Development of a Care Bundle for Stroke Survivors with Psychological Symptoms: Evidence Summary and Delphi Study

Abstract

Background. Psychological symptoms such as depression and anxiety are quite common among stroke survivors and have great negative impacts on patients. Objective. To develop a care bundle through reviewing and integrating care strategies for psychological symptoms after stroke and then improve the bundle by Delphi study. Methods. A structured search of the literature was performed to identify studies evaluating interventions for stroke patients with psychological symptoms such as depression and anxiety. Two trained researchers screened papers through the titles, abstracts, and full-texts independently. All studies complying with the eligibility criteria were appraised using quality assessment tools. Related interventions with evaluated evidence levels formed the preliminary bundle. Afterward, the Delphi study was carried out to improve the bundle, and the experts were contacted by e-mail. Ten clinical experts specialized in stroke and psychological rehabilitation were recruited. The reliability of experts was represented by the effective response rate and authority coefficient (Cr). The consensus was deemed to be reached when the mean score for item importance is all equal or above 3.50 and the coefficient of variation (CV) is all equal or below 0.20. The Kendall coefficient W test was adopted to evaluate the consensus on agreement among the experts as well. Data analysis was performed using SPSS V.22.0. Results. Through a systematic evidence summary and two-round Delphi study, the items that were given high scores and got consensus by experts were chosen for the bundle. The iDAME bundle consisted of five interventions eventually: maintaining Interaction, tailored Diet, Acupressure, mindfulness Meditation, and physical Exercise. Conclusion. The development of an evidence-based and consensus-based iDAME bundle which integrated western and traditional Chinese medicine intervention was described. Evidence summary made the bundle become scientific, while the Delphi study made it more maneuverable. Based on these results, the bundle would be potentially implemented in stroke patients for their psychological symptoms.

Establishment of a no-notice drill mode evaluation system for public health emergencies

“…The positive coefficient of the two rounds of experts was 95%. The expert authority coefficient (CR) was 0.805 (> 0.8), indicating that the expert consultation results were accurate and reliable [ 36 ].…”

Development of an evidence‐based care bundle protocol for preventing falls in hospitalized children: Delphi study and trial test

“…The development process of the care bundle protocol for preventing falls in hospitalized children is scientific. A care bundle is a set of evidence‐based or self‐evident good practice‐based interventions for a defined patient population and care setting (Chen et al, 2020 ). Researchers also recommended developing an evidence‐based fall prevention programme (Guo et al, 2020 ; Kim, Kim, & Lim, 2021 ).…”

“…The expert response rate of the Delphi survey rounds was 100%, >70% (Hayes et al, 2015 ), and 16% of the experts who put forward constructive opinions had good expert enthusiasm. The expert authority coefficients of the Delphi survey rounds were 0.891 and 0.877, respectively, which showed good expert authority (Chen et al, 2020 ). All mean scores for importance and feasibility on items were all equal to or above 3.50, and the coefficients of variation were all equal to or below 0.25 in the second round; Kendall′s coefficients of concordance of the importance in Delphi survey rounds were 0.287 and 0.231, respectively, and Kendall′s coefficients of concordance of the feasibility were 0.269 and 0.281, respectively, and the differences were statistically significant ( p < .01), indicating that the opinions of experts were relatively concentrated, the coordination was good, and the research results were reliable.…”

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“…Cs represented experts' familiarity with the research field, and Ca represented the judging criteria based on the experts. CV was defined as the SD divided by the mean, which is used to describe the relative dispersion degree of the item's importance evaluation from experts (Reed et al, 2002;Chen et al, 2020). The Kendall coefficient W-test evaluated the consensus on agreement among the experts.…”

“…It refers to the level of intra-expert understanding of all of the indicators (Xing et al, 2019). A two-tailed p-value of less than 0.05 was considered statistically significant (Chen et al, 2020). Therefore, we predefined a mean score of no less than 4, a CV of no more than 0.2, and a two-tailed p-value of Kendall coefficient W-test of no more than 0.05 among experts for the items to be included.…”