Stroke rehabilitation: issues for physiotherapy and physiotherapy research to improve life after stroke (2025)

Stroke survivors’ priorities for research related to life after stroke

Topics in Stroke Rehabilitation

Background: Stroke has transitioned from an untreatable, unpreventable disease to a highly treatable and preventable disease over recent decades, and the number of stroke survivors is expected to increase. The number is also foreseen to grow larger as a result of an aging population. With an escalating number of stroke survivors, research on how to improve life after stroke is needed. Aims: The primary aim was to determine which area of research related to life after stroke that stroke patients and their informal carers prioritized as being relevant and valuable. Methods: A cross-sectional study of all patients who had completed the 12 months of follow-up in the EFFECTS trial. In the questionnaire the stroke patients and their informal carers were asked to prioritize areas of research they considered important and valuable with respect to their life after stroke. Results: Of the 731 patients who were still alive after the 12 months-follow-up, 589 responded. The most prioritized areas of research were Balance and walking difficulties (290 (49%) responders) and Post-stroke fatigue (173 (29%) responders). Women answered the undefined alternative "other" more often than men (43 women (11%) versus 11 men (6%), p = .04). Younger patients prioritized Post-stroke fatigue to a higher extent (88 (45%) versus (22%), p < .001), and elderly prioritized Balance and walking difficulties (214 (54%) versus 76 (40%), p = .002) and Speech difficulties (38 (10%) versus 9 (5%), p = .045). Conclusions: Life after stroke is perceived differentely with aging. Future research should address strategies to face challenges such as imbalance and walking difficulties and post-stroke-fatigue.

Priorities for Stroke Rehabilitation and Research: Results of a 2003 Canadian Stroke Network Consensus Conference

Archives of Physical Medicine and Rehabilitation, 2007

Bayley MT, Hurdowar A, Teasell R, Wood-Dauphinee S, Korner-Bitensky N, Richards CL, Harrison M, Jutai JW. Priorities for stroke rehabilitation and research: results of a 2003 Canadian Stroke Network consensus conference. Arch Phys Med Rehabil 2007;88:526-8. The Canadian Stroke Network Consensus Conference panel met in 2003 in Toronto, Canada, to address areas of stroke rehabilitation that require additional research as well as increased efforts to knowledge translation. The results of an extensive literature review, of a study of factors related to poststroke quality of life, and a survey of clinicians were presented to the panel. From this review, the panel compiled a consensus list of 5 priority areas in stroke rehabilitation research that warrant further investigation. The priorities are: (1) multimodal programs for reintegration into the community;

Things to Note in Stroke Rehabilitation

Journal of Nursing & Care, 2015

Stroke results in impairment of motor, cognitive and sensory/perceptual functions. As such, activities of daily living (ADL) after stroke can be affected. These affectations can persist for a long time depending on the extent of the affectation in the brain and rehabilitation. In fact, stroke has lately been recognized as a long term condition. Thus, stroke rehabilitation requires intensive time. When stroke occurred, the brain capitalizes heavily on learning to recover function; and the best way to induce such learning is known to be through task specific training. Effective stroke rehabilitation requires knowledge of the current available evidence base. However, to embrace the current available evidence, skills in information retrieval and critical appraisal of the literature are needed. Unfortunately, the skills of a say, entry level physiotherapists may not be adequate for them to be abreast of the evidence-based practice. Thus, there is a need to summarize the literature for such therapists to help them note some important issues in stroke rehabilitation.

Stroke rehabilitation 2007: what should it be?

International Journal of Stroke, 2007

Background There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. Summary of review There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include (1) a functional approach targeted at specific activities e.g. walking, activities of daily living, (2) frequent and intense practice, and (3) commencement in the first days or weeks after stroke. Conclusion The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.

Scientific research with individuals post stroke: difficulties in recruitment, allocation and adherence on two different protocols of physiotherapy intervention

Fisioterapia e Pesquisa, 2015

Pesquisas científicas com indivíduos pós Acidente Vascular Encefálico: dificuldades no recrutamento, alocação e aderência em dois diferentes protocolos de intervenção fisioterapêutica Las investigaciones científicas con sujetos que sufrieron accidentes cerebrovasculares: dificultades para el reclutamiento, destinación y adherencia en dos diferentes protocolos de intervención fisioterapéutica

Three different points of view in stroke rehabilitation: patient, caregiver, and physiotherapist

Topics in stroke rehabilitation, 2015

The similarities or differences of the threesome (physiotherapists, patients, and caregivers) thought about the process of stroke rehabilitation can play a key role in the success of rehabilitation. The aim of this qualitative study was to investigate the perspectives of the threesome, with regard to the two themes of the study: (1) What are the problems faced by the patients after stroke?; and (2) What does recovery after stroke mean to you? The qualitative questions and possible answers were prepared by four physiotherapists. The answers were matched to International Classification of Functioning (ICF) components. Seventy patients who were having treatment as in-patient rehabilitation centers, their caregivers, and physiotherapists were invited to the study. After the questions were asked and the possible response choices were presented, subjects were asked to prioritize these response choices. One hundred and fifty-nine subjects, including 53 patients, 53 caregivers, and 53 physi...

Being a stroke patient: a review of the literature

Journal of Advanced Nursing, 1997

Being a stroke patient: a review of the literature The purpose of this paper is to review the research literature on the patient's experience of stroke. Four qualitative studies on how patients experience stroke were identified. The findings of these studies show that the stroke patient often has clear goals for himself in relation to functional abilities, against which he measures all success and forward progress in his rehabilitation. Even though the stroke patient accepts a lower level of functional ability, he is not willing to accept the rehabilitation professionals' prediction of his ultimate functional level if it is lower than his own goal. Furthermore, stroke patients see recovery as a return to the existence they had lived before the stroke, which is diÂerent from the health care providers' view. To the health care provider, recovery is measured in terms of isolated and discrete return of movement, whereas in the eyes of the patients, recovery is a return to previously valued activities. Further, studies on psychosocial function after stroke were reviewed. Recent studies show that the psychological impact of the stroke experience is immense and that stroke patients experience stress on a variety of levels. Also, depression exists in a large portion of the stroke population. The impact of stroke also influences the patient's social existence, as studies have shown that stroke patients do manifest diminished social function. However, the reviewed studies are not without limitations. Further studies, with a qualitative design, are needed to throw light on the patient's experience of being ill with stroke, and the process of his recovery.

Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda On behalf of the Scottish Stroke Nurses Forum (SSNF

Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda. Abstract Aim. To determine the top 10 research priorities specific to stroke nursing. Background. It is important that stroke nurses build their research capability and capacity. This project built on a previous James Lind Alliance prioritization project, which established the shared stroke research priorities of stroke survivors, carers and health professionals. Design. Research priority setting project using James Lind Alliance methods; a survey for interim prioritization and a consensus meeting for final priority setting. Methods. Between September-November 2014, stroke nurses were invited to select their top 10 priorities from a previously established list of 226 unique unanswered questions. These data were used to generate a list of shared research priorities (interim priority setting stage). A purposefully selected group of stroke nurses attended a final consensus meeting (April 2015) to determine the top 10 research priorities. Results. During the interim prioritization stage, 97 stroke nurses identified 28 shared priority treatment uncertainties. At the final consensus meeting, 27 stroke nurses reached agreement on the top 10 stroke nursing research priorities. Five of the top 10 questions relate to stroke-specific impairments and five relate to rehabilitation and long-term consequences of stroke. Conclusions. The research agenda for stroke nursing has now been clearly defined, facilitating nurses to undertake research, which is of importance to stroke survivors and carers and central to supporting optimal recovery and quality of life after stroke.

Stroke rehabilitation

Protocol of the Sunnaas International (SIN) Stroke Project an International Multicenter Study of Specialized Rehabilitation for Stroke Patients

Journal of Clinical Trials, 2014

Stroke is leading cause of serious, long-term disability in adults. Consequently, many individuals with stroke are in need of specialized rehabilitation. However, the content of specialized rehabilitation may vary.

Stroke Outcome and its Rehabilitation

2017

Outcome after stroke is measured in a number of ways, including medical morbidity, mortality, length of hospitalization, cost, functional ability, placement at discharge, and quality of life. The aim of the study was to assess the efficacy of rehabilitation in maintaining achieved gains and reducing long-term costs and illustrate the efficacy of various levels of rehabilitative services on stroke outcome. Recovery from a stroke can be a challenging process. Inpatient rehabilitation teams should combine personalized attention with leading-edge therapies to help each patient achieve the highest possible level of independence.

Chapter 6 : The elements of stroke rehabilitation

2020

The primary goals of stroke rehabilitation are to encourage and foster functional improvement and neurological recovery. Organised stroke care, processes of care, early timing of rehabilitation and high intensity of rehabilitation therapies are important factors which have been identified as promoting better overall outcomes for individuals with stroke. This chapter examines the evidence for those elements which have been proven to be important in the effectiveness of stroke rehabilitation. Norine Foley, MSc Norhayati Hussein MBBS, Marcus Saikaley, BSc Jerome Iruthayarajah, MSc Joshua Wiener, PhD Candidate Mark Speechley, PhD Robert Teasell, MD

Stroke recovery and rehabilitation research

Journal of rehabilitation research and development

3. Background Concepts in Stroke Rehabilitation

Recovery after stroke: A qualitative perspective

Journal of Quality In Clinical Practice, 2001

The purpose of this study was to determine the impact of stroke on survivors of the condition and to identify their physical and psychosocial needs in rural and regional settings. Data were collected via focus group interviews with stroke survivors, carers and key informants. Data were managed using NUD*IST and analysed using a content analysis method identifying major themes related to the impact of living in the community after having a stroke. It was found that stroke survivors suffered severe physical and emotional effects. The findings also identified the vulnerability of this group and a lack of organised, on-going psychosocial and rehabilitative support.

Moving stroke rehabilitation research evidence into clinical practice: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

International Journal of Stroke

Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identif...

Views of survivors of stroke on benefits of physiotherapy

Quality in Health Care, 1994

Objective-To describe the components of physiotherapy valued by survivors of a stroke.

Stroke research questions: a nursing perspective

British Journal of Nursing, 2009

Background: stroke is a national research priority. However, in the literature there is still minimal systematic investigation of stroke nursing -especially practice. The aim of this study was to explore stroke nurses' research priorities through a series of focus groups. Method: the study was qualitative and involved focus groups (n = 7) with registered nurses working in stroke care settings and who were members of the Scottish Stroke Nurses Forum. Data were analysed to identify conceptual categories, which were found to relate to the categories defined by Kirkevold (1997) and Booth (2001). Results: five priority areas for stroke nursing were described: preventive/conserving; supporting/consoling; restorative; integrative; and service structure/systems. Conclusion: by consulting stroke nurses it can be ensured that future research truly reflects the nature of nursing care and is of particular relevance to stroke nursing practice. The development of research evidence-base in stroke nursing will lead to increased knowledge, a better quality of care and ultimately better outcomes for patients.

Early versus late rehabilitation for stroke survivors: A prospective study

Bangabandhu Sheikh Mujib Medical University Journal, 2017

Healthcare Settings for Rehabilitation After Stroke

Clinical Pathways in Stroke Rehabilitation, 2021