about performing goal-centred care in the multidisciplinary team. OBJECTIVES The aim of this review was to explore working interventions on setting goals and working with goals designed for nurses in geriatric rehabilitation, and to describe their distinctive features. METHODS We performed a scoping review. We searched MEDLINE and CINAHL through August 4, 2021. Search terms related to the following themes: nurses, rehabilitation, geriatric, goal and method. We used snowballing to find additional. From the selected studies, we systematically extracted data on means, materials and the nursing role and summarized them in a narrative synthesis, using intervention component analysis. RESULTS The study includes 13 articles, describing 11 interventions which were developed for six different aims: improving multidisciplinary team care; increasing patient centredness; improving disease management by patients; improving the psychological, and emotional rehabilitation; increasing the nursing involvement in rehabilitation; or helping patients to achieve goals. The interventions appeal to four aspects of the nursing profession: assessing self-care skills incorporating patient's preferences; setting goals with patients, taking into account personal needs and what is medically advisable; linking the needs of the patient with multidisciplinary professional treatment and vice versa; and thus, playing an intermediate role and supporting goal achievement. CONCLUSIONS The interventions show that in goal-centred care, the nurse might play an important unifying role between patients and the multidisciplinary team. With the support of nurses, the patient may become more aware of the rehabilitation process and transfer of ownership of treatment goals from the multidisciplinary team to the patient might be achieved. Not many interventions were found meant to support the nursing role. This may indicate a blind spot in the rehabilitation community to the additional value of its contribution.
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Affiliation(s)
- Anne Marie Vaalburg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
- University Network of Organizations for Care for Older People of Amsterdam University Medical Centers (UNO Amsterdam), Amsterdam, Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
- University Network of Organizations for Care for Older People of Amsterdam University Medical Centers (UNO Amsterdam), Amsterdam, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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Young BM, Holman EA, Cramer SC. Rehabilitation Therapy Doses Are Low After Stroke and Predicted by Clinical Factors. Stroke 2023; 54:831-839. [PMID: 36734234 PMCID: PMC9992003 DOI: 10.1161/strokeaha.122.041098] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Stroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose. METHODS Adults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons. RESULTS Of 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses. CONCLUSIONS Rehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.
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Affiliation(s)
- Brittany M. Young
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute
| | - E. Alison Holman
- Sue and Bill Gross School of Nursing, University of California, Irvine
| | - Steven C. Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute
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Geller D, Winterbottom L, Goldberg C, Nilsen DM, Mahoney D, Gillen G. Exercise for Adults With Stroke to Improve ADL and/or Functional Mobility Performance (2012-2019). Am J Occup Ther 2023; 77:24093. [PMID: 37093617 DOI: 10.5014/ajot.2023.77s10004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions to improve activities of daily living (ADL) and functional mobility performance for people with stroke. This theme reports on exercise interventions.
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Affiliation(s)
- Daniel Geller
- Daniel Geller, EdD, MPH, OTR/L, is Assistant Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Lauren Winterbottom
- Lauren Winterbottom, MS, OTR/L, is Research Occupational Therapist, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center; and Instructor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Carly Goldberg
- Carly Goldberg, MS, OTR/L, is Advanced Clinician, Inpatient Rehabilitation Unit, New York Presbyterian-Columbia University Irving Medical Center; and Instructor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTR/L, FAOTA, is Professor and Interim Program Director, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center; and Per Diem Occupational Therapist, New York Presbyterian-Columbia University Irving Medical Center
| | - Danielle Mahoney
- Danielle Mahoney, OTD, OTR/L, is Assistant Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Glen Gillen
- Glen Gillen EdD, OTR/L, FAOTA, is Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
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Rumalla K, Catapano JS, Mahadevan V, Sorkhi SR, Koester SW, Winkler EA, Graffeo CS, Srinivasan VM, Jha RM, Jadhav AP, Ducruet AF, Albuquerque FC, Lawton MT. Socioeconomic Drivers of Outcomes After Aneurysmal Subarachnoid Hemorrhage Treatment at a Large Comprehensive Stroke Center. World Neurosurg 2023; 173:e109-e120. [PMID: 36775240 DOI: 10.1016/j.wneu.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Sparse data exist on socioeconomic disparities among patients treated for aneurysmal subarachnoid hemorrhage (aSAH). The authors analyzed factors possibly influencing patient outcomes, including having a primary care physician (PCP) at admission, family/caregiver support, a foreign language barrier, primary payer status, and race. METHODS Socioeconomic data were abstracted for patients treated endovascularly or microsurgically for aSAH at a single center (January 1, 2014-July 31, 2019). Binary logistic regression analyses were used to identify independent predictors of an unfavorable outcome (modified Rankin Scale [mRS] score >2) and for predictive modeling. RESULTS Among 422 patients, the median (interquartile range) follow-up was 2 (1-23) months. Lack of caregiver support was the only socioeconomic factor associated with an unfavorable outcome at discharge. Independent predictors of mRS score >2 at last follow-up included baseline markers of disease severity (P ≤ 0.03), nonwhite race (OR, 1.69; P = 0.047), lack of caregiver support (OR, 5.55; P = 0.007), and lack of a PCP (OR, 1.96; P = 0.007). Adjusting for follow-up mediated the effects of race and PCP, although caregiver support remained significant and PCP was associated with a lower mortality risk independent of follow-up (OR, 0.51; P = 0.047). Predischarge socioeconomic factors, alongside disease severity, predicted a follow-up mRS score >2 with excellent discrimination (area under the receiver operating curve, 0.81; 95% CI, 0.77-0.86). CONCLUSIONS At a large, urban, comprehensive stroke center, patients with PCPs, caregiver support, and white race had significantly better long-term outcomes after aSAH. These results reflect disparities in access to healthcare after aSAH for vulnerable populations with extensive lifetime needs.
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Affiliation(s)
- Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Varun Mahadevan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Samuel R Sorkhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ruchira M Jha
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Petrizzo A, Lyons KS, Bartoli D, Simeone S, Alvaro R, Lee CS, Vellone E, Pucciarelli G. The moderating role of caregiver preparedness on the relationship between depression and stroke-specific quality of life in stroke dyads: a longitudinal study. Eur J Cardiovasc Nurs 2023; 22:53-63. [PMID: 35670198 DOI: 10.1093/eurjcn/zvac037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/03/2023]
Abstract
AIMS To examine the moderating role of caregiver preparedness on the association between stroke survivors' depression and stroke-specific quality of life dimensions. METHODS AND RESULTS We used a multilevel modelling approach to analyse trajectories of change in the eight Stroke Impact Scale 3.0 subscales [i.e. strength, communication, mobility, activities of daily living (ADL)/instrumental activities of daily living (IADL), memory, emotion, hand function, participation] using Hierarchical Linear Modeling. Caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor communication (B = -0.95, P < 0.01), mobility (B = -0.60, P < 0.05), and ADL/IADL (B = -0.73, P < 0.01) at baseline; linear change for strength (B = 0.83, P < 0.05) and communication (B = 0.66, P < 0.05); and quadratic change for strength (B = -0.19, P < 0.01). Although caregiver preparedness did not significantly moderate the association between survivor depressive symptoms and strength at baseline, there was a significant moderating effect for change over time. Higher levels of caregiver preparedness were significantly associated with higher survivor scores of emotion, hand function, and participation at baseline. CONCLUSIONS Including immediate caregivers in the care process, through a psycho-educational training, would mean having better-prepared caregivers and consequently more-healthy stroke survivors. Given that preparedness includes coping with stress, responding and managing emergencies, assessing help and information may require tailored interventions aimed at improving the caregivers' skills and knowledge about stroke survivors' management.
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Affiliation(s)
- Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Karen S Lyons
- Boston College, William F. Connell School of Nursing, Boston, MA, USA
| | - Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, Boston, MA, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
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Chou A, Lutz BJ, Beach SR, Freburger JK. Informal caregiver training to address functional mobility limitations of stroke survivors: a scoping review. Top Stroke Rehabil 2022:1-14. [PMID: 36403145 DOI: 10.1080/10749357.2022.2145761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Informal caregivers of stroke survivors often report the need for training on how to care for a loved one with functional mobility limitations. Evidence on training interventions to help informal caregivers with issues related to mobility is varied. The objective of this scoping review was to examine the literature including skill-based training interventions that educate caregivers on functional mobility for stroke survivors. RESEARCH DESIGN AND METHODS We extracted studies from OVID Medline, Cochrane, ISI Web of Knowledge, and Embase published between 1990 and 2021. At every stage of assessment, data extraction forms were used to reach consensus among at least three out of four authors. We followed PRISMA-ScR guidelines and Arskey and O'Malley's framework to chart information into several tables based on research questions and summarized with descriptive statistics. RESULTS Most studies were conducted outside the US focused on training in mobility and activities of daily living. The stroke survivor, on average, was an older individual (mean age 64.8 [SD = 5.3] years). The informal caregiver was predominately a younger female spouse (mean age 54.2 [SD = 6.3]). More than a third of the studies reported improvement in the stroke survivors' physical function post-intervention, with a mean follow-up time of 4.4 months. Effective studies tended to include stroke survivors with less cognitive and functional mobility limitations at higher training dosages. DISCUSSION AND IMPLICATIONS Gaps in our understanding of informal caregiver training for those caring for stroke survivors are identified, and recommendations are provided for future research.
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Affiliation(s)
- Aileen Chou
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara J. Lutz
- School of Nursing, University of North Carolina-Wilmington, Wilmington, NC, USA
| | - Scott R. Beach
- University Center for Social and Urban Research, University of Pittsburgh, PA, USA
| | - Janet K. Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Hur YR, Song WS, Kim KM, Hwang KH. Comparison Between Comprehensive Nursing Care Ward and Private Care Ward on Functional Recovery in Stroke Patients. BRAIN & NEUROREHABILITATION 2022; 15:e21. [PMID: 36743201 PMCID: PMC9833468 DOI: 10.12786/bn.2022.15.e21] [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: 03/31/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022] Open
Abstract
The need for a comprehensive nursing care service ward (CNCW) is emerging, but few studies have investigated its medical validity. This study aimed to assess the effect of hospitalization on functional recovery and fall incidence in poststroke patients. This retrospective study enrolled 354 patients with subacute stroke between July 2017 and April 2020. CNCW provided full caregiving and nursing to the patient. Baseline demographic and hospital data, including fall occurrence, were collected. Functional outcomes, including the Medical Research Council (MRC), Korean version of the Modified Barthel Index (K-MBI), and Korean version of the Mini-Mental State Examination (K-MMSE), were evaluated upon admission and discharge. One hundred seventy-two patients were hospitalized in CNCW among the 354 stroke patients. Initial and final K-MMSE and K-MBI were significantly higher in the CNCW group. The K-MMSE score gain was significantly lower in the CNCW group (p < 0.05). The fall occurrence was significantly higher in the CNCW group (p < 0.01). Hospitalization in CNCW adversely affected cognitive function after stroke. Falls were detected more frequently and reported in CNCW.
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Affiliation(s)
- Yang Rok Hur
- Department of Physical Medicine and Rehabilitation, Dong-Eui Hospital, Busan, Korea
| | - Woo Sup Song
- Department of Physical Medicine and Rehabilitation, Dong-Eui Hospital, Busan, Korea
| | - Kyung Min Kim
- Department of Physical Medicine and Rehabilitation, Dong-Eui Hospital, Busan, Korea
| | - Ki Hun Hwang
- Department of Physical Medicine and Rehabilitation, Dong-Eui Hospital, Busan, Korea
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Choo WT, Jiang Y, Chan KGF, Ramachandran HJ, Teo JYC, Seah CWA, Wang W. Effectiveness of caregiver-mediated exercise interventions on activities of daily living, anxiety and depression post-stroke rehabilitation: A systematic review and meta-analysis. J Adv Nurs 2022; 78:1870-1882. [PMID: 35451521 DOI: 10.1111/jan.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/21/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
AIMS This review aims to examine updated evidence to evaluate the effectiveness of caregiver-mediated exercise interventions on basic and extended activities of daily living (ADL), anxiety and depression of post-stroke rehabilitation individuals. DESIGN A systematic review and meta-analysis. DATA SOURCES Six electronic databases, including CINAHL, CENTRAL, Embase, PubMed, PsycINFO and Scopus, grey literature and trial registry were searched from inception until February 2021. METHODS Only randomized controlled trials written in English were included. Meta-analyses were conducted for basic and extended ADL, anxiety and depression outcomes using RevMan software. Overall quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation framework. RESULTS A total of 11 randomized controlled trials comprising 2120 participants were identified, with 10 trials meta-analysed. Meta-analyses indicated statistically significant effects favouring caregiver-mediated exercise interventions for basic ADL. Subgroup analyses revealed significant effects for exercise-only interventions mediated by caregivers for basic ADL. No significant effects were found for extended ADL, anxiety and depression for stroke survivors. CONCLUSION Caregiver-mediated exercise interventions appear to have beneficial impacts on basic ADL for stroke survivors, suggesting caregiver-mediated exercise interventions as a potentially feasible way to improve functional independence. IMPACT Caregiver-mediated intervention with exercises as a major component could be a promising approach to augment stroke rehabilitation. Future research should include high-quality studies with focus on specific intervention components or to explore caregiver outcomes.
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Affiliation(s)
- Wen Ting Choo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kendy Gui Fang Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuen Wei Alvin Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Liu CK, Seo J, Lee D, Wright K, Kurella Tamura M, Moye J, Weiner DE, Bean JF. The Impact of Care Partners on the Mobility of Older Adults Receiving Hemodialysis. Kidney Med 2022; 4:100473. [PMID: 35663231 PMCID: PMC9157255 DOI: 10.1016/j.xkme.2022.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Rationale & Objective Many older adults receiving hemodialysis have mobility limitations and rely on care partners, yet data are sparse regarding the support provided by care partners. Our aim was to examine how care partners support the mobility of an older adult receiving hemodialysis. Study Design Qualitative study. Setting & Participants Using purposive sampling, we recruited persons aged 60 years or more receiving maintenance hemodialysis and care partners aged 18 years or more who were providing support to an older adult receiving hemodialysis. We conducted in-person semi-structured interviews about mobility with each individual. Analytical Approach We conducted descriptive and focused coding of interview transcripts and employed thematic analysis. Our outcome was to describe perceived mobility supports provided by care partners using qualitative themes. Results We enrolled 31 older adults receiving hemodialysis (42% women, 68% Black) with a mean age of 73 ± 8 years and a mean dialysis duration of 4.6 ± 3.5 years. Of these, 87% of patients used assistive devices and 90% had care partners. We enrolled 12 care partners (75% women, 33% Black) with a mean age of 54 ± 16 years. From our patient and care partner interviews, we found three themes: (1) what care partners see, (2) what care partners do, and (3) what care partners feel. Regarding what they see, care partners witness a decline in patient mobility. Regarding what they do, care partners guide and facilitate activities and manage others who also assist. Regarding what they feel, care partners respect the patient’s autonomy but experience frustration and worry about the patient’s future mobility. Limitations Modest sample size; single geographic area. Conclusions In older adults receiving hemodialysis, care partners observe a decline in mobility and provide support for mobility. They respect the patient’s autonomy but worry about future mobility losses. Future research should incorporate care partners in interventions that address mobility in older adults receiving hemodialysis.
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Escalante-Gonzalbo AM, Ramírez-Graullera YS, Pasantes H, Aguilar-Chalé JJ, Sánchez-Castillo GI, Escutia-Macedo XA, Briseño-Soriano TM, Franco-Castro P, Estrada-Rosales AL, Vázquez-Abundes SE, Andrade-Morales D, Hernández-Franco J, Palafox L. Safety, Feasibility, and Acceptability of a New Virtual Rehabilitation Platform: A Supervised Pilot Study. Rehabil Process Outcome 2022; 10:11795727211033279. [PMID: 34987304 PMCID: PMC8492031 DOI: 10.1177/11795727211033279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Stroke is the leading cause of disability in adults worldwide, with
hemiparesis being the most prevalent consequence. The use of video games and
movement sensors could contribute to improving patients’ chances of
recovery. We performed a supervised pilot study to validate the safety,
feasibility, and acceptability of a new virtual rehabilitation platform in
patients with chronic post-stroke upper limb hemiparesis. Methods: The participants (n = 9) participated in 40 rehabilitation sessions, twice a
week, for a period of 20 weeks. Their experiences with the platform were
documented using a Likert-scale survey. Changes in motor function were
evaluated using the Chedoke Arm and Hand Activity Inventory (CAHAI) and the
Wolf Motor Function Test (WMFT). Results and conclusions: All participants expressed that they enjoyed the experience and felt
comfortable using the platform. Preliminary results showed significant motor
recovery (P = .0039) according to the WMFT scores. Patients
with significant impairment showed no improvement in upper limb
task-oriented motor function after therapy. The new platform is safe and well-accepted by patients. The improvement in
motor function observed in some of the participants should be attributed to
the therapy since spontaneous functional recovery is not expected in chronic
stroke patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lorena Palafox
- Instituto Nacional de Neurología y Neurocirugía (INNN), CDMX, México
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16
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Yoshida Y, Tobinaga K, Kumamoto S, Kato S, Kisanuki K, Kubota Y. Effective physical therapy activities to improve the supine-to-seated transfer time in stroke patients: an observational pilot study. J Phys Ther Sci 2022; 34:187-192. [PMID: 35291476 PMCID: PMC8918106 DOI: 10.1589/jpts.34.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/02/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine the effective time allocation for physical therapy
activities in patients with stroke. The primary outcome measure was the improvement in the
time required to transition from the supine to the sitting position. [Participants and
Methods] This study enrolled 19 inpatients with stroke. The activities performed during
physical therapy were classified as nontherapeutic activities, minimal therapeutic
activities, moderate therapeutic activities, high therapeutic activities, and other
activities. We determined the relationship between the activities and the relative
shortening ratio of the time required to sit up from the supine position for up to 13
weeks of physical therapy. We also considered the following background factors: patient
information, functional independence measure, and Brunnstrom recovery stage. [Results] The
Brunnstrom recovery stage for the lower extremity was identified as the confounding
factor, and the participants were stratified into the Brunnstrom recovery stage 6 group,
in which moderate therapeutic activities and other activities were significantly related
to the relative shortening ratio. [Conclusion] The results suggested that other activities
exerted a similar effect as moderate therapeutic activities in the Brunnstrom recovery
stage 6 group and were more effective than high therapeutic activities in reducing the
time required to sit up from the supine position.
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Affiliation(s)
- Yuichi Yoshida
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare: 888 Tominoo, Tamana-shi, Kumamoto 865-0062, Japan
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Liew SL, Lin DJ, Cramer SC. Interventions to Improve Recovery After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Shaik AR, Ahmad F, Miraj M, Alqahtani M, Alzhrani M, Alanazi A, Kashoo F. Efficacy of the structured balance awareness program on perceived balance confidence and fear-related maladaptive behaviour in post-stroke survivors. NeuroRehabilitation 2021; 49:547-552. [PMID: 34542039 DOI: 10.3233/nre-210144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The risk of falling for individuals with stroke is about twice that of healthy older adults. Lack of appropriate initiative to address the fear-related maladaptive behaviour can manifest itself in the form of loss of physical functions resulting in disability and handicap. OBJECTIVE To examine the effectiveness of the structured balance awareness program (SBAP) in improving the perceived balance confidence, and thereby modifying the fear-related maladaptive behaviour in post-stroke survivors. METHODS A randomized experimental control design was used on a sample of 97 post-stroke survivors aged between 55 to 75 years. The patients received either the SBAP or health awareness program (HAP) for eight weeks and were compared on Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS) and Falls Efficacy Scale International (FESI). RESULTS A paired t-test demonstrated statistically significant improvement among all the variables in the SBAP group. An independent t-test exhibited a statistically significant improvement on ABC (t = 2.57, p = 0.012 *), BBS (t = 3.32, p = 0.001 *) and FESI (t = 3.38, p = 0.001 *) in the SBAP group. CONCLUSION The study showed that the SBAP was effective in minimizing the fear-related maladaptive behaviour in post-stroke survivors.
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Affiliation(s)
- Abdul Rahim Shaik
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mohammad Miraj
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
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Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev 2021; 6:CD012996. [PMID: 34184251 PMCID: PMC8238669 DOI: 10.1002/14651858.cd012996.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Affiliation(s)
- David H Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Karianne Backx
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
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Effects of Self RehAbilitation Video Exercises (SAVE) on Functional Restorations in Patients with Subacute Stroke. Healthcare (Basel) 2021; 9:healthcare9050565. [PMID: 34064979 PMCID: PMC8150768 DOI: 10.3390/healthcare9050565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Additional exercise therapy has been shown to positively affect acute stroke rehabilitation, which requires an effective method to deliver increased exercise. In this study, we designed a 4-week caregiver-supervised self-exercise program with videos, named “Self rehAbilitation Video Exercises (SAVE)”, to improve the functional outcomes and facilitate early recovery by increasing the continuity of rehabilitation therapy after acute stroke. Methods: This study is a non-randomized trial. Eighty-eight patients were included in an intervention group (SAVE group), who received conventional rehabilitation therapies and an additional self-rehabilitation session by watching bedside exercise videos and continued their own exercises in their rooms for 60 min every day for 4 weeks. Ninety-six patients were included in a control group, who received only conventional rehabilitation therapies. After 4 weeks of hospitalization, both groups assessed several outcome measurements, including the Berg Balance Scale (BBS), Modified Barthel Index (MBI), physical component summary (PCS) and the mental component summary of the Short-Form Survey 36 (SF-36), Mini-Mental State Examination, and Beck Depression Inventory. Results: Differences in BBS, MBI, and PCS components in SF-36 were more statistically significant in the SAVE group than that in the control group (p < 0.05). Patients in the SAVE group showed more significant improvement in BBS, MBI, and PCS components in SF-36 as compared to that in the control group. Conclusions: This evidence-based SAVE intervention can optimize patient recovery after a subacute stroke while keeping the available resources in mind.
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Marsiglio R, Watterson D, Maric V, Holland AE. A quality improvement project targeting physical, cognitive and social activity levels in inpatient rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims People undergoing inpatient rehabilitation largely spend their day by the bedside, inactive and alone. Increasing patients' physical, cognitive and social activity levels may improve rehabilitation outcomes for both the individual and the service. The aim of this study was to trial an activity programME that aimed to increase inpatient physical, cognitive and social activity levels, provided within existing resources whilE maintaining or increasing patient satisfaction. Methods A mixed-methods approach was used to develop and evaluate a multi-component activity programme for patients undergoing inpatient rehabilitation. Results Patient activity across the unit did not change but the amount of time spent alone during a weekday was significantly reduced. Patient satisfaction levels remained high. Each new therapy group was well received by patients and the volunteers who supported implementation. Novel programmes included table tennis coaching and independent gym access for selected inpatients, which were well used and not resource intensive. Therapist prescription of independent practice programmes remained low. Broader initiatives such as patient education folders require revision and further investment to succeed. Conclusions It is possible to change and evaluate multiple therapy services concurrently. The absence of change in overall activity levels demonstrates a need to establish the most successful components, harness support from the organisation to address some of the physical/environmental barriers and expand smaller programmes, and invest more time to consolidate the whole-of-service changes required to push the rehabilitation service in the direction of greater patient activity and ownership. Clinicians should pursue, implement, evaluate and revise novel programmes to engage their patient population.
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Affiliation(s)
- Rosemarie Marsiglio
- Caulfield Hospital Alfred Health, Caulfield, Australia
- University of Melbourne, Melbourne, Australia
| | - Dina Watterson
- Caulfield Hospital Alfred Health, Caulfield, Australia
- La Trobe University, Melbourne, Australia
| | | | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
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Cramer SC, Dodakian L, Le V, McKenzie A, See J, Augsburger R, Zhou RJ, Raefsky SM, Nguyen T, Vanderschelden B, Wong G, Bandak D, Nazarzai L, Dhand A, Scacchi W, Heckhausen J. A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke. Front Neurol 2021; 11:611453. [PMID: 33613417 PMCID: PMC7888185 DOI: 10.3389/fneur.2020.611453] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52-65.5), and 129 (52-486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3-56.7) h. Non-compliance doubled during weeks 7-12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5-12.5) points in the arm and 1 (-0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.
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Affiliation(s)
- Steven C. Cramer
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Vu Le
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Alison McKenzie
- Department of Physical Therapy, Chapman University, Orange, CA, United States
| | - Jill See
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Renee Augsburger
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Robert J. Zhou
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Sophia M. Raefsky
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Thalia Nguyen
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | | | - Gene Wong
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Daniel Bandak
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Laila Nazarzai
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Walt Scacchi
- Institute for Software Research, University of California, Irvine, Irvine, CA, United States
| | - Jutta Heckhausen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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Paci M, Prestera C, Ferrarello F. Generalizability of Results from Randomized Controlled Trials in Post-Stroke Physiotherapy. Physiother Can 2020; 72:382-393. [PMID: 35110812 PMCID: PMC8781507 DOI: 10.3138/ptc-2018-0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose: The randomized controlled trial (RCT) is considered a reliable experimental design, able to detect the effect of an intervention. However, a criticism frequently levelled at RCTs by clinicians is their lack of generalizability. This study aimed to evaluate the generalizability of findings from RCTs of physiotherapy interventions for individuals with stroke. Method: A sample of RCTs of physiotherapy interventions after stroke indexed in the PEDro database was selected, and the reported inclusion and exclusion criteria were analyzed. Results: We reviewed 100 articles, which included 7,366 participants (41.6% women, with a mean weighted age of 65.5 years). The most frequent criteria for exclusion were comorbidity (83%), cognitive impairments (69%), communication skills (55%), recurrent stroke (53%), low functional level (47%) and being elderly (25%). Conclusions: A variety of cohorts of individuals who have had a stroke are excluded from RCTs published in the field of physiotherapy. Because they represent a substantial proportion of the real-world population with stroke, and consequently treated in clinical practice, more vulnerable cohorts of participants should be included in RCTs.
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Affiliation(s)
- Matteo Paci
- Unit of Functional Recovery, Azienda USL Toscana Centro, Florence
| | - Claudia Prestera
- Rehabilitation Center, Fondazione Filippo Turati Onlus, Gavinana, Pistoia, Italy
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van Dijk M, Vreven J, Deschodt M, Verheyden G, Tournoy J, Flamaing J. Can in-hospital or post discharge caregiver involvement increase functional performance of older patients? A systematic review. BMC Geriatr 2020; 20:362. [PMID: 32962653 PMCID: PMC7510152 DOI: 10.1186/s12877-020-01769-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Regaining pre-hospitalization activity levels is only achieved in 30-50% of older patients. Extra physiotherapy time has been proven to improve functional outcome and shorten length of stay, but is costly. Considering their key role in caring for older people, involving informal caregivers in rehabilitation might further improve functional performance. AIM To determine if in-hospital or post discharge caregiver involvement can increase functional performance in older adults. The secondary aim was to determine if caregiver involvement can influence, quality of life of patient and caregiver, medical costs, readmission rate, discharge location, and mortality. DESIGN Systematic review with narrative synthesis. METHODS The electronic bibliographic databases MEDLINE, Embase, CINAHL, Cochrane and Web of Science were searched for (quasi) experimental and observational studies, with the following inclusion criteria; caregiver involvement regarding functional performance, mean age over 65 years, admitted to a hospital unit and subsequently discharged to their home setting. Risk of bias was assessed with the Rob 2 (randomized trials) and the ROBINS-1 tool (non-randomized studies). RESULTS Eight studies of an initial 4683 were included: four randomized controlled trials, one prospective cohort study, one non-randomized controlled trial, one subgroup analysis of an RCT and one prospective pre-post study. All but one study included patients with stroke. Three types of caregiver interventions could be distinguished: a care pathway (inclusion of caregivers in the process of care), education on stroke and teaching of bed-side handling-skills, and caregiver-mediated exercises. The one study evaluating the care pathway reported 24.9% more returns home in the intervention group. Studies evaluating the effect of education and bed-side handling-skills reported higher effect sizes for several outcomes with increasing session frequency. All studies with caregiver-mediated exercises showed beneficial effects on functional performance, immediately after the intervention and within 3 months follow-up. CONCLUSION The findings of this review suggest that involvement of caregivers in the rehabilitation of older adults leads to better functional performance up to 3 months after initiation. However, evidence is low and mainly focusing on stroke.
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Affiliation(s)
- Margaretha van Dijk
- Department of Physical Medicine and Rehabilitation, UZ Leuven - University Hospitals Leuven, campus Pellenberg, Weligerveld 1, 3212, Pellenberg, Belgium.
| | - Jasmien Vreven
- Department of Physical Medicine and Rehabilitation, UZ Leuven - University Hospitals Leuven, campus Pellenberg, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Geriatrics and Gerontology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Nursing Science (INS), Department of Public Health, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Healthcare and Ethics, Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, Geriatrics and Gerontology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department Geriatric Medicine, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Geriatrics and Gerontology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department Geriatric Medicine, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
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Sugiyama M, Kondo K, Jeong S, Shiraishi N, Matsumoto D, Hayashi T, Tanaka H. Effect of Care Capacity on Stroke Patients' Recovery in Activities of Daily Living: A Multi-Hospital Study. J Stroke Cerebrovasc Dis 2020; 29:105187. [PMID: 32912554 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105187] [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: 04/28/2020] [Revised: 07/11/2020] [Accepted: 07/19/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity. DESIGN Retrospective, observational, longitudinal study. SETTING Acute phase hospitals. PARTICIPANTS From 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0-3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8-60 days. MAIN OUTCOME MEASURES The main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation. RESULTS Among patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke. CONCLUSIONS These results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke.
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Affiliation(s)
- Motoya Sugiyama
- Department of Rehabilitation, Chubu Rosai Hospital, 1-10-6 Koumei, Minato-ku, Nagoya-city 455-8530, Aichi-ken, Japan.
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba-city, Chiba-ken, Japan; Department of Social Science, National Center for Geriatrics and Gerontology, Obu-city, Aichi-ken, Japan.
| | - Seungwon Jeong
- Department of Community Welfare, Faculty of Health Sciences, Niimi University, Niimi-city, Okayama-ken, Japan.
| | - Nariaki Shiraishi
- Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Chita-gun, Aichi-ken, Japan.
| | - Daisuke Matsumoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Kitakatsugi-gun, Nara-ken, Japan.
| | - Takahiro Hayashi
- Department of Rehabilitation and Care, Seijoh University, Tokai-city, Aichi-ken, Japan.
| | - Hirotaka Tanaka
- Department of Rehabilitation, Chubu Rosai Hospital, 1-10-6 Koumei, Minato-ku, Nagoya-city 455-8530, Aichi-ken, Japan.
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Yasmeen I, Krewulak KD, Grant C, Stelfox HT, Fiest KM. The Effect of Caregiver-Mediated Mobility Interventions in Hospitalized Patients on Patient, Caregiver, and Health System Outcomes: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100053. [PMID: 33543080 PMCID: PMC7853382 DOI: 10.1016/j.arrct.2020.100053] [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: 11/03/2022] Open
Abstract
OBJECTIVE To synthesize the evidence examining caregiver-mediated mobility interventions in a hospital setting and whether they improve patient, caregiver, or health system outcomes. DATA SOURCES We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to September 7, 2018. STUDY SELECTION Two reviewers independently selected original research in inpatient settings that reported on an intervention delivered by a caregiver (eg, family, friend, paid worker) and directed to the patient's mobility. Mobility interventions were categorized based on the level of caregiver engagement using a 3-category framework: inform (provision of education on patient's condition and management), activate (prompting caregivers to take action in patient care), and collaborate (encouraging interaction with providers or other caregivers). DATA EXTRACTION One reviewer extracted data, and another checked the data. Quality was assessed using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation approach. DATA SYNTHESIS Forty studies met the inclusion criteria; most were randomized controlled trials (n=16/40, 40.0%) and investigated older adults (n=18/40, 45.0%) with stroke (n=20/40, 50.0%). Inform (n=2) and activate (n=4) interventions and combined inform-activate (n=5/6, 83.3%) and inform-activate-collaborate (n=6/10, 60.0%) interventions were reported to improve patient mobility. Inform-activate and inform-collaborate interventions were reported to improve caregiver outcomes (eg, burden) (n=13/19, 68.4%). Studies that engaged caregivers in all 3 strategies (inform-activate-collaborate) were reported to improve health system outcomes (eg, hospital readmission) (n=4/6, 66.7%). Most studies were of unclear (n=22/40, 55.0%) or low risk of bias (n=11/40, 27.5%) for most domains. CONCLUSIONS Engaging caregivers in mobility of hospitalized patients may improve patient mobility as well as caregiver and health system outcomes.
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Affiliation(s)
- Israt Yasmeen
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D. Krewulak
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Jones F, Gombert-Waldron K, Honey S, Cloud G, Harris R, Macdonald A, McKevitt C, Robert G, Clarke D. Using co-production to increase activity in acute stroke units: the CREATE mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Stroke is the most common neurological disability in the UK. Any activity contributes to recovery, but stroke patients can be inactive for > 60% of their waking hours. This problem remains, despite organisational changes and targeted interventions. A new approach to addressing post-stroke inactivity is needed. Experience-based co-design has successfully initiated improvements for patients and staff in other acute settings. Experience-based co-design uses observational fieldwork and filmed narratives with patients to trigger different conversations and interactions between patients and staff to improve health-care services.
Objectives
To complete a rapid evidence synthesis of the efficacy and effectiveness of co-production as an approach to quality improvement in acute health-care settings; to evaluate the feasibility and impact of patients, carers and staff co-producing and implementing interventions to increase supervised and independent therapeutic patient activity in acute stroke units; and to understand the experience of participating in experience-based co-design and whether or not interventions developed and implemented in two units could transfer to two additional units using an accelerated experience-based co-design cycle.
Design
A mixed-methods case comparison using interviews, observations, behavioural mapping and self-report surveys (patient-reported outcome measure/patient-reported experience measure) pre and post implementation of experience-based co-design cycles, and a process evaluation informed by normalisation process theory.
Setting
The setting was two stroke units (acute and rehabilitation) in London and two in Yorkshire.
Participants
In total, 130 staff, 76 stroke patients and 47 carers took part.
Findings
The rapid evidence synthesis showed a lack of rigorous evaluation of co-produced interventions in acute health care, and the need for a robust critique of co-production approaches. Interviews and observations (365 hours) identified that it was feasible to co-produce and implement interventions to increase activity in priority areas including ‘space’ (environment), ‘activity’ and, to a lesser extent, ‘communication’. Patients and families reported benefits from participating in co-design and perceived that they were equal and valued members. Staff perceived that experience-based co-design provided a positive experience, was a valuable improvement approach and led to increased activity opportunities. Observations and interviews confirmed the use of new social spaces and increased activity opportunities. However, staff interactions remained largely task focused, with limited focus on enabling patient activity. Behavioural mapping indicated a mixed pattern of activity pre and post implementation of co-designed changes. Patient-reported outcome measure/patient-reported experience measure response rates were low, at 12–38%; pre- and post-experience-based co-design cohorts reported dependency, emotional and social limitations consistent with national statistics. Post-experience-based co-design patient-reported experience measure data indicated that more respondents reported that they had ‘enough things to do in their free time’. The use of experience-based co-design – full and accelerated – legitimised and supported co-production activity. Staff, patients and families played a pivotal role in intervention co-design. All participants recognised that increased activity should be embedded in everyday routines and in work on stroke units.
Limitations
Communication by staff that enabled patient activity was challenging to initiate and sustain.
Conclusions
It was feasible to implement experience-based co-design in stroke units. This resulted in some positive changes in unit environments and increased activity opportunities for patients. There was no discernible difference in experiences or outcomes between full and accelerated experience-based co-design. Future work should consider multiple ways to embed increased patient activity into everyday routines in stroke units.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona Jones
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK
| | - Karolina Gombert-Waldron
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK
| | - Stephanie Honey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Ruth Harris
- Department of Adult Nursing, King’s College London, London, UK
| | | | - Chris McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Glenn Robert
- Department of Adult Nursing, King’s College London, London, UK
| | - David Clarke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Olafsdottir SA, Jonsdottir H, Bjartmarz I, Magnusson C, Caltenco H, Kytö M, Maye L, McGookin D, Arnadottir SA, Hjaltadottir I, Hafsteinsdottir TB. Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study. BMC Health Serv Res 2020; 20:562. [PMID: 32571316 PMCID: PMC7310069 DOI: 10.1186/s12913-020-05432-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality. Methods A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings. Results Ten stroke survivors aged 55–79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (− 4.2) and 5xSST (− 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying − 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES. Conclusions ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.
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Affiliation(s)
- Steinunn A Olafsdottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland.
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ingibjörg Bjartmarz
- Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Mikko Kytö
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland.,Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Laura Maye
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - David McGookin
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - Solveig Asa Arnadottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thora B Hafsteinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Pucciarelli G, Lommi M, Magwood GS, Simeone S, Colaceci S, Vellone E, Alvaro R. Effectiveness of dyadic interventions to improve stroke patient-caregiver dyads' outcomes after discharge: A systematic review and meta-analysis study. Eur J Cardiovasc Nurs 2020; 20:14-33. [PMID: 33570593 DOI: 10.1177/1474515120926069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 04/23/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke survivor-caregiver dyads after discharge from the rehabilitation hospital to improve outcomes. AIMS The aims were to systematically review the evidence to identify which dyadic interventions have been implemented in stroke survivor-caregiver dyads to improve stroke survivor-caregiver dyads' outcomes and to analyse, through a meta-analysis, which intervention was found to be the most effective. METHODS A systematic review and meta-analysis were conducted using the following electronic databases: PubMed, CINAHL and PsycInfo. Randomized controlled trials (RCTs) and quasi-RCT studies published within the last 10 years were included. Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Pooled effects were analysed between the experimental and control groups for each outcome. RESULTS Sixteen studies involving 2997 stroke survivors (male gender=58%) and 2187 caregivers (male gender=25%) were included in this review. In 16 studies, which were subdivided into three quasi-RCTs and 13 RCTs, the application of dyadic interventions for stroke survivors and caregivers was systematically reviewed, but only a few of these identified a significant improvement in the stroke survivors' and caregivers' outcomes of its intervention group. Dyadic interventions showed a significant effect on stroke survivors' physical functioning (p=0.05), memory (p<0.01) and quality of life (p=0.01) and on caregivers' depression (p=0.05). CONCLUSIONS This study provides moderate support for the use of a dyadic intervention to improve stroke survivors' physical functioning, memory and quality of life and caregiver depression.
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Affiliation(s)
| | - Marzia Lommi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
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Li I, Bui T, Phan HT, Llado A, King C, Scrivener K. App-based supplemental exercise in rehabilitation, adherence, and effect on outcomes: a randomized controlled trial. Clin Rehabil 2020; 34:1083-1093. [PMID: 32508183 DOI: 10.1177/0269215520928119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
QUESTION To determine the uptake of an app-based supplemental exercise programme in a rehabilitation setting and the effect of such a programme on length of stay and function compared to usual care physiotherapy. DESIGN Randomized controlled trial with random allocation and assessor blinding. PARTICIPANTS A total of 144 individuals with mixed diagnoses (orthopaedic, neurological, reconditioning) admitted for inpatient sub-acute rehabilitation. INTERVENTIONS Participants were randomly allocated to usual care physiotherapy (control group) or usual care physiotherapy with the addition of an app-based supplemental exercise programme (intervention group). OUTCOME MEASURES The primary measure of interest was total supplementary exercise dosage completed by the intervention group. The primary between-group outcome measure was length of stay with secondary measures including walking endurance (Six-Minute Walk Test), walking speed (10-Metre Walk Test), functional mobility (Timed Up and Go Test) and level of disability (Functional Independence Measure). RESULTS Participants in the intervention group performed 7 minutes (SD: 9) or 49 repetitions (SD: 48) of supplementary exercise using the app each day. There were no differences between the groups for length of stay (mean difference (MD): -0.5 days, 95% confidence interval (CI): -3.2 to 2.2) or change in any secondary functional outcome measures, including walking speed (MD: -0.1 m/s, 95% CI: -0.2 to 0.0) and disability (MD: -0.9, 95% CI: -3.6 to 1.8). CONCLUSION A small supplementary exercise dose was achieved by participants in the intervention group. However, such a programme did not affect length of stay or functional outcomes when compared to usual care.
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Affiliation(s)
- Ingrid Li
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Tram Bui
- Royal Rehab, Sydney, NSW, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Katharine Scrivener
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
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31
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Vadas D, Kalichman L. The impact of availability and identity of the caregiver on the post-stroke patient. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background After having a stroke, most patients are helped by a caregiver with activities that they cannot perform by themselves. The caregiver presence and actions are an important variable that may affect rehabilitation in many ways. The aim of this review study was to evaluate the impact of caregiver presence (or absence) and identity (spouse, family, or foreign domestic worker) on therapeutic exercise performance, depression symptoms, patient–spouse relations and total functional outcomes of stroke patients. Assessing these effects may help health care professionals and families to prioritise/choose the caregiver for their patient/family member. Methods A narrative literature review was conducted, focusing on one-direction effects (caregiver on patient effects) on the topics of interest mentioned, in a post-stroke population. PubMed, CINAHL, PEDro, Trip database, and Google Scholar were searched, and included studies of most designs and research qualities. The search strategy had not been specified before commencing the review. Each study was analysed individually with the purpose of synthesising the available evidence to achieve a greater understanding of this topic. Results A total of 17 relevant papers were included: six randomised controlled trials, six observational studies, two systematic reviews, two survey-based studies, and one case series. Trials were consistent with the positive effect that caregivers have on therapeutic exercise performance. Studies have shown a positive effect of caregivers on the patient's depressive symptoms, but only at the chronic phase after stroke. A spouse caregiver seems to more positively affect the patient–spouse relations in the acute phase of rehabilitation, while foreign domestic workers can improve these relations at more chronic phases. The presence of a caregiver is shown to decrease functional outcomes within institutionalised rehabilitation centres, while it is necessary and positively affects functionality at more chronic phases within community settings. Conclusions The advantages and disadvantages of employing a caregiver depend in many cases on the rehabilitation phase. The caregiver might be beneficial or harmful to the patient's functional progress, depressive symptoms and marital relationship depending on the rehabilitation phase. More studies are needed to assess the caregiver effects on post-stroke patients' rehabilitation and quality of life.
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Affiliation(s)
- Dor Vadas
- The Israel Rehabilitation Center for Stroke and Brain Injury, Rehovot, Israel; Oxford University, Oxford, UK
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2020; 3:CD003316. [PMID: 32196635 PMCID: PMC7083515 DOI: 10.1002/14651858.cd003316.pub7] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function. OBJECTIVES The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function. SEARCH METHODS In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons. AUTHORS' CONCLUSIONS Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
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Affiliation(s)
- David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Daniel D Carter
- University of LimerickSchool of Allied Health, Faculty of Education and Health SciencesLimerickIreland
| | - Hannah Jarvis
- Manchester Metropolitan UniversityResearch Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and EngineeringJohn Dalton BuildingChester StreetManchesterUKM1 5GD
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Regenhardt RW, Takase H, Lo EH, Lin DJ. Translating concepts of neural repair after stroke: Structural and functional targets for recovery. Restor Neurol Neurosci 2020; 38:67-92. [PMID: 31929129 PMCID: PMC7442117 DOI: 10.3233/rnn-190978] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stroke is among the most common causes of adult disability worldwide, and its disease burden is shifting towards that of a long-term condition. Therefore, the development of approaches to enhance recovery and augment neural repair after stroke will be critical. Recovery after stroke involves complex interrelated systems of neural repair. There are changes in both structure (at the molecular, cellular, and tissue levels) and function (in terms of excitability, cortical maps, and networks) that occur spontaneously within the brain. Several approaches to augment neural repair through enhancing these changes are under study. These include identifying novel drug targets, implementing rehabilitation strategies, and developing new neurotechnologies. Each of these approaches has its own array of different proposed mechanisms. Current investigation has emphasized both cellular and circuit-based targets in both gray and white matter, including axon sprouting, dendritic branching, neurogenesis, axon preservation, remyelination, blood brain barrier integrity, blockade of extracellular inhibitory signals, alteration of excitability, and promotion of new brain cortical maps and networks. Herein, we review for clinicians recovery after stroke, basic elements of spontaneous neural repair, and ongoing work to augment neural repair. Future study requires alignment of basic, translational, and clinical research. The field continues to grow while becoming more clearly defined. As thrombolysis changed stroke care in the 1990 s and thrombectomy in the 2010 s, the augmentation of neural repair and recovery after stroke may revolutionize care for these patients in the coming decade.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Hajime Takase
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - David J Lin
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
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Nordin NAM, Aziz NA, Sulong S, Aljunid SM. Effectiveness of home-based carer-assisted in comparison to hospital-based therapist-delivered therapy for people with stroke: A randomised controlled trial. NeuroRehabilitation 2019; 45:87-97. [PMID: 31450518 DOI: 10.3233/nre-192758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The benefits of engaging informal carers or family in the delivery of therapy intervention for people with stroke have not been well researched. OBJECTIVES To assess the effectiveness of a home-based carer-assisted in comparison to hospital-based therapist-delivered therapy for community-dwelling stroke survivors. METHODS An assessor blinded randomised controlled trial was conducted on 91 stroke survivors (mean age 58.9±10.6 years, median time post-onset 13.0 months, 76.5% males) who had completed individual rehabilitation. The control group received hospital-based group therapy delivered by physiotherapists as out-patients and the test group was assigned to a home-based carer-assisted therapy. Targeted primary outcomes were physical functions (mobility, balance, lower limb strength and gait speed). A secondary outcome index was health-related quality of life. An intention-to-treat analysis was used to evaluate outcomes at week 12 of intervention. RESULTS Both therapy groups improved significantly in all the functional measures; mobility (p < 0.01), balance (p < 0.01), lower limb strength (p < 0.01), gait speed (p < 0.05), and in the quality of life score (p < 0.05) at trial completion. No statistical differences were found between the two groups in any outcome indices (all p > 0.05). CONCLUSIONS The home-based carer-assisted therapy is as effective as the hospital-based therapist-delivered training in improving post-stroke functions and quality of life.
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Affiliation(s)
- Nor Azlin Mohd Nordin
- Physiotherapy Program, Center for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan, Malaysia
| | - Noor Azah Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Saperi Sulong
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- International Center for Casemix and Clinical Coding, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait
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35
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Tijsen LM, Derksen EW, Achterberg WP, Buijck BI. Challenging rehabilitation environment for older patients. Clin Interv Aging 2019; 14:1451-1460. [PMID: 31496672 PMCID: PMC6697645 DOI: 10.2147/cia.s207863] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/07/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these patients in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support and the environment on a rehabilitation ward. However, since literature on the principles of CRE is scarce, this review aimed to explore and describe the principles of CRE. Methods A search was made in PubMed for relevant literature concerning CRE. Then, articles were hand searched for relevant keywords (ie, task-oriented training, therapy intensity, patient-led therapy, group training), references were identified, and topics categorized. Results After evaluating 51 articles, 7 main topics of CRE were identified: 1) Therapy time; ie, the level of (physical) activity; the intensity of therapy and activity is related to rehabilitation outcomes, 2) group training; used to increase practice time and can be used to achieve multiple goals (eg, activities of daily living, mobility), 3) patient-regulated exercise; increases the level of self-management and practice time, 4) family participation; may lead to increased practice time and have a positive effect on rehabilitation outcomes, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this challenges rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals during rehabilitation and good communication in a transdisciplinary team improve the quality of rehabilitation. Discussion This is the first description of CRE based on literature; however, the included studies discussed rehabilitation mainly after stroke and for few other diagnostic groups. Conclusion Seven main topics related to CRE were identified that may help patients to improve their rehabilitation outcomes. Further research on the concept and effectivity of CRE is necessary.
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Affiliation(s)
- Lian Mj Tijsen
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Oktober , Bladel, The Netherlands.,De Zorgboog , Bakel, The Netherlands
| | - Els Wc Derksen
- Department Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wilco P Achterberg
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Bianca I Buijck
- Oktober , Bladel, The Netherlands.,De Zorgboog , Bakel, The Netherlands
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Smith TO, Pearson M, Pfeiffer K, Crotty M, Lamb SE. Caregiver Interventions for Adults Discharged from the Hospital: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2019; 67:1960-1969. [PMID: 31350918 DOI: 10.1111/jgs.16048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/30/2019] [Accepted: 05/31/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital. DESIGN Systematic review and meta-analysis. SETTING Hospital and community. METHODS Published and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health-related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta-analyzed. PARTICIPANTS Adults who had been admitted to the hospital. RESULTS A total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills-based programs, with or without home visits/telephone follow-up. Caregiver interventions for patients following stroke may provide no benefit for patient HRQOL at 12 months (standardized mean difference = .29; 95% confidence interval = -.12 to .69; low-quality evidence). Caregiver interventions demonstrated benefit for caregiver burden and both patient and caregiver anxiety at 12 months. No consistent effect was found on functional outcomes, depression, HRQOL, adverse events, or health resource use measures. CONCLUSIONS Informal caregivers who receive training to facilitate the recovery of older people discharged from the hospital following stroke may have a lower burden and reduced anxiety at 12 months compared with those who do not. However, the evidence was moderate to low quality. Further study is warranted to explore whether caregiver interventions can be modified for nonstroke populations such as those with hip fracture. J Am Geriatr Soc 67:1960-1969, 2019.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew Pearson
- Physiotherapy Outpatients Department, Dynamic Health, Cambridgeshire Community Services NHS Trust, Huntingdon, United Kingdom
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Maria Crotty
- Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Lawler K, Shields N, Taylor NF. Training family to assist with physiotherapy for older people transitioning from hospital to the community: a pilot randomized controlled trial. Clin Rehabil 2019; 33:1625-1635. [DOI: 10.1177/0269215519853874] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:To investigate the safety and effectiveness of augmenting physiotherapy with family-assisted therapy, to inform a future, fully powered trial.Design:Parallel pilot randomized controlled trial.Setting:Transition Care Program.Participants:Thirty-five older adults with multimorbidity, recently hospitalized, with a mean age of 84.1 years (SD = 6.1 years) and mean Modified Barthel Index of 67.8 units (SD = 19.2 units), and 40 family members.Interventions:The control group ( n = 18) received usual physiotherapy care. The experimental group ( n = 17) received usual physiotherapy care and family-assisted therapy from a family member trained by a physiotherapist.Main measures:Primary outcomes were falls-related self-efficacy measured by the Short Falls Efficacy Scale – International and falls during the intervention period. Secondary outcomes included daily steps, EQ-5D-3L (three-level version of the EuroQoL five-dimensional health-related quality of life questionnaire) and ICECAP-O (ICEpop CAPability measure for Older people), Modified Barthel Index and Modified Caregiver Strain Index.Results:There were no between-group differences for falls-related self-efficacy. Relative to the control group, the experimental group was observed to have a reduced risk of falling (relative risk = 0.38, 95% confidence interval (CI) = 0.09–1.60) and a reduced falls rate (incidence rate ratio = 0.22, 95% CI = 0.04–1.20) was of borderline statistical significance. The experimental group walked a mean of 944 daily steps more than the control group (95% CI = 139–1748) and had a significant reduction in activity limitation. There were no between-group differences for quality of life or caregiver strain.Conclusion:Augmenting physiotherapy with family-assisted therapy is feasible for older people transitioning from hospital to the community. A fully powered randomized controlled trial is indicated.
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Affiliation(s)
- Katherine Lawler
- Department of Rehabilitation Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
| | - Nora Shields
- Department of Rehabilitation Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Nicholas F Taylor
- Department of Rehabilitation Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
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Stark A, Färber C, Tetzlaff B, Scherer M, Barzel A. Stroke patients' and non-professional coaches' experiences with home-based constraint-induced movement therapy: a qualitative study. Clin Rehabil 2019; 33:1527-1539. [PMID: 31104476 PMCID: PMC6716206 DOI: 10.1177/0269215519848813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the experiences of chronic stroke patients and
non-professional coaches with home-based constraint-induced movement therapy
(homeCIMT). Design: Qualitative study embedded within a cluster randomized controlled trial
investigating the efficacy of homeCIMT to improve the use of the affected
arm in daily activities. Setting: Patients’ home environment. Participants: 13 stroke patients and 9 non-professional coaches’ alias family members who
had completed the four-week homeCIMT programme in the context of the
HOMECIMT trial. Interventions: Semi-structured interviews; qualitative data were analysed using the
methodology of the hermeneutic phenomenological data analysis. Results: We identified six themes in the qualitative analysis describing the
experiences of patients and non-professional coaches with homeCIMT: (1)
homeCIMT can be integrated into everyday life with varying degrees of
success; (2) training together may produce positive experiences as well as
strain; (3) self-perceived improvements during and following homeCIMT; (4)
using the affected arm in everyday life is challenging; (5) subjective
evaluation of and experiences with homeCIMT-specific exercises; and (6)
impact of professional therapists’ guidance and motivation during homeCIMT.
Statements regarding theme five and six were only provided by patients,
whereas the other themes contain both, the experiences of stroke patients
and non-professional coaches. Conclusion: Patients’ and non-professional coaches’ narratives offer a detailed insight
into the manifold experiences with the practical implementation of homeCIMT
that may help improve implementing the homeCIMT programme and similar
approaches involving increased training duration and intensity and/or
involvement of family members.
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Affiliation(s)
- Anne Stark
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Färber
- 2 Department of Health Sciences, Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Britta Tetzlaff
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Barzel
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,3 Department of Innovation and Collaboration in Ambulatory Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Stewart C, Power E, McCluskey A, Kuys S. Development of a participatory, tailored behaviour change intervention to increase active practice during inpatient stroke rehabilitation. Disabil Rehabil 2019; 42:3516-3524. [PMID: 30982361 DOI: 10.1080/09638288.2019.1597178] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: An evidence-practice gap exists between the amount of active practice recommended and the amount completed by stroke inpatients. The aim of this paper is to describe steps in the design of a participatory, theoretically tailored staff behaviour change intervention to help staff use strategies to increase active practice by stroke inpatients.Methods: A staff behaviour change intervention was developed in one rehabilitation unit in Queensland, Australia using a six-step process guided by the Behaviour Change Wheel framework. Mixed methods were used including direct observation (behavioural mapping), and focus groups to identify barriers and facilitators to implementation. Barriers and facilitators were mapped to the behaviour change techniques, and a behaviour change intervention developed in participation with rehabilitation staff.Results: Staff chose to implement ward-based practice books. Barriers included patient factors (including low motivation and severity of stroke), environmental segregation and limited skills for motivating patients. Staff belief in increasing active practice was a facilitator to implementation. The staff intervention included a training programme about motivation, environmental restructuring, audit, and feedback.Conclusions: This example of collaborative implementation research can be used and adapted by clinicians and researchers in other rehabilitation services.IMPLICATIONS FOR REHABILITATIONRehabilitation staff can be actively involved in designing behaviour change interventions.Behaviour change interventions should target local barriers to increase activity levels and practice completed by stroke inpatients.The process of co-designing behaviour change interventions has the potential to improve the uptake of a strategy such as ward-based practice books, by more precisely identifying local barriers and possible solutions.
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Affiliation(s)
- Claire Stewart
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Allied Health Services, Sunshine Coast University Hospital, Birtinya, Australia
| | - Emma Power
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Suzanne Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Australia
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Vloothuis JDM, Mulder M, Nijland RHM, Goedhart QS, Konijnenbelt M, Mulder H, Hertogh CMPM, van Tulder M, van Wegen EEH, Kwakkel G. Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): A randomized controlled trial. PLoS One 2019; 14:e0214241. [PMID: 30958833 PMCID: PMC6453481 DOI: 10.1371/journal.pone.0214241] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE We designed an 8-week caregiver-mediated exercise program with e-health support after stroke (CARE4STROKE) in addition to usual care with the aim to improve functional outcome and to facilitate early supported discharge by increasing the intensity of task specific training. METHODS An observer-blinded randomized controlled trial in which 66 stroke patient-caregiver couples were included during inpatient rehabilitation. Patients allocated to the CARE4STROKE program trained an additional amount of 150 minutes a week with a caregiver and were compared to a control group that received usual care alone. Primary outcomes: self-reported mobility domain of the Stroke Impact Scale 3.0 (SIS) and length of stay (LOS). Secondary outcomes: motor impairment, strength, walking ability, balance, mobility and (Extended) Activities of Daily Living of patients, caregiver strain of caregivers, and mood, self-efficacy, fatigue and quality of life of both patients and caregivers. Outcomes were assessed at baseline, 8 and 12 weeks after randomization. RESULTS No significant between-group differences were found regarding SIS-mobility after 8 (β 6.21, SD 5.16; P = 0.229) and 12 weeks (β 0.14, SD 2.87; P = 0.961), and LOS (P = 0.818). Significant effects in favor of the intervention group were found for patient's anxiety (β 2.01, SD 0.88; P = 0.023) and caregiver's depression (β 2.33, SD 0.77; P = 0.003) post intervention. Decreased anxiety in patients remained significant at the 12-week follow-up (β 1.01, SD 0.40; P = 0.009). CONCLUSIONS This proof-of concept trial did not find significant effects on both primary outcomes mobility and LOS as well as the secondary functional outcomes. Treatment contrast in terms of total exercise time may have been insufficient to achieve these effects. However, caregiver-mediated exercises showed a favorable impact on secondary outcome measures of mood for both patient and caregiver. CLINICAL TRIAL REGISTRATION NTR4300, URL- http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4300.
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Affiliation(s)
- Judith D. M. Vloothuis
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Quirine S. Goedhart
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Manin Konijnenbelt
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | | | - Cees M. P. M. Hertogh
- Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maurits van Tulder
- Department of Health Sciences & Amsterdam Movement Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands
- Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Erwin E. H. van Wegen
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, United States of America
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Dorsch S, Weeks K, King L, Polman E. In inpatient rehabilitation, large amounts of practice can occur safely without direct therapist supervision: an observational study. J Physiother 2019; 65:23-27. [PMID: 30573440 DOI: 10.1016/j.jphys.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
QUESTIONS When a hospital gymnasium used for inpatient rehabilitation is set up to allow semi-supervised practice: what percentage of practice is performed as semi-supervised practice, what percentage of patients in the gym are actively engaged in practice at one time, and is the semi-supervised practice that occurs safe? DESIGN An observational study using periodic behaviour mapping. PARTICIPANTS Patients in general and stroke rehabilitation units of a metropolitan hospital. OUTCOME MEASURES Observations in the rehabilitation gym quantified the number of patients in the gym and the numbers of patients practising and resting. In observations of patients practising, the condition of practice was recorded as being with a therapist, with a family member, or with no direct supervision. The number of adverse events during the data collection period was collected from the hospital Incident Information Management System. RESULTS The rehabilitation gym was observed on 113 occasions, resulting in 1319 individual patient observations. An average of 12 patients were in the gym during the observations. Practice was being performed with family supervision in 15% of observations and with no direct supervision in 26% of observations, resulting in semi-supervised practice accounting for 41% of all observations of practice. The percentage of observations that were of patients taking part in active practice was 78%. There were no adverse events in the gym. CONCLUSION In an inpatient setting, a large percentage of practice can be performed as semi-supervised practice. This does not appear to compromise the time spent in active practice or patient safety.
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Affiliation(s)
- Simone Dorsch
- School of Allied Health, Australian Catholic University, Sydney, Australia; StrokeEd Collaboration, Sydney, Australia.
| | - Kevin Weeks
- Brindabella Rehabilitation Service, University of Canberra Hospital, ACT Health, Canberra, Australia
| | - Laura King
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Etesa Polman
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
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Levy T, Laver K, Killington M, Lannin N, Crotty M. A systematic review of measures of adherence to physical exercise recommendations in people with stroke. Clin Rehabil 2018; 33:535-545. [PMID: 30458647 PMCID: PMC6416703 DOI: 10.1177/0269215518811903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: To review methods for measuring adherence to exercise or physical activity practice recommendations in the stroke population and evaluate measurement properties of identified tools. DATA SOURCES: Two systematic searches were conducted in eight databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library of Systematic Reviews, Sports Discus, PEDro, PubMed and EMBASE). Phase 1 was conducted to identify measures. Phase 2 was conducted to identify studies investigating properties of these measures. REVIEW METHODS: Phase 1 articles were selected if they were published in English, included participants with stroke, quantified adherence to exercise or physical activity recommendations, were patient or clinician reported, were defined and reproducible measures and included patients >18 years old. In phase 2, articles were included if they explored psychometric properties of the identified tools. Included articles were screened based on title/abstract and full-text review by two independent reviewers. RESULTS: In phase 1, seven methods of adherence measurement were identified, including logbooks ( n = 16), diaries ( n = 18), 'record of practice' ( n = 3), journals ( n = 1), surveys ( n = 2) and questionnaires ( n = 4). One measurement tool was identified, the Physical Activity Scale for Individuals with Physical Disabilities ( n = 4). In phase 2, no eligible studies were identified. CONCLUSION: There is not a consistent measure of adherence that is currently utilized. Diaries and logbooks are the most frequently utilized tools.
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Affiliation(s)
- Tamina Levy
- 1 Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- 1 Flinders University, Adelaide, SA, Australia
| | | | - Natasha Lannin
- 2 School of Allied Health, La Trobe University, Melbourne, VIC, Australia.,3 Alfred Health, Melbourne, VIC, Australia
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Vloothuis J, Depla M, Hertogh C, Kwakkel G, van Wegen E. Experiences of patients with stroke and their caregivers with caregiver-mediated exercises during the CARE4STROKE trial. Disabil Rehabil 2018; 42:698-704. [PMID: 30384780 DOI: 10.1080/09638288.2018.1507048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: Caregiver-mediated exercises are a novel way of delivering augmented exercise therapy for patients with stroke, in which patients do additional therapeutic exercises together with a caregiver. This explorative qualitative study is part of the CARE4STROKE trial and focused on how participants manage these exercises together. The research questions were: (1) how do the patient-caregiver couples exercise together? and (2) what does exercising together bring about, besides more hours of practice?Methods: Semi-structured interviews were conducted with patients and caregivers who participated in the CARE4STROKE intervention. Inductive thematic data analysis was applied.Results: Seven patients and seven caregivers were interviewed. Three different role-dynamics were found during caregiver-mediated exercises: (1) patient in control, (2) in concert, and (3) the caregiver as informal carer. In addition, three themes were identified about what exercising together brings about: (a) tailor-made exercises through active involvement, (b) preparation for the home situation, and (c) opportunity to be involved.Conclusion: Different role-dynamics are at play in caregiver-mediated exercises, and it is important for participating staff to be aware of their possible effects on the strain of patient or caregiver. Caregiver-mediated exercises were found to enhance individualization of the treatment plan and preparation for home discharge.Implications for rehabilitationCaregiver-mediated exercises, in which a caregiver does exercises with a patient, are currently under investigation as a new form of augmented exercise delivery after strokeDoing exercises together seems to make patient and caregivers actively involved in rehabilitation, which they appreciate, and which seems to help them prepare for the home situationCaregiver selection and monitoring role-dynamics during exercising is an important task of the rehabilitation team.
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Affiliation(s)
- Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Marja Depla
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Stewart C, Subbarayan S, Paton P, Gemmell E, Abraha I, Myint PK, O’Mahony D, Cruz-Jentoft AJ, Cherubini A, Soiza RL. Non-pharmacological interventions for the improvement of post-stroke activities of daily living and disability amongst older stroke survivors: A systematic review. PLoS One 2018; 13:e0204774. [PMID: 30286144 PMCID: PMC6171865 DOI: 10.1371/journal.pone.0204774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 01/11/2023] Open
Abstract
Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is largely unknown. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [http://www.senator-project.eu]. A Delphi panel of European geriatric experts agreed activities of daily living and disability to be of critical importance as stroke rehabilitation outcomes. A comprehensive search strategy was developed and five databases (Pubmed, CINAHL, Embase, PsycInfo and Cochrane Database of Systematic Reviews) searched for eligible systematic reviews. Primary studies meeting our criteria (non-pharmacologic interventions, involving stroke survivors aged ≥65 years, assessing activities of daily living and/or disability as outcome) were then identified from these reviews. Eligible papers were double reviewed, and due to heterogeneity, narrative analysis performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence, allowing us to make recommendations regarding specific non-pharmacologic rehabilitation in older stroke survivors. In total, 72 primary articles were reviewed spanning 14 types of non-pharmacological intervention. Non-pharmacological interventions based on physiotherapy and occupational therapy techniques improved activities of daily living amongst older stroke survivors. However, no evidence was found to support use of any non-pharmacological approach to benefit older stroke survivors' disability. Evidence was limited by poor study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.
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Affiliation(s)
- Carrie Stewart
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Selvarani Subbarayan
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Pamela Paton
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Elliot Gemmell
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Iosief Abraha
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Phyo Kyaw Myint
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Denis O’Mahony
- Department of Geriatric Medicine, University College Cork, Cork, Ireland
| | - Alfonso J. Cruz-Jentoft
- Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roy L. Soiza
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
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Fiest KM, McIntosh CJ, Demiantschuk D, Leigh JP, Stelfox HT. Translating evidence to patient care through caregivers: a systematic review of caregiver-mediated interventions. BMC Med 2018; 16:105. [PMID: 29996850 PMCID: PMC6042352 DOI: 10.1186/s12916-018-1097-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/11/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Caregivers may promote the uptake of science into patient care and the practice of evidence-informed medicine. The purpose of this study was to determine whether caregiver-mediated (non-clinical caregiver-delivered) interventions are effective in improving patient, caregiver, provider, or health system outcomes. METHODS We searched the MEDLINE, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health, and Scopus databases from inception to February 27, 2017. Interventions (with a comparison group) reporting on a quality improvement intervention mediated by a caregiver and directed to a patient, in all ages and patient-care settings, were selected for inclusion. A three-category framework was developed to characterize caregiver-mediated interventions: inform (e.g., provide knowledge), activate (e.g., prompt action), and collaborate (e.g., lead to interaction between caregivers and other groups [e.g., care providers]). RESULTS Fifty-six studies met the inclusion criteria, and 64% were randomized controlled trials (RCTs). The most commonly assessed outcomes were patient- (n = 40) and caregiver-oriented (n = 33); few health system- (n = 10) and provider-oriented (n = 2) outcomes were reported. Patient outcomes (e.g., satisfaction) were most improved by caregiver-mediated interventions that provided condition and treatment education (e.g., symptom management information) and practical condition-management support (e.g., practicing medication protocol). Caregiver outcomes (e.g., stress-related/psychiatric outcomes) were most improved by interventions that activated caregiver roles (e.g., monitoring blood glucose) and provided information related to that action (e.g., why and how to monitor). The risk of bias was generally high, and the overall quality of the evidence was low-moderate, based on Grading of Recommendations Assessment Development and Evaluation ratings. CONCLUSIONS There is a large body of research, including many RCTs, to support the use of caregiver-mediated interventions that inform and activate caregivers to improve patient and caregiver outcomes. Select caregiver-mediated interventions improve patient (inform-activate) and caregiver (inform-activate-collaborate) outcomes and should be considered by all researchers implementing patient- and family-oriented research. SYSTEMATIC REVIEW PROSPERO, CRD42016052509 .
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Affiliation(s)
- Kirsten M Fiest
- Departments of Critical Care Medicine and Community Health Sciences, O'Brien Institute for Public Health and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Christiane Job McIntosh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Danielle Demiantschuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Henry T Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Lee MJ, Yoon S, Kang JJ, Kim J, Kim JM, Han JY. Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation. Ann Rehabil Med 2018; 42:406-415. [PMID: 29961738 PMCID: PMC6058591 DOI: 10.5535/arm.2018.42.3.406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/04/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy. Methods Acute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures. Results There were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p<0.0001). There were no significant (p=0.0755) differences in changes in TIS-S scores at 4 weeks from baseline between the two groups. MBI, FAC, BBS, and TIS scores showed significantly inverse correlations with FES-I scores in patients receiving CME. There were no TEAEs in our series. Conclusion CME was effective and safe in improving the degree of independence, ambulation status, dynamic and static balance, trunk function, and concerns about post-stroke falls in stroke survivors.
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Affiliation(s)
- Min Jun Lee
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Seihee Yoon
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jung Joong Kang
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jun Young Han
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
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Vloothuis J, de Bruin J, Mulder M, Nijland R, Kwakkel G, van Wegen EEH. Description of the CARE4STROKE programme: A caregiver-mediated exercises intervention with e-health support for stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1719. [PMID: 29797740 PMCID: PMC6055845 DOI: 10.1002/pri.1719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/09/2018] [Accepted: 04/27/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Julya de Bruin
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Rinske Nijland
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
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Kim SB, Lee KW, Lee JH, Lee SJ, Park JG, Park JW. Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series. Ann Rehabil Med 2018; 42:195-203. [PMID: 29765872 PMCID: PMC5940595 DOI: 10.5535/arm.2018.42.2.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/26/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To evaluate the effect of caregiver driven robot-assisted in-ward training in subacute stroke patients. Methods A retrospective evaluation was performed for patients treated with caregiver driven robot-assisted in-ward training to retain gait function from June 2014 and December 2016. All patients received more than 2 weeks of caregiver driven robot-assisted in-ward training after undergoing conventional programs. The robot was used as a sitting device, a standing frame, or a high-walker depending on functional status of the patient. Patients were evaluated before and after robot training. Patient records were assessed by Korean version of Modified Barthel Index (K-MBI), Functional Independence Measure (FIM), and Functional Ambulation Category (FAC). Results Initially, patients used the robot as a sitting device (n=6), a standing frame (n=7), or a partial body-weight support high-walker (n=2). As patient functions were improved, usage level of the robot was changed to the next level. At the end of the treatment, the robot was used as a sitting device (n=1), a standing frame (n=6), or high-walker (n=8). Scores of K-MBI (Δ17.47±10.72) and FIM (Δ19.80±12.34) were improved in all patients. Conclusion Patients' usage level of the robot and functional scores were improved. Therefore, performing additional caregiver driven robot-assisted in-ward training is feasible and beneficial for subacute stroke patients.
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Affiliation(s)
- Sang Beom Kim
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Jin Gee Park
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Joo Won Park
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
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Leung J, Fereday S, Sticpewich B, Hanna J. Extra practice outside therapy sessions to maximize training opportunity during inpatient rehabilitation after traumatic brain injury. Brain Inj 2018; 32:915-925. [PMID: 29718728 DOI: 10.1080/02699052.2018.1469046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine if extra practice outside therapy sessions can be conducted for patients with traumatic brain injury and identify factors that influence their participation. METHODS A purpose-designed survey was conducted on consecutive eligible patients with traumatic brain injury and their relatives on discharge from inpatient rehabilitation. RESULTS In total, 68 of the 69 of patients who took part in the survey reported that they participated in extra practice outside therapy sessions. Also, 58% reported that they conducted extra practice more than three times a week on average and 70% reported no barriers in conducting extra practice. Patients with poor motivation, reduced executive functioning and less severe brain injury are less likely to participate in extra practice and may require more support. Relatives tended to be involved in extra practice for patients who were dependent. A wide range of barriers were identified with poor motivation and lack of confidence being the main ones. CONCLUSION With appropriate support, extra practice outside therapy sessions is generally feasible to maximize training opportunity for patients with traumatic brain injury. Motivation, perception of being listened to, executive functioning and severity of injury are factors that influence participation in extra practice. Strategies that improve motivation, interaction and confidence are likely to enhance participation. Relatives are a useful source of support for the more dependent patients.
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Affiliation(s)
- Joan Leung
- a Department Brain Injury Unit , Royal Rehab , Sydney , Australia
| | - Sarah Fereday
- b Department Physiotherapy , Institution Royal Rehab , Sydney , Australia
| | - Bridget Sticpewich
- b Department Physiotherapy , Institution Royal Rehab , Sydney , Australia
| | - Joe Hanna
- a Department Brain Injury Unit , Royal Rehab , Sydney , Australia
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