Critical Appraisal of Stroke Rehabilitation: Patient and Caregiver Perception

This paper appraises a study on the combined perceptions of stroke patients and their caregivers regarding rehabilitation needs one year after stroke. The study uses a mixed method combining both qualitative and quantitative data analysis. The paper highlights the importance of involving caregivers in the decision-making process for rehabilitation interventions and the need to focus on the psychological well-being of both the patient and caregiver.

Page 1 of 11
Title page
Student Name:
HLSC122 Semester 1, 2018
Assessment 3: Critical appraisal of evidence
Word count:
Student name/student number

Page 2 of 11
Introduction: approximately 120 words (10%)
Rehabilitation of the patients after the stroke is very crucial and overall affects the
wellbeing of the patient throughout the life. In has been found that most of the patients
have their needs unaddressed. It is the amount and the type of the rehabilitation that
has been found to be important for the recovery of these stroke patients (Cameron et
al., 2013). There were studies that have shown that the informal caregivers play an
important role in the rehabilitation of the patients and that they should be more involved
in the rehabilitation process. And hence their perception regarding the rehabilitation
process is important. Thus perception is also important because in many cases the
informal care givers are elderly and hence suffer from both physical as well as
psychological burden(Cameron et al., 2013). Hence any future interventions should be
set as per the psychosocial needs of both the patients and the care givers. This paper
appraises a paper regarding the patient and the caregiver’s perception regarding stroke
rehabilitation.
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
Student name/student number

Page 3 of 11
Lisa Ekstam, having affiliations from the division of Occupational Therapy, Department
of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
and Department of Occupational Therapy, Karolinska University Hospital, Stockholm,
Sweden
Ulla Johansson, affiliated byDivision 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.
Susanne Guidetti, affiliated by the Division of Occupational Therapy, Department
of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
Charlotte Ytterberg, affiliated byDivision 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 question
How may a caregiver effectively support a (67 year old female) family member wi
th her activities of daily living following a stroke?
Student name/student number

Page 4 of 11
The aim of this study is to understand the association between the dyad’s
(person having stroke and informal caregiver) viewpoint of the individual with the
requirements for the rehabilitation of stroke and the severity of the stroke.
Research design
The study has used a mixed method combining both the qualitative and the
quantitative data analysis. This study has been conducted on the basis on the
secondary analysis of a data of an observational study of the progression of
rehabilitation after the stroke. Both qualitative and quantitative analysis have
disadvantages (Greenhalgh et al.,2016). Combination of the methodologies helps in the
reduction of the biases. Furthermore it combines both the inductive and the deductive
thinking, where the researcher can communicate both with words as well as number to
deal with audiences (Greenhalgh et al.,2016).
Data collection method and Sampling
86 persons with stroke (38 % women with mean age 73 years) and their
caregivers (40 % women with mean age 65 years were taken for the interview.
The sample size has been described in much details but the sample size was low,
which reduced the precision and the interpretation of the results (Greenhalgh et
al.,2016).
The candidates for the observational study were taken from the three stroke units
of the Karolinska University Hospital between 15 May 2006 and 14 May 2007 and 349
candidates were included in the study “life after stroke phase I”.
Student name/student number

Page 5 of 11
Outcome measures
Data regarding the age, sex, and severity of the stroke were collected at the
baseline level by the conduction of structured as well as semi structure interviews i.e
questionnaires and open ended questions (Ekstam et al., 2015).
The patient was asked to choose a personal care giver for the interview, which
could be their children or friend or partner. The participants chosen for this study had
been the participant of LAS-I. The questionnaire was based on the taxonomy prepared
by Ware and generally covered all the extent of patient satisfaction (Greenhalgh et
al.,2016). Among the different questions asked, a particular statement addressed the
level of satisfaction regarding the requirements of rehabilitation and hence was
considered as the dependent variable for the study. The five graded Likert scale was
used to score the statements. This scale is useful in measuring the levels of agreement
or disagreement for measuring the attitudes of the patients (Greenhalgh et al.,2016).
A similar questionnaire was also prepared for the informal care givers, at 3
months after the stroke. The rating given by the caregivers on the basis of Likert scale
with “agree and do not agree” as the end options. The sense of coherence was used by
the SOC scale.
The burden of the caregiver was been assessed by the Care giver’s burden
scale. Open ended questions were asked regarding the modifications that had come in
the daily life of the patients or any activity where the patient has asked for their
assistance (Myers et al., 2013).Open ended questions allow the respondents to include
attitudes, feelings and their perceptions of the subject as they do not limit the
Student name/student number

Page 6 of 11
answers.All the outcome measure were valid and reliable (Myers et al., 2013).This
study has been conducted on the basis of self-reported data and may cause biases.
Ethical considerations
Anofficial written consent has been taken from the participants. The ethical
approval was taken from the Regional Ethical Review Board in Stockholm, Sweden.
Data analysis
Tools used for the data analysis
The Kruskal Wallis ANOVA test was used to find out any statistical difference
between the three groups of joint perception such as the SOC, age and the use of the
inpatients (Grove et al., 2016). The χ2 test was used for detecting the distinction
between the combined perception groups with context to age, stroke severity and
informal care. The Mann Whitney U test was used to measure the comparison between
the combined ideas of the rehabilitation needs. Content analysis was used for analysis
the question and answers. This approach has been used correctly for examining the
data by adhering to the naturalistic paradigm (Grove et al., 2012). Mixed model analysis
was made to analyze the qualitative and the quantitative findings(Greenhalgh et
al.,2016).
Results
Findings
52 % of the dyads have professed that rehabilitation was achieved 12 months
after the stroke. Rehabilitation was found to be met more in less severe strokes. And
hence it can be said that the research question was answered as the paper has been
Student name/student number

Page 7 of 11
successful in proving the role of the caregiver’s perception in rehabilitation of the
patient. It is both the psychosocial wellbeing of the patient and the caregivers that the
matters in stroke rehabilitation.
Strengths
The strengths of this study is that it is a mixed method that applies makes the
use of both the qualitative as well as the quantitative analysis that helps to provide a
more comprehensive scenario of the rehabilitation after the stroke. The dyadic viewpoint
of this paper helps to provide knowledge about the use of the systemic approaches
used in the rehabilitation and the importance of the social environment (Cumming et al.,
2013).
Limitations
Some of the limitations of the study is that the open ended question used are not
sufficient to compare between the partners present in the dyads. The responds taken
from the persons with strokes are not rich for making the comparison between the
individuals of the dyads. The response taken from the persons with strokes and he
caregivers were analyzed distinctly and compared between the caregivers and the
person affected from stroke in a group level (Polit&Beck, 2018). Another limitation was
the smaller sample size and the SOC scale was not used for the caregivers.
The clinical implication of this study is that the addition of the caregivers and
other people in the rehabilitation of the stroke patients would be useful (Tistad et al.,
2013). From the findings that moderate to severe stroke requires more rehabilitation;
the extent of the interventions required could be easily decided in the future.
Student name/student number

Page 8 of 11
Barriers for the application of research in practice
The most important barrier for the use of the research findings from the nurse's
perspective is the lack of time, organizational factors such as guided protocols for the
nurses, lack of organizational and financial support, low ability of understanding of the
medical reports and improper system for the adequate development of the nurses.
PART B
Conclusion
In conclusion it can be said the extent of the rehabilitation and its fruitfulness can
be dependent upon the psychological and the physical support provided by the
caregivers. Further it has also been found that the rehabilitation interventions for the
person suffering from stroke has to focus more on the psychological wellbeing of both
the patient as well as the personal caregiver (Cumming et al., 2013). Using the
perception of the caregivers would definitely help in the making of suitable interventions
for the rehabilitation of the stroke patients. The studies have also been successful in
showing the home driven care has been found to be more useful than the hospital stay.
However it has also been observed that the psychological wellbeing of the patient also
depends upon the burden on the caregivers.
Normally the care givers are not involved in the planning of the stroke survivor's
rehabilitation regimen. Form these papers it can be understood that involving the
caregivers in the decision making process can provide the patient centered viewpoints
and further help in the appropriateness of the prescribed rehabilitation interventions.
Student name/student number

Page 9 of 11
Student name/student number

Page 10 of 11
References
Cameron, J. I., Naglie, G., Silver, F. L., &Gignac, M. A. (2013). Stroke family caregivers’
support needs change across the care continuum: a qualitative study using the
timing it right framework. Disability and rehabilitation, 35(4), 315-324.
https://doi.org/10.1111/hex.12095
Cumming, T. B., Marshall, R. S., & Lazar, R. M. (2013). Stroke, cognitive deficits, and
rehabilitation: still an incomplete picture. International Journal of Stroke, 8(1), 38-
45.Retrieved from: http://journals.sagepub.com/doi/abs/10.1111/j.1747-
4949.2012.00972.x?journalCode=wsoa
Greenhalgh, T., Bidewell, J., Crisp, E., Lambros, A., &Warland, J. (2016).
Understanding Research Methods for Evidence-Based Practice in Health.
Grove, S. K., Burns, N., & Gray, J. (2012). The practice of nursing research: Appraisal,
synthesis, and generation of evidence. Elsevier Health Sciences.
https://books.google.co.in/books?
hl=en&lr=&id=r32jPNVYIacC&oi=fnd&pg=PA4&dq=Grove,+S.+K.,+Burns,+N.,+
%26+Gray,+J.+(2012).+The+practice+of+nursing+research:+Appraisal,
+synthesis,+and+generation+of+evidence.
+Elsevier+Health+Sciences.&ots=viq6T0j26J&sig%20of%20nursing%20research
%3A%20Appraisal%2C%20synthesis%2C%20and%20generation%20of
%20evidence.%20Elsevier%20Health%20Sciences.&f=false
Student name/student number

Page 11 of 11
Myers, J. L., Well, A. D., &LorchJr, R. F. (2013). Research design and statistical
analysis. Routledge. https://www.taylorfrancis.com/books/9781135811563
Polit, D. F., & Beck, C. T. (2018). Nursing research: Generating and assessing evidence
for nursing practice. Lippincott Williams & Wilkins.
https://books.google.co.in/books?
hl=en&lr=&id=Ej3wstotgkQC&oi=fnd&pg=PA1&dq=Polit,+D.+F.,+%26+Beck,+C.
+T.+(2018).+Nursing+research:
+Generating+and+assessing+evidence+for+nursing+practice.
+Lippincott+Williams+
%26+Wilkins.&ots=wgKCCMcxyq&sig=YTcaWHLRYTyGrwWVdzzZGi5zIvI#v=on
epage&q&f=false
Tistad, M., Koch, L., Sjöstrand, C., Tham, K., &Ytterberg, C. (2013). What aspects of
rehabilitation provision contribute to self‐reported met needs for rehabilitation one
year after stroke–amount, place, operator or timing?.Health Expectations, 16(3).
https://doi.org/10.1111/hex.12095
Student name/student number