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Dissertations / Theses on the topic 'Self-management of stroke'
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1
Boger, Emma. "Self-management following stroke : concepts and measurement." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/362824/.
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Stroke is a major cause of disability world-wide, representing a significant health and social burden (Feigin et al., 2009). Self-management has potential importance for reducing the personal and health service impact of illness, but is yet to be fully understood or measured in stroke (Boger et al., 2013, Jones & Riazi, 2011).This research sought to develop a new patient-reported outcome measure (PROM) of self-management following stroke. A mixed methods paradigm with three distinct phases was adopted. Focus group methodology (n=28) first explored self-management from the perspectives of people following stroke and informed the content of a preliminary PROM. Three key themes identified from the data affect stroke self-management; Individual capacity; Support for self-management and Self-management environment. Following the focus group enquiry, the preliminary PROM item pool consisted of 57 items relating to Individual Capacity. Cognitive Interviewing methodology (n=11) was next employed to refine the item pool and explore acceptability of the items. Finally, the revised PROM was subject to psychometric evaluation using responses from a nationally derived sample (n=87). Mokken scale analysis and correlations with additional outcome measures of theoretical importance were used to identify scale structure and investigate reliability and validity. The subsequent PROM, the Stroke Self-Management Questionnaire (SSMQ) forms a unidimensional Mokken scale which measures the construct of self-management competency. The SSMQ possesses excellent internal consistency reliability (Mokken r 0.89), test retest reliability (ICC 0.928) and represents a valid tool for the evaluation of stroke self-management interventions.
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McKenna, Suzanne. "Bridges stroke self-management programme for stroke survivors in the community." Thesis, University of Ulster, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.629077.
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The research presented within this thesis utilised a mixed methods research design to explore self-management practices specific to stroke within four studies: 1) a systematic literature review of trials on stroke self-management; 2) a feasibility randomised controlled trial (RCT) exploring the Bridges stroke self-management programme (SSMP) in addition to community rehabilitation versus usual rehabilitation; 3) a qualitative study conducted with participants from the feasibility RCT to explore their experiences of the Bridges SSMP and, 4) a comparative study exploring the Bridges SSMP with an alternative self-management programme currently offered within Northern Ireland. Study 1 identified relatively few published studies on stroke self-management programmes. The types of programmes explored in these studies varied and results were mixed but findings suggest some effect on functional recovery, quality of life and confidence in recovery post stroke. Study 2 established that the Bridges SSMP appeared feasible to implement within the clinical rehabilitation setting, however, further exploration of the reasons behind relatively low recruitment needs further evaluation. Study 3 found that the Bridges SSMP was acceptable to all stakeholders and helped illuminate key mechanisms of change involved in the Bridges SSMP such as the personalised nature of goal setting which resulted in the perception by participants that they were better able to manage their progress. Study 4 suggested that the Bridges SSMP was equally as acceptable and feasible to deliver as the Taking Control self-management programme currently offered by Northern Ireland Chest Heart and Stroke but highlighted key issues related to the delivery of both programmes that need further exploration. The findings of this research suggest that self-management programmes may offer potential benefit to stroke participants and indicate that it may be feasible to deliver the Bridges SSMP in both the clinical rehabilitation and voluntary sector. Further research is needed to improve the understanding of the mechanisms and context of delivery.
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Jansen, Renee. "Perceptions of healthcare professionals and stroke patients regarding self-management." University of Western Cape, 2020. http://hdl.handle.net/11394/7344.
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Magister Scientiae (Physiotherapy) - MSc(Physio)Stroke is one of the leading causes of death and disability in the world. Stroke patients often place significant cost on the health care systems, due to long periods of care. Health care professionals play a key role in self-management as they work closely with stroke patients and patients can give insight into outcomes and during and post rehabilitation.
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Clark, Ella V. "The feasibility of a novel group self-management intervention for stroke." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10055835/.
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Background: Stroke survivors consistently report long term unmet needs. Unlike other chronic conditions stroke self-management programmes have been slow to emerge. Bridges self-management is a one-to one approach used by some UK NHS stroke services and aims to increase self-efficacy and confidence to manage long term needs post stroke. However, a one-to-one delivery does not facilitate peer support, which stroke survivors report as being valuable to the self-management process. In order to evaluate the potential for a one-one programme such as Bridges to be delivered in a group setting important parameters need to be explored, such as, acceptability, fidelity and outcome measure effect sizes. The MRC calls this type of research ‘feasibility’, and labels it an essential part of complex intervention development. The aim of this thesis was to explore the feasibility of delivering a one-to-one stroke self-management intervention (Bridges) in a group setting. Method: Feasibility was explored across three phases: (1) the development phase included patient involvement activities, stroke survivor interviews, and a systematic review to inform the design of a four-week self-management intervention, (2) the implementation phase monitored intervention delivery, 60 stroke survivors were randomised to the intervention or waitlist condition, (3) the evaluation phase used a mixed methods approach to explore acceptability and potential mechanisms of change as well as the effect of the intervention on mood, self-efficacy, quality of life and activities of daily living. Results: Overall it was feasible to adapt Bridges for group delivery. The intervention had high fidelity to the protocol. Recruitment occurred at a mean rate of 6.6 per month with a 21.667% drop out rate. The intervention was found to be acceptable to stroke survivors and carers. Potential mechanisms of change included vicarious learning and supported goal setting. At six-months post-baseline, outcomes had improved in favour of the intervention group. A number of recommendations were made to further develop the intervention, and for subsequent research on this topic. Conclusion: The thesis concludes that delivering a group self-management intervention for stroke may offer some benefits to stroke survivors and suggests research progress to a definitive trial.
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Wray, Faye Danielle. "Designing a self-management intervention for stroke survivors with communication difficulties." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/20839/.
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Background: Stroke survivors with communication difficulties have poor outcome in the longer-term and may benefit from the support typically offered by self-management approaches. Aim: To critically examine the suitability of self-management as an approach for stroke survivors with communication difficulties and to use this knowledge to design an intervention to support stroke survivors with communication difficulties in the longer-term. Methods: Medical Research Council guidance for the development of complex interventions provided a framework for designing the intervention (MRC, 2008). In line with this guidance the intervention was designed iteratively using a staged approach. The design of the intervention was informed by a mixed methods systematic literature review and qualitative fieldwork undertaken with key stakeholders (stroke survivors with communication difficulties, carers and speech and language therapists). The Behaviour Change Wheel (BCW) provided a theoretical framework to identify which behaviours the intervention should target and appropriate behaviour change techniques. A Delphi survey was conducted to gain an expert consensus on the design of the intervention. Results: Stroke survivors with communication difficulties need further support to manage the consequences of their condition in the longer-term. Self-management may provide a structured and clearly defined intervention to support this group of stroke survivors with the challenges they face. However, existing self-management interventions do not address the needs of stroke survivors with communication difficulties and a condition specific self-management intervention is required. A novel self-management intervention for stroke survivors with communication difficulties was designed using the BCW as a theoretical framework. Feedback from an expert panel was used to refine the design of the intervention. Discussion: To the authors knowledge this is the first theoretically informed self-management intervention designed specifically for stroke survivors with communication difficulties. Further research is needed to develop the intervention. Future plans for feasibility testing and large-scale evaluation of the approach are discussed.
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Josselin, Sylvia Marie Anaïs. "Os efeitos de um programa de ensino de autogestão em pacientes com sequelas de AVE: revisão bibliográfica." Bachelor's thesis, [s.n.], 2018. http://hdl.handle.net/10284/6736.
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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em FisioterapiaResumo: Introdução: A reabilitação em pacientes após sequelas de AVE é importante para minimizar as incapacidades funcionais. Assim, vários estudos têm utilizados o programa de ensino de autogestão sobre pacientes com sequelas de AVE. Objetivo: Avaliar os efeitos de um programa de ensino de autogestão em pacientes com sequelas de AVE. Metodologia: Foi realizada uma pesquisa computorizada com palavras-chaves nas bases de dados PubMed e PEDro e no motor de busca B-on de modo a encontrar artigos publicados na última década, randomizados controlados, publicados em inglês, e que abordassem o tema da autogestão na recuperação dos paciente com AVE. Foram excluídos estudos sem texto integral disponível e artigos duplicados. Resultados: Foram selecionados cinco artigos randomizados controlados com qualidade de metodologia de 6,8 na escala de PEDro. Conclusão: Os resultados análisados mostram que parece existir benefícios na reabilitação com um programa de ensino de autogestão em pacientes com sequelas de AVE, pelo que poderá ser um ferramenta terapêutica a aplicar em programa de fisioterapia.
Introduction: Rehabilitation in patients following stroke sequelae is important to minimize functional disabilities. Thus, several studies have used the Self-Management Program on patients with stroke sequelae. Aim: To evaluate the effects of a Self-Management Program in patients with stroke sequelae. Methodology: A computerized search with keywords in databases of PubMed, PEDro and B-on, in order to find articles published in the last decade, randomized controlled trials, published in English and that addressed of the Self-Management Program in the recovery of stroke. Results: Five randomized controlled articles with a methodology quality of 6.8 were selected on the PEDro scale. Conclusion: The analyse results show that there are benefits in the rehabilitation with Self-Management Program in patients with stroke sequelae.
N/A
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Sit, Janet WH, Sek Ying Chair, KC Choi, Carmen WH Chan, Diana TF Lee, Aileen WK Chan, Jo LK Cheung, Siu Wai Tang, Po Shan Chan, and Ruth E. Taylor-Piliae. "Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial." DOVE MEDICAL PRESS LTD, 2016. http://hdl.handle.net/10150/621999.
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Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG = 105, IG = 105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P, 0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.
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Smith, Janine Lynette. "Self-management strategies employed by stroke survivors in the Western Cape, South Africa." University of the Western Cape, 2019. http://hdl.handle.net/11394/6857.
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Magister Scientiae (Physiotherapy) - MSc(Physio)Ischaemic heart disease and stroke were the leading causes of death and disability globally, accounting for a combined 15 million deaths. Disability following a stroke is complex and multidimensional. Disability and functioning post stroke can be conceptualized within the framework of the International Classification of Functioning, Disability and Health (ICF). The involvement of the individual in their rehabilitation and recovery is essential. Therefore, it is a necessity for individuals, particularly in a low resource setting to engage in selfmanagement activities. Bandura’s social cognitive theory based on self-efficacy, forms the basis of self-management programmes. Self-management relates to one’s ability to manage one’s consequences post stroke, and self-efficacy has been proven to be pivotal in the management and improvement of long-term conditions. The aim of the study was to explore the self-management strategies employed by stroke survivors in the Western Cape, South Africa through an exploratory, qualitative design. Prior to the commencement of the data collection phase, ethical clearance was sought from the University of the Western Cape Research Ethics Committee. Participants were recruited from an urban and rural area in the Western Cape. An interview guide was developed based on previous literature. Interview questions were related to 1) what self-management strategies were adopted to address activity limitations and participation restrictions and 2) strategies used to address environmental challenges.
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Kahraman, Ayfer. "An exploration of self-management in the context of stroke: a mixed methods study." Thesis, St George's, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.616980.
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Stroke is a public health concern throughout the world due to its association with high levels of mortality and long-term morbidity. Stroke is a chronic condition. There is evidence that the use of self-management strategies can be associated with positive outcomes for people with chronic conditions. The evidence relating to stroke and self-management informs stroke policies in the UK. However, there is minimal understanding of self-management in the context of stroke. Rehabilitation interventions which can adequately address the longer term needs require an understanding of key factors which may influence self-management in stroke survivors. The overall aim of the research presented in this thesis was to explore the concept of self-management in the context of stroke. This thesis presents a mixed methods study that was designed to address three specific and connected research questions. This thesis described three studies. Firstly, through a systematic review of qualitative studies with thematic synthesis it systematically examined the current literature to determine stroke survivors' experiences of living with stroke and the biopsychosocial factors that may influence these experiences of post-stroke life as well as the components of these factors that might be relevant to self-management. Secondly, through a prospective quantitative cohort study, it investigated the biopsychosocial individual characteristics associated with self-management and self-efficacy in adults with stroke. Finally, through a qualitative interview study, it explored the meaning(s) ascribed to "self-management" by stroke survivors and healthcare professionals. The key findings taken together reveal new insights into the psychosocial phenomena that shape coping and adjustment after stroke; the biopsychosocial factors that influence selfmanagement and self-efficacy; and the conceptualisations of self-management. This thesis therefore develops new understandings of self-management in the context of stroke. Findings have implications for formulation, organization and delivery of better aftercare and the rehabilitation that follows.
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Groenewald, Ryan Clive. "The adaptation and contextualization of the bridges stroke self-management intervention for patients living with stroke in the Western Cape, South Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6564.
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Philosophiae Doctor - PhDBackground: Many patients with stroke feel ill-prepared for discharge from stroke rehabilitation, despite having undergone extensive periods of therapy. From the available research, there is clear evidence that disease specific self-management interventions (SMI) are effective at changing targeted behavioural outcomes, and ultimately improve patient participation restrictions, using self-efficacy principles. A stroke SMI, originally developed by the Bridges Organization to address participation restriction in patients living with stroke in the United Kingdom (UK); was successfully adapted and contextualized for the New Zealand stroke population. A similar stroke SMI could have equal positive benefits for the South African stroke population but would need to be contextually relevant. Aim: This study aims to adapt and contextualize the original UK Bridges stroke SMI workbook for implementation with the South African stroke population. Method: The qualitative, exploratory study is conducted in five phases. Thirteen healthcare professionals (Phase 1) and 12 patients with stroke (Phase 2) are engaged with by the researcher using focus group discussions to understand their views on the implementation of self-management intervention in the local context; and one-on-one interviews with local South African patients living with stroke are conducted to explore their experiences (Phase 3) and build contextually relevant local vignettes. The adaptation and contextualization process of the Bridges stroke SMI workbook to the South African context occurs using the participant feedback and built vignettes from Phases 1 to 3. Consensus on the adaptation of the workbook is then reached through the use of an expert panel for peer-review (Phase 4), and a final focus group discussion with local healthcare professionals in the field of stroke rehabilitation (Phase 5) to produce the final South African Bridges stroke SMI workbook. Phase 1 and 5 participants were conveniently selected; while purposive sampling was applied for Phases 2 and 3. Throughout the various study phases, a thematic analysis procedure is employed by the researcher to analyse and interpret the themes identified through the qualitative data collected. A deductive approach was employed by the researcher for the focus group discussion data of Phase 1, 2, and 5; and an inductive approach to the data from the interviews in Phase 3. The trustworthiness criteria of credibility, transferability, dependability, and confirmability were applied.
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Dryden, Jennifer M. "Adaptation and self-management after stroke : exploring the application of the Selection, Optimisation and Compensation model." Thesis, University of Strathclyde, 2018. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=29563.
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Background: Stroke can have long-term consequences for survivors, and recovery can be acomplex process. Unfortunately, there is a lack of theory-based evidence as to how stroke survivors can be aided in coping or adjusting to their new circumstances. The Selection, Optimisation and Compensation (SOC) model describes three processes of selection, optimisation and compensation, which are suggested to allow older adults to maintain activity in areas of life that are important to them, despite loss of functional or cognitive capacity. This thesis explored the Selection, Optimisation and Compensation (SOC) model as a model for post-stroke adaptation. Method: A mixed method approach consisted of systematically reviewing previous applications of the SOC model; conducting qualitative interviews with 30 stroke survivors to determine if SOC processes could be identified within coping strategies; and using Discriminant Content Validation (DCV) methodology to further analyse stroke-specific SOC strategies. Finally, the model was operationalised in the context of stroke through the development of a SOC self-management intervention, which was piloted with five stroke survivors. Findings: One hundred and forty nine stroke-specific SOC strategies were elicited from the interviews; 78% of which were significantly classified as at least one of the theoretical constructs of SOC using DCV analysis. Such findings were used to develop a SOC self-management intervention, which included descriptions of the SOC processes and examples of stroke-specific SOC strategies. Discussion: Overall, this thesis provided strength to the argument that the SOC model is indeed appropriate for the aim of helping stroke survivors come to terms with living with the long-term consequences of stroke. Further refinements are, however, necessary in the operationalisation of the SOC model into a post-stroke intervention. Future research should build upon these findings in order to increase the effective use of SOC strategies; with the ultimate aim of improving adaptation in stroke survivors.
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TAN, WEE-MENG, and 陳瑋銘. "Self-Management, Nutritional Status, and Quality of Life in Stroke Patient." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/72004178759210086194.
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碩士國立臺北護理健康大學
護理研究所
105
Background: Stroke patients have faced with high medical expenses burden, but also affected his or her quality of life. Re-admissions were reported after stroke due to recurrence stroke, malnutrition, respiratory tract infection, and so on. The lack of researches were explored the associated with self management, nutritional status, and quality of life in stroke patients. Purpose: The purposes of this study were to describe self management, nutritional status associated with quality of life in stroke patients. Methods: A cross-sectional was conducted with stroke patients recruited from neurology and neurosurgery ward of metropolitan teaching hospital in the Northern Taiwan. Data collection was completed by structured questionnaires. The questionnaires included: demographic data and disease characteristic, Partners in health scale (PIH), Mini-nutritional assessment short form (MNA-SF), and short form-12 (SF-12). Multivariate stepwise regression analyses determined independent predictors of scores. Models included age, monthly household income, stroke-related disability, comorbidity (Charlson index), hypertension, National institutes of health stroke scale (NIHSS) score, and nutritional status. Results: A total of 85 stroke patients participated (mean age 70.1, SD=12.5). Being 85 years of age or older (β=-6.32), lower-middle income (β=-5.80), moderate disability (β=-4.11), CCI scores of 3 (β=-7.11), having hypertension (β=-3.10) were independently correlated with PCS scores which predicted 41.66% of the total variances in overall quality of life. Nutritional status was positive correlation with PCS scores. The level of family support was positive correlation with MCS scores. Nutritional status was significant different with MCS scores. Conclusion: Age, monthly household income, stroke-related disability, comorbidity, and hypertension factors have differential effect on quality of life in stroke patients. KeyWords: Self-management, nutritional status, quality of life, stroke.
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TSAI, WEN-HUI, and 蔡文惠. "The Efficacy of Digital Remote Tele-Self-Management Program for Stroke Patients." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/54304558814851916878.
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碩士國立臺北護理健康大學
護理研究所
100
Aim: The purpose of this research is to evaluate the efficacy of a digital remote tele-self-management program for stroke patients. Background: Cerebrovascular disease is the third leading cause of death in Taiwan, and cardiovascular accidents have the potential to lead to deterioration in quality of life. Due to the constraints of insurance on the length of hospital stay, stroke patients may be discharged prematurely. Thus, after discharge, the patient needs a self-management intervention to enhance his or her quality of life. Because there is a scarcity of literature on self-management programs for stroke patients, the purpose of this research is to determine the efficacy of a digital remote tele-self-management program. Methods: A pre-/post-test quasi-experimental design was used. Patients participated in a one-month digital remote tele-self-management program, twice a week (for a total of 8 sessions), that involved 5-10 minutes of telephone or Internet communication to remind participants to take physiological measurements and medication as well as to provide disease care and health education. A total of 91 stroke patients from the inpatient department of a regional hospital in Taoyuan city participated in the study, a total 74 subjects complete of the study, which included the completion of the following questionnaires: demographic, Partners in Health Scale, and the SF-36 (Taiwan version). The data were analyzed using SPSS for Windows, Version 18.0, and analyses included descriptive statistics, independent t-tests, Pearson's product-moment correlations, and repeated-measures ANOVAs and GEEs. Results: The efficacy of self-management is increased by (a) patient’s level of understanding of his or her disease and treatment; (b) competence in self-monitoring of blood pressure, blood sugar, and symptoms; and (c) lifestyle changes. Both PCS and MCS scores indicated significant improvement (p < .001) post-intervention. The GEE results showed that the MRS score increased by 1 point and that the MCS score was reduced by 1.69 points, both of which also indicated a significant change (p < .05). Conclusion: A digital remote tele-self-management program for stroke patients can enhance their self-management knowledge and skills as well as promote their physical and mental health status.
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Lavin, Nicole, Michael Hellawell, and Caroline O'Brien. "E-health for stroke survivors and their carers." 2017. http://hdl.handle.net/10454/13523.
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YesStroke is the leading cause of adult disability in the UK. Many stroke patients report a feeling of ‘abandonment’ when they are discharged from therapy services. This in turn, leads to readmissions and re-referrals to both hospital and community services. This paper discusses the components of E-health and how E-health could be used to supplement conventional interventions to improve patient engagement, empowerment and decreased reliance on therapy services. In doing so it will consider how such interventions could better involve carers. An integrated E-health approach has the potential to improve outcomes for stroke survivors. A person centred approach needs to be employed through partnerships between stroke survivor, carer and healthcare professional. Remote monitoring could provide specific targeted interventions, preventing unnecessary hospital admissions or re-referrals and reducing cost of care. While the issues are well defined more work is required on what these integrated, patient centred E-health solutions may look like in order to be successful in supporting stroke survivors.
The full-text of this article will be released for public view at the end of the publisher embargo on 11 Apr 2018.
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Mawson, S., N. Nasr, J. Parker, R. Davies, H. Zheng, and Gail Mountain. "A personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation." 2015. http://hdl.handle.net/10454/11036.
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YesBackground: In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology–enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. Objective: To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.
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Nuckols, Kristin Noelle. "Metamorphosis: intensive telerehabilitation to maximize upper limb function and integration in adults with chronic stroke." Thesis, 2020. https://hdl.handle.net/2144/41440.
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Metamorphosis is a theory-driven occupational therapy program using telerehabilitation based on the concept of self-management of stroke (Warner et al., 2015), which emphasizes the crucial role of client adherence and engagement between formal therapy sessions to drive neuroplastic change. This program utilizes self-determination theory (Ryan & Deci, 2000) to cultivate the intrinsic motivation of individuals with chronic stroke to participate in evidence-based therapy from the home setting (Chemtob et al., 2019; Moore et al., 2016). Repetitious but interesting and engaging gamified therapy (Cramer et al., 2019; Proffitt & Lange, 2015; Thielbar et al., 2019) can lead to motor changes which are then translated into improvements in UL engagement during ADL guided by the Active Learning Program for Stroke (ALPS) (Fasoli & Adans-Dester, 2019), solidifying the motor changes by reducing learned non-use of the stroke-affected limb. Emotional support is provided through a moderated forum for stroke survivors (Owen et al., 2010) which can aid in continued translation of skills and motivation to participate in the program during a challenging time.2022-09-25T00:00:00Z