Perceived recovery as a predictor of physical activity participation after mild stroke

Purpose: The purpose of this study was to identify what acute care variables and/or perceived recovery factors could predict decreased participation in physical activities post-mild stroke. Methods: Secondary analysis of persons with mild stroke. Participants were split into two groups based on the percentage of high-demand leisure (HDL) activities retained on the Activity Card Sort (ACS) at 6 months post-stroke. Demographic variables, measures from the acute care setting (National Institutes of Health Stroke Scale (NIHSS), premorbid Barthel Index, and Modified Rankin Scale), and a perceived recovery measure collected at 6 months post-stroke (Stroke Impact Scale (SIS)) were analyzed between groups using independent samples t-tests and logistic regression. Results: There were no significant differences between groups on any of the demographic or acute care setting measures. Logistic regression indicated that only the overall perceived recovery (p = 0.05) and strength domain scores (p = 0.01) of the SIS were statistically significant factors for determining the percent of retained HDL activities following mild stroke. Conclusions: Clinicians must consider the clients’ own perceived recovery level and other more subjective factors in determining what barriers are limiting their physical activity participation after stroke.

Implications for Rehabilitation

• Persons with mild stroke are significantly decreasing their participation in physical activities post-stroke.

• Common stroke measures from the acute care setting that are currently used in practice are not sensitive enough to predict the changes in physical activity after mild stroke.

• Perceived level of recovery/limitations should be considered by clinicians in determining what barriers are affecting clients’ physical activity participation after stroke.

     

Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction

Purpose: This study examined the role of anxiety and upper limb dysfunction, amongst other variables, as predictors of health related quality of life (HRQOL) 6 months after stroke. Method: Participants: Stroke survivors (n = 85) who had previously participated in a randomised controlled trial of a physiotherapy intervention. Dependent variable: HRQOL – Nottingham Health Profile (NHP). Predictor variables: Mood – Hospital Depression and Anxiety Scale; Upper Limb Functioning - Action Research Arm Test; Rivermead Motor Assessment; Activities of Daily Living – Modified Barthel Index; Clinical and demographic factors. Results: Anxiety and depression significantly predicted 49% of variance in overall HRQOL (p < 0.05), but only anxiety significantly predicted NHP pain (13% variance, p < 0.001), emotional reactions (41% variance, p < 0.001), sleep (19% variance, p = 0.02) and social isolation (23% variance, p = 0.02). Depression and anxiety together significantly predicted 30% variance in energy level (p < 0.001). UL motor impairment and activities of daily living predicted 36% of variance in NHP physical activity score (p < 0.001). Conclusions: This study indicates that where anxiety is assessed, it appears more important in determining HRQOL than depression. UL impairment and ADL independence predicted perceived physical activity. Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL.

Implications for Rehabilitation

• Anxiety is a major predictor of quality of life six months after stroke.

• Post-stroke anxiety should be routinely assessed in rehabilitation.

• Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period.

• Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke.

• Rehabilitation of the upper limb should continue into the chronic post-stroke period.

     

Anxiety and depression after stroke: a 5 year follow-up

Purpose: The aim was to document the prevalence and predictors of anxiety and depression 5 years after stroke, across four European centres. Method: A cohort of 220 stroke patients was assessed at 2, 4 and 6 months and 5 years after stroke. Patients were assessed on the Hospital Anxiety and Depression Scale and measures of motor function and independence in activities of daily living. Results: At 5 years, the prevalence of anxiety was 29% and depression 33%, with no significant differences between centres. The severity of anxiety and depression increased significantly between 6 months and 5 years. Higher anxiety at 6 months and centre were significantly associated with anxiety at 5 years, but not measures of functional recovery. Higher depression scores at 6 months, older age and centre, but not measures of functional recovery, were associated with depression at 5 years. Conclusions: Anxiety and depression were more frequent at 5 years after stroke than at 6 months. There were significant differences between four European centres in the severity of anxiety and depression. Although the main determinant of anxiety or depression scores at 5 years was the level of anxiety or depression at 6 months, this accounted for little of the variance. Centre was also a significant predictor of mood at 5 years. There needs to be greater recognition of the development of mood disorders late after stroke and evaluation of variation in management policies across centres.

Implications for Rehabilitation

• Depression and anxiety persisted up to 5 years after stroke in about a third of patients.

• Variation in the rates of anxiety and depression between different European centres suggest management policies rather than stroke related factors may determine their persistence.

• The effect of variations in stroke management policies should be investigated.

• Patients’ mood should be monitored over time in order to detect those with late onset mood disorders after stroke.

     

Life satisfaction of couples 3 years after stroke

Purpose: To compare the life satisfaction of stroke patients to that of their spouses, and to examine spouses’ variables as determinants of the patients’ life satisfaction. Method: Patients with a first-ever stroke who were admitted to an inpatient rehabilitation centre and their spouses were included (n?=?78 couples). Measurements took place 3 years after the stroke. Life satisfaction was measured using the Life Satisfaction Questionnaire (LiSat-9). Results: More spouses (50%) than patients (28%) were dissatisfied with their life as a whole. Spouses were also more likely to be dissatisfied with all other domains of life satisfaction than patients. The associations between the life satisfaction of patients and of spouses were weak (Cramer’s V 0.00–0.43). In the backward linear regression analysis both patients’ participation in social activities and spouses’ life satisfaction were significantly related to patients’ life satisfaction. A total of 17.8% of the variance of patients’ life satisfaction could be explained by the model. Conclusions: Both spouse and patient in a couple experience decreased life satisfaction in the chronic phase after stroke, spouses even more so than patients. The life satisfaction of stroke patients was significantly related to spouses’ life satisfaction. Family-centred care should be an important part of the rehabilitation process.

Implications for Rehabilitation

• Both spouse and patient in a couple experience decreased life satisfaction in the chronic phase after stroke.

• The life satisfaction of stroke patients was significantly related to spouses’ life satisfaction.

• Family-centred care, in which the spouse is closely involved, should be an important part of the rehabilitation process.

     

Predicting sickness impact profile at six months after stroke: further results from the European multi-center CERISE study

Abstract

Purpose: To develop prognostic models and equations for predicting participation at six months after stroke. Methods: This European prospective cohort study recruited 532 consecutive patients from four rehabilitation centers. Participation was assessed at six months after stroke with the Sickness Impact Profile (SIP), which consists of a physical, psychosocial and independent dimension. Twenty-six independent variables on admission to the rehabilitation center and 13 additional variables measured at two months post stroke were included in the analysis. A multiple logistic regression analysis was conducted predicting good participation (SIP?<?20%). Sensitivity, specificity, positive and negative predictive values were calculated. Results: The prognostic models for the three dimensions provided independent predictors containing demographics, complications, diagnostic, and disability measures. Sensitivity ranged from 64–84%, specificity 66–85%, positive predictive value 70–78%, and negative predictive value 76–87%. Barthel Index on admission, Euroqol Health State at two months and Caregiver Strain Index at two months were retained in all prediction models. Conclusions: A combination of variables was found in the prognostic models of the three dimensions of the SIP at six months after stroke. Already from the early beginning of stroke rehabilitation it seems important to focus on personal activities of daily living as well as caregivers' strain.

• Implications for Rehabilitation

• Prognostic factors predicting participation, measured by the three dimensions of the Sickness Impact Profile at six months post stroke include demographic variables, post-stroke complications, diagnostic parameters and disability measures.

• Significant prognostic variables for all three dimensions of the Sickness Impact Profile were a higher Barthel Index score on admission to the rehabilitation center, a higher Euroqol Health State score at two months post stroke and a lower Caregiver Strain Index score at two months post stroke.

• Early stroke therapy should therefore further emphasize rehabilitation of personal activities of daily living such as mobility, walking, feeding, dressing, and toilet use, as well as considering strategies to reduce caregiver strain such as giving support, providing information and training carers.

     

Sensitivity and responsiveness of the health-related quality of life in stroke patients-40 (HRQOLISP-40) scale

Abstract

Purpose: To investigate the sensitivity and responsiveness of the Health-Related Quality of Life in Stroke Patients-40 (HRQOLISP-40) scale in evaluating stroke patients from onset to 12 months. Methods: Fifty-five patients with first-incidence stroke were followed-up for 12 months. The HRQOLISP-40 scale was used to assess health-related quality of life (HRQOL) while stroke severity was assessed with the Stroke Levity Scale. Sensitivity to change was assessed by analyzing changes in the HRQOLISP-40 scores between pairs of months with paired samples t-test. Standardized effect size (SES) and standardized response mean (SRM) were used to express responsiveness. Results: Overall HRQOL and domains in the physical sphere of the HRQOLISP-40 were sensitive to change at different time intervals in the first 12 months post-stroke. Marked responsiveness (SES and SRM >0.7) was demonstrated by the overall scale, and the physical, psycho-emotional and cognitive domains at varying time intervals. For instance, SRM was greater than 0.7 between 1 and 6, 3 and 12, 1 and 9, and 1 and 12 months for both the physical and psycho-emotional domains. Conclusion: The HRQOLISP-40 is a sensitive and responsive stroke-specific quality of life measure that can be used to evaluate the outcome of stroke rehabilitation.

• Implications for Rehabilitation

• Enhancing the health-related quality of life (HRQOL) of stroke survivors can be regarded as the ultimate goal of stroke rehabilitation.

• Sensitive and responsive stroke-specific HRQOL measures are required for use in evaluative studies, and clinical trials and practice.

• The Health-Related Quality of Life in Stroke Patients-40 (HRQOLISP-40) is a sensitive and responsive stroke-specific scale.

     

Exploring the experience of psychological morbidity and service access in community dwelling stroke survivors: a follow-up study

Abstract

Purpose: Post-stroke depression occurs in one-third of stroke survivors with a similar risk of development across short, intermediate and long-term recovery stages. Knowledge of factors influencing psychological morbidity beyond the first year post-stroke can inform long-term interventions and improve community service access for stroke survivors. This paper aimed to identify the physical and psycho-social functioning status of stroke survivors beyond 12 months post-stroke. Qualitative processes explored the longer term experiences of psychological morbidity and service access needs. Method: A cross-sectional follow-up of participants from a prospective cohort study. In that study, patients and were followed for 12 months post-stroke. In this study, participants from that cohort study were interviewed up to five years post-stroke. Data generation and analysis were concurrent and were analysed thematically, employing a process of constant comparison. Results: Our sample included 14 participants, aged 58–89 years at an average of three years post-stroke (range 18 months to five years). Our qualitative key themes emerged as follows: physical impacts on post-stroke psychological morbidity, the experience of psychological distress, factors attenuating distress and service delivery implications. Conclusions: The experience of psychological morbidity persists beyond 12 months post-stroke, having a profound impact on community access, and social participation. Clinical implications are a need for long-term psychological monitoring post-stroke and for ongoing rehabilitation that addresses disability, community participation and social support.

• Implications for Rehabilitation

• Psychological distress post-stroke is complex and persists over time, thus requiring longer term monitoring beyond the first 12 months of stroke onset.

• Longer term access to allied health can play a significant role in providing interventions that address distress and maintain community participation.

• If patients meet threshold scores at any time, then GPs should consider initiating appropriate treatment, including pharmacotherapy, referral to psychotherapy and referral to community stroke rehabilitation.

     

Factors associated with community ambulation in chronic stroke

Purpose: Loss of independent community ambulation is one of the most disabling consequences of stroke. The aim of this study was to investigate the association of multiple personal and post-stroke factors with community ambulation in persons between 1- and 3-year post-stroke. Methods: This was a cross-sectional study of 40 community-dwelling stroke patients, >18 years, between 1- and 3-year post-stroke. The main outcome measures used were self-report community ambulation questionnaire, demographic information, 10-M Walk Test, Timed Up and Go test, Activities-Specific Balance Confidence Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Trail-Making Test-Part B, Single Letter Cancellation Test. Results: Age, number of medications and use of a walking aid were found to be significantly associated with community ambulation (p?≤?0.05). Gait speed, walking balance and balance self-efficacy were also found to be significantly associated with community ambulation (p?≤?0.05). Balance self-efficacy was the only factor independently associated with community ambulation post-stroke (p?≤?0.05). Conclusion: Balance self-efficacy may be a significant determinant in the attainment of independent community ambulation post-stroke. This suggests that physical aspects such as gait speed and walking balance should not be considered in isolation when addressing community ambulation post-stroke.

• Implications for Rehabilitation

• Balance self-efficacy may play a significant role in the attainment of independent community ambulation in a chronic stroke population.

• Physiotherapy interventions addressing community ambulation post-stroke should consider methods for improving balance self-efficacy in chronic stroke, such as self management programmes.

     

The role of positive affect on social participation following stroke

Purpose: To examine the association between positive affect and social participation in adults with first-time stroke after in-patient medical rehabilitation. Methods: A prospective cohort design using information from the Stroke Recovery in Underserved Populations database (SRUP) for the years 2005–2006. Data were collected at discharge from in-patient medical rehabilitation and 3 months post-discharge. Participants were aged 50 and older with first-time stroke (n = 605) and admitted to 1 of 11 in-patient medical rehabilitation facilities across the United States. Primary measures included a positive affect scale and a home and community social participation instrument. Results: The mean age was 71.6 years, 50.3% were women, and 56.5% were married. Results of cumulative logit models showed each 1 point increase in positive affect was significantly associated with a 17% odds of higher social participation (OR: 1.17, 95% CI 1.10, 1.25), after adjusting for demographics, clinical characteristics, and negative affect. Conclusions: High positive affect at discharge from in-patient medical rehabilitation was associated with higher levels of social participation 3 months post-discharge. The significant association between higher positive affect and higher levels of social participation adds to accumulating evidence linking positive affect with beneficial physical and psychological outcomes after an acute event such as stroke.

Implications for Rehabilitation

• This study shows positive affect associated with greater social participation 3 months post-discharge from in-patient medical rehabilitation.

• Positive affect may be a critical factor in the recovery trajectory of the stroke patient.

• The assessment of positive affect during in-patient medical rehabilitation may identify those at risk for poor social participation post-discharge and may lead to the design of innovative interventions aimed at the re-integration of stroke individuals into the community.

     

Is early rehabilitation a myth? Physical inactivity in the first week after myocardial infarction and stroke

Purpose: To compare physical activity levels of patients in the first week after myocardial infarction (MI) and stroke. Method: We conducted an observational study using behavioural mapping. MI patients were consecutively recruited from Alfred Hospital, Melbourne. Data for stroke patients (Royal Perth Hospital or Austin Hospital, Melbourne) were retrieved from an existing database. Patients were observed for 1?min every 10?min from 8 am to 5 pm. At each observation, the patient’s highest level of physical activity, location and people present were recorded. Details of physiotherapy and occupational therapy sessions were recorded by the therapists. Results: Proportion of the day spent physically inactive was lower in MI (n?=?32, median 48%) than stroke (n?=?125, median 59%) patients, but this difference was not significant in univariate or multivariate (adjusting for age, walking ability and days post-event) regression. Time spent physically active was higher in MI (median 23%) than stroke (median 10%) patients (p?=?0.009), but this difference did not survive multivariate adjustment (p?=?0.67). More stroke patients (78%) than MI patients (19%) participated in therapy. Conclusions: This study provides the first objective data on physical activity levels of acute MI patients. While they were more active than acute stroke patients, the difference was largely attributable to walking ability.

• Implications for rehabilitation

• In the first week after myocardial infarction, patients spent about half the day physically inactive (even though 81% were able to walk independently).

• Similar levels of inactivity were seen in a comparable cohort of acute stroke patients, suggesting that environmental factors play an important role.

• There appears to be wide scope for increasing levels of physical rehabilitation after acute cardiovascular events, though optimal timing and dose remain unclear.

     

Psychometric properties of the Activities-Specific Balance Confidence Scale in persons 0–14 days and 3 months post stroke

Purpose: To test the internal consistency and validity of a Swedish translation of the Activities-specific Balance Confidence Scale (ABC) 0–14 days and 3 months post stroke. Method: 37 persons were tested at 0–14 days (median 5 days) post stroke and 31 were retested 3 months later (median 87 days). In addition to the ABC, the Functional Ambulation Categories, modified Rivermead Mobility Index, timed up and go test, 10-meter timed walk, SF-36 and the 12-item Walking Scale were used. Results: The internal consistency was high at α?=?0.94 to 0.97. Kendall correlation-τ coefficients were moderate and varied somewhat depending on time poststroke. At 0–14 days post stroke the highest correlation was found between the ABC and the 12-item Walking Scale (?0.55, p?<?0.01). At 3 months poststroke, the correlations with the Functional Ambulation Categories was 0.49 (p?<?0.01), timed up and go test ?0.43 (p?<?0.01), 10-meter timed walk ?0.41 (p?<?0.01), and modified Rivermead Mobility Index 0.46 (p?<?0.01). Divergent validity was established by the non-significant correlation (0.12) between the ABC and SF-36 mental component summary. Conclusions: The Swedish version of ABC has high internal consistency and is valid for measuring balance confidence in the acute and sub acute phases of stroke.

Implications for Rehabilitation

• The ABC is a valid measure of balance confidence in persons in the acute and sub acute phases after stroke.

• A moderate convergent validity was found between the ABC and measures of physical function.

     

Factors associated with community reintegration in the first year after stroke: a qualitative meta-synthesis

Abstract

Purpose: Although acute stroke care has improved survival, many individuals report dissatisfaction with community reintegration after stroke. The aim of this qualitative meta-synthesis was to examine the barriers and facilitators of community reintegration in the first year after stroke from the perspective of people with stroke. Methods: A systematic literature search was conducted. Papers that used qualitative methods to explore the experiences of individuals with stroke around community reintegration in the first year after stroke were included. Two reviewers independently assessed the methodological quality of papers. Themes, concepts and interpretations were extracted from each study, compared and meta-synthesised. Results: From the 18 included qualitative studies four themes related to community reintegration in the first year after stroke were identified: (i) the primary effects of stroke, (ii) personal factors, (iii) social factors and (iv) relationships with professionals. Conclusions: This review suggests that an individual’s perseverance, adaptability and ability to overcome emotional challenges can facilitate reintegration into the community despite persisting effects of their stroke. Appropriate support from family, friends, the broader community and healthcare professionals is important. Therapeutic activities should relate to meaningful activities and should be tailored to the individual stroke survivor.

• Implications for Rehabilitation:

• Stroke survivors feel that rehabilitation in familiar environments and therapeutic activities that reflect real-life could help their community re-integration.

• In addition to the physical sequelae of stroke, emotional consequences of stroke should be addressed during rehabilitation.

• Healthcare professionals can provide clear and locally relevant advice to facilitate aspects of community reintegration, including the return to driving and work.

     

Impact of depression following a stroke on the participation component of the International Classification of Functioning,Disability and Health

Purpose: To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF).

Method: Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann–Whitney test was used to compare the participation scores between the two groups. Spearman’s correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance.

Results: The group with depression had low participation scores (p?=?0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r?= ?0.6; p ?=?0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r²?=?0.51; p?=?0.001).

Conclusions: Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke.

• Implications for Rehabilitation

• Individuals with post-stroke depression experience a lower degree of social participation.

• Depression explains 51% of the decline in participation following a stroke.

• The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.

     

Sexuality after stroke: patient counseling preferences

Abstract

Purpose: Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers. The aim of this study was to examine patient preferences for counseling related to sexuality post-stroke. Method: Two hundred and sixty-eight patients from a stroke registry were provided an anonymous paper or online survey. Thirty-eight patients responded and completed the survey. The survey included demographic information, and scales of sexual dysfunction, fatigue, depression and functional independence. In addition, we queried subjects about stroke-related sexual dysfunction and their preferences for counseling and education materials. Results: Most respondents (71%) identified sexuality as a moderately to very important issue in their post-stroke rehabilitation. Sexual dysfunction was common, with 47% of respondents indicating that their sexual function had declined since the stroke. Eighty-one percent reported receiving insufficient information about sexuality post-stroke, and the majority (60%) expressed a preference for receiving counseling regarding sexuality from a physician. A substantial portion (26.5%) of patients wanted to receive counseling prior to discharge from a hospital or rehabilitation center, with 71% wishing to receive counseling within 1 year post-stroke. Conclusions: Many stroke survivors experience sexual dysfunction and indicate a desire for additional information and counseling from healthcare providers. Preferences regarding the timing of such counseling vary, creating challenges for optimizing the delivery of this care.

• Implications for Stroke Rehabilitation

• Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers.

• Many stroke survivors experience sexual dysfunction and indicate a desire for additional information and counseling from healthcare providers.

• Most stroke survivors identify sexuality as an important issue in their post-stroke rehabilitation.

• Exploring individual stroke survivor counseling preferences periodically over the course of recovery may be a useful strategy for delivering the desired information at the most appropriate time.

     

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.

     

Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study

Purpose: This study investigates the effectiveness of Lokomat + conventional therapy in recovering walking ability in non-ambulatory subacute stroke subjects involved in inpatient rehabilitation. Method: Thirty first-ever stroke patients completed 8 weeks of intervention. One group (n?=?16) received Lokomat therapy twice a week, combined with three times 30?min a week of conventional overground therapy. The second group (n?=?14) received conventional assisted overground therapy only, during a similar amount of time (3.5?h a week). The intervention was part of the normal rehabilitation program. Primary outcome measure was walking speed. Secondary outcome measures assessed other walking- and mobility-related tests, lower-limb strength and quality of life measures. All outcome measures were assessed before and after the intervention and at wk 24 and wk 36 after start of the intervention. Results: Patients showed significant (p?Conclusion: These results indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as conventional therapy alone.

• Implications for Rehabilitation

• Recovery of walking after stroke is important.

• Robot-assisted therapy is currently receiving much attention in research and rehabilitation practice as devices such as the Lokomat seem to be promising assistive devices.

• Technical developments, sub-optimal study designs in literature and new therapy insights warrant new effectiveness studies.

• Results of a financially and practically feasible study indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as compared to conventional overground therapy alone.

     

A thematic framework of illness narratives produced by stroke patients

Abstract

Purpose: The present study aims at elucidating the impact of stroke on psychosocial functioning of stroke survivors. Methods: Data were investigated using interpretative thematic analysis of illness stories produced by 29 patients. Results: Eight themes emerged from the data: Medical Information; Interpersonal Changes; Cognitive, Physical and Emotional Functioning; Strategies of Coping; Social Support; and Information Irrelevant to the Question. The most frequent organization of the themes followed the course of medical intervention and rehabilitation. Narrations of individual patients varied in terms of the presence of particular themes, the amount of information on each topic and organization. Conclusions: The results suggest that the analysis of non-guided illness narratives can be effectively used to identify the thematic areas important to individual stroke patients. The thematic content analysis of stroke stories can allow health professionals to better understand the patient’s state of knowledge related to illness as well as his or her socio-psychological functioning which may be useful in the course of planning further assessment and rehabilitation of patients with stroke.

• Implications for Rehabilitation

• Experience of illness and life changes following stroke should be recognized as central to the provision of targeted rehabilitation.

• To understand the subjective perspective a content analysis of the content narrative is recommended.

• Our study highlights seven general thematic categories that may be regarded as key.

• The categories may be useful for clinicians to help individuals to clarify their main concerns following a stroke.

     

Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study

Purpose: Meanings of movement for stroke survivors could give therapists significant insights, especially during maintenance phase. The purpose of this study was to examine how post-stroke users of a long-term elderly care facility had experienced changes in movement resulting from hemiplegia. Method: The participants of this study were 18 stroke survivors using a long-term elderly care facility. Based on phenomenology, between two and three interviews were conducted with each participant about their experiences with hemiplegia. Data analysis consisted of the following phases: ‘data immersion’, ‘data transformation’ and ‘thematic analysis’. This study was approved by the ethics committee of the authors’ institution. Results: Participants experienced seven themes resulting from hemiplegia, perceiving themselves differently from the way they did before the stroke. The themes were as follows: ‘inescapable dependence’, ‘sense of incompetence’, ‘lack of autonomy’, ‘symbol of deviation from normal’, ‘licence for amae’, ‘security of self-worth’ and ‘proof of effort’. Conclusions: The first four themes attempt to express participants’ pain and difficulty in living with their present body; the last three attempt to express methods for coping with the present body in the company of others. Results will assist therapists to understand the significant needs of their clients in the maintenance phase.

• Implications for Rehabilitation

• Hemiplegia is paralysis of half of the body; it represents one kind of physical disability caused by stroke.

• Re-interpretation of how patients had experienced the changes of their movements after they had hemiplegia is helpful for the therapists to understand the significant needs for their clients.

• It may be especially relevant for therapists working with stroke survivors in the maintenance phase, whose functional recovery of physical movements is not expected to occur to a greater extent.

     

Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review

Abstract

Purpose: People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. Method: A systematic search was conducted of common electronic databases. All English language abstracts where stair-climbing was assessed in patients with either knee OA or at least 6 months after TKA, and a relationship to any physical, psychological or demographic factors was reported. Results: Thirteen studies were included in the final review, nine investigated a knee OA population, and four investigated a TKA population. For patients with knee OA there was consistent and convincing evidence that greater stair-climbing ability was related to stronger lower limb muscles and less knee pain. For patients with TKA there was much less research, and no conclusions could be reached. Conclusions: For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research.

• Implications for Rehabilitation

• People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement.

• For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce.

• Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.