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Clients with stroke and non-stroke and their guardians' views on community reintegration status after in-patient rehabilitation.

ABSTRACT: Aim:The aim of this study was to compare client community reintegration status following discharge from the Kachere Rehabilitation Centre (KRC), Blantyre, Malawi, in 2 consecutive years with client versus guardian perspectives on reintegration status. Methods:Using quantitative methods, 35 clients with stroke and non-stroke diagnoses (spinal cord dysfunction and neuropathic conditions) and 32 client guardians (the family caregivers in Malawi) were separately interviewed using the WHO Disability Assessment Schedule (DAS) 2.0 (a measure of disability due to reintegration problems back into the community). The results were analyzed using descriptive statistics and the Wilcoxon Signed-Rank Test or the Mann-Whitney U Test, as appropriate, to test for significant differences between groups. The clients' home environments were categorized using an original checklist, the Home Observation Data Form (HOD). Results:Moderate to severe perceived levels of disability related to reintegration difficulties were noted by clients in years 1 and 2. For those with non-stroke diagnoses, there was a significant change in year 2 results compared to year 1, but not for those with stroke diagnoses. Guardians agreed with their client's perceptions of difficulty in year 2. Major areas of concern were taking care of household responsibilities, participating in day-to-day work or school routines, joining in community activities, and walking one kilometer per day. Conclusions:Community reintegration challenges in suburban Blantyre, Malawi continued to plague individuals with stroke and non-stroke diagnoses for 2 consecutive years after discharge from KRC. Based on the important role guardians play during their client's rehabilitation phase and when they return to the community, opportunities may exist to improve client perception of disability related to their reintegration status. Future studies are important to replicate these results, investigate the idea of a more important role for guardians in patient-centered care, and the relationship between motor and cognitive function and reintegration status.

SUBMITTER: Glickman LB

PROVIDER: S-EPMC6307047 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Clients with stroke and non-stroke and their guardians' views on community reintegration status after in-patient rehabilitation.

Glickman Leslie B LB Chimatiro George G

Malawi medical journal : the journal of Medical Association of Malawi 20180901 3

<h4>Aim</h4>The aim of this study was to compare client community reintegration status following discharge from the Kachere Rehabilitation Centre (KRC), Blantyre, Malawi, in 2 consecutive years with client versus guardian perspectives on reintegration status.<h4>Methods</h4>Using quantitative methods, 35 clients with stroke and non-stroke diagnoses (spinal cord dysfunction and neuropathic conditions) and 32 client guardians (the family caregivers in Malawi) were separately interviewed using the ...[more]

PMID: 30627352

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Project description:BACKGROUND:Despite increasing evidence regarding the benefit of intensive task-specific practice and aerobic exercise in stroke rehabilitation, implementation remains difficult. The factors influencing implementation have been explored from therapists' perspectives; however, despite an increased emphasis on patient involvement in research, patients' perceptions have not yet been investigated. OBJECTIVE:The study aimed to investigate factors influencing implementation of higher intensity activity in people with stroke and to compare this with therapists' perspectives. DESIGN:The design was a cross-sectional qualitative study. METHODS:The study used semistructured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from interviews with people with stroke were compared and contrasted with factors perceived by rehabilitation therapists. RESULTS:Ten people with stroke were interviewed before data saturation was reached. Participants had a positive attitude regarding working hard and were satisfied with the graded exercise test, high intensity intervention, and the feedback-monitoring devices. Therapists and patients had contrasting perceptions about their beliefs regarding intensive exercise and the content of the intervention, with therapists more focused on the methods and patients more focused on the personal interactions stemming from the therapeutic relationship. CONCLUSIONS:People with stroke perceived no barriers regarding the implementation of higher intensity rehabilitation in practice and were positive towards working at more intense levels. Contrastingly, from the therapists' perspective, therapists' beliefs about quality of movement and issues around staffing and resources were perceived to be barriers. In addition, therapists and people with stroke perceived the contents of the intervention differently, highlighting the importance of involving patients and clinicians in the development and evaluation of rehabilitation interventions.

Project description:BACKGROUND:Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation. OBJECTIVE:This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption. METHODS:We invited stakeholders (n=60), comprising stroke survivors (20/60, 33%), therapists (20/60, 33%), caregivers, and technology developers (including researchers; 20/60, 33%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions to enhance adoption. RESULTS:A total of 25 priorities were generated from the survey; these were reduced to 10 nonranked priorities through discussion, consensus activities, and voting at Workshop 1: access to technologies, ease of use, awareness of available technologies, technologies focused on function, supports self-management, user training, evidence of effectiveness, value for money, knowledgeable staff, and performance feedback. The second workshop provided recommendations for improving the adoption of technologies in stroke rehabilitation: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies, and a user network to inspire and test new technologies. CONCLUSIONS:The key outcomes from this series of stakeholder workshops provides a starting point for an integrated approach to promoting greater adoption of technologies in stroke rehabilitation. Bringing technology developers and users together to shape future and evaluate current technologies is critical to achieving evidence-based stroke rehabilitation.

Project description:BackgroundStroke in adults aged between 18 and 64?years old is increasing significantly worldwide. Studies have reported that this group of young stroke survivors encounters enormous difficulties reintegrating into their social roles. Individualised discussions with healthcare professionals and learning from other survivors are imperative for them to reconstruct their identities after stroke. There is also great demand for community support during their chronic stage of recovery to help them rebuild life skills to promote reintegration.Methods/designThis is a randomised controlled trial to investigate the effects of a 24-week Narrative and Skills-building Intervention (NSI) on young stroke survivors' community reintegration and psychosocial outcomes. A total of 208 adults aged 18-64?years old with a first-ever or recurrent ischaemic or haemorrhagic stroke and have been discharged home will be recruited and randomly assigned to receive usual care or usual care with NSI. The NSI is grounded in Narrative Theory and Bandura's principles of Self-efficacy and Outcome Expectation, consisting of successive eight individual sessions over six months delivered by a trained facilitator (a registered nurse). Participants will be facilitated to narrate their survival experiences and rebuild core life skills. Videos of peer young stroke survivors' experiences of recovery will be provided. Outcomes including community reintegration, depressive symptoms, health-related quality of life, self-efficacy, outcome expectation and satisfaction with performance of self-management behaviours will be measured before (T0) and immediately after NSI (T1), then six (T2) and 12?months after NSI (T3). Generalised estimating equations models will be used to compare the differential changes in outcomes across time between the two groups. Focus group interviews will be conducted with the facilitator at T1 and with the participants in the intervention group at T1 and T3.DiscussionThis study will evaluate the short and long-term effects of a theory-based NSI on young stroke survivors' community reintegration and establish a new model of community reintegration after stroke to inform future research. The results will also provide valuable evidence to develop clinical guidelines for young stroke survivors' community reintegration.Trial registrationClinicalTrials.gov identifier: NCT04560140 , registered on 23 September, 2020.

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Clients with stroke and non-stroke and their guardians' views on community reintegration status after in-patient rehabilitation.

Publications

Clients with stroke and non-stroke and their guardians' views on community reintegration status after in-patient rehabilitation.

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