Falls efficacy among stroke survivors living in the community

Purpose.?The study focused on the falls efficacy of stroke survivors in the community and its association with the related factors.

Method.?The study was conducted through a cross-sectional design in the community setting. One hundred seven stroke survivors were recruited. Falls efficacy was measured by the 7-item Falls Efficacy Scale International version, where the higher mean score showed more concern about falling in daily life.

Results.?Activities of daily living (ADL) dependency levels, including mild, moderate and severe, contributed to 33.5%% of the explained variance. Women were over 7.5 times more likely to have high falls efficacy than men. Moderate and severe ADL dependency participants were 10.8 and 13.6 times more likely to have high falls efficacy than ADL independent participants. Single fall participants were also nearly 13 times more likely to have high falls efficacy than others who had either recurrent falls or no falls.

Conclusions.?Female gender, strong ADL dependency, and single falls were associated with high falls efficacy. The levels of ADL dependency were the most correlated with falls efficacy than with other related factors. Rehabilitation interventions should also be incorporated to minimise ADL dependency, and to improve falls efficacy for stroke survivors.     

Falls among stroke survivors: an online survey on perceptions and approaches among physiotherapists in Flanders

Objective.?To describe physiotherapists' perceptions of fall risk and appropriate fall prevention interventions in rehabilitating stroke patients.

Method.?A web-based survey addressed to physiotherapy units on a stroke unit, general neurology department or rehabilitation ward/centre in Flanders.

Results.?Hospital response rate was 66.3%. Sixty-five physiotherapy units were taken into account. About 84.6% recognised falls among stroke patients as an essential problem and 73.8% thought falls interfered with the outcome. About 56.9% agreed with the need of a standardised fall assessment at the beginning of the treatment and only 36.9% reported that on their department stroke patients are screened on risk of falling. The most used fall risk assessments are: Berg Balance scale and Tinetti-test. The most popular fall prevention measures are: specific exercises for balance, gait and functional abilities (100%), informative education (92.3%) and adapting or intensifying the treatment after a fall (81.5%).

Conclusions.?Physiotherapy units acknowledge falls as an essential threat, implying a need for risk screening and prevention. However, results reveal that perception of the necessity of such screening is lower and that the performance is even less. This discrepancy underlines the necessity of guidelines and education of therapists working with stroke patients.     

Exploring poststroke mood changes in community-dwelling stroke survivors: a qualitative study

White JH, Magin P, Attia J, Pollack MR, Sturm J, Levi CR. Exploring poststroke mood changes in community-dwelling stroke survivors: a qualitative study.

Objective

To explore the long-term experience of mood changes in community-dwelling stroke survivors at 1, 3, and 5 years after stroke.

Design

A qualitative study using a modified grounded theory approach. The primary data collection method was semi-structured interviewing.

Setting

Community-dwelling stroke survivors in metropolitan Newcastle, NSW, Australia.

Participants

Twelve community-dwelling stroke survivors (6 men, 6 women; age range 43−92y; 4 participants from each cohort) discharged from a tertiary referral hospital.

Interventions

Not applicable.

Main Outcome Measures

Qualitative outcomes were participants' perceptions using in-depth, semi-structured interviews with participants from 3 community-based cohorts of stroke survivors at 1, 3, and 5 years poststroke.

Results

Four main categories of mood change were described by participants including feelings of frustration, reduced self-efficacy, dependency, and loss. Factors that modulated these mood changes included the presence or absence of insight, hope for the future, faith, and support. A modified grounded theory approach was used for data analysis using a process of constant comparison.

Conclusions

Mood changes continued well beyond discharge and in some cases commenced after discharge in this sample of stroke survivors. Use of qualitative methodology extends our understanding of the extent and nature of low mood after stroke. There is a need for enhanced services to monitor and address low mood.     

Issues in recruiting community-dwelling stroke survivors to clinical trials: The AMBULATE trial

BackgroundRecruitment to clinical trials is often slow and difficult, with a growing body of research examining this issue. However there is very little work related to stroke.AimsThe aim of this study was to examine the success and efficiency of recruitment of community-dwelling stroke survivors over the first two years of a clinical trial aiming to improve community ambulation.MethodRecruitment strategies fell into 2 broad categories: (i) advertisement (such as newspaper advertising and media releases), and (ii) referral (via hospital and community physiotherapists, a stroke liaison officer and other researchers). Records were kept of the number of people who were screened, were eligible and were recruited for each strategy.ResultsThe recruitment target of 60 in the first two years was not met. 111 stroke survivors were screened and 57 were recruited (i.e., a recruitment rate of 51%). The most successful strategy was referral via hospital-based physiotherapists (47% of recruited participants) and the least successful were media release and local newspaper advertising. The referral strategies were all more efficient than any of the advertisement strategies.ConclusionsIn general, recruitment was inefficient and costly in terms of human resources. Given that stroke research is underfunded, it is important to find efficient ways of recruiting stroke survivors to clinical trials. An Australian national database similar to other disease-specific data bases (such as the National Cancer Database) is under development. In the interim, recruiting for several clinical trials at once may increase efficiency.     

Vision, attention, and self-reported driving behaviors in community-dwelling stroke survivors

OBJECTIVE: To elucidate the relationships among vision, attention, driving status, and self-reported driving behaviors in community-dwelling stroke survivors. DESIGN: A cross-sectional design to compare stroke survivors to older adults without stroke on visual measures, attentional measures, and self-reported driving behaviors. SETTING: Rehabilitation center at a university hospital. PARTICIPANTS: Fifty stroke survivors and 105 older adults without neurologic or visual impairment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Visual acuity, contrast sensitivity, peripheral vision, useful field of view (UFOV), Behavioral Inattention Test, and a driving habits questionnaire. RESULTS: Stroke survivors had impaired contrast sensitivity, peripheral vision, and UFOV compared with older adults in good visual and neurologic health. Driving stroke survivors typically had less attentional impairment than nondrivers. Stroke survivors who returned to driving reported difficulty in challenging driving conditions, drove less, and relied more on other people for transportation than older adults without stroke. CONCLUSIONS: These results suggest that vision and attention, both of which are important for driving, are often impaired in stroke survivors. The severity of these deficits could be an influence on driving status and driving behavior. Stroke survivors who return to driving strategically limit their driving exposure and rely on others for transportation, which suggests that they may deliberately self-regulate their driving behavior.     

Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives

Purpose: Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants’ experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall.

Methods: Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n?=?9), family caregivers (n?=?4), and domestic helpers (n?=?4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software.

Results: All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor’s safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process.

Conclusions: Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore.

• Implications for rehabilitation

• Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities.

• Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors.

• Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers.

• A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.

     

Falls and functional impairments in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN): a University of Rochester CCOP study

Purpose

This study was conducted in order to characterize the prevalence of falls and functional impairments (FIs) and their association with chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors.

Methods

We analyzed baseline assessments from a phase III RCT in cancer survivors with self-reported CIPN scores of >4 out of 10. Patients completed the EORTC QLQ-CIPN-20 for neuropathy and reported falls in the previous 3 months. FIs were defined using the Activities of Daily Living subsection of the Vulnerable Elder’s Scale. Associations of baseline characteristics and CIPN with falls and FIs were examined using logistic regression.

Results

Of 421 patients, 11.9 % experienced recent falls and 26.6 % reported FIs. Motor neuropathy was the only factor associated with falls (OR?=?1.127, p?=?0.01). Factors associated with FIs included non-white race (OR?=?0.335 white relative to non-white, 0.781, p?=?0.01) and greater motor neuropathy scores (OR?=?1.262, p?<?0.0001).

Conclusion

CIPN, primarily motor, is associated with falls and FIs. Future prospective research should investigate the ability of motor neuropathy severity to predict falls.     

Health-related quality of life of community-dwelling stroke survivors: a comparison of fallers and non-fallers

[Purpose] The purpose of this study was to compare the health-related quality of life (HRQOL) of stroke survivors between fallers and non-fallers. [Subjects] The subjects were community-dwelling stroke patients (n = 4,560) in South Korea. All stroke patients were diagnosed by a doctor. [Methods] This study used raw data from the 2014 Korean Community Health Survey. The survey was conducted from August 16, 2014, to October 31, 2014. Trained surveyors visited households selected from the sample and conducted face-to-face interviews. The content of the survey included demographic data and HRQOL. [Results] Fallers were 1,425 (31.25%), non-fallers 3,125 (68.53%), and 10 (0.22%) answered unknown. Gender, living status, occupation, and smoking experience differed significantly between the fallers and non-fallers. The domains of HRQOL, excluding VAS, also differed significantly between the fallers and non-fallers. [Conclusion] These results provide important base data for rehabilitation services for fallers among stroke survivors.Key words: Fall, Health-related quality of life, Stroke     

Correlations between ankle–foot impairments and dropped foot gait deviations among stroke survivors

BackgroundThe purpose of this paper is to 1) evaluate the relationship between ankle kinematics during gait and standardized measures of ankle impairments among sub-acute stroke survivors, and 2) compare the degree of stroke-related ankle impairment between individuals with and without dropped foot gait deviations.MethodsFifty-five independently ambulating stroke survivors participated in this study. Dropped foot was defined as decreased peak dorsiflexion during the swing phase and reduced ankle joint motion in stance. Standardized outcome measures included the Chedoke–McMaster Stroke Assessment (motor impairment), Modified Ashworth Scale (spasticity), Medical Research Council (muscle strength), passive and active range of motion, and isometric muscle force.FindingsFoot impairment was not related to peak dorsiflexion during swing (r = ? 0.17, P = 0.247) and joint motion during stance (r = 0.05, P = 0.735). Active (r = 0.45, P < 0.001) and passive (r = 0.48, P < 0.001) range of motion was associated with stance phase joint motion. Peak dorsiflexion during swing was related to isometric dorsiflexor muscle force (r = ? 0.32, P = 0.039). Individuals with dropped foot demonstrated greater motor impairment, plantarflexor spasticity and ankle muscle weakness compared to those without dropped foot.InterpretationOur investigation suggests that ankle–foot impairments are related to ankle deviations during gait, as indicated by greater impairment among individuals with dropped foot. These findings contribute to a better understanding of gait-specific ankle deviations, and may lead to the development of a more effective clinical assessment of dropped foot impairment.     

Handicap in stroke survivors

Background and purpose: As survival following stroke improves, individuals are more likely to live with the aftermath of stroke rather than immediately die from it. The purpose of this study was to examine the consequences of stroke on the life activities of survivors in the social realm (stroke handicap) using the framework of the World Health Organization's International Classification of Impairments, Disabilities and Handicaps. Methods: Multivariate analysis of variance was applied to cross-sectional data from a clinical study to investigate the correlates of handicap in a cohort of hemispheric stroke survivors at 3 months (n= 145) and at 1 year (n= 135) after stroke onset. Handicap was assessed with the Reintegration to Normal Living Index, impairment by the Adams' Hemispheric Stroke Scale and Zung Depression Scale, and disability by the Functional Independence Measure. Environmental variables in the model included marital status and receipt of rehabilitation therapy. Results: Physical disability and post-stroke depressive symptoms were associated with handicap at both follow-up periods (p<0.05). Cognitive disability and impairments from a previous stroke were also associated with handicap (p<0.01), but only at 1 year. The presence of a spouse was found to benefit male survivors at 1 year. Conclusions: Disability and depressive symptoms restrict the meaningful life activities of stroke survivors in the first year of recovery. Social supports may be influential in reducing their impact.     

Handicap in stroke survivors

BACKGROUND AND PURPOSE: As survival following stroke improves, individuals are more likely to live with the aftermath of stroke rather than immediately die from it. The purpose of this study was to examine the consequences of stroke on the life activities of survivors in the social realm (stroke handicap) using the framework of the World Health Organization's International Classification of Impairments, Disabilities and Handicaps. METHODS: Multivariate analysis of variance was applied to cross-sectional data from a clinical study to investigate the correlates of handicap in a cohort of hemispheric stroke survivors at 3 months (n = 145) and at 1 year (n = 135) after stroke onset. Handicap was assessed with the Reintegration to Normal Living Index, impairment by the Adams' Hemispheric Stroke Scale and Zung Depression Scale, and disability by the Functional Independence Measure. Environmental variables in the model included marital status and receipt of rehabilitation therapy. RESULTS: Physical disability and post-stroke depressive symptoms were associated with handicap at both follow-up periods (p < 0.05). Cognitive disability and impairments from a previous stroke were also associated with handicap (p < 0.01), but only at 1 year. The presence of a spouse was found to benefit male survivors at 1 year. CONCLUSIONS: Disability and depressive symptoms restrict the meaningful life activities of stroke survivors in the first year of recovery. Social supports may be influential in reducing their impact.     

Cognitive impairments in survivors of out-of-hospital cardiac arrest: A systematic review

Objective

To describe the current evidence on the frequency and nature of cognitive impairments in survivors of out-of-hospital cardiac arrest.

Design

Systematic review.

Data sources

Pubmed, Embase, PsychInfo and Cinahl (1980–2006). No language restriction was imposed.

Review methods

The following inclusion criteria were used: participants had to be survivors of out-of-hospital cardiac arrest, 18 years or older, and there had to be least one cognitive outcome measure with a follow-up of 3 months or more. Case reports and qualitative studies were excluded. The articles were screened on title, abstract and full text by two reviewers. All selected articles were reviewed and assessed by two reviewers independently using a quality criteria list.

Results

Out of the 286 articles initially identified, 28 were selected for final evaluation. There was a high heterogeneity between the studies with regard to study design, number of participants, outcome measures and duration of follow-up. In general, the quality of the articles appeared low, with a few positive exceptions.The reported frequency of cognitive impairments in survivors of out-of-hospital cardiac arrest ranged from 6% to 100%. Memory problems were the most common cognitive impairment, followed by impairments in attention and executive functioning. Three high-quality prospective studies found that cognitive problems occurred in about half of the survivors of out-of-hospital cardiac arrest.

Conclusion

There are few good studies on the frequency of cognitive impairments after out-of-hospital cardiac arrest. However, cognitive problems, in particular memory problems, seem common in survivors of out-of-hospital cardiac arrest.     

Navigating stroke care: the experiences of younger stroke survivors

Abstract

Purpose: Although stroke is associated with ageing, a significant proportion of strokes occur in younger people. Younger stroke survivors have experienced care available as inappropriate to their needs. However, insufficient attention has been paid to how the social context shapes their experiences of care. We investigated this question with younger stroke survivors in Greater London, UK. Method: We conducted in-depth interviews with individuals aged between 24 and 62 years. Interviews were analysed thematically, with interpretation informed by Bourdieu’s concepts of field, capital and habitus. Results: In the acute care setting it was implicit for participants that expertise and guidance was to be prioritised and largely this was reported as what was received. Individuals’ cultural capital shaped expectations to access information, but health care professionals’ symbolic capital meant they controlled its provision. After discharge, professional guidance was still looked for, but many felt it was limited or unavailable. It was here that participants’ social, cultural and economic capital became more important in experiences of care. Conclusions: The field of stroke shaped younger stroke survivors’ experiences of care. Navigating stroke care was contingent on accessing different forms of capital. Differences in access to these resources influenced longer term adjustment after stroke.

• Implications for Rehabilitation

• Stroke care can be conceptualised as a temporal field of social activity and relationships which shapes variations in experiences of care among younger stroke survivors, and differences in expectations of support at different time points after stroke.

• On entering the field of stroke participants reported needing health care professional guidance and expertise to manage the acute event, yet difficulties accessing information in hospital limited the agency of some individuals wanting to take an active role in their recovery.

• After discharge from hospital variations in experiences of care among participants were more evident, with a number still seeking professional guidance, and requiring the capital and agency to navigate the field of stroke.

• Despite international efforts to improve the quality of acute care, effective models of community stroke care still need to be developed.