Impact of Health Literacy and Illness Perception on Rehabilitation Adherence among Patients with Stroke

Purpose: This study explored the level of Rehabilitation Adherence (RA) in patients with stroke receiving rehabilitation treatment and identified the impact of health literacy and illness perception on RA.Methods: A total of 163 patients with stroke were recruited during hospitalization for rehabilitation treatment in a descriptive cross-sectional study. Data were collected from August 25, 2018 to October 30, 2018 using self-report structured questionnaires and analyzed using descriptive statistics and hierarchical regression analysis with SPSS/WIN 26.0 program.Results: The mean score for RA in participants was 3.02±0.49 (range 1~4). Men (t=2.12, p=.035), family caregiver (F=6.59, p=.002), hemorrhagic stroke (t=-2.78, p=.006), shorter period in disease diagnosis (≤12 month) (F=7.49, p=.001) and need of someone’s help for activities of daily living (F=5.20, p=.006) were associated with higher RA. Hierarchical regression analysis showed that health literacy and emotional illness perception explained RA by additional 26%p and 3%p, respectively. Higher health literacy, higher perception about concern and emotional response about disease were effective factors of higher RA in stroke patients. Health literacy was the strongest variable to explain RA among patients with stroke.Conclusion: The study provides insight into how health literacy and emotional illness perception promote RA in stroke patients. It suggests that health literacy and illness perception need to be considered in developing a nursing intervention to increase RA for patients with stroke receiving rehabilitation treatment.

Distinguishing Characteristics Between High and Low Adherence Patients Following Anterior Cruciate Ligament Reconstruction: A Qualitative Examination

The purpose of this study was to identify factors that distinguished between injured athletes who displayed high compared with low levels of rehabilitation adherence following anterior cruciate ligament reconstructive surgery. In order to gain an in-depth understanding of these factors, semistructured qualitative interviews were conducted with six high adherers, six matched low adherers and for each injured athlete, a significant other. Thematic analysis was used to identify the themes that distinguished between high and low adherers. Three themes were generated based on the findings: (a) preparation for postoperative rehabilitation, (b) an active versus passive approach to rehabilitation, and (c) the threat of a poor outcome. Each theme comprised a number of subthemes that further elucidated the participants’ rehabilitation experiences and adherence behaviors. The findings have important implications for medical professionals, sport psychology consultants, coaches, and athletes with a vested interest in expediting recovery following anterior cruciate ligament reconstructive surgery.

Perceived Barriers and Facilitators of Sports Rehabilitation Adherence in Injured Volleyball Athletes: A Qualitative Study From Greece

Adherence to exercise rehabilitation has been shown to be an important factor that may influence successful treatment. In professional athletes, a significant reduction in exercise adherence delays recovery. The aim of this study was to explore barriers to and facilitators of exercise rehabilitation adherence in injured volleyball athletes. Eight professional volleyball athletes were recruited, and qualitative data were collected using semistructured interviews. All athletes had completed their rehabilitation program after they had suffered a musculoskeletal injury. All data were analyzed using thematic analysis after the investigators ensured that saturation had been reached. Pain was identified as a significant barrier to exercise adherence by all athletes. The provision of social support, including mental, practical, and task related, also had a significant positive impact. The athletes’ ability to develop the necessary coping strategies and confidence on performing exercises at home was also mentioned as a factor that affected exercise adherence, although less often.

Effectiveness of a Theory-Driven mHealth Intervention on Patients’ Post-Surgery Rehabilitation Adherence: A Randomized Clinical Trial (Preprint)

BACKGROUND Low adherence to post-surgery rehabilitation programs among anterior cruciate ligament (ACL) reconstruction patients is frequently reported. It is important to develop effective interventions that promote adherence to treatment and rehabilitation in ACL ruptured patients. OBJECTIVE This study aimed to assess effects of a theory-based smartphone-delivered intervention on ACL ruptured patients’ psychological, behavioral, and clinical outcomes during post-surgery rehabilitation period. METHODS We recruited 96 eligible participants (Mage = 27.824, SD = 8.732, range = 18 to 53; female = 38.947%) who underwent ACL reconstruction surgery. Participants were randomly assigned to a treatment group (n=41), which received standard post-surgical treatment and smartphone application (“ACL-Well”) delivering the intervention, or a control group (n=55), which received standard post-surgical treatment only. The primary outcomes were the recovery outcomes from ACL surgery, measured by knee muscle strength and laxity, and subjective knee evaluation completed 4-month post-intervention. Secondary outcomes were the psychological and behavioral outcomes measured at baseline within 2 weeks of surgery, and at 2- and 4-month post-intervention follow-up. RESULTS ANCOVA suggested no significant difference between the intervention and the control group in the recovery outcomes. Growth mixture modelling revealed self-determined treatment motivation declined significantly over the intervention period in the control group, but not in the intervention group. Intention and rehabilitation adherence also revealed similar patterns among patients who had lower levels of motivational or behavioral factors of rehabilitation at baseline. CONCLUSIONS The smartphone application developed in this project shows promise as a means to promote orthopedic outpatients’ motivation and adherence to treatment, but fell short in promoting recovery. Research on long-term effects of interventions are needed. CLINICALTRIAL HKUCTR-2761

A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial

Objective: Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon. Design: Prospective multi-centre randomised controlled trial. Setting: Four hand surgery departments in Sweden. Subjects: A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control ( n = 49) or intervention group ( n = 52). Intervention: A smartphone application to facilitate rehabilitation. Main outcome measures: Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks. Results: Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8–13.3), 11.8 (CI 11.0–12.8) for the intervention group, and 13.3 (CI 12.6–14.0), 12.8 (CI 12.0–13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9–99.5) compared to the controls 82.9 (CI 76.9–88.8) ( P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction. Conclusion: The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed. Level of evidence: I. Randomised controlled trial

HUBUNGAN DUKUNGAN KELUARGA DAN KEPATUHAN REHABILITASI DENGAN KEMANDIRIAN PASIEN PASCA STROKE

Introduction: Families who do not support patients can influence the level of rehabilitation adherence, which in turn will reduce the level of independence of patients after stroke. The purpose of the study was to explain the relationship between family support and rehabilitation adherence with the independence of stroke patients. Methods: This study used a cross-sectional type with a sample size of 73 post-stroke patients out of a total of 126 people. Samples were taken by consecutive sampling technique. The independent variable is the level of family support and the level of rehabilitation compliance. The dependent variable is the level of independence of patients after stroke. The research data obtained were analyzed with Spearman's Rho α ≤0.05. Results and Analysis: There was a relationship between family support and the independence of post-stroke patients with a value of α≤0.05, p = 0.001 and r = 0.384. There is a relationship between rehabilitation adherence with the independence of post-stroke patients with a value of α≤0.05, p = 0.000 and r = 0.473. Conclusion: Family support and good rehabilitation adherence do not affect post-stroke patients with severe degrees of disability and cognitive changes.