The experiences of everyday activities post-stroke

Atler, Karen

doi:10.3109/09638288.2015.1061603

“…Although most studies have collected data on patient stroke experiences weeks or even years after their stroke (Sarre et al., ), much less is known about their initial experiences after discharged directly home from the hospital. Atler () found that understanding daily activities of stroke survivors can provide insight into their recovery and care needed. Stroke survivors who are discharged home also have continued issues 6–8 months after discharge (Taule & Råheim, ).…”

Section: Introductionmentioning

confidence: 99%

Stroke survivors’ experiences transitioning from hospital to home

Connolly

¹

,

Mahoney

²

2018

Journal of Clinical Nursing

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“…Sedentary behavior is evident and has adverse effects for individuals with stroke (Alzahrani et al., 2011; Atler, 2016). More recently, the duration of time spent on sedentary behavior has been associated with cardiovascular disease risk, type 2 diabetes, breast and colon cancers, and cardiovascular and all-cause mortality (Tremblay et al., 2010).…”

Section: Discussionmentioning

confidence: 99%

A controlled study analyzing the temporal activity patterns of individuals with stroke compared to healthy adults

Tatli

¹

,

Akel

²

2019

British Journal of Occupational Therapy

1

0

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Introduction: The understanding of the temporal pattern of individuals can add a wider perspective to interventions. Therefore, the present study is aimed toward analysis of the temporal activity pattern of individuals with stroke compared to healthy adults. Method: This study is a prospective, case-control, analytic research study. The study sample comprised 50 individuals with stroke and 50 individuals without disease, for 80% power with a 5% type 1 error. The Modified Occupational Questionnaire was administered to assess the temporal activity pattern. Individuals identified the activities performed at each hour of the day and data was analyzed. Results: The temporal activity pattern of individuals with stroke differed from healthy controls; education and play activities were not part of stroke participants' daily routines. Also, participation in work, leisure and social participation activities was significantly different for people with stroke compared to healthy controls (p < 0.01). The study group assigned very low values to the activities; the value perceived by individuals differed significantly between groups (p < 0.01). Conclusion: Clinicians are in a position to enable individuals' time use and help to engage them in meaningful activity. Individuals with stroke may benefit from a program focusing on the temporal aspect of activities.

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“…Overall, the RATULS trial participants' accounts of stroke were strongly aligned with the existing qualitative literature concerning the multifaceted impacts of stroke, 68,69,77 variable nature of recovery over time 76,78,79 and expression of hopes and expectations concerning fuller recovery over time. 76,80 Participating in the RATULS trial was viewed by patients as an opportunity to extend or supplement their recovery process, particularly in relation to upper limb rehabilitation. Some participants expressed disappointment on being allocated to the usual care group.…”

Section: Qualitative Process Evaluationmentioning

confidence: 99%

Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT

Rodgers

¹

,

Bosomworth

²

,

Krebs

³

et al. 2020

Health Technol Assess

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Background Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. Objective The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. Design This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. Setting The trial was set in four NHS trial centres. Participants Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. Interventions Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. Main outcome measures The primary outcome was upper limb functional recovery ‘success’ (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. Results A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery ‘success’ was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. Conclusions Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. Future work Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. Limitations Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. Trial registration Current Controlled Trials ISRCTN69371850. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.

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The experiences of everyday activities post-stroke

Cited by 8 publications

References 61 publications

Stroke survivors’ experiences transitioning from hospital to home

Stroke survivors’ experiences transitioning from hospital to home

A controlled study analyzing the temporal activity patterns of individuals with stroke compared to healthy adults

Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT

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