Computer-based interventions for stroke survivors: A systematic review.

Abstract

Review question/objectives This systematic review will be undertaken to answer the following review question: ‘What is the effectiveness of computer-based interventions in enhancing outcomes of stroke survivors?’ The primary objectives of this systematic review are: 1.To present the best available research evidence pertaining to the effectiveness of computer-based interventions in optimising stroke survivors’ physical and psychosocial outcomes. 2.To determine the effectiveness of computer-based interventions in improving knowledge and self-care self-efficacy among stroke survivors. The secondary objectives are: 1.To determine the effectiveness of computer-based interventions in enhancing stroke survivors’ satisfaction with care provided. 2.To determine the effectiveness of computer-based interventions in reducing health services utilisation among stroke survivors. The specific review questions to be addressed are: 1.What is the effectiveness of computer-based interventions in enhancing stroke survivors’ physical outcomes (for example, functional ability) and psychosocial outcomes (including depression, self-esteem, social participation, and quality of life)? 2.What is the effectiveness of computer-based interventions in improving knowledge and self-care self-efficacy among stroke survivors? 3.What is the effectiveness of computer-based interventions in enhancing stroke survivors’ satisfaction with care provided? 4.What is the effectiveness of computer-based interventions in reducing stroke survivors’ health services utilisation? 5.What is the effectiveness of different formats of computer-based interventions (for example: delivered via DVD/CD-ROM, internet-based, or computer programmes) on outcomes for stroke survivors? 6.What is the effectiveness of computer-based interventions compared with usual care (for example: education using leaflet, group education, one-to-one teaching, face-to-face education led by lay leaders) on outcomes for stroke survivors? Inclusion criteria Types of participants This review will consider studies that included adults aged 18 years or above who had had a first-ever or recurrent stroke, or are stroke survivors in the acute, rehabilitation or community settings, regardless of gender or ethnicity. The standard WHO stroke definition will be followed, that is, ‘a focal neurological impairment of sudden onset, and lasting more than 24 hours, and of presumed vascular origin’.25 (p.1-4) There are three major stroke subgroups, namely, ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage.25 We will exclude studies with participants who have transient ischaemic attack, subdural haemorrhage and epidural haemorrhage, as these are excluded from the standard WHO stroke definition. Types of interventions This review will consider computer-based interventions for adult stroke survivors. For the purpose of this review, the computer applications employed in the computer-based interventions include the use of DVD, CD-ROM, website, telehealth/telemedicine/telenursing/telecare, or other computer programme. The formats of information delivery in terms of texts, graphics, videos, discussion forums, interactive games or other means delivered via the computer applications will be included. Computer-based interventions delivered by healthcare professionals, trained voluntary stroke survivors, peers, or volunteers will be included. Types of comparisons Foreseen comparisons include: 1.Comparison between computer-based interventions vs. usual care. For example, computer-based interventions vs. education using leaflet vs. group education vs. one-to-one teaching vs. face-to-face education led by lay leaders vs. other educational interventions for stroke survivors. 2.Comparison between different formats of computer-based interventions. For example, interventions delivered via DVD vs CD-ROM vs website vs telehealth/telemedicine/telenursing/telecare vs computer programme. Types of outcomes This review will consider studies that include the following outcome measures: The primary outcomes of interest will include: 1. Physical outcome: a) Functional ability is operationally defined as the degree of independence of a patient has in performing the various self-care and mobility activities of daily living tasks.26 Outcome measures include Barthel Index, Modified Barthel Index, and Functional Independence Measure. 2. Psychosocial outcomes: a) Depression is operationally defined as having depressive symptoms of dysphoric mood, withdrawal, apathy, lack of vigour, hopelessness, cognitive impairment, and anxiety,27 Outcome measures include self-reported measures such as Geriatric Depression Scales (GDS-30, GDS-SF and GDS-4), Hospital and Depression Scale, and Center for Epidemiologic Studies Depression Scale. b)Self-esteem is operationally defined as self perceived worthiness or inadequacy, confidence about the appearance and body image, as well as the evaluation people make about their relationships with others in the various roles in their lives.28 Outcome measures include, but are not limited to, State Self-Esteem Scale and Rosenberg Self-Esteem Scale. c)Social participation is operationally defined as the level of participation in society that is possible when there is disability resulting from a health condition.29 Outcome measures include Frenchay Activities Index and London Handicap Scale. d)Quality of life would be assessed using generic or disease-specific quality of life instruments such as Stroke-Specific Quality of Life Scale (SS-QoL, and SS-QoL-12). 3. Knowledge of stroke care. This would be measured by using knowledge tests assessing knowledge of risk factors, symptoms, treatments, information resources, and self-care management, and self-care behaviours. 4. Self-care self-efficacy is operationally defined as stroke survivors’ self-efficacy in performing self-care tasks during stroke recovery. Outcome measure includes Stroke Self-Care Self-Efficacy Questionnaire.