Critical Appraisal of Evidence Based Nursing Research on Stroke Rehabilitation

This paper critically appraises research study conducted by Ekstam et al (2015) in a bid to shed more light on how individuals with stroke can be aided in their daily lives. The study aimed to assess how individuals with stroke and their caregivers perceive the rehabilitation needs and how such needs contribute to the caregiver burden. Additionally, this study sought to understand the effectiveness of the strategies that were employed by caregivers during rehabilitation.

Running head: EVIDENCE BASED NURSING RESEARCH 1
Evidence Based Nursing Research
Student’s Name
Institution

EVIDENCE BASED NURSING RESEARCH 2
Evidence Based Nursing Research
Stroke patients often face unmet rehabilitation needs characterized by insufficient
provision of care or provision of care that does not conform to patient-centered care. Studies
have therefore attempted to assess such plight that is met by stroke survivors. This paper
critically appraises research study conducted by Ekstam et al (2015) in a bid to shed more light
on how individuals with stroke can be aided in their daily lives.
Critical Appraisal of the Research Paper
Authorship
This research was carried out by Lisa Ekstam affiliated with occupational therapy
division and occupational therapy department at Karolinka University Hospital. Johansson
Ulla is the second researcher also affiliated with division of occupational therapy at the same
institute as well as department of clinical research at Upssala University in Sweden. Guidetti
Susanne is another researcher also affiliated with the division of occupational therapy at
Karolinka University Hospital.
The two remaining authors, Eriksson Gunilla and Ytterberg Charlotte are also affiliated
with the same division with the former being involved in the department of neuroscience
rehabilitation medicine at Uppsala University while the latter also associated with the department
of clinical neuroscience and department of physiotherapy at Karolinka University Hospital
(Ekstam et al, 2015). Given these affiliations, possible conflict of interest could arise from
the last two authors who are not associated with the organization where the study was
conducted. Also there exists possible conflicts of interest arising from academic competition
since all the authors are not of the same academic level. The generalization of the findings

EVIDENCE BASED NURSING RESEARCH 3
obtained from Karolinka University Hospital provides ground for bias since three of the
authors are affiliated with this institution.
Research Questions
The study identified two main research questions including;
1. What are the relations among stroke patients’ discernment concerning the needs of
rehabilitation and severity of stroke, individual aspects, informal care,
rehabilitation amenities, and the burden to the caregiver? (Ekstam et al, 2015).
2. What are the individual experiences of daily life modifications amongst individuals
suffering from stroke in relation to informal caregivers? (Ekstam et al, 2015).
3. What are the strategies used by informal caregivers to handle the everyday life changes
that are experienced by individuals with stroke? (Ekstam et al, 2015).
The authors in the study acknowledge the fact that informal caregivers comprising
primarily of family and friends have a greater role to play in the rehabilitation of individuals who
have suffered from stroke especially during the provision of rehabilitation and care at the
home of the patient (Bergstrom et al, 2015). However, in most cases, the informal caregivers are
elderly and they are also in need of support to help them cope with the burden experienced
during the everyday life with a stroke patient (Pindus et al, 2018). The study therefore aimed to
assess how individuals with stroke and their caregivers perceive the rehabilitation needs and how
such needs contribute to the caregiver burden. Additionally, this study sought to understand the
effectiveness of the strategies that were employed by caregivers during rehabilitation.
Research Design

EVIDENCE BASED NURSING RESEARCH 4
The interviews conducted and the availed medical records provided data on the stroke
severity thereby enabling the study to address one aspect of research question. At 12 months
after stroke, the study utilized data from a previously conducted study involving people with
stroke to determine the received satisfaction and the need for health care provision in the
process enabling the researchers to obtain data on the level of fulfillment from the rehabilitation
process. Similarly, the data collected from the open ended questions provided insight on the
changes involved in handling the daily life undertakings during post stroke and which
approaches were used in managing any associated difficulties. Additionally, in order to
measure the caregiver burden, the study used data on informal care provided by the caregivers
which was obtained from the interviews (Ekstam et al, 2015).
Research Methods
This study employed a mixed method where both qualitative and quantitative data were
used in the gathering and analysis of data involving the views of persons suffering from stroke
occurrence and their cares. The research work was further grounded on secondary data
analysis obtained from observational study involving the restoration process during post stroke
periods. This research also made an inclusion of 349 subjects who comprised of stroke patients
admitted in one stroke unit within a span of one year. Structured and semi structured interviews
were conducted by a specially trained occupational therapist. The study used the Barthel index to
analyze the severity of the stroke among the participants (Alderson, 2016).
A five graded likert scale was used to rate the caregivers’ contentment with the health
care provision. ANOVA test was used in the analysis to determine probable differences
concerning the perception of rehabilitation needs. Ideally, this test was essential in understanding

EVIDENCE BASED NURSING RESEARCH 5
how the stroke patients and their caregivers perceived the whole process of rehabilitation which
was one of the chief aims of the study (Prel, Rohrig & Blettner, 2009). Answers obtained from
the questionnaires were also analyzed separately and grouped in accordance with the met or
unmet needs of rehabilitation (Ekstam et al, 2015). This process enabled the researchers to
differentiate the perceptions of caregivers on their roles in providing care to individuals with
stroke.
Results
The results of the study indicate that the severity of stroke is related to the dyad’s
needs of rehabilitation. In this case, the dyad’s whose rehabilitation needs were met
experienced similar lives as they did before they suffered from stroke and hence exhibited
limited difficulties while undertaking daily activities (Ekstam et al, 2015). Similar studies also
reveal that patients with mild or moderate stroke are more positive about their lifestyles and, they
also believe that they can maintain a healthy lifestyle and be able to undertake their daily
activities with limited difficulties (Baker et al, 2017). However, dyad’s with unmet rehabilitation
needs had more severe stroke cases and as such, they had to give up physically demanding tasks
and also experienced major life events such as new stroke or dementia (Ekstam et al, 2015).
The findings also indicate a relationship between rehabilitation needs and used strategies
to overcome stroke. In this light, results revealed that dyad’s whose rehabilitation needs were
met were in most of the cases involved in several strategies to manage their daily problems
among them including; physical aids, use of partners or aids, and engaging in activities that they
liked doing. However, the study provided limited findings to illustrate the relationship between
personal factors and rehabilitation needs or caregiver burden, and the effectiveness of caregiver

EVIDENCE BASED NURSING RESEARCH 6
strategies. Contrarily, study by Hesamzadeh et al (2017) reveal that caregiver burden and
caregiver dependence can be managed through encouraging physical activity, filling leisure time
and facilitating religious or financial issues.
The study illustrated that there was a positive relationship between less caregiver burden
and met rehabilitation needs. In this case, the results of the study indicated that carers assumed
low burden during provision of care in dyad’s whom recuperation desires were met unlike
those whose rehabilitation needs were unmet. Also regardless of the rehabilitation needs,
caregivers reported having reduced activity in their social lives where they could not keep in
touch with their families and friends (Ekstam et al, 2015)
The Barriers to the Application of Evidence to Practice
Marginalization by healthcare services as well as limited knowledge and skills to allow
for re-engagement has led to stroke survivors and their caregivers being left abandoned (Pindus
et al, 2018), and contributing to caregiver burden (Ekstam et al, 2015). It is therefore essential to
increase stroke health literacy as well as facilitate timely provision of information. Such
initiatives will prove to be critical in enhancing the patients’ and the caregivers’ access to
information thereby fostering their understanding of data on stroke rehabilitation as well as
reducing the unmet rehabilitation needs of stroke patients (Eames et al, 2015).
Conclusion
Individuals suffering from stroke and especially those with severe cases of stroke
exhibited increased patient care needs that in most cases prove to be burdensome to the
caregivers. Availing such information in addition to improving stroke literacy among patients is

EVIDENCE BASED NURSING RESEARCH 7
critical in alleviating the lives of stroke patients as well as their caregivers’ by meeting the
rehabilitation needs of such individuals.
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