Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review

Abstract Background Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies. Results Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks). Conclusion From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance. Registration: PROSPERO CRD42017072799—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72799

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Advantages and challenges in using telehealth for home-based palliative care: A systematic mixed studies review protocol (Preprint)

10.2196/preprints.22626 ◽

2020 ◽

Author(s):

Simen A Steindal ◽

Andréa Aparecida Goncalves Nes ◽

Tove E. Godskesen ◽

Susanne Lind ◽

Alfhild Dhle ◽

...

Keyword(s):

Palliative Care ◽

Care Delivery ◽

Patient Centered ◽

Care Services ◽

Home Based ◽

Mixed Studies Review ◽

Palliative Care Services ◽

Meta Analyses ◽

Systematic Mixed Studies Review ◽

At Home

BACKGROUND Due to the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care. OBJECTIVE The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. METHODS This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data and assess methodological quality. The data will then be analyzed using thematic synthesis. RESULTS We described the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. CONCLUSIONS Following the ethos of patient-centered palliative care, this systematic mixed studies review could contribute recommendations for practice and policy enabling the development of telehealth applications and services that align with patients’ preferences and needs when using telehealth applications and services at home.

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Leveraging the opportunities of mixed methods in research synthesis: Key decisions in systematic mixed studies review methodology

Research Synthesis Methods ◽

10.1002/jrsm.1436 ◽

2020 ◽

Author(s):

Sarah L. Ferguson ◽

Monica Reid Kerrigan ◽

Katrina A. Hovey

Keyword(s):

Mixed Methods ◽

Research Synthesis ◽

Mixed Studies Review ◽

Systematic Mixed Studies Review

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Advantages and challenges in using telehealth for home-based palliative care: A systematic mixed studies review (Preprint)

JMIR Research Protocols ◽

10.2196/22626 ◽

2020 ◽

Author(s):

Simen A Steindal ◽

Andréa Aparecida Goncalves Nes ◽

Tove E. Godskesen ◽

Susanne Lind ◽

Alfhild Dhle ◽

...

Keyword(s):

Palliative Care ◽

Home Based ◽

Mixed Studies Review ◽

Systematic Mixed Studies Review

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Factors That Influence Substance Use Among American Indian/Alaskan Native Youth: A Systematic Mixed Studies Review

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211038050 ◽

2021 ◽

pp. 107839032110380

Author(s):

Cedric Woods ◽

BoRam Kim ◽

Kristine Guo ◽

Tuyet Nyguen ◽

Sarin Taplayan ◽

...

Keyword(s):

Substance Use ◽

Native American ◽

Mixed Methods ◽

American Indian ◽

Substance Misuse ◽

Alaskan Native ◽

Systems Model ◽

Mixed Studies Review ◽

Native Youth ◽

Systematic Mixed Studies Review

BACKGROUND: The American Indian/Alaskan Native (AI/AN) mortality rate from illicit drug use was 22.7%, double that of the general population between 2007 and 2009. Fifteen percent of AI/AN youth reported receiving treatment for substance use compared with 10% of non-AI/AN peers. OBJECTIVE: The purpose was to explore the factors that influence substance use among AI/AN youth. METHOD: We performed a systematic review using a results-based convergent synthesis design. Eight electronic databases were searched for articles published between 2014 and 2019 using the search terms “Native American youth,” “Native American adolescent,” “Native Youth,” “substance use,” “substance misuse,” and “substance abuse.” The Mixed Methods Appraisal Tool was used to appraise the studies. RESULTS: Forty-seven studies met the inclusion criteria (44 quantitative, one qualitative, and two mixed-methods studies). The results were organized using the ecological systems model and included evaluation of both protective and risk factors related to AI/AN youth substance use. Three system levels were found to influence substance use: individual, micro- and macrosystems. The individual systems-level coping mechanisms played a key role in whether AI/AN youth initiated substance use. Family, school, and peer factors influence the microsystem level. At the macrosystem level, community environmental factors were influential. CONCLUSION: The major factor linking all the systems was the influence of a connected relationship with a prosocial adult who instilled future aspirations and a positive cultural identity. Findings of this systematic mixed studies review will assist in intervention development for AI/AN youth to prevent substance misuse.

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Effect of home-based rehabilitation of purposeful activity-based electrical stimulation therapy for chronic stroke survivors: a crossover randomized controlled trial

Restorative Neurology and Neuroscience ◽

10.3233/rnn-211157 ◽

2021 ◽

pp. 1-8

Author(s):

Seigo Minami ◽

Yoshihiro Fykumoto ◽

Ryuji Kobayashi ◽

Hideaki Aoki ◽

Tomoki Aoyama

Keyword(s):

Upper Limb ◽

Repeated Measures ◽

Controlled Trial ◽

Phase 1 ◽

Chronic Stroke ◽

Stroke Survivors ◽

Electrical Stimulation Therapy ◽

Home Based ◽

Group A ◽

Purposeful Activity

Background: In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study. Objective: The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial. Methods: The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the Fugl–Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light). Results: Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching. Conclusions: The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors.

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Stroke survivors' perspectives on recovering in rural and remote Australia: A systematic mixed studies review

Australian Occupational Therapy Journal ◽

10.1111/1440-1630.12779 ◽

2021 ◽

Author(s):

Sarah M. Jackson ◽

Bridee A. Neibling ◽

Ruth N. Barker

Keyword(s):

Stroke Survivors ◽

Rural And Remote ◽

Mixed Studies Review ◽

Systematic Mixed Studies Review

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Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study

BMC Health Services Research ◽

10.1186/s12913-020-05432-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Steinunn A. Olafsdottir ◽

Helga Jonsdottir ◽

Ingibjörg Bjartmarz ◽

Charlotte Magnusson ◽

Héctor Caltenco ◽

...

Keyword(s):

Physical Activity ◽

Mixed Methods ◽

Community Dwelling ◽

Mixed Methods Study ◽

Stroke Survivors ◽

Home Based

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Legacy perceptions and interventions for adults and children receiving palliative care: A systematic review

Palliative Medicine ◽

10.1177/0269216321989565 ◽

2021 ◽

pp. 026921632198956

Author(s):

Jessika C Boles ◽

Maile T Jones

Keyword(s):

Palliative Care ◽

Mixed Methods ◽

Pediatric Patients ◽

Continuing Bonds ◽

Future Research ◽

Care Recipients ◽

Mixed Studies Review ◽

Adults And Children ◽

Assess Quality ◽

Operational Concept

Background: Legacy has been invoked as a means for strengthening human attachments, continuing bonds, and ensuring that individuals will be remembered; however, little is known about the spectrum of approaches to, outcomes associated with, and best practices for legacy interventions. Aim: To systematically review research on legacy perceptions and interventions in pediatric and adult palliative care recipients. Design: A systematic mixed studies review synthesizing quantitative, qualitative, and mixed-methods study findings using PRISMA guidelines. Data sources: PubMed, PsycINFO, and CINAHL databases were searched on October 1, 2020. GRADE criteria were used to assess quality of quantitative reports, and the Johns Hopkins Evidence Level and Quality Guide was used to rate qualitative, mixed methods, and review articles. Data were synthesized using integrative thematic analysis. Results: The 67 studies reviewed describe a variety of legacy perceptions and interventions with adult and pediatric patients receiving palliative care. Statistically significant improvements in various dimensions of wellbeing are documented, with significant reduction in incidence and symptoms of depression in adults. Studies highlight the utility, feasibility, and perceived benefits of legacy interventions according to adult patients and their caregivers, and parents/caregivers of pediatric patients. Conclusions: Though future research with high-quality, experimental designs is needed, the positive outcomes associated with legacy interventions are documented in adult patient populations; additionally, the application of legacy interventions for children with serious illnesses receiving palliative care is reasonable based on the existing body of evidence. A consistent and operational concept of legacy is still needed for future research and practice.

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