#COT2017 S90. Neurology

Factors associated with participation in life situations after stroke in community dwelling adults: a systematic review

By Leisle Ezekiel (@lezeki ‏)

Ezekiel presented part one of her three planned systematic reviews that explored factors associated with participation in life situations after stroke in community dwelling adults. The lack of long-term support after stroke and the changing stroke demographic (an increase in the under 55 population) were highlighted. We were reminded that, as Occupational Therapists, we work at adapting the intersection between person and environment making participation modifiable.

The criteria for inclusion in this systematic review was outlined to include studies that investigated biopsychosocial factors over time in quantitative data. I found the discussion around bias useful to remember when reading research. For example, studies that excluded people after experiencing a severe stroke or people with communication difficulties were omitted. These would be the populations that would have increased difficulty in participation and therefore, we would be eager to record their experiences. This resulted in a review of over 11,000 participants between the ages of 18-99 years old living at home or a care facility.

Time was tight in this session so I couldn’t record all the findings but in summary, every factor of life effected participation after stroke apart from the type of stroke (a clot or a bleed) and more evidence was needed around the factor of driving. It was clear little research has been carried out past one year after stroke but commented that having poor participation after one year resulted in continued poor participation. Of course, the more severe strokes experienced resulted in poorer participation. Social support looked to be a positive factor for participation. Studies commented depression after stroke was difficult to treat which led us nicely into the next study by Aisling Durkin. Finally, Ezekiel suggested treatment plans need a change in vision creating a top-down approach. Personally, I have just finished my first placement in acute stroke rehabilitation and enjoyed the overview of the research available that this session brought.

Exploring the current education levels and practices for the assessment and treatment for post-stroke anxiety and depression: a survey of occupational therapists, physiotherapists, and speech and language therapists in the UK

By Aisling Durkin (@ais_d)

Figures show that 30% of people after stroke experience depression and 25% with post-stroke anxiety (PSA). Durkin concurred with our previous speaker, Leisle Ezekiel, that psychological changes such as depression and PSA effects participation but also mobility and cause an increase in clients’ length of hospital stay. It was also reiterated that not all people are receiving their review six months after stroke. This study recruited its 421 participants through social media comprising of occupational therapists, physiotherapists, and speech and language therapists working across the United Kingdom.

The findings revealed there is limited guidance on what education all professions should receive regarding assessing and treating depression and PSA with only some speech and language therapists reporting they attended formal counselling training for depression. Those that had had formal or informal training were shown to assess for depression and PSA. The most popular formal assessment was the Hospital and Depression Score (HADS) but many were assessing informally or within a general hospital questionnaire. Surprisingly, among many interesting statistics, 4.25% of Speech and Language Therapist did not assess for PSA when patients had aphasia post-stroke. As for treatment, Occupational Therapists were performing lifestyle, group, peer-supported, and individual self-help workbook interventions for depression post-stroke. Whereas, goal-setting, relaxation, graded approaches to activities, CBT, and individual self-help workbook interventions were reported as being used to treat PSA.

A positive finding for many in the audience was the fact the majority of all the professions either agreed or strongly agreed that it is their responsibility to assess for these conditions after stroke. It was also encouraging to see the work physiotherapists were doing already in this area but on the other hand, there was room for improvement for speech and language therapists.

In conclusion, Durkin reveals the gap between guideline expectations and reality in practice regarding gaining education in this area. Echoes from Diane Cox’s Casson address, ‘publish, publish, publish,’ were heard in my mind as non-validated tools and interventions are being undertaken in stroke rehabilitation at present. The agreement of every profession accepting responsibility for assessing depression and PSA after stroke is a big encouragement and was discussed in the question period after this presentation.

 Blog Squad writer: Orla Hughes (@orlatheot)


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