An Educational Intervention for Stroke Rehabilitation Patients and Their Families: Healthy Living After Stroke

Validity and feasibility of a learning style instrument for brain injury rehabilitation

PURPOSE

Identifying learning styles of acquired brain injury (ABI) patients may aid the learning process by tailoring to the patient's learning needs and preferences. Currently, there is no learning style instrument for ABI patients. We therefore determined the validity and feasibility of the Adapted Learning Style Inventory (A-LSI) for patients with ABI.

METHOD

We included 99 patients with ABI and 42 healthy controls. Learning styles were determined and subgroups were used to evaluate the validity of the A-LSI. Furthermore, rehabilitation professionals' perceptions on learning style and the A-LSI were evaluated.

RESULTS

In the patient group, the A-LSI yielded the following learning styles: 4 doers, 54 observers, 2 deciders and 39 thinkers. A similar distribution was found for the control group (3, 28, 0 and 11, respectively). Spearman correlations revealed moderate internal validity. Content validity of the A-LSI was also moderate; 11 out of 19 patients recognized themselves in their A-LSI learning style. Furthermore, 12 rehabilitation professionals reported positive and negative aspects of the A-LSI and suggestions for using learning style in rehabilitation.

CONCLUSIONS

Rehabilitation professionals were generally positive about using learning style in ABI rehabilitation. This study, however, raises doubts about the validity and feasibility of the A-LSI for this population.

IMPLICATIONS FOR REHABILITATION

Rehabilitation professionals are generally positive about the assessment and implementation of learning style in rehabilitation. The A-LSI seems to be an inappropriate learning style instrument for individuals with ABI. There is a need for a more practical instrument to assess learning style directly at start of rehabilitation.

Perceptions of pediatric physical therapists and physical educators on classifying learning styles of children and adolescents with cerebral palsy

The purpose of this study was to examine professionals' perceptions on classifying learning styles in the context of teaching motor activities to children and adolescents with cerebral palsy (CP). The participants were 21 pediatric physical therapists (PPTs) and seven physical educators (PEs) in three schools for special education in The Netherlands. All participants were introduced to the key descriptions of two existing learning style instruments (Kolb's Learning Style Inventory and Myers-Briggs Type Indicator), applied them to children and adolescents with CP, and reported their perceptions in written surveys. This study had a mixed-methods design. Quantitative and qualitative data analyses showed that PPTs and PEs are mostly positive about the idea of classifying learning styles in the context of teaching motor activities to children and adolescents with CP, giving three main reasons: individual approach, professional communication, and treatment awareness. Additionally, qualitative data analysis showed that the key descriptions of the two learning style instruments were not feasible as classifications for children and adolescents with CP. It is therefore recommended that other learning style classification instruments should be explored and that possibly a new learning style classification instrument should be developed in the context of teaching motor activities to children and adolescents with CP.

Delivery styles and formats for different stroke information topics: patient and carer preferences

OBJECTIVE

To identify the preferences of patients with stroke and their carers for format and delivery style, of different categories of stroke information, and whether these preferences changed over time.

METHODS

A semi-structured questionnaire, designed to explore preferences for four topic categories was administered to 34 acute stroke unit patients and 18 carers prior to discharge and again, 3 months after discharge to 27 of these patients and 16 of these carers.

RESULTS

Overall format preferences were a combination of face-to-face, written and telephone for both patients and carers prior to discharge. This combination continued for carers following discharge, while patients preferred face-to-face, written and alternative formats of online and audiovisual at this time. Patients and carers most frequently preferred delivery styles appeared to be a mix of active and passive delivery styles, across all topics. Access to a telephone hotline was a popular delivery style.

CONCLUSION

Patient and carer preferences varied, supporting the need to offer a variety of formats and delivery styles at each point of contact.

PRACTICE IMPLICATIONS

By focusing on specific formats and delivery styles for different topics, health professionals may maximise the access to, and relevance of, stroke information for patients and their carers.

Do clinical rehabilitation education programs really improve stroke-related knowledge?

OBJECTIVE

We evaluated the effectiveness of a clinical stroke education program for improving stroke-related health knowledge after inpatient rehabilitation in a "real world" setting.

DESIGN

Thirty-four patients participated in an inpatient rehabilitation clinical stroke education program. Their stroke-related health knowledge in three key domains-risk factors, warning signs, and appropriate actions to take if a stroke is suspected-was evaluated at admission and 12 wks later using a single-group, pretest-posttest design. Pretest and posttest comparisons were conducted using the Marginal Homogeneity test and the McNemar test.

RESULTS

Small, nonsignificant improvements in stroke-related health knowledge were detected at posttest. Twelve weeks after the education program, 29% of participants were unable to name a single risk factor, 32% were unable to name a single warning sign, and 29% were unable to name appropriate emergency action in the event they suspected a stroke.

CONCLUSIONS

A substantial proportion of patients who completed our clinical stroke education program continued to have poor stroke-related health knowledge. We noted several limitations in our program that may have contributed to this outcome. Changes may be useful for improving the success of clinical stroke education programs, thereby reducing knowledge deficits.

A quasi-experimental study on a community-based stroke prevention programme for clients with minor stroke

AIM

The aim of this study was to determine the effectiveness of a community-based stroke prevention programme in (1) improving knowledge about stroke; (2) improving self-health-monitoring practice; (3) maintaining behavioural changes when adopting a healthy lifestyle for stroke prevention.

BACKGROUND

People with minor stroke (or transient ischaemic attack) tend to under-estimate the long-term impact of this on their health. The challenge for nurses is to prevent subsequent strokes by finding ways to promote and sustain appropriate behaviours. Educational intervention is of paramount importance in equipping those at risk with relevant knowledge and self-care strategies for secondary stroke prevention.

DESIGN

This study adopted a quasi-experimental design.

METHOD

One hundred and ninety subjects were recruited, of whom 147 (77 in the intervention group and 70 in the control group) completed the study. Data were obtained at three time points: baseline (T0); one week after (T1) and three months after (T2) the intervention. The intervention programme consisted of eight weekly two-hour sessions, with the aims of improving the participants' awareness of their own health signals and of actively involving them in self-care management of their own health for secondary stroke prevention.

RESULTS

Significant positive changes were found among participants of the intervention group in the knowledge on stroke warning signs (P < 0.001); treatment seeking response in case of a stroke (P < 0.001); medication compliance (P < 0.001); self blood pressure monitoring (P < 0.001) as well as lifestyle modification of dietary habits (reduction in salted food intake, P = 0.004). No significant improvement was found in walking exercise participation in the intervention group, yet a significant decrease was detected among the control group.

CONCLUSION

This study found a three-month-sustained effect of positive changes in knowledge and skill from participants who undertook a nurse-led community-based stroke prevention programme.

RELEVANCE TO CLINICAL PRACTICE

Effective educational intervention by professional nurses helped clients integrate their learned knowledge into their real-life practice. This empowering, that is, the taking of responsibility by clients for their own self-care management on a daily basis, affirms that patient education has moved beyond teaching people facts.