Once again dumping all the responsibility for recovery on the survivor. YOU really need to push back forcefully against this idea. Our stroke medical professionals need to actually solve the problems in stroke, not just push them under the rug. I expect our professionals to solve the neuronal cascade of death. By solving this cascade the resulting disability would be much less and self-care might be appropriate at that time. But don't let them do this until they have solved the cascade of death problem.
http://www.medscape.com/viewarticle/845824
An innovative group program of rehabilitation and education
encouraging self-care for patients who have stroke or transient ischemic
attack (TIA) and their carers is boosting patients' confidence to
re-engage in life and helping them to make lifestyle changes to lower
their risk for a recurrent event.
The Acute stroke,
Self-management support, Prevention, Information, Rehabilitation,
Exercise (ASPIRE) program has been introduced at Yeovil District General
Hospital in Somerset, United Kingdom, and consists of post-discharge
group work for 2 hours for 12 weeks. Patients can come with spouses or
carers and participate in interactive information sessions and
individually tailored goal-orientated exercises.
A key and novel
part of the program is the involvement of other stroke patients who have
previously participated in the course as volunteers.
Peer-to-Peer Support
Presenting
details of the ASPIRE program at the recent 24th European Stroke
Conference (ESC), consultant therapist in rehabilitation Deborah Neal
said the peer-to-peer support provided by other stroke patients helps
the new patients build confidence and change their mindset so they
better engage in healthy lifestyle behaviors.
She presented new
data from the program showing that patients completing the course had a
significant benefit in stroke knowledge and that scores for
self-efficacy (confidence) also approached significance.
"Normally
we wouldn't expect to see any major changes after just 12 two-hour
sessions but because this program appears to bring about a change in
mindset, the patients go home and change their behaviours," she
commented. "One of the key elements that brings about this mindset
change is the fact we have the 'expert' patients present. They act as
role models. This is the theory of self-efficacy," she added. "It is a
very cost-effective model."
Neal also noted that unlike some other
group programs, the ASPIRE course is very inclusive. "We take everyone
who has had a stroke — ischemic or hemorrhagic — or a TIA. We have no
age or disability limits so we take people in wheelchairs and those who
are fully mobile, and the whole spectrum of communication and cognition.
They all receive an individually tailored exercise program."
The
course is run by a physiotherapist, a nurse, and a rehab assistant, with
guest speakers including a pharmacist, dietitian, and occupational
therapist. Then the patient volunteers and carers add more support.
"We
find friendships build up and patients become empowered by each other
to follow healthy behaviors outside the program. For example, they may
join a local walking group or gym together," Neal said. "We also run a
buddy system, putting new patients in touch with others who have been
through the program who may live locally to them. In this way we are
setting up a stroke community where good habits are spread by the
patients themselves. The social interaction itself also helps
enormously."
"Drip, Drip, Drip" Approach
Neal
noted that before ASPIRE was established, about half the stroke patients
in the area were going home without any rehabilitation or regular
follow up. "We found that people were still in shock — many hardly
recognized that they had had a stroke, but they were at high risk of
having another one if they didn't change their lifestyle. They are told
at the hospital about risk factors but most don't remember. But our
12-week 'drip, drip, drip' approach is much more effective at getting
the messages across."
The
weekly sessions also act as a point of contact for previous patients to
"drop in" for further advice. Carers also get the chance for some
respite if they prefer not to stay at the sessions.
Neal notes
that this approach will be difficult to validate in a randomized trial
because the program is very pragmatic and heavily individualized. So
they are looking at qualitative data instead.
"The number needed
to treat in terms of a benefit on mortality or recurrent stroke will be
high but effects on confidence and quality of life will be much more
obvious and easier to demonstrate," she said.
The
current analysis involved two phases In the first, 10 patients
attending the program and 7 carers (all spouses) were interviewed about
three major outcomes: confidence in doing important everyday activities,
developing knowledge for reducing vascular risk, and the benefits of
peer support.
The second phase tested the phase 1 outcomes in 19
patients and 6 carers using relevant standardized validated tools,
including the Stroke Knowledge Test, the Stroke Self-Efficacy
Questionnaire, the Hospital Anxiety and Depression Scale, and the
Caregiver Strain Index.
24th European Stroke Conference (ESC). Presented May 14, 2015.
No comments:
Post a Comment