Introduction
The objective of this systematic review was to synthesise the evidence for cognitive strategy training to determine its effectiveness to improve performance of activities of daily living ...in an adult neurological population.
Method
Medline, CINAHL, EMBASE, PSYCInfo, PsycBITE and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched until August 2019. Studies examining the effect of cognitive strategy training on functional performance were included. Population criteria included adults with non-progressive neurological conditions. External and internal validity of included studies was systematically evaluated using an appropriate methodological quality assessment for each study design. A content analysis was conducted of the methodologies used.
Findings
Forty-one studies met the inclusion criteria and were appraised for content, 16 randomised or quasi-randomised trials were meta-analysed. Trial quality was generally ‘good’, Physiotherapy Evidence Database scale scores ranged from 3 to 8 (out of 10). For activity performance outcomes post-intervention, there was a significant benefit of cognitive strategy training over usual care (standardised mean difference 0.79, 95% confidence interval 0.49–1.09; P < 0.00001).
Conclusion
More high-quality research is needed to strengthen the evidence base for cognitive strategy interventions to improve activity performance outcomes for adults with non-progressive neurological conditions.
Systematic review registration
PROSPERO CRD42016033728
The focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can ...experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke.
Systematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term < 3 months, medium-term 3-12 months, and long-term > 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline.
This living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments.
Abstract
Purpose: The purpose of this study was to investigate the experiences and expectations of people with stroke, during their transition from hospital to home, after participating in a novel ...inpatient outreach program, entitled STRENGTH. Methods: A qualitative study was conducted using semi-structured interviews, which were undertaken at discharge and 4-6 weeks post discharge. Thematic analysis was used to code the interview transcripts. Results: The study incorporated data from seven people with stroke, who had a mean age of 61 years. Thematic analysis derived two themes, each with two sub-themes. The first theme was "Hospital and home" and described clients' experiences of therapy and the hospital environment. The second theme was "Life will never be what it was before" and elaborated on the adaptations and changing expectations that clients had before and after discharge. Conclusions: People with stroke described the therapy they received in both the hospital and home as beneficial. The results support the addition of the home-based inpatient program, STRENGTH, to the current rehabilitation system, as it appeared to realign the expectations of people with stroke and better prepare them for their discharge home.Implications for RehabilitationSTRENGTH aids clinicians to identify difficulties in the home environment for people with stroke.STRENGTH improves the confidence of people with stroke while they transition home.Further research is warranted for psychological interventions that prepare people with stroke for difficulties that arise in the community.
Burns to one or both hands can impact how a person interacts with the world around them. Research regarding the specific impact of hand burn injuries and the experiences of individuals who have ...sustained hand burn injuries remains limited.
The aim of this study was to explore the lived experiences of people with severe hand burn injuries, including their return to daily activities.
This study used an interpretive description approach, incorporating 23 semi-structured interviews with people who had sustained severe hand burn injuries.
A major theme, “changes over time “, was identified and reflected the progressive nature of the experience over time. This was present in all three sub-themes: physical recovery, activities of daily living recovery, and psychosocial impact. Participants described a dual process of managing the recovery of the burn injury and burn rehabilitation interventions, whilst simultaneously learning to live with their injury and finding ways to engage in their occupations to the best of their abilities.
The findings of the study suggest that burns recovery could be described in terms of performance rather than impairment and needs to be continuously monitored overtime.
•Burns to one or both hands can impact how an individual interacts with the world around them.•Gaining an understanding of individual experiences and perspectives is enriched through qualitative explorations.•Twenty- three individuals participated in semi-structured interviews.•“Changes over time” was the major theme which was identified and reflected the progressive experience over time.•Recovery for hand severe hand burn injuries could be described in terms of performance rather than impairment.
A new outcome measure for hand burn injuries was co-designed within a Participatory Action Research framework with expert clinicians and individuals with hand burn injuries. The outcome measure ...reviews activities which are commonly interrupted post hand burn injuries and includes 18 activities.
The aim of this study was to establish the clinical utility, face, and content validity of the newly developed outcome measure.
Three constructs of interest were examined using study specific questionnaires from the perspectives of clinicians and individuals with hand burn injuries. Clinicians working in burns centres around Australia and New Zealand and individuals attending a burn centre within one tertiary hospital trialled the outcome measure. Upon testing the outcome measure each participant completed the questionnaire.
Twenty individuals with hand burn injuries and eight clinicians trialled the outcome measure. There was 85% agreement from individuals and 100% agreement from clinicians for face validity. Content validity was tested across the domains of relevance and clarity. Individuals rated all activities and clinicians rated 16 activities as relevant. Clarity of activities was high for both participant groups (>75% agreement). Clinical utility (measured in the domains of appropriateness, accessibility, practicability, and acceptability) was high, 95% of individuals reported agreement for practicability and 100% agreement for acceptability. Clinicians reported agreement of > 87.5% for appropriateness, accessibility, practicability, and acceptability.
The results demonstrated agreement for clinical utility, face, and content validity of the co-design outcome measure for hand burn injuries. Further validity and reliability testing is planned, including Rasch analysis.
•Testing of a new -co-designed outcome measure for hand burn injuries found high levels of agreement for face validity•Agreement for relevance of activities included in was rated at 88.9% by clinicians and 100% by individuals with hand burn injuries•Clarity of activities included in the outcome measure was high > 75% agreement from both clinicians and individuals•Agreement for clinical utility of the new co-designed outcome measure was high < 87.5% from clinicians and individuals
There is minimal understanding of how people with mild stroke experience health services. With recent acknowledgement of the difficulties this population faces, it is imperative that their views are ...sought on services required to meet their needs. This study aimed to answer the question: 'How do people with mild stroke perceive their experience of stroke-related healthcare services?'. Qualitative investigation using an interpretative phenomenological analysis. Five participants were interviewed at 1-, 3-, and 6- months post discharge. Three themes were identified that reflected the 'essence' of healthcare service experiences: 1) The difficult diagnosis, 2) Standard care: good but not good enough, and 3) A journey better not done alone. It was clear that people with mild stroke and health professionals experienced difficulty linking symptoms to stroke. Following hospital discharge, issues relating to service coordination, information provision, and secondary prevention were identified. A formal support person appeared to increase participants' feelings of support.
Objective: To longitudinally explore the transition home for a spousal dyad following mild stroke, in the context of a mild stroke-specific health service.
Research Design: A case study approach, ...using an Interpretative Phenomenological Analysis (IPA), was identified as suitable for this study, as it enabled the essence of the phenomenon to be examined.
Method: Participants were purposively chosen from a Randomised Control Trial (RCT), to reflect the average age, gender and marital status of the mild stroke population. The participants were a male (age 64) and his wife (age 62). Participants received the RCT intervention. Semi-structured interviews were completed separately with participants at 1-, 3-, 6- and 9- months post stroke.
Results: Two themes were identified: (1) The Unexpected, Undesirable and Short-Lived, and (2) The New 'Normal'. The first theme reflects the confusion, adjustment and adaptation that occurred for the couple, especially during the first month at home. The second represents the couple's journey back to their everyday lives following hospital discharge, but also the questions and changes that remained present at 9-months post-discharge.
Conclusions: Themes demonstrate an ongoing process of adjustment and the contextual nature of the transitional experience. Results also indicate the need to ensure that individuals have access to mild-stroke specific information across the transition continuum.
To understand and combat the challenges in taking up and implementing technology in rehabilitation settings, the HabITec Lab, a clinical service focused on technology, was piloted for 12-months ...within a tertiary hospital. This article reports on its preliminary impacts as a clinical service and on clients, including the types of assistive technology (AT) in demand.PURPOSETo understand and combat the challenges in taking up and implementing technology in rehabilitation settings, the HabITec Lab, a clinical service focused on technology, was piloted for 12-months within a tertiary hospital. This article reports on its preliminary impacts as a clinical service and on clients, including the types of assistive technology (AT) in demand.Referral and administrative data from 25 individuals who attended the HabITec Lab were collated and analysed using descriptive statistics. For those who attended more than once (n = 12), goal attainment was assessed using the Modified Goal Attainment Measure (MGAM). Post-intervention semi-structured interviews were completed with participants to understand their experience at the HabITec Lab. Interviews were analysed using thematic analysis.MATERIALS AND METHODSReferral and administrative data from 25 individuals who attended the HabITec Lab were collated and analysed using descriptive statistics. For those who attended more than once (n = 12), goal attainment was assessed using the Modified Goal Attainment Measure (MGAM). Post-intervention semi-structured interviews were completed with participants to understand their experience at the HabITec Lab. Interviews were analysed using thematic analysis.Most attendees (92%) were undergoing inpatient rehabilitation following a spinal cord injury (SCI). The majority (73%) of goals related to improving entertainment and connection. All participants who completed the MGAM showed improved goal attainment following their HabITec Lab attendance. Qualitative data highlighted appreciation for the service and suggestions for its future.RESULTSMost attendees (92%) were undergoing inpatient rehabilitation following a spinal cord injury (SCI). The majority (73%) of goals related to improving entertainment and connection. All participants who completed the MGAM showed improved goal attainment following their HabITec Lab attendance. Qualitative data highlighted appreciation for the service and suggestions for its future.This study revealed a high level of demand for support to use AT amongst individuals with SCI, particularly consumer-grade smart devices that could assist communication. This finding may have been influenced by the impacts of the COVID-19 pandemic and frequent lockdowns during this period. This study indicated that the HabITec Lab was able to address important goals for attendees, but also illuminate a new future and trigger enthusiasm about future goals. Attendance was liberating, but resourcing barriers were frustrating.CONCLUSIONSThis study revealed a high level of demand for support to use AT amongst individuals with SCI, particularly consumer-grade smart devices that could assist communication. This finding may have been influenced by the impacts of the COVID-19 pandemic and frequent lockdowns during this period. This study indicated that the HabITec Lab was able to address important goals for attendees, but also illuminate a new future and trigger enthusiasm about future goals. Attendance was liberating, but resourcing barriers were frustrating.
The threat of climate change to the health and wellbeing of the Australian population is well documented. Literature is emerging to support the role of occupational therapy in environmental ...sustainability. To date, the perspectives of occupational therapists practicing in Australia are yet to be explored. This study aimed to explore these perspectives, specifically occupational therapists' knowledge, skills, and attitudes regarding environmental sustainability.
A mixed methods study using a cross-sectional survey design and convergence model was undertaken. A survey was developed using closed- and open-ended questions drawn from the World Federation of Occupational Therapists Guiding Principles for Sustainability. The online survey remained open from March to September 2021. Quantitative data were analysed descriptively, and inductive content analysis was used to analyse qualitative data. Merged integration was used to identify convergence and divergence between data sets and enable conclusions to be drawn.
Responses were received from 37 participants. For occupational therapists practicing in Australia there appeared to be an incongruence between the importance of environmental sustainability in daily life compared to professional practice. In professional practice, there are several perceived barriers that are outside of the locus of control of the therapist. Therapists are motivated to engage in this concept but are unsure how to do so.
Findings provide an initial understanding about environmental sustainability from the current perspectives of occupational therapists practicing in Australia. More structured guidance is required to integrate environmental sustainability considerations into professional practice. Future research should focus on developing a more in-depth understanding of the concepts preliminarily explored in this study.
Background: Mild stroke occurrences are rising and in order to comprehensively understand the experience of this health phenomenon, the context in which people with mild stroke live must be explored. ...Spouses are an important part of the lives of this population, but their experiences are yet to be fully understood.
Aims/Objectives: To answer the question: "What is the essence of the mild stroke experience from the perspective of spouses during the first 9-months after acute hospital discharge, in Australia?"
Materials and Methods: Qualitative study involving four spouses at 9-months post-acute hospital discharge for their family member. Interpretative phenomenological analysis used to analyze interview transcripts.
Results: Two themes identified: (1) Activities gained but time lost, and (2) Small changes but big impacts. The first theme portrays the increase in daily activity that spouses experienced due to caregiving related activities, which impacted on their occupational participation. The second highlights the impact that people with mild strokes' behavioral and emotional changes can have on spouses.
Conclusions and Significance: Whilst spouses generally return to their daily routines after a family members' mild stroke, some will experience increased time pressures and occupational disruptions. Health providers should prepare spouses for behavioral and emotional changes in people with mild stroke.
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