Method: One hundred and sixty-six subjects with mild to moderate stroke were recruited and interviewed using the PS-SES. The principal axis factoring analysis was run to examine the factor structure, and internal consistency was assessed by computing Cronbach’s alpha coefficient.
Results: The final measure is a 35-item scale with six subscales: (1) managing home participation, (2) staying organized, (3) planning and managing community participation, (4) managing work/productivity, (5) managing communication, and (6) advocating for resources. The instrument demonstrated high internal consistency.
Conclusion: The PS-SES is a reliable measure offering unique information regarding self-efficacy in managing participation.
- Implications for Rehabilitation
Post-stroke participation requires complex management of resources, information, and strategies.
There is a gap in instruments that can assess self-efficacy in managing participation following a stroke.
The PS-SES is a valid tool measuring self-efficacy in using participation strategies in home, work, and community contexts.
Materials and methods: A systematic review was conducted to identify relevant articles from the following databases: Medline (PubMed), Web of Science, PEDro, REHAB+, Rehabdata, Science Direct, CIRRIE, and Cochrane library. Studies were included when they involved adult stroke patients; were controlled clinical trials; assessed static and dynamic balance; and incorporated trunk exercises on stable or unstable support surfaces. Databases were systematically screened until April 2017. Risk of bias assessment was performed by means of the PEDro scale.
Results: Seven studies met the inclusion criteria, of which one had a low risk of bias and six a high risk. In total, 184 stroke patients were evaluated. Unstable support surfaces used during therapy were physio balls, balance pads, air cushions, tilting boards, and slings. Trunk training was provided either as additional therapy or without conventional therapy. All modalities, except for the sling, showed larger improvements compared to stable support surfaces on balance performance.
Conclusions: Trunk training on unstable support surfaces seemed to be superior to stable support surfaces in improving static and dynamic balance. However, more research is necessary, since the risk of bias of the included studies was high.
- Implications for Rehabilitation
Trunk training on unstable surfaces seems to be superior to stable surfaces in improving static and dynamic balance.
Physio balls, air cushions, balance pads, and unstable boards are appropriate supports to enhance balance during stroke rehabilitation.
Implementing unstable supports early in rehabilitation might be more beneficial.
Method: This study included 111 stroke inpatients. Simple and multiple regression analyses were conducted to establish the association between the FIM® instrument scores for transfer or stair-climbing and Berg Balance Scale. Furthermore, receiver operating characteristic curves were used to elucidate the amount of balance necessary for the independence of transfer and stair-climbing.
Result: Simple and multiple regression analyses showed that the FIM® instrument scores for transfer and stair-climbing were strongly associated with Berg Balance Scale. On comparison of the independent and supervision-dependent groups, Berg Balance Scale cut-off values for transfer and stair-climbing were 41/40 and 54/53 points, respectively. On comparison of the independent-supervision and dependent groups, the cut-off values for transfer and stair-climbing were 30/29 and 41/40 points, respectively.
Conclusions: The calculated cut-off values indicated the amount of balance necessary for the independence of transfer and stair-climbing, with and without supervision, in stroke patients. Berg Balance Scale has a good discriminatory ability and cut-off values are clinically useful to determine the appropriate independence levels of transfer and stair-climbing in hospital wards.
- Implications for rehabilitation
The Berg Balance Scale’s (BBS) strong association with transfer and stair-climbing independence and performance indicates that establishing cut-off values is vitally important for the established use of the BBS clinically.
The cut-off values calculated herein accurately demonstrate the level of balance necessary for transfer and stair-climbing independence, with and without supervision, in stroke patients.
These criteria should be employed clinically for determining the level of independence for transfer and stair-climbing as well as for setting balance training goals aimed at improving transfer and stair-climbing.
This observational cross-sectional study identifies features and occupational needs of complex inpatients during rehabilitation, focusing on function and ability, regardless of diagnosis.
Method: This study included sixteen adult inpatients with stroke, deemed complex according to Rehabilitation Complexity Scale-Extended, at admission to Rehabilitation ward (from July 2014 to February 2015). Patients with primary psychiatric disorders, language barriers, cognitive or severe communication deficits were excluded. Upon admission, a multidisciplinary team collected data on general health, independence in daily activities (Modified Barthel Index), fatigue (Fatigue Severity Scale), resistance to sitting and ability to perform instrumental activities (Instrumental Activities of Daily Living). The occupational therapist identified occupational needs according to Canadian Occupational Performance Measure.
Results: Inpatients enrolled in this study were dependent in basic ADL, limited in instrumental ADL and easily fatigable. Their occupational needs related to self-care (75%) and, to a lesser extent, productivity (15%) and leisure (10%). According to inpatients, rehabilitation process should firstly address self-care needs, followed by productivity and leisure problems.
Conclusions: Despite small sample size, this study described patterns of occupational needs in complex inpatients with stroke. These results will be implemented in client-centered rehabilitation programs to be tested in a phase-two trial. [NCT02173197]
- Implications for Rehabilitation
Priority occupational needs of complex inpatients with stroke during rehabilitation are focused on self-care area.
Productivity and leisure problems also arise in early post-acute phase.
Client-centered rehabilitation programs should firstly address self-care needs and, later on, they should also focus on the recovery of family and social roles.
Methods: The Jacket Test completion times were measured along with the Fugl–Meyer Upper Extremity Assessment, hand grip strength, 5-times Sit-to-stand test, Berg Balance Scale and timed “up and go” test, and Community Integration Measure using the cross-sectional design.
Results: The Jacket Test completion times showed excellent intra-rater, inter-rater and test–retest reliability (Intra-class Correlation Coefficient = 0.781–1.000). The unaffected-side Jacket Test times were significantly correlated with FMA-UE score, affected hand grip strength, Berg Balance Scale score, timed “up and go” test times and Community Integration Measure score. The affected-side Jacket Test times significantly correlated with affected hand grip strength. The cutoff time of 18.33s in affected side and 18.38s for unaffected side (sensitivity 96.7%; specificity 85.7–96.4%) was used to best discriminate the subjects with stroke and healthy older adults.
Conclusion: The Jacket Test is a reliable and valid measure tool in clinic to evaluate the upper extremity function in people with chronic stroke.
- Implication for rehabilitation
The Jacket Test completion times has excellent intra-rater, inter-rater and test–retest reliabilities in patients with chronic stroke.
The Jacket Test completion times significantly correlated with motor functions of the upper limbs.
The Jacket Test completion times of 18.33s in affected side and 18.38s for unaffected side (sensitivity 96.7%; specificity 85.7%-96.4%) was found to be the most representative for discriminating chronic stroke survivors and healthy older adults.
The Jacket Test is a reliable and valid measuring tool to evaluate the upper extremity function of people with chronic stroke.
Materials and methods: The literature was searched systematically, including MEDLINE database, EMBASE and PsychINFO, combining variations of the terms stroke, rehabilitation and comorbidities. Results were limited to English language publications. Included studies had a functional outcome.
Results: Twenty relevant articles were identified. Fifteen small prospective or large retrospective studies using global comorbidity scales produced conflicting relationships between comorbidities and rehabilitation outcomes. Five publications addressed specific comorbidities, with three studies finding negative correlation between diabetes and rehabilitation outcomes, although effects diminished with age. In general, there were discrepancies in how comorbidities were identified. Few studies specifically focused on comorbidities and/or rehabilitation outcomes.
Conclusions: There is conflicting evidence regarding the impact of comorbidities on stroke rehabilitation outcomes. However, the presence of more severe diabetes may be associated with worse outcomes. The role of comorbidities in stroke rehabilitation would be best clarified with a large cohort study, with precise comorbidity identification measured against rehabilitation specific outcomes.
- Implications for rehabilitation
Benefit of rehabilitation after stroke in improving functional outcome is well-established.
Many stroke patients have comorbid conditions which can impact rehabilitation participation, leading to less benefit obtained from rehabilitation.
The burden of comorbid conditions may slow rehabilitation progress, which may warrant a longer duration of rehabilitation to obtain required functional gain to be discharged into the community.
Methods: Prospective cohort study in which 326 patients were assessed at stroke onset, two months and one year after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used to measure participation restrictions one year after stroke. Bivariate and multivariate logistic regression analyses were performed including demographic factors, stroke-related factors, emotional functioning and comorbidity as possible predictors.
Results: Stroke survivors aged over 70 years perceived more participation restrictions in comparison to stroke survivors aged under 70 years one year after stroke. Independently significant predictors for unfavorable participation outcomes were advancing age, more severe stroke and anxiety symptoms in patients aged over 70 years, and female gender, more severe stroke, impaired cognition and depression symptoms in patients aged under 70 years. Lower age was the only independent predictor associated with favorable participation after one year in stroke survivors aged over 70 years.
Conclusions: This study emphasizes the need to pay more attention to participation restrictions in elderly stroke survivors.
- Implications for rehabilitation
More attention in the rehabilitation process should be paid to restrictions in participation of stroke survivors aged older than 70 years, taking into account the different participation needs and predictors of older stroke survivors.
Early screening on the presence of anxiety symptoms could potentially prevent long-term restrictions in participation in stroke survivors aged over 70-year old.
Stroke survivors experience considerable restrictions in physical activity and mobility after one year, highlighting the need for the development of community-based exercise programs for stroke survivors.
Methods: A systematic literature search was conducted. Studies that employed qualitative methods to explore the experiences of individuals with stroke around return to work after stroke were included. The methodological quality of the studies was assessed by two independent reviewers. Overarching themes, concepts and interpretations were extracted from each individual study, compared and meta-synthesized.
Results: Fifteen studies were included and the overall methodological quality of the studies was good. Four broad themes emerged as factors associated with return to work after stroke. These included (i) the nature of the effects of stroke, (ii) the preparatory environment, (iii) personal coping strategies and internal challenges and (iv) the meaning of work.
Conclusion: Return to work after stroke is a complex process which can be facilitated or impeded by organizational, social or personal factors, as well as accessibility to appropriate services.
- Implications for Rehabilitation
Following a period of dedicated inpatient rehabilitation, there is a need to integrate community-support services to optimize return to work among stroke survivors.
A dedicated community stroke support liaison officer may help to facilitate the transition between the hospital and the community and workplace environment.
Education provided by healthcare professionals is necessary in the community and the workplace to ensure that family, friends and employers are aware of the impairments, activity limitations and participation restrictions of the stroke survivor.
Method: Alvesson and Sandberg’s method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives.
Results: Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation.
Conclusions: Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation.
- Implications for rehabilitation
Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation.
The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke.
The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or more severe stroke.
Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.
Method: Electronic searches were conducted in PubMed, SCOPUS, CINAHL, ProQuest, Ovid, Wiley InterScience, and ScienceDirect databases from their start dates to December 2015.
Results: Of the 1123 identified articles, 12 met the inclusion criteria for qualitative synthesis, eight of which were deemed appropriate for meta-analysis. Qualitative synthesis found that the type of cerebral palsy, early motor milestones, primitive reflexes and postural reactions, absence of visual impairment, absence of intellectual disability, absence of epilepsy or seizure, and ability to feed self were indicated as potential predictors for ambulation. Meta-analysis detected four significant prognostic predictors for ambulation: sitting independently at 2 years, absence of visual impairment, absence of intellectual disability, and absence of epilepsy or seizure.
Conclusion: These prognostic predictors should be taken into consideration in therapeutic plans and rehabilitation goals, especially sitting independently before the age of 2 years.
- Implications for rehabilitation
The meta-analysis supports strong evidence that sitting independently at 2 years of age, absence of visual impairment, absence of intellectual disability, and absence of epilepsy or seizure are positive predictors for ambulation in children with cerebral palsy.
The therapeutic plans and rehabilitation goals should be considered cautiously for these predictors, especially sitting independently before the age of two years.
Method: Qualitative research methodology was applied, and included in-depth interviews with stroke survivors.
Results: This study revealed: (a) social and material differences in clinical, private and public places; (b) ambivalences and shifting tensions in bodily, family and community life; (c) differences in access to resources to be used for mobility. Moving around safely was not a matter of being physically able to walk independently, it also involved dealing with different human actors – such as children, partners and shoppers, and non-human actors – such as doorbells and traffic rules. Stroke survivors had to balance exercise and training, family and working life, and leisure and pleasure, and to renegotiate their mobility in each context.
Conclusions: Our study showed that mobility has many aspects that interact with each other in multiple ways for stroke survivors when they return home and thereafter. The current focus on adherence to mobility and exercise training at home needs to be critically reviewed as it does not capture the multiplicities embodied in real-life settings.
- Implications for rehabilitation
Rehabilitation medicine needs to consider mobility as a way to connect places that are meaningful to individuals rather than as movements from A to B.
Clinical outcome measurement tools, such as the 10-meter walk test, are inadequate for evaluating participation in the mobility domain at home or in the community.
Mobility issues at the participation domain need to be considered in “how they hang together” rather than distinguished in different disciplinary domains.
Rehabilitation practitioners should teach stroke survivors concrete strategies on how to creatively deal with the ambivalences and tensions around mobility in home and community life.
Method: Two stroke survivors with a first time stroke living at home with a spouse were included. Data were generated through participant observations at their own environment at 3, 6, 9, 15 and 21 months post-discharge. The narrative analysis focused on the actions of participants.
Results: Daily activities can be understood as an arena where role management and a meaningful live is negotiated and co-constructed with others. Everyday activities gave stroke survivors and their spouses insight into stroke survivors’ capacities in daily situations. This was sometimes empowering, and other times conflicting when a spouse had negative perceptions of the abilities of the stroke survivors.
Conclusion: The findings add to the current understanding of self-management and role management with regard to how these are situated in everyday activities. Daily activities can help both spouses to reflect and understand about self-management, role management and comanagement in daily life. Moreover, observing stroke survivors in everyday situations provides professionals with concrete pictures of stroke survivors’ performance and self-management in interaction with their spouses.
- Implications for Rehabilitation
Self-management is a dynamic process in which individuals actively manage a chronic condition and finally live a meaningful life with a long-term chronic condition; self-management can be divided into medical, role, and emotional management; comanagement is when individuals activate resources and use the capacities of other persons to manage a situation together.
Self-management is situated in everyday activities. Everyday activities give stroke survivors ánd their partners impressions about stroke survivors’ self-management abilities post-stroke in an everyday context.
Everyday activities give stroke survivors ánd their partners an arena where role management and a meaningful life are negotiated and coconstructed through doing.
Observing stroke survivors in everyday situations provides professionals a concreter picture of stroke survivors’ self-management and comanagement with their partners than can be obtained from an informal interview.
Method: Thirteen pwMS and 14 chronic stroke patients performed 36 (stroke) or 40 (pwMS) training sessions with the I-TRAVLE system. Evaluation of upper limb function was performed at baseline, after training and at 3 months follow-up. Clinical outcome measures consisted of active range of motion (ROM), Motricity Index, Jamar handgrip strength, perceived fatigue and strength, Wolf Motor Function Test (WFMT) and ABILHAND. Robot-generated outcome measures consisted of movement velocity, ROM and actual covered distance compared to straight-line distance.
Results: In pwMS, significant improvements were found after training in active shoulder ROM, handgrip strength, perceived strength and WMFT activities. No significant change in clinical outcome was found in stroke patients, except for perceived strength. Significant improvement in speed and movement duration was found after training in both groups. At follow-up, clinical outcome deteriorated in pwMS and was maintained in stroke patients.
Conclusions: Robot-mediated training resulted in improved movement coordination in both groups, as well as clinical improvement in pwMS. Absence of functional improvements in stroke patients may relate to severe upper limb dysfunction at baseline.
- Implications for Rehabilitation
Robot-mediated training improved strength, active range of motion and upper limb capacity in pwMS.
Robot-mediated therapy allows for adapted training difficulty.
Methods: This study presents the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. On day 7, stroke evaluation was performed using the functional assessment battery including the National Institute of Health Stroke Scale (NIHSS). At 6 months after stroke, functional outcomes using the face-to-face functional assessment battery including Functional Independence Measure (FIM) were analyzed in the patients who had a score of 0 on the NIHSS at 7 days after stroke onset.
Results: In the very mild stroke group, 455 patients were followed up at 6 months. Out of these patients, 11.0% had impairments in cognitive function, 14.1% had motor impairment, and 2.1% had impairments in their mobility measured by the functional assessment battery. At 6 months after onset, 3.3% of stroke survivors without recurrence showed dependency according to the FIM.
Conclusions: Many acute stroke patients with mild stroke severity as assessed by the NIHSS had impairments in various functional domains, and could have been easily overlooked for intensive rehabilitation therapy. Candidates for comprehensive rehabilitation therapy might be better identified by the functional assessment battery.
- Implications for rehabilitation
Many acute stroke patients with mild stroke severity assessed by NIHSS could be easily overlooked for intensive rehabilitation therapy.
Candidates for comprehensive rehabilitation therapy should be evaluated using a functional assessment battery rather than the NIHSS.
Method: We evaluated components of the therapeutic intervention, from the patients’ and the therapists’ points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals.
Results: The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted.
Conclusions: Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients.
- Implications for Rehabilitation
Computerised Mirror Therapy is feasible for clinical use
Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting
Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation
Method: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on “whodas” using the ProQuest, PubMed, and Google Scholar electronic databases.
Results: We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).
Conclusions: The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them.
- Implications for Rehabilitation
WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability.
The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry.
WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations.
A critical issue for rehabilitation is that a single “minimal clinically important .difference” score for the WHODAS 2.0 has not yet been established.