Functioning and subjective health among stroke survivors after discharge from hospital

AIM: This paper reports a study exploring functioning (functions, activities and participation) and subjective health among stroke survivors 6 months after discharge from hospital. A further aim was to investigate patterns of functions and activities, and associations between functioning and subjective health. BACKGROUND: Nurses tend to emphasize functional and activity outcomes and rarely look to people's participation in their social world. By integrating individual and social contextual factors in their assessments, nurses will have a powerful tool to broaden their outlook. The International Classification of Functioning, Disability and Health can be used as a framework for understanding the consequences of stroke. Studies are needed, however to make the International Classification of Functioning operational for practical use. METHODS: A cross-sectional and explorative design was used using structured interviews and assessments with a number of scales with 89 stroke survivors 6 months after their hospital stay. The measures used were Personal Activities of Daily Living, including cognitive ability, transfer, dressing, bathing, energy to eat, ingestion, swallowing, going to the toilet, faecal continence, and urinary continence; and Instrumental Activities of Daily Living, including washing clothes, cooking, cleaning, transport and shopping. Factor analysis was performed for functions and activities and the final solution had an explained variance of 70%. The data were collected during autumn 2003 and spring 2004. FINDINGS: Close associations (r(s) > 0.5) were found between Activities of Daily Living in relation to participation and subjective physical health. CONCLUSION: Existing Activities of Daily Living scales were expanded and found to relate to a participation scale and a subjective health scale. Using these scales in nursing care has the potential to correct current bias towards functions and activities by broadening the focus to include the social as well as the physical.     

Fear of falling among stroke survivors after discharge from inpatient rehabilitation

The objectives of this study were to assess the incidence of falls and fall consequences among patients who were discharged from inpatient stroke rehabilitation and to investigate the proportion of those who experienced a fear of falling following a fall. This was a follow-up postal questionnaire study of patients who were admitted to the rehabilitation ward in a local hospital (Japan) for stroke rehabilitation. Seventy-three patients who met inclusion criteria were sent questionnaires and 49 (67%) responded to the questionnaire. Thirty-three patients had at least one fall after discharge from the hospital and of these, four patients experienced fractures resulting from their falls. Twenty-nine patients developed a fear of falling. As falls are common in stroke survivors, more attention should be paid to falls after stroke during inpatient rehabilitation to prevent physical and emotional consequences of falls.     

延续性护理在脑卒中出院患者康复中的应用效果

目的 探讨延续性护理在脑卒中出院患者康复中的应用效果。 方法 选取住院部2015年1~6月收治并康复出院的脑卒中患者110例作为观察对象,按照入院编号奇偶数分为对照组和观察组,每组55例。对照组给予常规护理,观察组给予延续性护理。以生活质量以及日常生活活动能力为评价指标,比较2组患者出院后的康复效果。 结果 观察组心理状态评分、家务活动评分、家庭关系评分、工作及经济情况评分均高于对照组(t=2.202,P=0.021;t=1.991,P=0.031; t=3.591,P<0.001; t=2.438,P=0.019)。观察组日常生活活动能力评分高于对照组(F_组间=5.783,P=0.049)。 结论 应用延续性护理对脑卒中出院患者进行干预,可有效提高脑卒中患者出院后生活质量以及日常生活活动能力。     

Skilled nursing facility rehabilitation and discharge to home after stroke

OBJECTIVE: To determine the relation between rehabilitation therapy (RT) intensity and time to discharge home for stroke patients in skilled nursing facilities (SNFs). DESIGN: Retrospective cohort study. We used regression analyses, stratified by expected outcome, and propensity score adjustment. Setting All SNFs in Ohio, Michigan, and Ontario, Canada. PARTICIPANTS: A cohort of residents, aged 65 and over, admitted from hospitals to SNFs with a diagnosis of stroke (N=23,824). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Time to discharge home from an SNF. RESULTS: RT was given to more than 95% of residents for whom discharge was expected within 90 days and to more than 60% of residents for whom discharge was uncertain or not expected. RT increased the likelihood of discharge to the community for all groups except those expected to be discharged within 30 days. The dose-response relation was strongest for residents with either an uncertain discharge prognosis or no discharge expected. CONCLUSIONS: Postacute residents with an uncertain prognosis are an important target population for intensive RT.     

Life experiences after stroke among Iranian stroke survivors

DALVANDI A., HEIKKILÄ K., MADDAH S.S.B., KHANKEH H.R. & EKMAN S.L. (2010) Life experiences after stroke among Iranian stroke survivors. International Nursing Review 57 , 247–253 Background: Stroke is a major cause of disability worldwide. It is a life‐threatening and life‐altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long‐term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. Aim: To illuminate how stroke survivors experience and perceive life after stroke. Method: A grounded theory approach was recruited using semi‐structured interviews with 10 stroke survivors. Findings: The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio‐economical situation and life disintegration. The core concept of life after stroke was functional disturbances. Conclusions: The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.     

Evidence-based guidelines for blood transfusion

The AABB has initiated a process to develop evidence-based guidelines for blood transfusion to assist clinicians, other health professionals, and patients in their transfusion decisions. In this article, the author discusses the process of developing the recently published guidelines for plasma transfusion using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology.     

Caregiving problems and feelings experienced by family caregivers of stroke survivors the first month after discharge

The purpose of this study was to identify the major problems and associated feelings experienced by family caregivers of stroke survivors during the first month after returning home. Safety, difficulty in managing activities of daily living, and cognitive, behavioral and emotional changes of stroke survivors (for example, mood swings, lack of motivation, forgetfulness and memory loss, depression and calling the caregiver often) were the three most common problems experienced by caregivers during the first month. Other problems were loss of caregiver independence, confinement, tiredness and inadequate time to do caregiving tasks as well as managing stroke survivor physical symptoms, for example, pain, not eating and skin problems. The first month of caregiving is very dynamic and distressful for caregivers of stroke survivors and telephone contacts appear to be beneficial in assisting caregivers to cope with the caregiving process.     

Life satisfaction in long-term survivors after stroke

Different aspects of the quality of life before and after stroke were registered for 62 communicable, representative long-term (4-6 years) survivors, who reported the global and domain specific life satisfaction that they experienced (7 items, 6 graded-ordinal scales). Reference subjects were 60 healthy individuals in two age cohorts (60-61 years, n = 34; 79-81 years, n = 26) none of whom had been hospitalized during the last seven years prior to the investigation. The main finding is that, after the stroke, at least one aspect of the quality of life had decreased for 61% of them; this concerned global, sexual and leisure satisfaction mainly. Moreover, persisting motor impairment and ADL-disability had a negative effect on several aspects of life satisfaction. As nearly 30% of the non-impaired and the non-disabled interviewees reported decreased global life satisfaction, these changes indicate that they do not cope psychosocially with the stroke as such nor with its sequelae. In contrast, the levels of life satisfaction were similar for the 60-61 and 79-81 year-old interviewees, clinically healthy respondents, indicating stability in the quality of life that they experienced from late middle age into senectitude. For the patients, social integration estimated normatively did not covariate significantly with post-stroke satisfaction derived from social relationships.     

Early supported discharge after stroke.

Patients after stroke conventionally receive much of their rehabilitation in hospital. Services have been developed that offer patients an early discharge from hospital with more rehabilitation at home (early supported discharge). This paper sets out a systematic review of all randomized trials of early supported discharge services that included 12 trials (1659 patients). There was a reduced odds of death or dependency equivalent to 5 fewer adverse outcomes (95% confidence interval 1-10) for every 100 patients receiving an early supported discharge service (p = 0.04). Patients receiving early supported discharge services showed an 8 day reduction (p < 0.0001) in the length of hospital stay. The greatest benefits were seen in the trials evaluating a co-ordinated multidisciplinary early supported discharge team and with patients with mild-moderate disability. The experience of a trial from Stockholm is described in order to explore the potential mechanism of action of early supported discharge services. In conclusion, an illustrative case report is set out, indicating a typical patient pathway in an early supported discharge service.     

Quality of life for caregivers and stroke survivors in the immediate discharge period.

Caregiver burnout leads to a decline in caregivers' quality of life and in the quality of care they can deliver. A sample of 22 stroke survivors and informal care givers from a 500-bed metropolitan teaching hospital were interviewed using a questionnaire. Pre- (at discharge) and post- (1 month later) test scores were tested using Wilcoxon rank tests. Associations between activities of daily living and quality of life were tested with Spearman's correlation coefficient. Over the month, caregivers' scores for relationships, social companionship, and daily emotional support decreased (but not significantly). Short hospital stays affected the recruitment for this study and contributed to problems for ward staff in implementing discharge plans. More innovative discharge planning is needed if caregivers' needs are to be met.     

Evidence-based clinical practice guidelines

Evidence-based practice is a process, encompassing research utilization, clinical expertise, and appreciation of the unique needs of patients. Clinical practice guidelines are tangible evidence of an environment that fosters evidence-based practice. Development and evaluation of guidelines need to be research-based, and the implementation needs to be styled for the particular organization.     

Practice guidelines for early ambulation of burn survivors after lower extremity grafts

The objective of this review was to systematically evaluate the available clinical evidence for early ambulation of burn survivors after lower extremity skin grafting procedures so that practice guidelines could be proposed. It provides evidence-based recommendations, specifically for the rehabilitation interventions required for early ambulation of burn survivors. These guidelines are designed to assist all healthcare providers who are responsible for initiating and supporting the ambulation and rehabilitation of burn survivors after lower extremity grafting. Summary recommendations were made after the literature, retrieved by systematic review, was critically appraised and the level of evidence determined according to Oxford Centre for Evidence-Based Medicine criteria. A formal consensus exercise was performed to address some of the identified gaps in the literature which were believed to be critical building blocks of clinical practice.     

脑卒中患者院外功能锻炼依从性与社会支持的相关性

目的了解脑卒中患者院外功能锻炼依从性及社会支持状况,并探讨两者之间的相关性。方法采用自设脑卒中患者功能锻炼依从性问卷和肖水源的"社会支持评定量表",对135例脑卒中患者进行调查分析。结果脑卒中患者院外功能锻炼依从性平均得分为(33.61±8.49)分;82.96%的脑卒中患者依从率处于中低等水平;社会支持平均分为(29.21±6.30)分;院外功能锻炼依从性与社会支持的相关系数为r=0.511,P<0.01。结论脑卒中患者院外功能锻炼依从性处于中低水平,与社会支持呈中度正相关,医护人员应积极评估并制定干预措施,提高脑卒中患者的社会支持,尤其是家庭支持,进而提高其院外功能锻炼依从性。     

Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study

Purpose: To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home.

Methods: A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke,?<1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a ‘mixing matrix’ and integrated by ‘following threads’. Finally, a synthesis was written into a vignette.

Results: The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants.

Conclusion: Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect.

• Implications for Rehabilitation

• Findings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation.

• Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient’s own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient’s daily life context.

• The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying.