Editorial

2 pages, 161 KiB

Open AccessEditorial

Stroke Secondary Prevention: Everyone’s Business

by Maggie Lawrence, Olive Lennon and James Faulkner

Healthcare 2022, 10(11), 2236; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10112236 - 08 Nov 2022

Cited by 1 | Viewed by 1344

Stroke secondary prevention is everyone’s business and requires cohesive working across the multiprofessional team and beyond [...] Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

Research

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19 pages, 291 KiB

Open AccessArticle

“I Assumed It Would Be Somebody Who Had a Stroke That Was Doing This”: Views of Stroke Survivors, Caregivers, and Health Professionals on Tailoring a Relaxation and Mindfulness Intervention

by Thomas Atkinson, Emma Brown, Georgina Jones, Karen Sage and Xu Wang

Healthcare 2023, 11(3), 399; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11030399 - 31 Jan 2023

Cited by 1 | Viewed by 1726

Abstract

Stroke survivors and informal caregivers experience high levels of stress and anxiety, linked to heightened risk of secondary stroke in survivors. Relaxation and mindfulness could reduce stress and anxiety; being most effective when tailored to the target populations. Aims of the PPI include [...] Read more.

Stroke survivors and informal caregivers experience high levels of stress and anxiety, linked to heightened risk of secondary stroke in survivors. Relaxation and mindfulness could reduce stress and anxiety; being most effective when tailored to the target populations. Aims of the PPI include to: (1) consult on possible alterations to an existing relaxation and mindfulness intervention, delivered via YouTube/DVD and (2) discuss relevance and preference of prompts and cues designed to facilitate the daily practice of the intervention. Eleven UK PPI contributors were consulted during 2020: four stroke survivors (F = 2, M = 2), three caregivers (F = 1, M = 2), and four HCPs (F = 4) (range = 23–63 years). Contributors watched the existing intervention and provided feedback via online discussions. Transcripts were analysed using thematic analysis. Five themes were identified, highlighting several necessary alterations to the intervention: “Who represents the stroke population?”; “The paradox of age”; “Specifically selected language”; “Visual presentation of the intervention”; and the “Audio qualities”. Contributors ranked the prompts and cues in order of preference with setting alarms and email alerts as the most popular. The PPI consultations resulted in several alterations enabling a revised version of the intervention. Including a PPI consultation at an early stage of the research improves the relevance and appropriateness of the research. The revised intervention is more representative of the stroke population thus more likely to be practised by survivors and caregivers, which will enhance the extent of effectiveness, reducing the risk of a secondary stroke. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

11 pages, 426 KiB

Open AccessArticle

The Use of Teach Back at Hospital Discharge to Support Self-Management of Prescribed Medication for Secondary Prevention after Stroke—Findings from A Feasibility Study

by Sebastian Lindblom, Charlotte Ytterberg, Maria Flink, Axel C. Carlsson, Una Stenberg, Malin Tistad, Lena von Koch and Ann Charlotte Laska

Healthcare 2023, 11(3), 391; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11030391 - 30 Jan 2023

Cited by 1 | Viewed by 1835

Abstract

The study aimed to investigate whether a structured discharge letter and the use of the person-centred communication method Teach Back for sharing information at hospital discharge could support perceived understanding and knowledge of and adherence to prescribed medication for secondary prevention after stroke. [...] Read more.

The study aimed to investigate whether a structured discharge letter and the use of the person-centred communication method Teach Back for sharing information at hospital discharge could support perceived understanding and knowledge of and adherence to prescribed medication for secondary prevention after stroke. Data from a feasibility study of a codesigned care transition support for people with stroke was used. Patients who at discharge received both a structured discharge letter and participated in the person-centred communication method Teach Back (n = 17) were compared with patients receiving standard discharge procedures (n = 21). Questionnaires were used to compare the groups regarding perceived understanding of information about medical treatment, knowledge of information about medical treatment and medication adherence at 1 week and 3 months. There was a statistically significant difference in perceived understanding of information about medical treatment (p > 0.01) between the groups in favour of those who participated in Teach Back at the discharge encounter. No differences between groups were found regarding understanding health information about medical treatment and medication adherence. The results indicate that the use of Teach Back at the discharge encounter positively impacts perceived understanding of information about medical treatment in people with stroke. However, considering the nonrandomised study design and the small sample size, a large-scale trial is needed. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

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18 pages, 571 KiB

Open AccessArticle

The HEADS: UP Development Study: Working with Key Stakeholders to Adapt a Mindfulness-Based Stress Reduction Course for People with Anxiety and Depression after Stroke

by Maggie Lawrence, Bridget Davis, Leyla De Amicis, Jo Booth, Sylvia Dickson, Nadine Dougall, Madeleine Grealy, Bhautesh Jani, Margaret Maxwell, Ben Parkinson, Matilde Pieri and Stewart Mercer

Healthcare 2023, 11(3), 355; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11030355 - 26 Jan 2023

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Abstract

Background: Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a [...] Read more.

Background: Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a standard MBSR course specifically for people affected by stroke. Methods: We recruited stroke survivors and family members with symptoms of anxiety and/or depression to take part in a co-development study comprising two rounds of MBSR ‘taster’ sessions, followed by focus groups in which views were sought on the practices sampled. Data were collected in October 2017 and May 2018 and were analysed using framework analysis, informed adaptations to mindfulness materials and delivery. Results: Twenty-eight stroke survivors and seven family members participated. Nineteen (76%) stroke survivors had anxiety; 15 (60%) had depression. Five (71.4%) family members reported anxiety; n = 4 (57.1%) depression. Thirty participants attended the first round of taster sessions and focus groups; twenty (66%) the second and three (10%) were unable to attend either round. Framework analysis informed adaptations to course delivery, practices, and materials, ultimately resulting in a stroke-specific MBSR course, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). Conclusions: HEADS: UP may provide a feasible, appropriate, and meaningful self-management intervention to help alleviate symptoms of mood disorder. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

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15 pages, 277 KiB

Open AccessArticle

Understanding the Experiences of People Living with Stroke Engaging in a Community-Based Physical-Activity Programme

by Matthew Smith, Andrew Scott, Serena Mellish and James Faulkner

Healthcare 2023, 11(2), 154; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11020154 - 04 Jan 2023

Cited by 1 | Viewed by 2152

Abstract

Research has evidenced that regular exercise can provide physical and physiological benefits for people living with stroke. Our study aims to explore the experiences of people living with stroke when participating in a community physical activity programme. This programme was created to offer [...] Read more.

Research has evidenced that regular exercise can provide physical and physiological benefits for people living with stroke. Our study aims to explore the experiences of people living with stroke when participating in a community physical activity programme. This programme was created to offer targeted physical activity and education interventions following the discharge of patients from the healthcare pathway. This qualitative study involved semi-structured interviews with 16 participants living with stroke who were recruited from individuals who had engaged with the activity programme. A reflexive thematic analysis was conducted on the data, and four overarching themes were developed: (i) Feelings of appreciation, (ii) Interactions with other patients, (iii) Positive contributions of trained instructors, and iv) Personal progress. Generally, participants reported very positive perceptions of the exercise programme, and were very grateful for the opportunity that the exercise classes provided. We hope that these findings will offer practical suggestions for healthcare providers who might develop similar activity programmes for clinical populations. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

16 pages, 307 KiB

Open AccessArticle

Perspectives and Experiences of Cardiac Rehabilitation after Stroke—A Qualitative Study

by Olive Lennon, Alexandra Crystal, Michelle Kwan, Caoimhe Tierney, Anne Gallagher and Sean Murphy

Healthcare 2022, 10(8), 1579; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10081579 - 19 Aug 2022

Cited by 4 | Viewed by 2121

Abstract

Cardiac rehabilitation (CR) after stroke has been proven to be a safe and feasible secondary prevention intervention. Limited qualitative data capture people’s experiences and perceptions of attending CR following stroke, but with none addressing translational aspects when CR is delivered as routine clinical [...] Read more.

Cardiac rehabilitation (CR) after stroke has been proven to be a safe and feasible secondary prevention intervention. Limited qualitative data capture people’s experiences and perceptions of attending CR following stroke, but with none addressing translational aspects when CR is delivered as routine clinical care. Using a phenomenological, qualitative approach, four semi-structured focus groups were conducted with 15 individuals (60% male) who had completed CR during their stroke care pathway. Our inductive thematic analysis identified five themes. The first centred on recognising stroke as a cardiovascular disease and the applicability of CR post-stroke. The second addressed how peer understanding, camaraderie, and medical supervision created a safe and supportive environment. The third identified how the programme-built confidence supported longer-term healthy lifestyle choices in physical activity, diet, and smoking. The penultimate theme addressed the period from hospital discharge to attending CR as a time of uncertainty where many participants experienced cognitive difficulties, mood disturbances, and mental fatigue without adequate support. Lastly, participants identified unmet needs in their care pathway that included a lack of information about their referral to CR, the programme content, and accessing local supports ahead of CR. Ongoing and unmet needs both during and after CR related to self-management of secondary prevention medications, neurological issues, post-stroke fatigue, and the lack of structured support following CR completion. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

15 pages, 280 KiB

Open AccessArticle

Mindfulness and Relaxation Techniques for Stroke Survivors with Aphasia: A Feasibility and Acceptability Study

by Xu Wang, Lindsey Thiel and Naomi de Graff

Healthcare 2022, 10(8), 1409; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10081409 - 28 Jul 2022

Cited by 3 | Viewed by 2542

Abstract

Stroke survivors with aphasia (SsWA) tend to experience high levels of anxiety and stress, leading to an increased risk of recurrent strokes. Mindfulness and/or relaxation that does not require language outputs could reduce psychosocial stress; however, these approaches work best if they consist [...] Read more.

Stroke survivors with aphasia (SsWA) tend to experience high levels of anxiety and stress, leading to an increased risk of recurrent strokes. Mindfulness and/or relaxation that does not require language outputs could reduce psychosocial stress; however, these approaches work best if they consist of a range of techniques and are modified to suit the needs of SsWA. Using a mixed-methods approach, we examined the feasibility and acceptability of a set of tailored mindfulness and relaxation techniques for SsWA. Nine SsWA were recruited (six men and three women, median age = 51 years). Four relaxation and mindfulness techniques which had been tailored for SsWA were filmed into a DVD/YouTube video and were given to participants together with a practice diary for home practice once daily for 5 weeks. The participants joined focus group discussions and completed a feasibility scale 5 weeks later. The participants perceived these techniques as easy, user-friendly and acceptable for SsWA in general. Although practised less often than instructed, many participants reported benefits of regular practice. The perceived relevance of these techniques to the participants’ own situations and the intention to continue varied. Future research could encourage the regular practice of self-help interventions by incorporating behavioural change techniques such as using prompts and cues. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

15 pages, 774 KiB

Open AccessArticle

Engagement in Everyday Activities for Prevention of Stroke: Feasibility of an mHealth-Supported Program for People with TIA

by Ann-Helen Patomella, Lisette Farias, Christina Eriksson, Susanne Guidetti and Eric Asaba

Healthcare 2021, 9(8), 968; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9080968 - 30 Jul 2021

Cited by 8 | Viewed by 2648

Abstract

Most of the risk factors for stroke are modifiable, yet incorporating and sustaining healthy lifestyle habits in daily life that reduce these risk factors is a major challenge. Engaging everyday activities (EEAs) are meaningful activities that are regularly performed that have the potential [...] Read more.

Most of the risk factors for stroke are modifiable, yet incorporating and sustaining healthy lifestyle habits in daily life that reduce these risk factors is a major challenge. Engaging everyday activities (EEAs) are meaningful activities that are regularly performed that have the potential to contribute to the sustainability of healthy lifestyle habits and reduce risk factors for stroke. The aims of this study were (1) to investigate the feasibility and acceptability of a digitally supported lifestyle program called “Make My Day” (MMD) for people at risk for stroke following a transient ischemic attack, and (2) to describe participants’ stroke risk and lifestyle habits pre- and post-intervention. A multiple case study design using mixed methods was utilized (n = 6). Qualitative and self-reported quantitative data were gathered at baseline, post-intervention, and 12 months post-baseline. The results indicate that MMD can support lifestyle change and self-management for persons at risk for stroke following a TIA. The findings indicate a high acceptability and usability of MMD, as well as a demand for digital support provided via a mobile phone application. Self-management with digital support has the potential to increase participation in EEAs for persons at risk for stroke following a TIA. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

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Review

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13 pages, 312 KiB

Open AccessReview

A Scoping Review of Non-Pharmacological, Non-Surgical Secondary Prevention Strategies in Ischaemic Stroke and TIA in National Stroke Guidelines and Clinical Audit Documents

by Patricia Hall, Lena von Koch, Xu Wang and Olive Lennon

Healthcare 2022, 10(3), 481; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10030481 - 04 Mar 2022

Cited by 8 | Viewed by 3542

Abstract

The Stroke Action Plan for Europe (2018–2030) calls for national-level secondary prevention plans that address lifestyle, in addition to prevention medications and surgical interventions. This scoping review examines national stroke care guideline and audit documents across WHO regions to identify non-pharmacological, non-surgical stroke [...] Read more.

The Stroke Action Plan for Europe (2018–2030) calls for national-level secondary prevention plans that address lifestyle, in addition to prevention medications and surgical interventions. This scoping review examines national stroke care guideline and audit documents across WHO regions to identify non-pharmacological, non-surgical stroke secondary prevention recommendations and associated performance indicators. Using a snowballing methodology, 27 guideline documents met the inclusion criteria. Sixteen (59%) detailed, non-pharmacological, non-surgical stroke secondary prevention-addressing known, modifiable population attributable risk factors, of physical inactivity (N = 11), smoking (N = 11), unsafe alcohol consumption (N = 10), diet (N = 8), weight (N = 5), stress (N = 4) and depression (N = 2). Strategies recommended to address these risk factors were: assessment of stroke risk/risk factors (N = 4); provision of advice and information on reducing lifestyle related risk (N = 16); education and counselling for lifestyle behaviour change (N = 8) and onward referral for specialist management of risk (N = 4). Of the nine stroke audits/registries identified, only three (33%) included non-pharmacological, non-surgical quality indicators of documented provision of advice or information on the following: general lifestyle (N = 2); smoking cessation for current smokers (N = 2); reduction in alcohol consumption, where relevant (N = 1), exercise participation (N = 1) and diet (N = 1). Preventive quality indicators addressing the management of weight, stress or depression were absent. This review highlights current gaps in optimal stroke secondary prevention recommendations and their implementation. Full article

(This article belongs to the Special Issue Healthy Living and Risk Reduction after TIA and Stroke)

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