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Discuss about the Critical Appraisal of Evidence for Health Problem.
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.
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. British Medical Journal, 5(2), 1?7. Retrieved from: https://bmjopen.bmj.com/content/5/2/e006784
Lisa Ekstam, with 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.
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.
How may a caregiver effectively support a (67 year old female) family member with 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 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.
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.
Authorship
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).
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.
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.
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 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.
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.
Research Questions
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 stroke. The mixed method used in this study has helped to get a comprehensive picture of the stroke rehabilitation (Greenhalgh et al., 2016). .
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).
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).
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 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.
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. https://doi.org/10.4103/2277-9531.184553
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. British Medical Journal, 5(2), 1?7. Retrieved from: https://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. https://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.
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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