Critical Appraisal of Evidence on Stroke Rehabilitation at Home

This critical appraisal paper reviews an article on stroke rehabilitation at home. The article discusses the perception of stroke patients and their caregivers after one year of stroke, and the need for social and psychological support in the rehabilitation process. The mixed method approach was used to collect data, and the results indicate the need for more research on the topic.

Running head: CRITICAL APPRAISAL OF EVIDENCE
Title page
Student Name:
HLSC122 Semester 1, 2018
Assessment 3: Critical appraisal of evidence
Word count:

1CRITICAL APPRAISAL OF EVIDENCE
Table of Contents
Introduction:...............................................................................................................................................2
Body:...........................................................................................................................................................2
PART A.........................................................................................................................................................2
Authorship...............................................................................................................................................2
Research questions..................................................................................................................................2
Research design.......................................................................................................................................3
Research methods...................................................................................................................................3
Results.....................................................................................................................................................4
PART B.........................................................................................................................................................4
Conclusion:..................................................................................................................................................4
References...................................................................................................................................................6
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Introduction:
This is basically an appraisal paper that reviews an article. The chosen article is aimed at finding
the perception of the person with stroke & the informal caregiver at the home and also their daily
experience after 1 year of stroke. Moreover, the paper raises two very important points such as the
social and psychological adaptation of rehabilitation process at homes and also the daily experience
which the person with stroke & the informal caregiver at the home do experience.
Body:
PART A
Article: Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined
perceptions of people with stroke and their carers regarding rehabilitation need 1 year after
stroke: mixed methods study. BMJ open, 5(2), e006784.
Authorship
(Lisa Ekstam, Ulla Johansson, Susanne Guidetti, Gunilla Eriksson & Charlotte
Ytterberg)
Strengths
The biggest strength was the authors’ capability to select such a good topic which has not
attracted many research works in past. The dyadic perspective is a rare topic which the authors have
effectively justified with their good mixing of methodologies and the findings as well.
Limitations
The biggest weakness or the possible ground for bias in this study is the analysis section where
authors have compared the results of persons with stroke and informal care givers on a group level.
Samples could have been much bigger than it ended with. Participants compared separately but not in
groups could have produced the wider results.
Research questions
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3CRITICAL APPRAISAL OF EVIDENCE
How may a caregiver effectively support a (67 year old female) family member with her activities of daily
living following a stroke?
Justification
The one justification which might have attracted the authors’ interest towards the topic is
possibly the quality of recovery which is yet unknown due to the unavailability of quality research work
on the topic. The available data are basically the general findings and the research has just been on the
same track.
Another justification can be the fact that stroke is a severe accident and that there is no
universal model to deal with it effectively. The traditional model of seeking the disease related remedial
from health experts are not effective. Additionally, the home based model to provide the care services
to patients is effective; however, it is yet to find the sufficient evidence for whether the dyad’s process
at homes is effective and that daily experience of stroke patient & the informal caregivers is still an
unknown fact. The research indicates a collaborative work between the stroke patients and the informal
caregiver. There are still more research works needed to make it apparent that dyad’s process can be
used and that their perceptions for the challenges can also be changed (Martin et al., 2015).
Research design
In the chosen article, the mixed method approach was adopted by combining both the
qualitative and quantitative data. Participants were interviewed in homes with the necessary set of
questions. Two forms were being used to collect the data such as open-ended interviews and the
established instruments. Questionnaires were prepared using a Ware’s taxonomy. The results were
judged with respect to three designed groups such as met, discordant and unmet. The sense of
coherence (SOC) in person with stroke was judged with the help of the SOC-scale. Burdens for the
caregiver were assessed using the Caregiver Burden Scale (Whalon, Conroy, Martinez & Werch, 2015).
It looks as if the authors have systematically approached towards the research objective. The approach
was quite systematic and had tried to measure every possible outcome. However, the design lacks at
one point and which is the data analysis section where the analysis was made on the dyad’s process in
group level. It did not consider or executed the examination with one person at one time. This could
have delivered a much narrower result and the results could have been different also.
Research methods
As already stated, the research uses a mixed method approach by considering both the
qualitative and the quantitative form of data analysis. Basically, open-ended interview with the
participants was being chosen as the method to collect the data. Participants were being interviewed at
their homes. Both the person with stroke and the informal caregiver to that person were interviewed.
The set of questions were also well structured as it had followed the Ware’s taxonomy to structure the
questions (Venable, Pries-Heje & Baskerville, 2016). The selection of instruments was appropriately
done. However, the research was not able to get the separate data of participants. Group basis data
were being obtained and hence, things became difficult to understand the individual feeling for the daily
experience after one year of stroke.
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4CRITICAL APPRAISAL OF EVIDENCE
Results
In Fifty-two percent cases, it was found that the dyad’s process was able to overcome the
rehabilitation challenges. However, met rehabilitation process was checked against the less severe
cases. Consequently, caregivers were found to have fewer burdens on a daily basis. It can be said that
there is a need for social and psychological developments in stroke patients and the informal caregivers.
However, there is still very less evidence available on the fact. There is a need for more research works
on the same topic. The study had little strength and the limitations as well. It has raised a very important
concern which is to understand the impact of dyad’s process after stroke. The dyadic perspective does
still have a very limited number of research works on it. However, this is necessary that more research
works are done on the topic. There must be the understood ways for changing the social and
psychological perspectives in stroke patients and the caregivers at homes (Van Dyk, 2014). If such thing
could be made possible then a systematic approach to rehabilitation will be much viable at homes. This
will make things easier for both the medical institutions and the home settings. Till now, physical
therapies have not been successful in providing a quick relief to stroke patients. Additionally, there is
very less evidence to support a robust home setting for helping the stroke patients to recover the impact
quicker.
PART B
Generic
This can be a challenge to create a healthy environment at homes. This is due to a fact that
families can anytime interfere with the process if something appears to them as unnecessary. Although
it is of no importance that families are aware of every single process of the medical field as because they
do not belong to the sector. However, a collaborative approach towards the goal without much any
interruption from families will be the key to overcome the identified barrier (Bertilsson et al., 2016).
Specific
The post-stroke period is a challenge not for the medical team only but for families also. It is
important that health services have the effective way out of the issue. This is important also that home
setting is suitable and appropriate to support the recovery process in stroke patients. However, on a
realistic note, the health service providing firms have no better option than just training. The research
paper indicates that there is the need for more future studies on identifying whether rehabilitation
process can be successfully intervened at homes. Moreover, it also identifies the needs for focussing on
the social and psychological support for the dyad’s process (Martin et al., 2015).
Conclusion:
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5CRITICAL APPRAISAL OF EVIDENCE
To conclude, home setting for caring the stroke patients in their daily living is still in the early
stage. In the light of the chosen research work, this can be said that caregiver and stroke patients are
both underdeveloped in terms of their social and psychological understanding for daily experience after
stroke. There are very fewer research studies on the topic as well. There is still the need for more
research works, so that, the systematic approach to support the stroke patients and the caregiver as
stated in the research work is attained.
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References
Bertilsson, A. S., Eriksson, G., Ekstam, L., Tham, K., Andersson, M., Von Koch, L., & Johansson, U. (2016).
A cluster randomized controlled trial of a client-centred, activities of daily living intervention for
people with stroke: One year follow-up of caregivers. Clinical rehabilitation, 30(8), 765-775.
[DOI: 10.3109/11038128.2015.1115549]; Accessible at:
file:///C:/Users/User/Downloads/110381282E20152E1115549.pdf
Martin, L. J., Hathaway, G., Isbester, K., Mirali, S., Acland, E. L., Niederstrasser, N., ... & Sternberg, W. F.
(2015). Reducing social stress elicits emotional contagion of pain in mouse and human
strangers. Current Biology, 25(3), 326-332. [DOI: 10.1016/j.cub.2014.11.028]; Accessible at:
https://www.sciencedirect.com/science/article/pii/S0960982214014894
Van Dyk, L. (2014). A review of telehealth service implementation frameworks. International journal of
environmental research and public health, 11(2), 1279-1298. [DOI: 10.3390/ijerph110201279];
Accessible at: http://www.mdpi.com/1660-4601/11/2/1279/htm
Venable, J., Pries-Heje, J., & Baskerville, R. (2016). FEDS: a framework for evaluation in design science
research. European Journal of Information Systems, 25(1), 77-89. [DOI: 10.1057/ejis.2014.36];
Accessible at: https://link.springer.com/article/10.1057/ejis.2014.36
Whalon, K. J., Conroy, M. A., Martinez, J. R., & Werch, B. L. (2015). School-based peer-related social
competence interventions for children with autism spectrum disorder: A meta-analysis and
descriptive review of single case research design studies. Journal of autism and developmental
disorders, 45(6), 1513-1531. [DOI: 10.1007/s10803-015-2373-1]; Accessible at:
https://www.researchgate.net/profile/Maureen_Conroy2/publication/271710068_School-
Based_Peer-
Related_Social_Competence_Interventions_for_Children_with_Autism_Spectrum_Disorder_A_
Meta-Analysis_and_Descriptive_Review_of_Single_Case_Research_Design_Studies/links/
54d8c9b50cf2970e4e793321/School-Based-Peer-Related-Social-Competence-Interventions-for-
Children-with-Autism-Spectrum-Disorder-A-Meta-Analysis-and-Descriptive-Review-of-Single-
Case-Research-Design-Studies.pdf
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