Critical Appraisal Of International Stroke Therapy And Rehabilitation: An Essay.

Discuss About The International Of Therapy And Rehabilitation.

Stroke patients often face unmet rehabilitation needs characterized by insufficient provision of care or provision of care that does not conform to patient-centered care. Studies have therefore attempted to assess such plight that is met by stroke survivors. This paper critically appraises research study conducted by Ekstam et al (2015) in a bid to shed more light on how individuals with stroke can be aided in their daily lives.

This research was carried out by Lisa Ekstam affiliated with occupational therapy division and occupational therapy department at Karolinka University Hospital. Johansson Ulla is the second researcher also affiliated with division of occupational therapy at the same institute as well as department of clinical research at Upssala University in Sweden. Guidetti Susanne is another researcher also affiliated with the division of occupational therapy at Karolinka University Hospital.

The two remaining authors, Eriksson Gunilla and Ytterberg Charlotte are also affiliated with the same division with the former being involved in the department of neuroscience rehabilitation medicine at Uppsala University while the latter also associated with the department of clinical neuroscience and department of physiotherapy at Karolinka University Hospital (Ekstam et al, 2015). Given these affiliations, possible conflict of interest could arise from the last two authors who are not associated with the organization where the study was conducted. Also there exists possible conflicts of interest arising from academic competition since all the authors are not of the same academic level. The generalization of the findings obtained from Karolinka University Hospital provides ground for bias since three of the authors are affiliated with this institution.

The study identified two main research questions including;

1. What are the relations among stroke patients’ discernment concerning the needs of rehabilitation and severity of stroke, individual aspects, informal care, rehabilitation amenities, and the burden to the caregiver? (Ekstam et al, 2015).
2. What are the individual experiences of daily life modifications amongst individuals suffering from stroke in relation to informal caregivers? (Ekstam et al, 2015).
3. What are the strategies used by informal caregivers to handle the everyday life changes that are experienced by individuals with stroke? (Ekstam et al, 2015).

The authors in the study acknowledge the fact that informal caregivers comprising primarily of family and friends have a greater role to play in the rehabilitation of individuals who have suffered from stroke especially during the provision of rehabilitation and care at the home of the patient (Bergstrom et al, 2015). However, in most cases, the informal caregivers are elderly and they are also in need of support to help them cope with the burden experienced during the everyday life with a stroke patient (Pindus et al, 2018). The study therefore aimed to assess how individuals with stroke and their caregivers perceive the rehabilitation needs and how such needs contribute to the caregiver burden. Additionally, this study sought to understand the effectiveness of the strategies that were employed by caregivers during rehabilitation.

Research Questions

The interviews conducted and the availed medical records provided data on the stroke severity thereby enabling the study to address one aspect of research question. At 12 months after stroke, the study utilized data from a previously conducted study involving people with stroke to determine the received satisfaction and the need for health care provision in the process enabling the researchers to obtain data on the level of fulfillment from the rehabilitation process. Similarly, the data collected from the open ended questions provided insight on the changes involved in handling the daily life undertakings during post stroke and which approaches were used in managing any associated difficulties. Additionally, in order to measure the caregiver burden, the study used data on informal care provided by the caregivers which was obtained from the interviews (Ekstam et al, 2015).

This study employed a mixed method where both qualitative and quantitative data were used in the gathering and analysis of data involving the views of persons suffering from stroke occurrence and their cares. The research work was further grounded on secondary data analysis obtained from observational study involving the restoration process during post stroke periods. This research also made an inclusion of 349 subjects who comprised of stroke patients admitted in one stroke unit within a span of one year. Structured and semi structured interviews were conducted by a specially trained occupational therapist. The study used the Barthel index to analyze the severity of the stroke among the participants (Alderson, 2016).

A five graded likert scale was used to rate the caregivers’ contentment with the health care provision. ANOVA test was used in the analysis to determine probable differences concerning the perception of rehabilitation needs. Ideally, this test was essential in understanding how the stroke patients and their caregivers perceived the whole process of rehabilitation which was one of the chief aims of the study (Prel, Rohrig & Blettner, 2009). Answers obtained from the questionnaires were also analyzed separately and grouped in accordance with the met or unmet needs of rehabilitation (Ekstam et al, 2015). This process enabled the researchers to differentiate the perceptions of caregivers on their roles in providing care to individuals with stroke.

The results of the study indicate that the severity of stroke is related to the dyad’s needs of rehabilitation. In this case, the dyad’s whose rehabilitation needs were met experienced similar lives as they did before they suffered from stroke and hence exhibited limited difficulties while undertaking daily activities (Ekstam et al, 2015). Similar studies also reveal that patients with mild or moderate stroke are more positive about their lifestyles and, they also believe that they can maintain a healthy lifestyle and be able to undertake their daily activities with limited difficulties (Baker et al, 2017). However, dyad’s with unmet rehabilitation needs had more severe stroke cases and as such, they had to give up physically demanding tasks and also experienced major life events such as new stroke or dementia (Ekstam et al, 2015).

Research Design

The findings also indicate a relationship between rehabilitation needs and used strategies to overcome stroke. In this light, results revealed that dyad’s whose rehabilitation needs were met were in most of the cases involved in several strategies to manage their daily problems among them including; physical aids, use of partners or aids, and engaging in activities that they liked doing. However, the study provided limited findings to illustrate the relationship between personal factors and rehabilitation needs or caregiver burden, and the effectiveness of caregiver strategies. Contrarily, study by Hesamzadeh et al (2017) reveal that caregiver burden and caregiver dependence can be managed through encouraging physical activity, filling leisure time and facilitating religious or financial issues.

The study illustrated that there was a positive relationship between less caregiver burden and met rehabilitation needs. In this case, the results of the study indicated that carers assumed low burden during provision of care in dyad’s whom recuperation desires were met unlike those whose rehabilitation needs were unmet. Also regardless of the rehabilitation needs, caregivers reported having reduced activity in their social lives where they could not keep in touch with their families and friends (Ekstam et al, 2015)

Marginalization by healthcare services as well as limited knowledge and skills to allow for re-engagement has led to stroke survivors and their caregivers being left abandoned  (Pindus et al, 2018), and contributing to caregiver burden (Ekstam et al, 2015). It is therefore essential to increase stroke health literacy as well as facilitate timely provision of information. Such initiatives will prove to be critical in enhancing the patients’ and the caregivers’ access to information thereby fostering their understanding of data on stroke rehabilitation as well as reducing the unmet rehabilitation needs of stroke patients (Eames et al, 2015).

Conclusion

Individuals suffering from stroke and especially those with severe cases of stroke exhibited increased patient care needs that in most cases prove to be burdensome to the caregivers. Availing such information in addition to improving stroke literacy among patients is critical in alleviating the lives of stroke patients as well as their caregivers’ by meeting the rehabilitation needs of such individuals.

References

Alderson, D. (2016). How to Critically Analyze a Research Paper. Pediatrics and Child Health, 26(3), 110-113. Retrieved from https://www.sciencedirect.com/science/article/pii/S1751722215002012

Baker, N. C., Carpenter, C., Robinson, T., & Annegret, C. (2017). A Qualitative Study Exploring Patients’ with Mild to Moderate Stroke, and their Carers’ Perception of Healthy Lifestyles. International Journal of Therapy and Rehabilitation, 24(9). Retrieved from https://www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2017.24.9.375

Bergstrom, A. L., Von Koch, L., Andersson, M., Tham, K., & Eroksson, G. (2015). Participation in Everyday Life and Life Satisfaction in Persons with Stroke and their Caregivers 3-6 Months after Onset. Journal of Rehabilitation Medicine, 47(6), 508-515. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25882897

Eames, S., Hoffman, T., Worrall, L., & Read, S. (2015). Stroke Patients’ and Carers’ Perception of Barriers to Accessing Stroke Information. Topics in Stroke Rehabilitation, 17(2), 69-78. Retrieved from https://www.tandfonline.com/doi/abs/10.1310/tsr1702-69

Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The Combined Perception of People with Stroke and their Carers Regarding Rehabilitation Needs 1 Year after Stroke: A Mixed Methods Study. BMJ Open, 2015.

Hesamzadeh, A., Dalvandi, A., Maddah, S. B., Khoshknab, M. F., Ahmadi, F., & Arfa, N. M. (2017). Family Caregivers’ Experience of Activities of Daily Living Handling in Older Adult with Stroke: A Qualitative Research in the Iranian Context. Scandinavian Journal of Caring Sciences, 31(3), 515-526. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/scs.12365

Pindus, D, M., Mullis, R., Lim, L., Wellwood, I., Rundell, A. V., Aziz, N. A., & Mant, J. (2018). Stroke Survivors’ and Informal Caregivers’ Experiences of Primary Care and Community Healthcare Services: A Systematic Review and Meta-Ethnography. PLoS ONE, 13(4). Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192533

Prel, J. B., Rohrig, B., & Blettner, M. (2009). Critical Appraisal of Scientific Articles. Deutsches Arzteblatt International, 106(7), 100-105. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696241/