Preferences In Inpatient Stroke Rehabilitation: A Mixed Methods Study

Importance of rehabilitation services and emotional and social support for stroke patients and their caregivers

Discuss About The Preferences Inpatient Stroke Rehabilitation.

Rehabilitation services are extremely important after the occurrence of stroke in individuals. Researchers are of the opinion that every healthcare professional should ensure healthcare services as well as emotional and social support that ensure patients to develop quality life (Ekstam et al., 2015). Moreover, it is also important for the healthcare professionals to ensure that informal caregivers are also able to acquire necessary financial, social as well as mental and physical support so that they can care for the patients. Caregivers also go through hard days while caring for patients and therefore both of them need to meet the demands of the rehabilitation services to provide high quality life.

“Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke: a mixed methods study. BMJ open, 5(2), e006784.”

The author of the paper is Lisa Ekstam who is mainly working in the Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden. The second author is Ulla Johansson who is belonging to the Department of Occupational Therapy, Karolinska University Hospital, Stockholm, Sweden. The third author is Susanne Guidetti who is from Department of Clinical Research, Uppsala University/County Council of Gävle, Gävle, Sweden. Another author is Gunilla Eriksson from Department of Neuroscience and Rehabilitation Medicine, Uppsala University, Uppsala, Sweden. Charlotte Ytterberg is Department of Clinical Neuroscience, Division of Neurology, Karolinska University Hospital, Huddinge, Sweden. After stroke, occupational therapy is the main care that helps clients to come back into normal life and conduct the daily activities of living. Since all the authors are mainly socialized in occupational therapy and rehabilitation (Witthy, Hefferman & riby, 2017). Therefore, they will be correctly able to set up the experiments and find out results that would help the healthcare professionals to develop idea about how to help stroke patients.

The research question was quite clear. It mainly aimed to explore the perception of the dyad formed by the informal caregiver and the stroke patient regarding the rehabilitation needs of them, amount of informal care, personal factors, use of rehabilitation services, stroke severity, as well as caregiver burden. This article also aims clearly to find out the personal experiences of the different types of life changes everyday among the patients  who suffered stroke as well as their informal carers and also their different types of strategies for handling them one year after stroke.

Exploring the perception of the dyad regarding rehabilitation needs, amount of informal care, personal factors, use of rehabilitation services, stroke severity, and caregiver burden

The research design was mainly seen to be inductive where the researchers wanted to see the answers and replies of the clients and caregivers and thereby infer from the response provided by the dyad (Harrison et al., 2017).

The research was mainly seen to be provide a mixed method design that mainly combines quantitative as well as a qualitative data and their subsequent analysis. About 349 patients were included and their base assessments were done at 3,6, 12 months after stroke onset. Structures questionnaires and semi-structured open ended questions were used in the interviews. Data was also collected from the caregiver through similar set of questionnaires. Stroke severity is collected by Barthel Index. It is indeed one of the best tool that helps professionals in identification of the severity of the strokes (Creasy et al., 2015). Secondly, need for and satisfaction of care from the healthcare organisations was collected by questionnaires. The questions were based on taxonomy by ware that had likert scale helping the participants to record their satisfaction level. Moreover, sense of coherence was also collected with the help of 13 items that were actually found to be rated on seven graded likert scale. Open-ended questionnaires were collected after one year. This was very helpful as the patients could pour their heart out and hence the researchers could understand what issues they faced after one year. The burden of the caregiver was assessed with caregiver burden scale. Questionnaires on their perception of the need of caregivers in stroke maintenance were also seen. An open-ended questionnaires for different types of changes that take place in daily life since the onset of rehabilitation was also seen. The Kruskal-Wallis ANOVA test, Mann Whitney U test, χ² test were all conducted. The most interesting feature was that the authors had rightly used every tool in the proper manner so that the data they get are correct and not abrupt (Irby et al., 2015), the detailed description was done in a way by which the methodology was understood easily and was helpful for the reader to connect with the objective.  Every parameter was correctly measured.

A detailed result has been provided out of which the noteworthy was that the 52% of the people only stated that their rehabilitation needs were met at 12 months and 13% stated that their rehabilitation needs were unmet. 35% was not seen in agreement. Separately, 6percent of stroke patients said that their needs were met and 59% of the caregivers showed that their needs were met. Moreover, it was seen that greater the severity of the stroke, there were more unmet needs and from this it can be understood that person centered rehabilitation services are required. This means more severe the stroke, greater will be the requirements and needs of caregivers and patients and hence accordingly healthcare services need to plan (hong et al., 2018). More coping strategies were seen to be associated with met rehabilitation needs which proves when the needs of the caregivers and patients regarding rehabilitation services are provided, they would develop more effective coping strategies. They will thereby develop less caregiver burden.

Valuable knowledge for rehabilitation professionals to plan and provide interventions in relation to personal factors, stroke severity, and caregiver burden

One of the most interesting feature of the study was that it had provided a dyadic perspective about the rehabilitation needs of the patients as well as the caregiver to come back to normal regular lives. This adds valuable knowledge that helps us to know about the systematic approach required for perfect rehabilitation and also helps us to know the social environment that is required for the development of the health conditions after the stroke people. The rehabilitation professionals would b able to plan and provide the best rehabilitation interventions in relation to the aspects like personal factors, stroke severity and caregiver burden. The qualitative data is mainly seen to provide important information about the perceptions of the participants that help the professionals to gain an insight of the problems faced by the professionals. The quantitative data is also seen to be compared with the other generalised studies that were published till dates. However, there are also some barriers that are found that can prevent the implementation of the ideas in the care practices.  One of the most important barriers is that the data that had been taken were not sufficient for making effective comparison between the partners in dyads. The answers are mainly seen to compare patients with stroke and that the caregivers separately and were compared with stroke and caregivers in the group level. Therefore, when the perceptions about partners of each and cannot be known, then effective intervention plan for covering the needs of a dyad as a whole cannot be understood. Unless, we known the perception of both the members in a dyad, the interventions provided will be half hearted. Moreover, the experiments had only provided set answers on the statement about rehabilitation needs on a particular stamen. Without in-depth knowledge on the characteristics of the rehabilitation needs, as well as the expectations of the dyads for rehabilitation of the stroke (Fourie et al., 2017). Therefore, without these instructions it would be difficult for the professionals to develop ideas on the issues and take necessary initiatives.

Conclusion:

It is therefore seen, that every healthcare professionals and social workers working in the multidisciplinary teams are providing care to not only the patients but also hep the caregivers to lead quality lives. Improper person centred care of half hearted rehabilitation services would never be able to meet the need of the patient as well as the caregiver. This will lead to rise of caregiver burden, recurrent cases of stokes, difficulty in conducting of daily activities of life, mental pressures on both and others. Therefore, in the case study also, the client has been released without providing proper rehabilitation services and hence, issues have reoccurred in the lives.

References:

Creasy, K. R., Lutz, B. J., Young, M. E., & Stacciarini, J. M. R. (2015). Clinical Implications of Family?Centered Care in Stroke Rehabilitation. Rehabilitation Nursing, 40(6), 349-359.

Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke: a mixed methods study. BMJ open, 5(2), e006784.

Fourie, P. H., Schutte, G. C., Carstens, E., Hattingh, V., Paul, I., Magarey, R. D., ... & Kriticos, D. J. (2017). Scientific critique of the paper “Climatic distribution of citrus black spot caused by Phyllosticta citricarpa. A historical analysis of disease spread in South Africa” by Martínez-Minaya et al.(2015). European Journal of Plant Pathology, 148(3), 497-502.

Harrison, M., Ryan, T., Gardiner, C., & Jones, A. (2017). Psychological and emotional needs, assessment, and support post-stroke: a multi-perspective qualitative study. Topics in stroke rehabilitation, 24(2), 119-125.

Hong, H. (2018). Towards a Critique of Neoclassical Economics: how to Neutralize and Radicalize our Understanding of the Postulate of Independence of Agents and Goods (No. 2018rwp-119). Yonsei University, Yonsei Economics Research Institute.

Irby, B. J., Lunenburg, F. C., Lara-Alecio, R., & Tong, F. (2015). Qualitative Critique: A Heuristic Tool for Doctoral Students to Use in Improving their Research Skills. Journal of Education and Literature, 3(4), 147-158.

Luker, J., Murray, C., Lynch, E., Bernhardsson, S., Shannon, M., & Bernhardt, J. (2017). Carers' Experiences, Needs, and Preferences During Inpatient Stroke Rehabilitation: A Systematic Review of Qualitative Studies. Archives of physical medicine and rehabilitation, 98(9), 1852-1862.

Witty, C., Heffernan, T., & Riby, L. (2017). Stroke Patients And Their Partner's Perceptions Of Survivor Functioning. Acta Neuropsychologica, 15(2).