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.

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Therapists’ perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore

Disability and Rehabilitation ◽

10.1080/09638288.2018.1471168 ◽

2018 ◽

Vol 41 (21) ◽

pp. 2528-2537 ◽

Cited By ~ 1

Author(s):

Tianma Xu ◽

Kate O’loughlin ◽

Lindy Clemson ◽

Natasha A. Lannin ◽

Gerald Koh ◽

...

Keyword(s):

Community Dwelling ◽

Falls Prevention ◽

Prevention Programme ◽

Stroke Survivors

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Experience of family caregivers of community-dwelling stroke survivors and risk of elder abuse: a qualitative study

The Journal of Adult Protection ◽

10.1108/jap-03-2014-0007 ◽

2014 ◽

Vol 16 (5) ◽

pp. 276-293 ◽

Cited By ~ 7

Author(s):

Celia Chow ◽

Agnes Tiwari

Keyword(s):

Qualitative Study ◽

Family Caregivers ◽

Local Community ◽

Service Providers ◽

Elder Abuse ◽

Community Dwelling ◽

Stroke Survivors ◽

Content Type ◽

The Disabled ◽

Personal Resilience

Purpose – The purpose of this paper is to explore the following questions. First, what are the experiences of family caregivers in caring for community-dwelling stroke survivors? Second, what services help or do not help the caregivers in managing their caregiving role? Design/methodology/approach – A qualitative study was conducted with a total of six focus group interviews with 29 stroke caregivers selected using convenience sampling in a local community centre. All interviews were recorded and transcribed for content analysis. Findings – The results pointed to three main themes working together to facilitate desirable outcomes in caregiving and prevent elder abuse: factors contributing to caregiver stress and factors that have a buffering effect on caregiver stress and unmet needs identified from caregivers’ experiences. Research limitations/implications – The authors found that there were a number of factors contributing to caregiver stress. The findings matched with the concept that caregiver stress should not be considered as the primary cause of elder abuse. Findings provided information for further research to investigate positive coping and adjustment for stroke survivors, caregivers and their families. Practical implications – Policy makers and service providers may consider specific policies and tailor-made services to enhance the effectiveness of current practice. The themes emerging from the study could be further reviewed in a longitudinal way to explore the cost-effectiveness, the outcomes and trajectory of interventional programmes. Social implications – Education would be essential to let the public understand caregivers’ difficulties and needs. Prevention of elder abuse may be approached with a range of risk factors for both perpetrating and being elder abuse victim. Originality/value – From the findings of the study, the authors found that there were service gaps within policy and interventions. Concrete suggestions for improving the public's attitude and public facilities/transport for the disabled were captured in the study. In addition to personal resilience, caregivers had a strong wish for a supportive environment and services that would facilitate a better caregiving outcome.

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Abstract TP383: Creating Educational Modules for Family Caregivers to Reduce Potentially Preventable Hospitalizations in Stroke Survivors

Stroke ◽

10.1161/str.47.suppl_1.tp383 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Linda L Pierce ◽

Victoria Steiner

Keyword(s):

Family Caregivers ◽

Nurse Practitioners ◽

Reading Level ◽

Community Dwelling ◽

Chronic Obstructive ◽

Stroke Survivors ◽

Comorbid Conditions ◽

Preventable Hospitalizations ◽

Potentially Preventable Hospitalizations ◽

Educational Modules

Background and Issues: Preventable hospitalization utilization among stroke survivors is common. Although about 1/3 of potentially preventable hospitalizations are attributed to recurrent ischemic stroke, other comorbidities that lead to hospitalization are prevalent and need to be monitored. Timely and appropriate care for community-dwelling stroke survivors is critical. Since family caregivers provide the majority of care in the home, support and education of caregivers is essential to monitoring comorbid conditions. Purpose: This project’s aim was to develop brief educational modules on common comorbid conditions (e.g. chronic obstructive pulmonary disease, congestive heart failure, gastroenteritis); have family caregivers and nurse practitioners (NPs) review the content for validity; and then construct 8-10 minute voice-over PowerPoint presentations for each module. Methods: Based on evidence from randomized controlled trials, these modules were developed to provide caregivers with needed information to competently care for stroke survivors. Each module was concisely written at an 8th grade reading level and consists of: 1) a short introduction to the topic and key points; 2) what caregivers can do to alleviate the condition, should watch for, and should report to healthcare providers; 3) linked websites for more information and references; and 4) a four-question assessment about what they learned. Results: Once developed, these modules were evaluated by family caregiver (n=10) and NP (n=5) reviewers. The caregivers thought that the modules were appropriate in length to facilitate easy reading and understanding. The NPs noted that some content needed to be added, such as additional websites and drug information, but overall believed the modules contained supportive resources for caregivers. To provide an alternate learning modality, audio-presentations that highlight pertinent information for each module were then constructed. Conclusions: Registered nurses are well-suited to assess, teach, and support family caregivers. These modules are appropriate for inclusion in web-based or in-person education/support for these caregivers.

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Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives

Disability and Rehabilitation ◽

10.1080/09638288.2017.1419293 ◽

2017 ◽

Vol 41 (9) ◽

pp. 1044-1054 ◽

Cited By ~ 4

Author(s):

Tianma Xu ◽

Kate O’Loughlin ◽

Lindy Clemson ◽

Natasha A. Lannin ◽

Catherine Dean ◽

...

Keyword(s):

Prevention Program ◽

Community Dwelling ◽

Falls Prevention ◽

Stroke Survivors

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Evaluation of the Reitman Centre CARERS program for supporting dementia family caregivers: a pre–post intervention study

International Psychogeriatrics ◽

10.1017/s1041610220004019 ◽

2021 ◽

pp. 1-12

Author(s):

Joel Sadavoy ◽

Sima Sajedinejad ◽

Mary Chiu

Keyword(s):

Family Caregivers ◽

Group Intervention ◽

Adult Child ◽

Cost Effective ◽

Skills Training ◽

Well Being ◽

Community Dwelling ◽

Rank Test ◽

Post Intervention ◽

People With Dementia

ABSTRACT Objectives: While family caregivers (CGs) of persons with dementia are cost-effective for the health system, this form of caregiving leads to disproportionate vulnerability to physical, mental, and social adverse health consequences among CGs. The study goal was to determine the effect of the Reitman Centre CARERS program on key outcomes in family CGs of people with dementia. The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills training intervention based on integrated problem-solving techniques (PST), simulation learning, and group psychotherapy designed to address each CGs’ unique situation. Design: A quasi-experimental, non-randomized, pre–post evaluation, multiple groups, multisite trial. Setting: Multisite group intervention provided in community agencies and hospital-based locations. Participants: Spousal or adult child family CGs (n = 264) living in the community and providing care to community-dwelling family members with dementia. Measurement: CGs were assessed for depression (CES-D); stress (PSS); burden (12-item SZBI); role overload, mastery, caregiving competence, and role captivity (Perlin scales), coping (CISS – Coping Inventory for Stressful Situations), CG reactions to CR’s memory and behavioral symptoms (RMBPC). Care recipients (CRs) were assessed on basic and complex activities of daily living (Katz and Lawton). Paired t-tests and Wilcoxon signed-rank test were used for statistical analysis of both the whole group and a more compromised subgroup of CGs. Results: For the group as a whole, CGs showed significant positive change on post-intervention outcome measures of stress, depression, burden, competence, role captivity, overload, mastery, coping, and reaction to memory issues. The intervention showed especially robust effect sizes (ES) in more compromised CGs. These positive outcomes emerged despite a significant measured deterioration in CRs’ function. Conclusion: The CARERS program may be an effective multicomponent intervention to improve the well-being, functioning, and coping skills of dementia CGs.

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Race and Gender Differences in 1-Year Outcomes for Community-Dwelling Stroke Survivors With Family Caregivers

Stroke ◽

10.1161/strokeaha.110.595322 ◽

2011 ◽

Vol 42 (3) ◽

pp. 626-631 ◽

Cited By ~ 47

Author(s):

David L. Roth ◽

William E. Haley ◽

Olivio J. Clay ◽

Martinique Perkins ◽

Joan S. Grant ◽

...

Keyword(s):

Gender Differences ◽

Family Caregivers ◽

Community Dwelling ◽

Stroke Survivors ◽

Race And Gender ◽

And Gender

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Effectiveness of a support intervention for family caregivers and stroke survivors

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.4991.3482 ◽

2021 ◽

Vol 29 ◽

Author(s):

Jaine Kareny da Silva ◽

Rita Narriman Silva de Oliveira Boery

Keyword(s):

Family Caregivers ◽

Effect Size ◽

Intervention Group ◽

Group Method ◽

Control Group ◽

Stroke Survivors ◽

Post Intervention ◽

Support Intervention ◽

Bonferroni Adjustment ◽

Quasi Experimental

Objective: to analyze the effectiveness of a support intervention on the burden and stress of family caregivers and on the stroke survivors’ independence level, compared to the Control Group. Method: a quasi-experimental study conducted with 37 participants (Intervention Group, n=20; and Control Group, n=17). The intervention lasted 8 months. The outcomes of the caregivers (burden and stress) and of the survivors (independence level) were measured by the Zarit, Perceived Stress and Katz scales, at the following moments: pre-intervention, the fourth month of the intervention and post-intervention. The differences of these outcomes between groups and intra-group and the effect size were calculated using the Mann-Whitney and Friedman tests (Bonferroni adjustment by Wilcoxon) and the Kendall’s W coefficient. Results: the Intervention Group reduced burden (p=0.039) and stress (p=0.009), mainly, after 8 months of intervention, which was not observed in the Control Group. The independence level did not change between the groups or moments (p>0.05). The intervention presented moderate effect size (p=0.45 and p=0.54). Conclusion: the intervention was effective to reduce the burden and stress of family caregivers, but did not alter the stroke survivors’ independence level, when compared to the Control Group.

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Changes in symptoms, sleep, oxidative stress, and inflammatory markers among community-dwelling stroke survivors after a tai chi exercise intervention

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.075 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

R Taylor-Piliae ◽

H Morrison ◽

C-H Hsu ◽

M Grandner

Keyword(s):

Oxidative Stress ◽

Inflammatory Markers ◽

Tai Chi ◽

Conventional Care ◽

Community Dwelling ◽

Stroke Survivors ◽

Post Intervention ◽

Post Stroke ◽

Symptoms Of Depression ◽

Tai Chi Exercise

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Laurence B. Emmons Research Award Background Depression is prevalent among one-third to two-thirds of stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even 5-10 years post-stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms, thus we investigated the feasibility of Tai Chi, alongside conventional care, to manage post-stroke depression. Purpose Describe changes in symptoms of depression, anxiety and stress, sleep, oxidative stress, and inflammatory markers post-intervention among community-dwelling stroke survivors with depressive symptoms. Methods In this feasibility study, a single-group pre-post intervention design was used. Due to COVID-19, participants attended a 1-hour Tai Chi exercise class three times per week for 8 weeks, instead of the planned 12-weeks. Symptoms of depression, anxiety and stress were assessed using standardized questionnaires (Center for Epidemiological Studies Depression scale, CESD; Generalized Anxiety Disorder Assessment; Perceived Stress Scale), objective sleep was assessed via a research-grade triaxial accelerometer (ActiGraph GT9X), and blood samples were taken to assess oxidative stress (plasma superoxide dismutase, SOD) and inflammatory markers (serum tumor necrosis factor-alpha, interleukin-6, interleukin-10). Pre-post intervention changes were assessed using paired t-tests. Results Community-dwelling stroke survivors (N = 11) on average 69.7 ± 9.3 years old, mainly retired (73%, n = 8), married men (55%, n = 6) with >13 years education (91%, n = 10), reporting depression symptoms (CESD = 17.3 ± 11.4) and 55% taking anti-depressant medications, enrolled. The majority of participants reported having an ischemic stroke (82%, n = 9) with hemiparesis (55%, n = 6), but were able to walk 15 feet without assistance (91%, n = 10). After the Tai Chi intervention, we observed significant reductions in symptoms of depression (-5.3 ± 5.9, p = 0.01), anxiety (-2.2 ± 2.4, p = 0.01) and stress (-4.6 ± 4.8, p = 0.01); along with better sleep efficiency (+1.8 ± 1.8, p = 0.01), less wakefulness after sleep onset (-9.3 ± 11.6, p = 0.04), and less time awake (-9.3 ± 11.6, p = 0.04). In addition, there was a 36% decrease in SOD activity (p = 0.02) indicative of a decreased oxidative environment post-intervention; though no significant changes in any of the inflammatory markers were found (all p-values >0.05). Conclusion Symptoms of depression, anxiety and stress were observed in these community-dwelling stroke survivors along with sub-optimal sleep. Among community-dwelling stroke survivors, Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage post-stroke depression and may also aid in reducing symptoms of anxiety and stress, and improve sleep. Further research is needed with rigorous study designs and larger samples, before widespread recommendations can be made.

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