scholarly journals Medication adherence early after stroke: using the Perceptions and Practicalities Framework to explore stroke survivors’, informal carers’ and nurses’ experiences of barriers and solutions

2021 ◽  
pp. 174498712199350
Author(s):  
Josephine Gibson ◽  
Jacqueline Coupe ◽  
Caroline Watkins
Keyword(s):  
Medication Adherence ◽  
Stroke Survivors ◽  
Post Discharge ◽  
Factors Affecting ◽  
Post Stroke ◽  
Evolving Systems ◽  
Lack Of Information ◽  
Informal Carers ◽  
Group Interviews ◽  
Poor Medication Adherence

Background Secondary prevention medication after stroke reduces risk of recurrence, but adherence is often poor. Stroke survivors’, carers’ and nurses’ perspectives of early post-stroke medication adherence are unexplored. Aim The aim of this study was to explore stroke survivors’, carers’ and nurses’ views and experiences about adhering to medication early after post-stroke hospital discharge. Methods Qualitative individual and group interviews, utilising the Perceptions and Practicalities Framework, were employed. Nine people <2 months post-stroke, three carers and 15 nurses from one UK stroke unit participated. Interviews were digitally recorded, transcribed and thematically analysed. Results There were four main themes with two sub-themes. (1) Perceptions of medication taking after stroke. Factors affecting adherence included depression, imperceptible benefits and concerns about adverse effects. (2) Perceptions about those at higher risk of poor medication adherence. Nurses suggested that poor adherence might be more likely in those living alone or with previous non-adherence. (3) Practicalities of taking medication early after stroke; these included post-stroke disabilities, cognition, polypharmacy and lack of information. (4a) Practicalities of addressing poor medication adherence during the hospital stay. Solutions included multidisciplinary co-ordination, but nurses and stroke survivors described suboptimal use of opportunities to promote adherence. (4b) Practicalities of addressing poor medication adherence post-discharge. Solutions included modifications and support from carers, but stroke survivors reported difficulties in evolving systems for taking medications. Conclusions Stroke survivors and informal carers lack knowledge and support needed to manage medication early after discharge. Nurses’ opportunities to promote medication adherence are under-exploited. Medication adherence strategies to support stroke survivors early after discharge are needed.

Abstract WP237: Facilitators and Barriers to Medication Adherence Among Stroke Survivors in India

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shani SD ◽  
Vr Kutty ◽  
Rp Varma ◽  
Jissa VT ◽  
Sylaja PN
Keyword(s):  
Medication Adherence ◽  
Life Style ◽  
Structured Interview ◽  
Stroke Survivors ◽  
Care Seeking ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Daily Routines ◽  
Post Stroke ◽  
Facilitators And Barriers

Background: Medication nonadherence is a major problem and is an important mediator between the treatment and the outcome. Strict compliance with medication and life style modification are integral to secondary stroke prevention. Methods: Cross sectional survey among 240 stroke survivors within a post-stroke period of three months to one year was conducted. Interview based self-reported medication adherence was defined as consumption at least more than 80% of their medication, based on their last prescription. Medication adherence was calculated for five categories of medication; antiplatelets, antihypertensives, antidiabetics, statin and anticoagulants. Overall adherence was defined as adherence to all the categories of medications prescribed. Structured interview using pretested interview schedule was done to collect sociodemographic data, health care seeking behaviour, life style, facilitators and barriers to medication adherence. Results: Stroke survivors [n=240; mean age 58.64 ±10.96 years); 25.4% females; post-stroke period of 6.65±3.36 months] were interviewed. Patients with diabetes, hypertension and dyslipidaemia constituted 64.2%, 88.8% and 96.7% and optimal control was achieved in 26%, 36.2% and 72.9% respectively. Overall medication adherence was 43.8% (n=240). Adherence to antiplatelet was 62.24% (n=196). Medication adherence was 34.4% (n=134), 52.6% (n=190) and 56.7% (n=224) for antidiabetics, antihypertensives and statins respectively and was associated with risk factor control (Diabetes: Odds Ratio(OR)=4.85;95% Confidence Interval(CI) 2.12-11.08, Hypertension: OR=3.42; 95% CI 1.83-6.4, Dyslipidaemia: OR=3.88;95% CI 1.96-7.69). Having daily routines (OR=2.82;95% CI 1.52-5.25), perceived need of medication (OR= 2.33;95% CI 1.04-5.2) and perceived poor state of health (OR= 3.09; 95% CI 1.44-6.62) as facilitators. Memory problem (OR 0.32; 95% CI 0.51-0.66), experiencing side effects (OR 0.24; 95% CI 0.11-0.53) and belonging to below poverty line (OR 0.46; 95% CI 0.24-0.91) were barriers to medication adherence. Conclusion: Establishing daily routines, periodic reminders, and financial supports to buy medicines and patient education can enhance medication adherence to prevent future strokes.

Abstract TP141: Navigation Services for Stroke Survivors and Caregivers Post-discharge

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Julia B Richards ◽  
Amy Larson ◽  
Jamie Charbonneau
Keyword(s):  
Caregiver Burden ◽  
Barriers To Care ◽  
Stroke Recovery ◽  
Community Living ◽  
Stroke Survivors ◽  
Post Discharge ◽  
Patient Centered ◽  
Post Stroke ◽  
Medical Issues ◽  
Healthcare It

Background: Patient navigation is a community-based intervention designed to help clients identify and overcome barriers to care. Navigation is a widely used, evidence-based model for patient-centered healthcare. It is well documented that stroke survivors and caregivers face enormous obstacles in returning to their community living situations post-stroke. Purpose: National Stroke Association’s Stroke Recovery Navigator Program is designed to reduce barriers to care, lower incidence of secondary stroke, eliminate re-hospitalization due to post-stroke conditions, and provide support for adjusting to community living. Method: National Stroke Association implemented a pilot program to determine if navigation is an effective intervention for stroke survivors and caregivers. Clients were referred to the program upon discharge from partner hospitals. Clients completed either the Reintegration to Normal Living Index (RTNLI) or the Zarit Screening Measure of Caregiver Burden (respectively) at enrollment and at graduation. Results: The Stroke Recovery Navigator Program received 180 referrals with 90 clients converted to active participation. Stroke survivors made up 82% of participants and caregivers 18%. RTNLI scores went up and Caregiver Burden scores went down when clients received navigation services. During the pilot phase, 12 stroke survivors were re-hospitalized, 4 for stroke-related issues; 8 for new medical issues. Post-pilot evaluations of participants showed that 95% of respondents believe the program provides a valuable service. Referral source surveys revealed that more than half of their patients received information about the program at discharge. Conclusions: Navigation for stroke survivors and caregivers shows increased reintegration to normal living and reduced caregiver burden scores. Clients receiving navigation were re-hospitalized below the levels documented in recent studies. Based on these findings National Stroke Association concludes that navigation post-stroke results in positive outcomes for survivors, caregivers and hospitals.

scholarly journals Socio-demographic and Clinical Correlates of Community Reintegration of Stroke Survivors in Nigeria

2020 ◽  
pp. 1-7
Author(s):  
Muhammad Usman Ali ◽  
Auwal Yahaya Garba ◽  
Adewale Luqman Oyeyemi ◽  
Mamman Ali Masta ◽  
Fatima Kachallah Gujba ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Sampling Technique ◽  
Haemorrhagic Stroke ◽  
Public Hospitals ◽  
Rehabilitation Services ◽  
Stroke Survivors ◽  
Community Reintegration ◽  
Post Discharge ◽  
Post Stroke ◽  
The Impact

Background: Low level of community reintegration among stroke survivors is a major obstacle to rehabilitation services post discharge from acute care. Few studies have assessed the impact of community reintegration on stroke survivors in Nigeria. This study investigates community reintegration and associated factors among stroke survivors in Maiduguri, Nigeria. Methodology: Purposive sampling technique was used to recruit 55 stroke survivors attending rehabilitation services from two public hospitals in Maiduguri. Community reintegration was assessed with the Reintegration to Normal Living Index (RNLI) questionnaire, while information on sociodemographics (e.g., age group, gender, employment status, educational status) and clinical characteristics (e.g., post stroke duration, types of stroke, side of affectation) was obtained using the data form. Logistic regression analyses with odd ratios were used to test the associations between community reintegration and sociodemographic and clinical characteristics. Results: The mean age and post stroke duration of the participants were 44.69±13.06 years and 17.25±24.90 months respectively. The participants’ community reintegration scores showed that 60%, 38.2% and 1.8% have no integration, mild to moderate reintegration and complete reintegration respectively. The results indicated that stroke survivors with a stroke duration greater than 8 months (OR=3.32, C.I=1.08-10.27) and those with haemorrhagic stroke (OR=4.67, C.I=1.05-20.66) were more likely to be reintegrated into the community than their counterparts with 6-8 months post stroke duration and ischaemic stroke, respectively. There was significant association between community reintegration and sociodemographic characteristics such as post stroke duration and type of stroke. Conclusions: Rehabilitation strategies should focus on clinical characteristics of the stroke survivors when planning and delivering effective community reintegration interventions.

Abstract 3861: The Effect of Stroke Survivor and Caregiver Family Function and Mutuality on Post Stroke Depression

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Kyler M Godwin ◽  
Paul Swank ◽  
Sharon K Ostwald
Keyword(s):  
Structural Model ◽  
Inpatient Rehabilitation ◽  
Stroke Survivor ◽  
Mediating Effect ◽  
Stroke Survivors ◽  
Post Discharge ◽  
Family Function ◽  
Her Family ◽  
Post Stroke ◽  
Post Stroke Depression

Background: Post-stroke depression is common among both stroke survivors and their caregivers. This secondary data analysis explored the effect that stroke survivor and caregiver family function and mutuality, a measure of the perceived positive aspects of the caregiving relationship, had on the depression of spousal dyads over the first 12 months post discharge from inpatient rehabilitation. Methods: Longitudinal meditational analysis was employed to examine the mediating effect of mutuality on the dyads’ perception of family function and caregiver and stroke survivor depression over time. The model was estimated in MPlus version 6.1 using bootstrap estimation with 1000 draws. The final structural model had good model fit to the data with a chi square ( df= 16; N = 132) of 17.55, p =.35, a comparative fit index (CFI) of 0.996, and root mean square error of approximation (RMSEA) of 0.027 (CI = 0-.087). Results: This study included 159 stroke survivors and their spousal caregivers who were an average (standard deviation) age of 66.4 (9.1) and 62.5 (10.5) years, respectively. The majority of stroke survivors were predominately male and non-Hispanic white, although almost 40% of the sample was represented by ethnic minorities. Mutuality was not found to mediate the relationship between caregivers’ and stroke survivors’ perception of family function at baseline and their own or their partners’ depression at 12 months as hypothesized. However, caregivers who perceived healthier family functioning at baseline and stroke survivors who had higher perceived mutuality at 12 months had lower depression at one year post discharge from inpatient rehabilitation (-.117, p=.048; -1.007, p=.034, respectively). Additionally, caregiver mutuality at 6 months, but not at baseline or 12 months, was found to be inversely related to caregiver depression at 12 months (-1.06, p=.04). Conclusions: This study highlights the importance of focusing on the relational aspects of stroke. A stroke does not only happen to the stroke survivor. It affects his or her family, and it oftentimes changes the life of both the stroke survivor and their spousal caregiver. Health professionals should encourage couples who have experienced a stroke to focus on the positive aspects of the caregiving relationship to mitigate post-stroke depression.

scholarly journals Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ingrid Johansen Skogestad ◽  
Marit Kirkevold ◽  
Petra Larsson ◽  
Christine Råheim Borge ◽  
Bent Indredavik ◽  
...  
Keyword(s):  
Future Development ◽  
Health Professionals ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Post Stroke ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

scholarly journals ‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

2021 ◽  
pp. 026921552110007
Author(s):  
Hannah Stott ◽  
Mary Cramp ◽  
Stuart McClean ◽  
Ailie Turton
Keyword(s):  
Support Groups ◽  
Phenomenological Study ◽  
Community Support ◽  
Phenomenological Approach ◽  
The Body ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Personal Perceptions ◽  
Psychological Sense ◽  
Qualitative Phenomenological

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.

Aquatic Therapy for improving Lower Limbs Function in Post-stroke Survivors: A Systematic Review with Meta-Analysis

2021 ◽  
pp. 1-17
Author(s):  
Mahboubeh Ghayour Najafabadi ◽  
Ardalan Shariat ◽  
Jan Dommerholt ◽  
Azadeh Hakakzadeh ◽  
Amin Nakhostin-Ansari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Lower Limbs ◽  
Stroke Survivors ◽  
Aquatic Therapy ◽  
Post Stroke

scholarly journals Role of caregiver factors in outpatient medical follow-up post-stroke: observational study in Singapore

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shilpa Tyagi ◽  
Gerald Choon-Huat Koh ◽  
Nan Luo ◽  
Kelvin Bryan Tan ◽  
Helen Hoenig ◽  
...  
Keyword(s):  
Observational Study ◽  
Management Strategies ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Memory Problems ◽  
Healthcare Needs ◽  
Stroke Study

Abstract Background Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke. Method Stroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0–3 months (early) and 4–12 months (late) post-stroke. Results For the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits. Conclusion We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments.

scholarly journals Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

2020 ◽  
pp. 026921552098172
Author(s):  
Niall M Broomfield ◽  
Robert West ◽  
Allan House ◽  
Theresa Munyombwe ◽  
Mark Barber ◽  
...  
Keyword(s):  
Item Response ◽  
Psychometric Evaluation ◽  
Self Report ◽  
Stroke Survivors ◽  
Reference Standard ◽  
Stroke Units ◽  
Post Stroke ◽  
Response Variance ◽  
Mild Stroke ◽  
Functional Outcome Measures

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects. Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach’s alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of −7.18, 95% CI (−8.07 to −6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism. Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

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