Critical Appraisal of Evidence on Stroke Rehabilitation Needs and Caregiver Burden

This paper critically appraises the evidence on stroke rehabilitation needs and caregiver burden. It explores the perceptions of stroke patients and their caregivers regarding rehabilitation needs and the severity of stroke. The study employs both qualitative and quantitative data analysis to provide a comprehensive picture of stroke rehabilitation. The paper concludes that involving caregivers in the care plan may enhance the rehabilitation process.

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Title page
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HLSC122 Semester 1, 2018
Assessment 3: Critical appraisal of evidence
Word count:
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Introduction
Stroke is a serious, common and a disabling health problem that leads to poor
functional outcome. Rehabilitation in the stroke patient is therefore required to improve
the quality of life. Studies have shown that the informal caregivers or home care can
help in meeting the rehabilitation needs of the patient. Hence it is necessary to
understand the viewpoint of the caregivers or asses their burden for the rehabilitation of
the patients (Godwin et al., 2013). Future scopes of practice or interventions for
improving the rehabilitation procedure can be made by focusing on the psychological
and the physical needs of the patients and the caregivers.
Full reference using APA format
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combi
ned perceptions of people with stroke and their carers regarding rehabilitation ne
eds 1 year after stroke: A mixed methods study. British Medical Journal, 5(2), 1‐
7. Retrieved from: http://bmjopen.bmj.com/content/5/2/e006784
PART A
Authorship
Lisa Ekstam, with affiliations from the division of Occupational Therapy, Department of
Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden and
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Department of Occupational Therapy, Karolinska University Hospital, Stockholm,
Sweden.
Susanne Guidetti, Division of Occupational Therapy, Department of Neurobiology
Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
Ulla Johansson, affiliation from Division of Occupational Therapy, Department of
Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden and
Department of Clinical Research, Uppsala University/County Council of Gävle, Gävle,
Sweden.
Charlotte Ytterberg, Division of Occupational Therapy, Department of
Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden,
Department of Clinical Neuroscience, Division of Neurology, Karolinska University
Hospital, Huddinge, Sweden and Division of Physiotherapy, Department of
Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
Research questions
How may a caregiver effectively support a (67 year old female) family member wi
th her activities of daily living following a stroke?
He objective of this study is to research on the association between perception of
the dyad (person suffering from stroke and an informal caregiver) regarding the person
with rehabilitation requirements and the severity of the stroke., the association of the
personal factors such as the gender, sense of coherence, age and the burden on the
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informal caregiver. This paper also aims to explore the various lifestyle changes and the
personal experience of the patient as well as the caregivers during the rehabilitation
period of 1 year after the stroke.
Research design
This study has employed both qualitative and quantitative data analysis.
Application of a mixed method help in increasing the comprehensiveness of the overall
findings by showing how the qualitative data provided explanation for the statistical data
and secondly it helped in the expansion of the dimension of the topic ((Greenhalgh et
al., 2016). It also facilitated the increase of the methodological rigor and reduction of the
biases (Greenhalgh et al., 2016). This study was made on the basis of the secondary
data analysis from a prospective observational study of the rehabilitation process after
the stroke namely “Life after the stroke” phase 1, taking the participants from three
stroke units the Karolinska University Hospital between 15 May 2006 and 14 May 2007.
Participants and data collection method
86 persons with stroke and their caregivers were chosen for the study (mean
age- 73 years, 38 % women), care givers (65 years and 40 % women). Data were
collected from the home of the patients. The low sample size of this study can lead to
prevention of the extrapolation of the statistical analysis. It increases the chance of the
assumption as true a false premise (Faber & Fonseca, 2014).
Outcome measures
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Data on sex, age and the severity of the stroke at the baseline is collected by
means of the interviews and medical records. The stroke severity was measured using
the Barthel index and was categorized as mild (50-100) and moderate (0-49).
Data collection was done by open ended interviews and established instruments.
The questionnaire was made on the basis of the Ware's taxonomy. The results were
collaborated and divided in to three groups- met, not in agreement, unmet rehabilitation
needs, which is referred to as a five graded Likert scale . In order to assess the SOC for
12 months, an SOC scale was used, which consists of a questionnaire with 13 items
rated on a seven graded likert scale.
Data on the sex, age and the relation of the caregiver to the person were
collected for three months after the stroke by means of the interviews. Level of
agreements were measured using the five graded Likert scale. The burden of the
caregivers were assessed by the caregiver burden scale.
Ethical considerations
Written informed consent was taken from the patients and their informal
caregivers. The study was approved by the Regional Ethical Review Board in
Stockholm, Sweden.
Data analysis
The χ2 test was used to detect the difference of perceptions between those with
different age groups, stroke severity and informal care. The presence of any statistical
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difference between the various age groups on an ordinal dependent variable were
measured using the Kruskal Wallis ANOVA test, which had been appropriate for the
study (Greenhalgh et al., 2016). The use of the content analysis for the analysis of the
questions and answers has been appropriate in measuring the question and answers.
The application of the mixed model analysis has been appropriate (Myers et al., 2014).
The Mann Whitney U test was used for measuring the comparison between the ideas of
the rehabilitation requirements.
Results
Hence it the paper is appropriate in showing the impact the caregivers’ viewpoint
affecting the rehabilitative care for the patient with stroke. Only 45 dyads perceived that
the stroke rehabilitation needs of the patient were met within 12 months. 11 have found
that the rehabilitation needs were not met and 30 were not in accordance. 61 patients
noted that their rehabilitation needs were met. It was found that more the severity of the
stroke, more is the rehabilitation needs. Most of the difficulties faced by the patients are
physical weaknesses. It was also found that the care givers feel less burden in those
dyads where the rehabilitation needs are met, and hence had a higher level of SOC.
Strengths
One of the important strength of the study is that the dyadic perceptive of this
paper that provides an accurate data regarding the complete approach of the
rehabilitation and the importance of the social ambience in the rehabilitation of the
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stroke. The mixed method used in this study has helped to get a comprehensive picture
of the stroke rehabilitation (Greenhalgh et al., 2016). .
Limitations
An important limitation of the study is that the open ended question could not
provide some specific answer to the question and was not successful in comparing the
dyad partners. Instead the answers were separately analyzed and compared between
the caregivers and the person with the stroke only within a group. Other limitations are
small sample size and that the SOC scale was not used during the response for the
caregivers (Greenhalgh et al., 2016).
Barriers for the research application
Some of the important barriers that are used in the research findings are the size
and the complexity of the research, difficulties in setting up evidence base clinical
policies, organizational barriers, lack of time, lack of adequate facilities and nurse’s little
interest in the conduction of the studies (Bahadori et al., 2016).
PART B
Conclusion
It is important to understand the perception of the informal caregivers as well as
the patients regarding the needs of the stroke rehabilitation to improve the future scope
of practice (Karahan et al., 2014). It has been found that the success of the
rehabilitation depends upon the physical and the mental support provided by the
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informal care givers to the patients. It can be said that the paper is successful in
exploring the research question. The research methods has been successful in
analyzing the statistical data obtained. The study showed that it is also the wellbeing
and the burden on the caregivers that determines how fast the rehabilitation needs and
met. Hence it can be said that involving the caregivers in the making of a care plan for
the patients may enhance the rehabilitation process in the patient.
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References
Bahadori, M., Raadabadi, M., Ravangard, R., & Mahaki, B. (2016). The barriers to the
application of the research findings from the nurses’ perspective: A case study in
a teaching hospital. Journal of Education and Health Promotion, 5, 14.
http://doi.org/10.4103/2277-9531.184553
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combi
ned perceptions of people with stroke and their carers regarding rehabilitation ne
eds 1 year after stroke: A mixed methods study. British Medical Journal, 5(2), 1‐
7. Retrieved from: http://bmjopen.bmj.com/content/5/2/e006784
Faber, J., & Fonseca, L. M. (2014). How sample size influences research
outcomes. Dental Press Journal of Orthodontics, 19(4), 27–29.
http://doi.org/10.1590/2176-9451.19.4.027-029.ebo
Godwin, K. M., Swank, P. R., Vaeth, P., & Ostwald, S. K. (2013). The longitudinal and
dyadic effects of mutuality on perceived stress for stroke survivors and their
spousal caregivers. Aging & mental health, 17(4), 423-431.
Greenhalgh, T., Bidewell, J., Crisp, E., Lambros, A., &Warland, J. (2016).
Understanding Research Methods for Evidence-Based Practice in Health.
Karahan, A. Y., Kucuksen, S., Yilmaz, H., Salli, A., Gungor, T., & Sahin, M. (2014).
Effects of rehabilitation services on anxiety, depression, care-giving burden and
perceived social support of stroke caregivers. Acta Medica, 57(2), 68-72.
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Myers, J. L., Well, A. D., &LorchJr, R. F. (2013). Research design and statistical
analysis. Routledge. https://www.taylorfrancis.com/books/9781135811563
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