Critical Appraisal: Study on Stroke Rehabilitation Needs and Carers

This report presents a critical appraisal of a mixed methods study that investigated the combined perceptions of stroke patients and their caregivers regarding rehabilitation needs one year after a stroke. The study, employing both qualitative and quantitative methods, explored the relationships between the dyads' perceptions of rehabilitation needs, individual factors like sense of coherence, and the utilization of rehabilitation services. The report evaluates the authorship, research questions, design, and methods, including the use of interviews, questionnaires, ANOVA, and content analysis. It highlights key findings, such as the correlation between stroke severity and rehabilitation needs, and discusses the impact of caregiver burden. Furthermore, the appraisal considers factors influencing the practical application of evidence and concludes with recommendations for improving the lives of stroke patients and supporting caregivers, emphasizing the importance of addressing unmet rehabilitation needs.

Running head: CRITICAL APPRAISAL 1
Critical Appraisal
Student’s Name
Institutional Affiliation

CRITICAL APPRAISAL 2
Critical Appraisal
The combined perceptions of people with stroke and their carers regarding rehabilitation
needs 1 year after stroke: a mixed methods study.
Introduction
Caregivers are essential in helping people that are recovering from a stroke. Therefore, a
care-provider can apply various techniques. Specifically, the practices can be utilized when
supporting a female who is a 67-year-old family member (Aunt Sue‐Anne). First, caregivers
have to comprehend the side effects of stroke. It is vital to effectively adhere to the medical
schedule outlined by a health expert. The people taking care of those recovering from a stroke
should clearly understand stroke’s emotional impact, for instance, anxiety and depression.
However, they have to help the patients overcome these situations.
Body
PART A
Authorship
The authors conducted an outstanding research that is helpful to the society as they are
qualified health experts. The strength of the authors’ expertise is the discovery that dyadic
perspective is significant in regards to the utilization of an organized approach when conducting
rehabilitation. Although the authors were qualified to perform the research, the utilization of
open-ended questions did not seem to provide adequate information. Consequently, the
responses from people with stroke and caregivers were examined separately and comparison
made between caregivers and people with stroke at a group level. The research finding could be
biased due to the existence of varied ideologies and personal attributes or experiences (Opara and

CRITICAL APPRAISAL 3
Jaracz, 2010). For instance, the coding of the interviews may be done at one’s own perception or
understanding hence providing wrong analysis.
Research questions
The major purpose of the study was to examine the relationships which exist between
dyad’s (people with stroke and their informal caregivers) perception of the people with
rehabilitation needs of stroke and its severity, individual factors (sense of coherence, age and
gender), utilization of rehabilitation services, caregiver burden and amount of crucial informal
care. Therefore, authors considered their research to be imperative. Subsequently, this is because
their study aimed at exploring the individual experiences of daily life transformations among
people with stroke (Ekstam et al, 2015). Furthermore, the research analyzed caregivers and the
techniques they use when handling the stroke patients after 1 year.
Research design
In accordance with the article, the research design is relevant hence suitable. The
authors have explicitly justified the various methods utilized during the research. A diversified
methods design was applied combining qualitative and quantitative data and consequent analysis.
Data collection was done through various conventional techniques and open-ended interviews
(Ekstam et al, 2015). The perception of the dyads in regards to rehabilitation needs of the people
with stroke and the informal caregivers was done through questionnaires.
Attained results were categorized into three classifications. These were unmet, met and
discordant rehabilitation needs. SOC, sense of coherence, was assessed using SOC-scale whereas
caregiver burden was evaluated caregiver burden scale (Jakobsson, 2011). Data concerning
utilization of rehabilitation services was acquired from a computerized register of the Stockholm
County Council.

CRITICAL APPRAISAL 4
Research methods
The research utilized a diversified methods design which combined qualitative and
quantitative data and subsequent analysis. Structured and semi-structured interviews were used
to conduct baseline evaluation during the first week of stroke. The structured interviews were in
form of questionnaires while the semi-structured interviews were open-ended questions. Crucial
data from informal caregivers were collected using similar techniques (Ekstam et al, 2015).
Participants in the study were required to answer a question in regards to the satisfaction of
rehabilitation necessities mostly after one year of follow-up.
Medical records and interviews were utilized in collecting data from people affected by
stroke. Specifically, the data was on stroke severity, age, and sex. In the same token, open-ended
questions were significant in data collection more so one year after stroke concerning
transformations in managing and handling daily activities. Participants conveyed answers orally
as research assistants noted them down.
Data from informal caregivers on their relationships with persons with stroke, age and
sex were obtained by the use of interviews. Questionnaires were then applied to determine the
caregiver’s opinion in regards to satisfaction and the necessity of healthcare services. Care-
provider Burden Scale was essential more so after 12 months in assessing caregiver burden
(Ekstam et al, 2015). Inquiry using interviews was made from caregivers to determine if there
was any assistance sought by stroke patients concerning help in conducting daily activities.
The researchers of the study extensively used interviews in data collection. Interviews
are beneficial because they enable the asking of more detailed questions. It is easy to seek
comprehensive information concerning personal perceptions, feelings, and opinions. Ambiguities
are clarified and inadequate responses followed up (King and Horrocks, 2010). Interviewee’s

CRITICAL APPRAISAL 5
answers are not influenced by other factors. Consequently, facial expressions and body language
used to reinforce explanations are explicitly identified and comprehended.
On the contrary, interviews are time-consuming. Typically, interviews require much
time in preparing interview questions, the actual interview, transcribing, analysis and reporting
(Rowley, 2012). Therefore, these factors make interviews to be costly to perform. Different
interviewees may understand the same question differently hence provide varied responses
(Marshall et al, 2013). Likewise, interviews can lead to the delivery of biased responses hence
wrong data. Contrariwise, it is vital to use an interview to conduct a successful research hence
obtain first-hand data.
The utilization of questionnaires in the research was necessary. They are economical
both to researchers and respondents in terms of effort, cost and time. They ensure a wide
coverage hence collect maximum information. It is easy to review responses hence encourages
future analysis of the already collected data. Planning and administering questionnaires is easy.
Respondents are at liberty to respond to the questionnaires at their own convenience (Langhorne,
Bernhardt and Kwakkel, 2011). Additionally, this method ensures that there is uniformity in
responses provided. Information gathered is more valid since there is the bias of the research as
the recording of information in the questionnaires is done by respondents. Respondents are
confident when disclosing information because questionnaires ensure anonymity.
Nonetheless, questionnaires are not explained to the targeted respondents hence are
misinterpreted leading to the collection of irrelevant information. Similarly, this method of data
collection is only relevant to literate people and hence it lacks personal contact. Unless
questionnaires are administered in person, there could be a poor response. Questionnaires are
unreliable if questions are misunderstood (Saris and Gallhofer, 2014). Consequently,

CRITICAL APPRAISAL 6
questionnaires could be useless if the handwriting of respondents is illegible. Moreover, they do
not create rapport with subjects. Typically, some people are not willing to convey vital
information unless they are impressed by the personality of the researcher.
Data analysis was conducted to find out dyad’s collective perception of rehabilitation
necessities. Results in regards to rehabilitation needs were combined and grouped into unmet,
discordant and met rehabilitation needs. ANOVA test was specifically important in revealing
whether there exists any difference between the outlined three classifications. Chi-square test
was imperative in analyzing the difference between various groups of joint perception
concerning rehabilitation necessities with regard to informal care, stroke severity and sex
(Ekstam et al, 2015). Information in the form of responses from the standard open-ended
questions was analyzed by use of content analysis. Information from interviews was individually
coded by the authors. Summaries were then discussed by the authors.
The use of ANOVA in data analysis ensures the reduction of random variability. It also
provides a robust design in data scrutiny. ANOVA evaluates the relationship that exists between
various factors (Cardinal and Aitken, 2013). On the contrary, with the use of one-way ANOVA
in evaluating different categories of data, it is difficult to find out the group that is different.
Subsequently, content analysis is cheap, easy to comprehend hence was appropriate for
data analysis for the study conducted. Furthermore, the research was successful in using content
analysis because it is a powerful tool, especially when combined with interviews (Schreier,
2012). It is straightforward and easy to determine reliability through the use of content analysis
(Neuendorf, 2016). Nevertheless, content analysis is basically a descriptive method hence might
not disclose the reasons for the observed patterns or results.
Results

CRITICAL APPRAISAL 7
The research found out that only 86 people out 349 of those suffering from stroke had
a caregiver one year after the condition. 62 out of the 86 caregivers were partners, six were
children of the persons and 18 people failed to reveal the relationship explicitly. The average age
of the care-providers was 65 years. The male caregivers were 17 while women were 39.
Additionally, the data of 20 people in regards to their gender was not available. Amongst the
dyads, 52% supposed that rehabilitation necessities were met, 13% observed that the needs were
not met and 35% were categorized as discordant since they were not in agreement (Ekstam et al,
2015). 29% of the persons with stroke alleged that their rehabilitation requirements were not met
whereas 71% supposed that their needs were met. Likewise, 66% (57 in number) of care-
providers perceived met recovery needs for people with a stroke while 34% (29 caregivers)
supposed not met needs.
Stroke severity was discovered to be associated with dyads’ rehabilitation
requirements. A majority of the people with stroke revealed that their lives were same as before
the situation. However, amongst the dyads’, many people with stroke stated that they had
difficulties in walking and had to rely on wheelchairs. Dyads whose recovery necessities were
fulfilled testified that they had minimal walking difficulties. Furthermore, they only had
particular challenges like general hand weakness causing problems in conducting activities such
as buttoning clothes and peeling potatoes (Ekstam et al, 2015). Contrariwise, dyads with unmet
rehabilitation requirements had challenges in performing activities which are more demanding
like gardening and dressing. Similarly, the people developed other conditions, for instance,
dementia and pneumonia.
Statistical analysis revealed that there were no differences in the perception in regards
to rehabilitation requirements in relation to rehabilitation services use, age or sex. People with

CRITICAL APPRAISAL 8
met rehabilitation needs displayed a greater sense of coherence in comparison to discordant
dyads. Strategies, for example, getting involved in physical activities reduce challenges
associated with stroke (Hillier and Inglis‐Jassiem, 2010). Caregivers perceived minimal care-
providers burden in dyads in case rehabilitation necessities were met. Generally, all care-
providers regardless of the group revealed that the felt homebound hence could not leave the
people with stroke alone. Therefore, from the above findings, it is evident that the results of the
research sufficiently fulfill the purpose of the study.
PART B
There are various factors which impact on the usage of evidence practically. Education
level greatly influences the extent to which evidence is applied in actual practice. Capability to
review literature affects the ability to actually implement research evidence. On the other hand,
several barriers hinder the application and implementation of evidence to practice. They include
inadequacy of appropriate information and time (Felicity, 2013). Moreover, improper planning
also curtails applying evidence to practice.
Conclusion
The research is effective as it will aid improve the lives of the people with stroke more so
one year after rehabilitation. On the contrary, caregivers ought to be encouraged or motived to
conduct their duties effectively regardless of whether their care provision alters with their social
lives. Nonetheless, there are advantages that arise as a result of spending time with stroke
recovering patients. Profound relationships are established due to having adequate time
especially if the caregivers are family members. Moreover, it is imperative in the society to
adequately take care of people who are recovering from diverse medical conditions.

CRITICAL APPRAISAL 9
References
Cardinal, R. N., & Aitken, M. R. (2013). ANOVA for the behavioral sciences researcher.
Psychology Press.
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined
perceptions of people with stroke and their carers regarding rehabilitation needs 1 year
after stroke: a mixed methods study. BMJ open, 5(2), e006784.
Felicity Bright, B. S. L. T. (2013). Barriers and facilitators to engagement in rehabilitation for
people with stroke: a review of the literature. New Zealand Journal of Physiotherapy,
41(3), 112.
Hillier, S., & Inglis‐Jassiem, G. (2010). Rehabilitation for community‐dwelling people with
stroke: home or centre based? A systematic review. International Journal of Stroke, 5(3),
178-186.
Jakobsson, U. (2011). Testing construct validity of the 13-item sense of coherence scale in a
sample of older people. The Open Geriatric Medicine Journal, 4(1), 6-13.
King, N., & Horrocks, C. (2010). Interviews in qualitative research. Sage.
Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet,
377(9778), 1693-1702.
Marshall, B., Cardon, P., Poddar, A., & Fontenot, R. (2013). Does sample size matter in
qualitative research?: A review of qualitative interviews in IS research. Journal of
Computer Information Systems, 54(1), 11-22.
Neuendorf, K. A. (2016). The content analysis guidebook. Sage.

CRITICAL APPRAISAL
10
Opara, J. A., & Jaracz, K. (2010). Quality of life of post–stroke patients and their caregivers.
Journal of medicine and life, 3(3), 216.
Rowley, J. (2012). Conducting research interviews. Management Research Review, 35(3/4),
260-271.
Saris, W. E., & Gallhofer, I. N. (2014). Design, evaluation, and analysis of questionnaires for
survey research. John Wiley & Sons.
Schreier, M. (2012). Qualitative content analysis in practice. Sage Publications.