Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by th...

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

Objective To describe and explain stroke survivors and informal caregivers' experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services. Design Systematic review and meta-ethnography. Data sources Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015). Eligibility criteria Primary qualitative studies focused on adult community-dwelling stroke survivors' and/or informal caregivers' experiences of primary care and/or community healthcare services. Data synthesis A set of common second order constructs (original authors' interpretations of participants' experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods' criteria. Results 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke. Limitations Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems. Conclusions Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services. Systematic review registration number PROSPERO 2015:CRD42015026602.

/pdf/stroke-survivors-and-informal-caregivers-experiences-of-4ektsr6qds.pdf

Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography.

Although stroke is now the fourth, not the third, most common cause of death in the United States,1 the burden of stroke has increased. Stroke is now the third (fifth in 1990) largest cause of disability-adjusted life years in the developed world.2 Around half of those who do survive stroke are permanently disabled.3

There are a wide range of poststroke problems, including movement and function, mobility, balance, cognition, attention, memory, pain, sensation, perception, emotional problems, and psychological issues. The physical and psychosocial consequences of stroke are complex and long term.

Longer-term problems are reported by stroke survivors 1 to 5 years post stroke. The most common include mobility (58%), fatigue (52%), concentration (45%), and falls (44%). Around half of those surviving report that their needs relating to these problems are not being met and this is higher among those who are more disabled.4

Addressing the long-term needs of people during life after stroke is a priority from both a service provision and a research perspective—many uncertainties remain on how best to address long-term post stroke problems.

The aim of this review was to assess whether the multiple effects of exercise and physical activity correspond with the outcomes considered most important, by patients and carers, for life after stroke.

Physical activity is defined as all human movement produced by the action of skeletal muscle that substantially increases energy expenditure. Physical activity is essential for improving and maintaining physical fitness. Exercise is a subset of physical activity that is planned, structured, and repetitive and is performed deliberately with the intention of improving physical fitness.5 Key indices of physical fitness include cardiorespiratory fitness and muscle strength and power; these determine our capacity to perform and tolerate physical activity.

Physical fitness is impaired after stroke. Cardiorespiratory fitness (![Graphic][1] peak) is …

 [1]: /embed/inline-graphic-1.gif

Physical Activity and Exercise After Stroke: Review of Multiple Meaningful Benefits

Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS) continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE) on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were ‘inactive’ (i.e. they are not currently meeting UK physical activity guidelines). Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement). Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and ‘making exercise a habit’ post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a dislike of the music and TV and a lack of confidence in operating gym equipment were frequently reported. These findings provide valuable insights that commissioners and providers should consider. The main themes were consistent across a large number of studies and further research should concentrate on programmes that reflect these findings.

/pdf/adherence-to-exercise-referral-schemes-by-participants-what-1j8vo8u6mq.pdf

Adherence to exercise referral schemes by participants - what do providers and commissioners need to know? A systematic review of barriers and facilitators

Reduced Ambulatory Activity after Stroke: The Role of Balance, Gait, and Cardiovascular Fitness

Experiences of an exercise referral scheme from the perspective of people with chronic stroke: a qualitative study

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Experiences of an exercise referral scheme from the perspective of people with chronic stroke: a qualitative study