Finding Positivity Through Adversity in Poststroke Care: Harmony Sierens, MD

 I'm not wasting 4 minutes when this is about acceptance!

The first line of stroke treatment seems to always be "Acceptance" which is fucking bullshit!

Send me hate mail on this: oc1dean@gmail.com. Especially you:Harmony Sierens, MD, I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? I need an explanation of why you are putting out acceptance as your first line instead of recovery?

Finding Positivity Through Adversity in Poststroke Care: Harmony Sierens, MD

The medical director of the Inpatient Rehabilitation Unit at Ascension Genesys Hospital discussed the importance of early intervention, sustained care, and rehabilitation in managing poststroke patients. [WATCH TIME: 4 minutes]

Current Time 1:05

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Duration 4:35

 

"Stroke is common, many people are living with poststroke and have different levels of deficits. I think in stroke, we know early intervention is important, and there's a lot of information out there. There are all these mnemonics that help remember, ‘this could be a stroke, get emergency care, get to the hospital, there's intervention’ and that's wonderful. But I think we don't do a good job of talking about the management(NO, SURVIVORS WANT RECOVERY! DO YOU NOT UNDERSTAND?), poststroke, and how it changes lives and how it changes everybody's life that is involved with a person who's had a stroke.”

Stroke, a widespread disease, greatly impacts the quality of life of an individual, mostly through disability and physical changes, which can bring about different psychological and cognitive processes.¹ Although stroke mortality has declined, research shows that the annual incidence of stroke in the general population is increasing.² As more patients are living poststroke, practicing clinicians practice have the ability to optimize treatment management for their patients to improve outcomes and reduce the risk of other complications of the disease.

According to a review published in the Singapore Medical Journal, researchers recommend that clinicians institute secondary prevention and attention to bowel and bladder problems to reduce medical complications and readmissions.² The researchers also suggested that adequate analgesia, positioning/splinting of limbs, and physiotherapy can also reduce any discomfort and preventable pain in patients.² Stroke clinicians can help patients treat poststroke moods with psychological counseling and can provide additional support for patients by helping them have a more positive outlook on life.

In a recent conversation with NeurologyLive®, Harmony Sierens, MD, a physiatrist and medical director at Ascension Genesys Inpatient Rehab Unit, discussed how society can better address the long-term management and care needs of patients living poststroke(WRONG, WRONG, WRONG!You need to create protocols for 100% recovery. Survivors don't want 'care' and 'management'. They want to get back to their old life! You haven't even defined the problem you need to solve correctly! Talk to me, I can help with that.) She talked about the role that physiatrists play in optimizing rehabilitation for these patients, and how early intervention gaps can be closed. In addition, Sierens spoke about how clinicians can shift the narrative surrounding strokes, from being solely devastating events to opportunities for positive life changes for patients.(So acceptance? I'd scream my head off at any stroke medical person who gives me this crapola!)

Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment

NO, NO, NO!  Stroke survivors want 100% recovery! NOT ACCEPTANCE! GET THERE!  Will you blithering idiots actually talk to survivors and not provide your tyranny of low expectations. Survivors expect recovery, why don't you provide it?

Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment

Johanne CC Rauwenhoff https://orcid.org/0000-0002-0064-6560, Yvonne Bol, […], and Caroline M van Heugten caroline.vanheugten@maastrichtuniversity.nl+1View all authors and affiliations

OnlineFirst

https://doi.org/10.1177/02692155231218813

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• • Abstract
  • Introduction
  • Method
  • Results
  • Barriers and facilitators, which patients named throughout the interviews were categorised
  • Barriers and facilitators, which therapists named throughout the interviews were categorised
  • Discussion
  • Acknowledgments
  • Declaration of Conflicting Interests
  • Funding
  • ORCID iD
  • Data availability statement
  • References
  • Supplementary Material
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Abstract

Objective

To evaluate the feasibility of Acceptance and Commitment Therapy for people with acquired brain injury.

Design

A process evaluation of the BrainACT treatment was conducted alongside a randomised controlled trial.

Setting

Psychology departments of hospitals and rehabilitation centres.

Subjects

Tweny-seven participants with acquired brain injury and 11 therapists.

Intervention

BrainACT is an Acceptance and Commitment Therapy adapted for the needs and possible cognitive deficits of people with acquired brain injury, provided in eight one-hour face-to-face or video-conference sessions.

Measurements

The attendance and compliance rates, engagement, satisfaction, and perceived barriers and facilitators for delivery in clinical practice were investigated using semi-structured interviews with participants and therapists and therapy logs.

Results

212 of the 216 sessions in total were attended and 534 of the 715 protocol elements across participants and sessions were delivered. Participants were motivated and engaged. Participants and therapists were satisfied with the intervention and participants reported to have implemented skills in their daily routines acquired during therapy. Key strengths are the structure provided with the bus of life metaphor, the experiential nature of the intervention, and the materials and homework. Participants and therapists often preferred face-to-face sessions, however, when needed video-conferencing is a good alternative.

Conclusion

BrainACT is a feasible intervention for people with anxiety and depressive symptoms following acquired brain injury. However, when the content of the intervention is too extensive, we recommend adding two extra sessions.

Introduction

In this study, we present the outcomes of the process evaluation of the BrainACT intervention. The process evaluation was conducted alongside a trial,¹ among participants allocated to the Acceptance and Commitment Therapy arm of this trial. The BrainACT study is a randomised controlled trial in which the effectiveness of an adapted Acceptance and Commitment Therapy for anxiety and depressive symptoms following acquired brain injury is investigated. Next to investigating the effectiveness of an intervention, it is important to monitor the feasibility, implementation and delivery of the intervention in a systematic way, as this will enrich the interpretation of the results.² In addition, next to quantitative data on effectiveness, process evaluations, through qualitative data, can provide narratives on implementation processes, their nuances and the identification of complex processes, which are not identified with questionnaires.³

Previous studies have shown the potential effectiveness of Acceptance and Commitment Therapy for people with brain injury-related mood symptoms.^4–6 Acceptance and Commitment Therapy is a third-wave behavioural therapy, which focuses on the improvement of psychological flexibility. This entails living in alignment with personal values while accepting internal processes and being in contact with the present moment.⁷ We developed the BrainACT intervention, which is a treatment programme adapted for the needs and possible cognitive deficits of people with brain injury and investigated its effectiveness in a series of four single cases.⁸ Despite promising results in terms of effectiveness, no process evaluation has been conducted on the feasibility of Acceptance and Commitment Therapy for people with acquired brain injury.

The current process evaluation was performed before the analysis of the effectiveness to avoid bias in the interpretation of results.² The feasibility of the BrainACT intervention, provided face-to-face as well as through video-conferencing, was evaluated by: (1) the attendance (number of sessions attended by participants) and compliance rates (elements of the protocol delivered by therapists); (2) engagement with the protocol; (3) satisfaction of participants and therapists; and (4) barriers and facilitators for delivery in clinical practice as experienced by both participants and therapists.

More at link.

Michigan Stroke Transitions Trial A Clinical Trial to Improve Stroke Transitions

Comparing this intervention to the failure rate of 90% not getting to 100% recovery seems the height of stupidity. But I'm not medically trained so I can't criticize any stroke process. We as stroke survivors have to just accept the appalling failures in stroke rehab. 

Michigan Stroke Transitions Trial - A Clinical Trial to Improve Stroke Transition

Mathew J. Reeves

,

Michele C. Fritz

,

Amanda T. Woodward

,

Anne K. Hughes

,

Constantinos K. Coursaris

,

Sarah J. Swierenga

,

Mojdeh Nasiri

,

Paul P. Freddolino

Originally published12 Jul 2019https://doi.org/10.1161/CIRCOUTCOMES.119.005493Circulation: Cardiovascular Quality and Outcomes. 2019;12

Abstract

Background:

To test whether access to home-based social worker–led case management (SWCM) program or SWCM program combined with a website providing stroke-related information improves patient-reported outcomes in patients with stroke, relative to usual care.

Methods and Results:

The MISTT (Michigan Stroke Transitions Trial), an open (unblinded) 3-group parallel-design clinical trial, randomized 265 acute patients with stroke to 3 treatment groups: Usual Care (group-1), SWCM (group-2), and SWCM+MISTT website (group-3). Patients were discharged directly home or returned home within 4 weeks of discharge to a rehabilitation facility. The SWCM program provided in-home and phone-based case management services. The website provided patient-orientated information covering stroke education, prevention, recovery, and community resources. Both interventions were provided for up to 90 days. Outcomes data were collected by telephone at 7 and 90 days. Primary patient-reported outcomes included Patient-Reported Outcomes Measurement Information System Global-10 Quality-of-Life (Physical and Mental Health subscales) and the Patient Activation Measure. Treatment efficacy was determined by comparing the change in mean response (90 days minus 7 days) between the 3 treatment groups using a group-by-time interaction. Subjects were aged 66 years on average, 49% were female, 21% nonwhite, and 86% had ischemic stroke. There were statistically significant changes in Patient-Reported Outcomes Measurement Information System Physical Health (P=0.003) and Patient Activation Measure (P=0.042), but not Patient-Reported Outcomes Measurement Information System Mental Health (P=0.56). The mean change in Patient-Reported Outcomes Measurement Information System Physical Health scores for group-3 (SWCM+MISTT Website) was significantly higher than both group-2 (SWCM; difference, +2.4; 95% CI, 0.46–4.34; P=0.02) and group-1 (usual care; difference, +3.4; 95% CI, 1.41–5.33; P<0.001). The mean change in Patient Activation Measure scores for group-3 was significantly higher than group-2 (+6.7; 95% CI, 1.26–12.08; P=0.02) and marginally higher than group-1 (+5.0; 95% CI, −0.47 to 10.52; P=0.07).

Conclusions:

An intervention that combined SWCM with access to online stroke-related information produced greater gains in patient-reported physical health and activation compared with usual care or case management alone. There was no intervention effect on mental health.

Clinical Trial Registration:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT02653170.

 

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The first line of stroke treatment seems to always be "Acceptance"

A comment from one of my readers. If this is your medical staff you need to start screaming about their incompetence.

Quality of life after TIA and stroke

Less than 5 years after stroke is way too early to evaluate how you feel about your quality of life. You probably haven't made it to acceptance yet.
http://www.neurology.org/content/early/2013/10/09/WNL.0b013e3182a9f45f

1. Ramon Luengo-Fernandez, DPhil,
2. Alastair M. Gray, PhD,
3. Linda Bull, RGN,
4. Sarah Welch, RGN,
5. Fiona Cuthbertson, MCSP,
6. Peter M. Rothwell, FMedSci;
7. For the Oxford Vascular Study

+Show Affiliations

| + Show Full Disclosures

1. Correspondence to Prof. Rothwell: peter.rothwell@ndcn.ox.ac.uk

1. Published online before print October 9, 2013, doi: 10.1212/WNL.0b013e3182a9f45f Neurology 10.1212/WNL.0b013e3182a9f45f

• Abstract
• Full Text (PDF)

1. Also available:
2. Data Supplement

Abstract

Objective: To evaluate the 5-year impact of stroke and TIA on utility and quality-adjusted survival.

Methods: TIA and stroke patients from a UK population-based study (Oxford Vascular Study) were recruited from 2002 to 2007, and followed up until 2012. Quality of life was assessed over 5 years using the EQ-5D (EuroQol-5 Dimensions), with responses converted into utilities ranging from −0.59 (worse than death) to 1 (perfect health), using UK population valuations. Utilities for stroke and TIA patients were compared with those in matched controls obtained from the 2006 Health Survey for England. Five-year quality-adjusted life years were estimated by combining utility and survival information.

Results: Four hundred forty TIA and 748 stroke patients were ascertained and included. Utility remained constant at approximately 0.78 over the 5 years after TIA. Utility improved from 0.64 one month after stroke to 0.70 at 6 months (p = 0.006), remaining at approximately 0.70 thereafter. Matched controls had considerably higher utility levels than stroke/TIA patients (0.85, p < 0.001). Event severity and recurrent stroke were significant predictors of decreased long-term utility. Five-year quality-adjusted life expectancy was 3.32 (95% confidence interval: 3.22–3.48) quality-adjusted life years after TIA and 2.21 (2.15–2.37) after stroke, varying considerably by severity (minor: 2.94; moderate: 1.65; and severe: 0.70).

Conclusion: Quality-adjusted survival is low over the 5 years after stroke and TIA, with severity and recurrent stroke being major predictors. There remains considerable scope for improvements in acute treatment and secondary prevention to improve the quality of life after TIA and stroke.