Stroke Survivors In Community Research Articles

Validation of the self-rated Dimensional Apathy Scale in community stroke survivors

Apathy, a disorder of motivation observed in up to 40% of stroke survivors, is negatively associated with stroke rehabilitation outcomes. Different apathy subtypes have been identified in other conditions, but there is currently no validated multidimensional measure of post-stroke apathy (PSAp). The Dimensional Apathy Scale (DAS) assesses apathy across three subtypes: Executive, Emotional and Initiation apathy. We aimed to determine if the DAS is a reliable and valid tool to detect and characterise apathy in stroke. Fifty-three stroke survivors, (45.3% males, median age 54), and 71 people without stroke (26.8% males, median age 45) completed measures of apathy (DAS, Apathy Evaluation Scale, AES), depression (Patient Hospital Questionnaire, PHQ-9) and anxiety (Generalised Anxiety Disorder scale, GAD-7) as part of an online survey. The DAS showed high internal consistency and convergent validity with the current gold standard unidimensional assessment for apathy (AES) and divergent validity with depression (PHQ-9) and anxiety (GAD-7). Stroke survivors scored significantly higher on the total score of the DAS and all subscales, compared with controls. There were however no significant differences on depression and anxiety scores between the two groups. Our results suggest the DAS is a reliable and valid screening tool to detect and characterise PSAp.

The Influential Factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis.

To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors. Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied. A cross-sectional descriptive study. In total, 208stroke survivors (70.25±9.08years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE. The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors. The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population. Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.

High tech and high touch: Recruitment strategies for enrolling African American stroke survivors in Community Based Intervention under Nurse Guidance after stroke (CINGS) trial

BackgroundSubstantial effort has been undertaken to improve the recruitment and retention of participants in stroke trials. African Americans are disproportionately under-represented in stroke clinical trials as well as clinical trials for other chronic disease conditions. To circumvent barriers to recruitment, clinical trial recruitment strategies used to recruit African Americans have focused on different aspects of community engagement. PurposeThis study examined a community-engaged, multi-phased tailored approach to recruiting African Americans with stroke. The recruitment approach described was designed to support the Community Based Intervention under Nurse Guidance after Stroke (CINGS) trial, part of the Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels (WISSDOM) Center established to explore stroke disparities. MethodsA multiple-phased recruitment approach was undertaken and involved a recruitment planning phase and a recruitment phase. The recruitment planning phase involved the use of focus groups designed to explore barriers and facilitators of stroke recovery. The active recruitment phase included multiple strategies with ongoing evaluation. ResultsInformation gained from focus groups offered insights into strategies critical to recruiting African Americans with stroke for behavioral research during the early recovery period. Strategies to enhance the identification of and recruitment of potential participants included use of: a) a hospital system stroke database, b) system-wide friendly visits/warm handoff approaches, c) electronic health record, d) associated external sites and e) protocol adjustments. ConclusionsDeveloping tailored approaches to curtail barriers to research participation is critical for increasing the probability of reaching African American study participant recruitment and retention goals. Research teams may require training in community-engagement research strategies essential for obtaining achieving target recruitment goals.

Care of stroke survivors in community: a case study of rural Thai community

PurposeThis study aims to describe survivors of stroke circumstances, issues with providing care for survivors of stroke and services expected by caregivers and survivors of stroke.Design/methodology/approachA qualitative research design was conducted in Singburi Province. Data collection methods included in-depth interviews, focus groups and participatory observations. Semi-structured in-depth interview guides, quality-of-life scale and depression scale were used to collect data from survivors of stroke, their caregivers, health personnel, local governors and village health volunteers. Naturalistic research tradition was used for qualitative data analysis and descriptive statistics for quantitative data analysis.FindingsThe majority of survivors of stroke had hemiplegic limb and severe deficits in their activities of daily living. Caregivers were family members, and they often developed depression. Issues with providing care to stroke survivors included lack of knowledge about stroke and home care, inadequacy and discontinuity of care and the shortage of stroke care personnel in the community. A stakeholder's expected stroke services included the provision of effective continuing care, community participation in care and enhancing the village health volunteer's capacity.Originality/valueThis study illustrated the stroke service systems in rural Thai communities. The study's findings could be applied when planning future research using community participation to test a model of care for stroke survivors to promote better outcomes and be responsive to the needs of stroke survivors, especially those who are disabled.

Stepping On after Stroke falls-prevention programme for community stroke survivors in Singapore: A feasibility study

Introduction Intervention studies to date have shown limited evidence of falls reduction in community-dwelling stroke survivors. This study tests the acceptability and feasibility of the Stepping On after Stroke programme in Singapore. Method A pre–post-intervention study design was used over a 6-month period. Falls incidence was the main outcome measure, with the recruitment process and attendance rate recorded to test feasibility. Data analysis from evaluation questionnaires (descriptive statistics) and interviews (content analysis) were applied to determine acceptability. Results Eight stroke participants and seven caregivers completed the programme at two community sites facilitated by two programme leaders. Stroke participants achieved full attendance over the 7-week programme but family caregivers did not (38%). All participants highlighted their acceptability of the group-based falls-prevention programme. Both programme leaders achieved 92% fidelity in session delivery. Four stroke participants fell during the study period. Stroke participants demonstrated clinically meaningful improvements in community participation at 1 month post-intervention. Family caregivers reported no changes in pre–post evaluations. Conclusion The Stepping On after Stroke programme appears feasible and acceptable to therapists and service users in Singapore; however, caregivers’ participation was limited. Findings can be used to further improve the programme and its methodology before testing its effectiveness in a larger-scale trial.

Abstract TP516: Mobile Health mHealth for Secondary Stroke Prevention is Feasible and Effective

Background: Evidence indicates inadequate access to secondary stroke prevention (SSP) in rural and poor urban areas. While self-management support (SMS) soon after stroke results in improvements, the best mode of delivery and its use in underserved populations is understudied. Methods: A pre/post repeated measures design was applied to determine feasibility and effectiveness of mHealth to deliver SMS to stroke survivors in community based urban clinics and in rural South Texas. Adults with stroke and two or more uncontrolled stroke risk factors were eligible. The telehealth SMS program, Video-teleconference - Self-management TO Prevent stroke (V-STOP) was delivered by trained staff on a video teleconferencing mobile application (see Table 1). Participants received up to 3 stroke follow-up clinic visits and 3 group SMS sessions at home on their mobile device. Primary outcomes were feasibility (attendance and satisfaction); blood pressure, disability, psychosocial measures, and stroke knowledge. Paired t-test was used to determine improvement in outcomes at baseline, 6, 12, 18 weeks. Results: V-STOP was delivered using mHealth to 66 participants over 1 year. Mean age: 57, 42% female, 17% Black and 62% Hispanic: annual income of less than $25,000 (54%) and no health insurance (63%). Attendance rate was 40% for all 6 sessions. Satisfaction with the program and mHealth delivery was high, mean score of 4.88 out of 5. Improvements from baseline to 18 weeks were observed in systolic blood pressure, mean reduction 19 mmHg, ( p =0.015); stroke knowledge, ( p = 0.001); self-efficacy, ( p =0.004); exercise ( p =0.03); activity limitations ( p =0.001); anxiety ( p =0.025); disability ( p =0.024). Conclusions: Implementation of SMS using mHealth is feasible for SSP among medically underserved stroke survivors. mHealth increases post stroke follow-up and helps stroke survivors improve risk factors.

Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey

ObjectivesTo design a questionnaire and use it to explore unmet needs with practical aspects of medicine taking after stroke, predictors of medicine taking and to estimate the proportion of survivors...

Abstract WP408: Tacls: Taking Action for Optimal Community and Long Term Stroke Care

Introduction: In Canada, approximately 12% of acute stroke patients are admitted to long-term care (LTC; or residential aged care) facilities following an acute stroke event. An additional 20-30% of patients are discharged home from hospital with referral for community-based homecare. Training programs for health care providers in these settings is variable and at times inconsistent with best practices. Internationally, focus is now shifting from a predominant inpatient acute care focus, to one encompassing ongoing care and support in the community for people living with stroke. In 2015, an educational resource called Taking Action for Optimal Community & Long Term Stroke Care (TACLS) was launched across Canada to ensure the appropriate knowledge and skills of front line care providers for stroke survivors in community and LTC facilities; the focus of this resource is on rehabilitation and recovery. Methods: The purpose of this interactive session is to introduce the TACLS resource and to engage health professionals in an examination of current international community based rehabilitation and recovery programs. The discussion/workshop will allow participants to examine, compare and contrast components of the TACLS program with programs being developed or offered elsewhere. Results: As health care providers helping stroke survivors live well and longer means investing in the use of best practice tools and resources that fit the local context and organizational practices. Bringing together international opinions and observations around post-stroke community care will allow cross-collaboration and inter-professional networking opportunities that ultimately will benefit patients living with stroke in community based settings. Discussion: As care shifts from hospital to community based settings, the importance of tools available to support stroke survivors in this area of the care continuum is essential. In Canada, utilizing the HSF education resource (TACLS) provides information to support community based health care providers working with people who have had a stroke in helping them achieve optimal outcomes, regain their best level of functioning, and live meaningful lives.

Virtually home: Exploring the potential of virtual reality to support patient discharge after stroke

Introduction The level of assessment and intervention received by patients prior to discharge varies widely across stroke services in the United Kingdom. This study aimed to explore the potential value of virtual reality in preparing patients for discharge following stroke. Method Semi-structured interviews were carried out with 13 occupational therapists, eight patients with a stroke and four community stroke survivors. Views were sought of the perceived acceptability, potential utility and limitations of a ‘virtual home’ environment for use in pre-discharge education and assessment. Data were analysed thematically. Findings Interviewees found the virtual home to be an acceptable and visual means of facilitating discussions about discharge. It was perceived as valuable in assessing patient insight into safety risks and exploring the implications of installing assistive equipment at home. Limitations were identified relating to specific software issues and the use of virtual reality with patients with cognitive or perceptual impairments. Conclusion The results demonstrate the potential utility of the virtual home within stroke rehabilitation. Patients and therapists engaged with the virtual home and, moreover, made practical suggestions for future development. Feasibility and pilot testing in a clinical setting is required to compare the use of the virtual home with traditional approaches of pre-discharge assessment.

Analysis of restricting factors of long-term care of stroke survivors in community

Objective To investigate the restricting factors of long-term care of stroke survivors in community.Methods The phenomenological methodology was adopted in the study.Sixteen stroke survivors were interviewed.Data were analyzed by Colaizzi's method.Results Three themes were found,including physical barriers,incorrect attitude towards disease,and defects of community health service.Conclusions On the basis of improving technology and ability,medical workers in community should consider of supporting the with information of disease and useful resources in a variety of ways,and improving the patients health literacy. Key words: Community; Stroke; Long-term care; Restrict factors

Poststroke Anxiety is Prevalent at the Population Level, Especially among Socially Deprived and Younger Age Community Stroke Survivors

Most studies of poststroke anxiety prevalence are hospital based, so knowledge of anxiety in community stroke survivors is limited. Few studies address the association between poststroke anxiety and patient age. No study has explored the relationship between poststroke anxiety prevalence and social deprivation. This study aims to describe population level prevalence data of poststroke anxiety and to explore association of poststroke anxiety prevalence with patient age, gender, and social deprivation. Observational study of 3831 community stroke survivors attending general practice reviews from April 1, 2009 to March 31, 2010 in Greater Glasgow, United Kingdom. Univariate and multivariate analyses investigated the association between poststroke anxiety prevalence (Hospital Anxiety and Depression Scale: anxiety sub-scale [HADS-A]), age, gender, and deprivation variables. Six hundred eighteen (16·1%) of 3831 community-dwelling stroke survivors had definite abnormal mood on HADS-A (≥11), with 952 (31·5%) scoring ≥8. Sixty-five (35·5%) of stroke survivors aged under 50 years had definite abnormal mood on HADS-A compared with 59 (7·2%) of over 80 year olds. Three hundred forty (19·8%) of women had definite abnormal mood on HADS-A compared with 278 (13·1%) of men. Three hundred seventy-two (22·6%) of most deprived stroke survivors had definite abnormal mood on HADS-A compared with 49 (7·6%) of least deprived. Age, gender, and social deprivation all contributed significantly to HADS-A score variance. Using a conservative HADS-A cutoff, a high prevalence of definite abnormal anxiety in community stroke survivors is observed. This prevalence increases markedly in younger and more socially deprived stroke survivors.

Analysis of the status of stroke survivors' adherence to functional exercise in the community and countermeasures

Objective To analyse the adherence of community-dwelling stroke survivors to functional exercise regimens and explore the influencing factors.Then to establish measures to improve the situation.Methods A total of 208 stroke survivors from 10 communities were randomly recruited.Four questionnaires-a general information questionnaire,an exercise adherence questionnaire,a self-efficacy perceptions scale and a perceived social support scale-were administered.Results The mean adherence score was 34.71 ± 8.45 and the mean adherence rate was 61.98％.The compliance to physical exercise,seeking advice positively and exercise effectiveness monitoring scores ranged from highest to lowest in order.Self-efficacy perceptions and perceived social support were both positively correlated with the adherence rate.Multiple linear regression showed that the influencing factors included self efficacy perceptions,social support perceptions,self-care ability and age.Conclusions The community stroke survivors' exercise adherence was moderate in general,but it could be improved by increasing their self-efficacy and social support perceptions and their self-care ability. Key words: Stroke; Exercise; Exercise adherence

Cognitive Dysfunction in Stroke Survivors: A Community-Based Prospective Study from Kolkata, India

The frequency of cognitive dysfunction among community stroke survivors (SS) is not known in India. This prospective study investigated the prevalence of poststroke mild cognitive impairment (psMCI) and poststroke dementia (psDem), the annual progression rate to dementia, and pertinent risk factors in a sample population of SS in Kolkata, India between September 2006 and July 2010. From a community-based stroke registry, 281 SS were assessed at baseline year after excluding attrition due to various causes. Validated cognitive tools were applied by trained field workers under supervision of a neuropsychologist. The assessment was repeated annually for consecutive three years. The mean follow-up period was 1.89 years (range, 1-3 years). The period prevalence rate of psDem was 13.88% (95% confidence interval [CI], 9.91%-18.90%) at baseline, and the average annual progression rate to dementia was 3.53% (95% CI, 2.09%-5.58%). Compared with subjects without dementia, those with psDem were significantly older at first-ever stroke and more likely to have cortical atrophy. The period prevalence rate of psMCI was 6.05% (95% CI, 1.45%-13.64%) at baseline, and 10.6% (95% CI, 4.57%-20.88%) of these subjects converted to psDem annually. Survival analysis of psDem patients showed a greater risk of death in psDem SS as compared to nondemented SS (hazard ratio, 2.65; 95% CI, 1.72-6.15). Our data suggest that the overall prevalence of psDem is higher than that of psMCI, possibly related to nonexclusion of prestroke dementia, but that the average annual progression rate of SS to psDem and that of psMCI to psDem are comparable. Older age at first-ever stroke and cortical atrophy are associated with increased risk for dementia among SS.