Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke-A Scoping Review.

Research studies may have limited generalizability when survivors of stroke with physical, language, or cognitive impairments are excluded. To assess whether presence of cognitive, language, or global impairments affects participation in self-management programs. Stroke survivors were recruited in South Australia from seven hospitals or via advertisements into a randomized controlled trial (1:1:1 ratio) of a Stroke Self-Management Program, the Stanford chronic condition self-management program, or standard care. Impairment status was measured using: Cognistat (cognition), Frenchay Aphasia assessment (language), modified Rankin Score (mRS; where score 3-5 = global disability). participation (i.e. booked, accessed, and completed a program (defined as attending ≥ 50% of sessions)) and safety (i.e. adverse events). Outcomes were compared by impairment status. Among 315 people screened 143/149 eligible were randomized (median age 71 years; 41% male; with impairments: 62% cognitive, 34% language, 64% global disability). Participation did not differ by cognitive or language impairment status (cognitive 75%, no cognitive 68%, p = 0.54; language 78%, no language 69%, p = 0.42). However, participation did vary by global impairment status (global disability 61%, no disability 96%, p < 0.001). Participants with cognitive impairment experienced more adverse events (severe n = 9 versus no cognitive impairment n = 1). Survivors of stroke with cognitive, language, or global impairments are able to participate in self-management programs and should be included in these types of research studies or programs. Reduced participation by those with global disability and the possibility of more adverse events in people with cognitive impairments needs to be considered.

BackgroundExergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician.ObjectiveThis study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy.MethodsThis study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention).ResultsA total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants.ConclusionsThe VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae.International Registered Report Identifier (IRRID)RR2-10.2196/14629

Prospectively planned collection and analysis of adverse event (AE) data are essential parts of well-conducted clinical trials. The AE data in a trial sponsor's database should be comparable with what is stipulated in the protocol and with the AE data published. We examined whether the published AE data differ from those in the sponsor's database and from the data collection requirements stated in study protocols. We searched the National Cancer Institute (NCI) Clinical Data Update System (CDUS) for studies that used the Common Toxicity Criteria version 2.0 and for which a final study publication was available. We extracted from the protocols information pertaining to AE collection and reporting methods and compared it with the methods cited in the article. We also compared the AE data in the trial publication with the AE data submitted by the investigators to CDUS. We identified 22 studies meeting the criteria for this review. There was considerable inconsistency between AE collection and reporting methods cited in the protocols versus final publications. AE data in the article and CDUS were not identical. Twenty-seven percent of article high-grade AEs could not be matched to agent-attributable AEs in the CDUS. Twenty-eight percent of CDUS high-grade AEs could not be matched to AEs in the corresponding article. In 14 of 22 articles, the number of high-grade AEs in CDUS differed from the number in the articles by 20% or more. Lack of consistency in and reporting of AEs are associated with NCI database and trial publication AE data discrepancy.

ObjectivesTo search the literature systematically in order to map and identify gaps in research investigating patient and family member psychoeducation needs regarding post-stroke cognition.DesignScoping review conducted in line with Joanna...

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.

Introduction: Post-stroke cognitive impairment (PSCI) has a considerable impact on patients and society. However, the characteristics and prevalence of long-term PSCI may be influenced by assessment methods and selection bias. We therefore used two cognitive screening methods to assess PSCI in ten-year stroke survivors, made comparisons with non-stroke individuals, and compared these screening methods. Methods: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered and compared in a population-based consecutive sample of ten-year stroke survivors. In addition, age- and sex-matched non-stroke controls were assessed with the MMSE. Regression analyses adjusting for education compared the stroke survivors’ MMSE performance with the controls. Moderate/severe cognitive impairment, approximating to dementia, was defined using MMSE&lt;24 and MoCA&lt;20 as cut-offs. To detect those with mild cognitive impairment, alternative cut-offs of MMSE&lt;27 and MoCA&lt;25 were also used. Results: In total, 127 of 145 stroke survivors participated. The total MMSE-scores were similar for stroke survivors (median 27) and 354 controls (median 27; p =0.922); as well as proportions with MMSE&lt;24 (23% vs. 17%; p =0.175) or MMSE&lt;27 (47% vs. 49%; p =0.671). After adjustment for education, stroke survivors showed an increased risk for moderate/severe cognitive impairment defined by MMSE&lt;24 (OR=1.82; p =0.036). Executive dysfunction was seen in 42% of the stroke survivors vs. 16% of the controls as evaluated by MMSE ( p &lt;0.001). According to MoCA, moderate/severe cognitive impairment (MoCA&lt;20) was observed in 28% of the stroke survivors; any degree of cognitive impairment (MoCA&lt;25) was seen in 61%; and 45-61% displayed executive function deficits. Conclusions: PSCI including executive dysfunction is common among ten-year stroke survivors, who have an increased risk of moderate/severe cognitive impairment compared to non-stroke controls. The prevalence of long-term PSCI may have been previously underestimated, and MoCA may be more suitable for post-stroke cognitive assessment.

In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.

Objective To observe the effects of ICB orthopedic sole combined with rehabilitation training on balance and walking function in stroke survivors. Methods Thirty hemiplegic stroke patients were recruited and divided into a study group (n=15) and a control group (n=15) by using a random number table. Both groups took exercises based on the principles of a motor relearning program and conducted core stability control training, and the study group additionally undertook hemiplegic lower extremity weight-bearing exercises and walking with ICB orthopedic sole used in daily living. The program was administered 20 min twice per day for 4 weeks. All patients were evaluated with Rest Calcaneus Standing Position (RCSP), Malleolar Position (MP), Forefoot Position (FP), Berg Balance Scale (BBS), 10 m Maximum Walking Speed (MWS) and walking section of Motor Assessment Scale (MAS) before and after the program. Results After 4 weeks of intervention, all the measurements except the FP in both groups improved significantly, and significant differences were observed between the two groups. After 4 weeks of training, the average RCSP (1.78±0.32)° and MP (13.33±2.51)° were improved significantly compared to those of the control group [(2.58±0.59)° and (12.45±3.31)°, respectively]. Moreover, the average BBS, MAS and MWS improved significantly compared to the control group. Conclusions ICB orthopedic sole combined with rehabilitation training can improve the weight-bearing, balance and ambulation abilities of stroke survivors. Key words: ICB orthopedic sole; Stroke; Balance; Ambulation

The objective of this scoping review is to examine and map knowledge of nursing provisions for self-determination while providing care to clients with cognitive impairment in residential aged care facilities. Maintaining the ability to have choices and to make decisions about daily activities is important for older adults. In residential aged care facilities, nurses' can be challenged to preserve clients' self-determination in favor of ritualistic care routines and a perceived duty to care. Moreover, nurses may perceive that their professional responsibilities to protect clients requires them to guard against decisions that are considered unwise or pose a risk to clients' health or safety. Insight into how nurses negotiate choice with clients with cognitive impairment who are living in a residential care facility will provide an in-depth understanding of the role self-determination plays in clients' lives. The scoping review will consider research and narrative reports on nursing provisions for self-determination in clients with cognitive impairment who are living in a residential aged care facility. The concepts of interest are self-determination and nursing provisions. Self-determination is defined as client choice and nursing provisions are the intentional reactions to clients' expressed choices. This scoping review will aim to locate published and unpublished literature employing a three-step search strategy. Only papers published in English from 1995 onward will be included. Data extracted from included papers will outline details on the participants, context, strategy, activity, and outcomes. Extracted data will be reported in a tabular form and presented narratively to address the review objective.

Aerobic Exercises for Cognition Rehabilitation following Stroke: A Systematic Review

Purpose Fatigue is a long-term symptom for stroke survivors. This scoping review synthesized how survivors achieve fatigue adaptation. Methods Four databases were searched for studies between 2012 and 2021. Qualitative studies or qualitative findings from mixed-methods studies were included if they described survivors’ experiences with fatigue and/or care partners’ experiences in helping survivors adapt to fatigue. Studies were excluded if they were poster abstracts, reviews, or editorials. Results Thirty-six articles were analyzed. Survivors with fatigue described different adaptive challenges – fatigue made them less productive, brought emotional distress, and was indiscernible to others. To respond to these challenges, stroke survivors did adaptive work including conserving energy, changing mindset, and restructuring normality. Care partners, employers, and colleagues showed adaptive leadership by adjusting daily routines or role responsibilities. Most survivors described that the current clinical practice did not meet their needs to address fatigue. Conclusions Stroke survivors had many types of challenges and strategies for fatigue adaptation. Survivors received family, employer, and colleague support but how care partners help survivors develop new skills is unknown. Stroke survivors expressed that healthcare professionals need to teach survivors and care partners basic knowledge of fatigue that meet their personal needs and provide adaptive interventions for survivors. Implications for rehabilitation The challenges of poststroke fatigue are multifaceted because fatigue influences stroke survivors' physical, cognitive, mental, and social aspects of recovery. Stroke survivors need support from their care partners such as helping them adapt to the fatigue, adapt to new life routine, and adjust role responsibilities. Healthcare professionals, stroke survivors, and care partners need to work together to develop strategies about poststroke fatigue that meet stroke survivors’ personal needs.

The purpose of the present study was to review all available work published within the last decade focusing on coping strategies in stroke caregivers and their impact on quality of Life (QoL) and psycho-emotional status. A literature search of two databases (MEDLINE, Scopus) was conducted to identify all relevant full-text English studies published between 2013–2023. Sixteen articles were traced and were finally included. Cognitive and behavioral coping strategies were beneficial for stroke caregivers’ and survivors’ QoL. The level of mutuality in the caregiver-survivor relationship was associated with the impact of depressive symptoms on caregivers’ QoL and the protective effect of mutuality on survivors’ QoL over time. The level and quality of social support were positively associated with QoL for stroke caregivers and survivors. Caregivers’ preparedness was a moderator for the impact of depression on both caregivers’ and survivors’ QoL. High levels of spirituality had a significant role in ameliorating the negative impact of depressive symptoms on the psychological and physical QoL of stroke caregivers and survivors. In conclusion, the study of coping strategies can be used as a psychological reserve in the process of stroke rehabilitation and actively contribute to improving the QoL of both caregivers and stroke survivors.

This study aimed to describe stroke survivors' experiences receiving telemedicine visits at the Lone Star Stroke Consortium during the COVID-19 pandemic. A qualitative descriptive phenomenological design was applied to gather patients' telemedicine experiences through in-depth interviews, using a study guide. Audio-recorded interviews were conducted via ZOOM and transcribed verbatim. Two independent reviewers used the Giorgi descriptive method to analyze the data and search for the essence of stroke survivors' follow-up telemedicine experiences during the COVID-19 pandemic. Fifteen underserved patients were recruited: mean age, 51.8 (15.7), and 9 (60%) females. Three themes emerged: (1) vivid memory of the stroke acute phase, (2) poststroke care experiences, and (3) perceived telemedicine experiences. The phenomenon of follow-up telemedicine visits during COVID-19 pandemic, as experienced by the stroke survivors, was positive. It showed patients' improved care access for poststroke visits. Telemedicine was satisfactory, except where the full medical exam was needed. Study findings highlight the individual approach was important, as well as the need for reliable internet and training to improve patients' technological skills. A hybrid approach for post-pandemic follow-up visits (in-person and telemedicine) was recommended by stroke survivors. These findings suggest that telemedicine is feasible and effective for poststroke care. Additional strategies are needed to improve future telemedicine integration into the continuum of care.

Cognitive and motor impairments are common among stroke survivors. Physical therapy is often used to improve the functional capacity of stroke survivors. However, limited adherence to rehabilitation programs is a challenge. Motivation plays a crucial role in the success of rehabilitation programs as it influences individual adherence to treatment and overall health outcomes. This review aims to identify current trends in motivational strategies used by healthcare professionals for stroke survivor rehabilitation. Following the framework developed by Arksey and O'Malley, a scoping review was conducted. We performed a literature search using MEDLINE, CINAHL, the Cochrane Central Register of Controlled Trials, Nursing & Allied Health, and MedicLatina databases. A total of 906 papers were identified. After selecting and analyzing the articles, 17 papers were included in this review. Health professionals use various strategies to motivate stroke survivors. These approaches include establishing a therapeutic alliance, improving patients' health literacy, defining realistic goals, fostering problem-solving skills, personalizing the rehabilitation program, showcasing success stories, utilizing persuasive techniques, offering encouragement and compliments, providing emotional support, and effectively managing symptoms. The knowledge gathered in this review can guide healthcare professionals in helping patients overcome barriers to rehabilitation, improve their motivation, and ultimately enhance their recovery outcomes.

IntroductionReturning to work is a goal for many stroke survivors, with benefits for individuals and society. The ReTurn to work After stroKE (RETAKE) trial, which aimed to improve stroke survivors’ work outcomes through early stroke-specific vocational rehabilitation (ESSVR), was ongoing during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on stroke survivors’ work ability and return-to work support.MethodsNine stroke survivors and five employers were interviewed. Thematic analysis informed by Normalisation Process Theory, found that biographical disruption experienced as a result of stroke was compounded by disruption on a global scale due to the pandemic.ResultsAttempts to mobilise resources in response to disruption were hampered by pandemic-related issues. Although returning to work offered continuity in pre-stroke identity, businesses were also disrupted by the pandemic. Findings suggest that returning to work was easier for stroke survivors able to work from home and those receiving ESSVR. The opportunity to work from home helped stroke survivors adapt to new ways of working necessitated by the impact of stroke and social distancing rules during the pandemic.DiscussionPost-pandemic, remote working is more acceptable, which may benefit future stroke survivors aiming to return to work whilst managing post-stroke fatigue. This may mitigate disruption to lives and post-stroke identities.