Strengths

Discuss About The Telehealth Service Implementation Framework.

This is basically an appraisal paper that reviews an article. The chosen article is aimed at finding the perception of the person with stroke & the informal caregiver at the home and also their daily experience after 1 year of stroke.  Moreover, the paper raises two very important points such as the social and psychological adaptation of rehabilitation process at homes and also the daily experience which the person with stroke & the informal caregiver at the home do experience.

Article: Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined perceptions of people with stroke and their carers regarding rehabilitation need 1 year after stroke: mixed methods study. BMJ open, 5(2), e006784.

(Lisa Ekstam, Ulla Johansson, Susanne Guidetti, Gunilla Eriksson & Charlotte Ytterberg)

Strengths

The biggest strength was the authors’ capability to select such a good topic which has not attracted many research works in past. The dyadic perspective is a rare topic which the authors have effectively justified with their good mixing of methodologies and the findings as well.

Limitations

The biggest weakness or the possible ground for bias in this study is the analysis section where authors have compared the results of persons with stroke and informal care givers on a group level. Samples could have been much bigger than it ended with. Participants compared separately but not in groups could have produced the wider results.  

How may a caregiver effectively support a (67 year old female) family member with her activities of daily living following a stroke? 

Justification

The one justification which might have attracted the authors’ interest towards the topic is possibly the quality of recovery which is yet unknown due to the unavailability of quality research work on the topic. The available data are basically the general findings and the research has just been on the same track.

Another justification can be the fact that stroke is a severe accident and that there is no universal model to deal with it effectively. The traditional model of seeking the disease related remedial from health experts are not effective. Additionally, the home based model to provide the care services to patients is effective; however, it is yet to find the sufficient evidence for whether the dyad’s process at homes is effective and that daily experience of stroke patient & the informal caregivers is still an unknown fact. The research indicates a collaborative work between the stroke patients and the informal caregiver. There are still more research works needed to make it apparent that dyad’s process can be used and that their perceptions for the challenges can also be changed (Martin et al., 2015).

Limitations

In the chosen article, the mixed method approach was adopted by combining both the qualitative and quantitative data. Participants were interviewed in homes with the necessary set of questions. Two forms were being used to collect the data such as open-ended interviews and the established instruments. Questionnaires were prepared using a Ware’s taxonomy. The results were judged with respect to three designed groups such as met, discordant and unmet. The sense of coherence (SOC) in person with stroke was judged with the help of the SOC-scale. Burdens for the caregiver were assessed using the Caregiver Burden Scale (Whalon, Conroy, Martinez & Werch, 2015).

 It looks as if the authors have systematically approached towards the research objective. The approach was quite systematic and had tried to measure every possible outcome. However, the design lacks at one point and which is the data analysis section where the analysis was made on the dyad’s process in group level. It did not consider or executed the examination with one person at one time. This could have delivered a much narrower result and the results could have been different also.

As already stated, the research uses a mixed method approach by considering both the qualitative and the quantitative form of data analysis. Basically, open-ended interview with the participants was being chosen as the method to collect the data. Participants were being interviewed at their homes. Both the person with stroke and the informal caregiver to that person were interviewed. The set of questions were also well structured as it had followed the Ware’s taxonomy to structure the questions (Venable, Pries-Heje & Baskerville, 2016). The selection of instruments was appropriately done.  However, the research was not able to get the separate data of participants. Group basis data were being obtained and hence, things became difficult to understand the individual feeling for the daily experience after one year of stroke.  

In Fifty-two percent cases, it was found that the dyad’s process was able to overcome the rehabilitation challenges. However, met rehabilitation process was checked against the less severe cases. Consequently, caregivers were found to have fewer burdens on a daily basis. It can be said that there is a need for social and psychological developments in stroke patients and the informal caregivers. However, there is still very less evidence available on the fact. There is a need for more research works on the same topic. The study had little strength and the limitations as well. It has raised a very important concern which is to understand the impact of dyad’s process after stroke. The dyadic perspective does still have a very limited number of research works on it. However, this is necessary that more research works are done on the topic. There must be the understood ways for changing the social and psychological perspectives in stroke patients and the caregivers at homes (Van Dyk, 2014). If such thing could be made possible then a systematic approach to rehabilitation will be much viable at homes. This will make things easier for both the medical institutions and the home settings. Till now, physical therapies have not been successful in providing a quick relief to stroke patients. Additionally, there is very less evidence to support a robust home setting for helping the stroke patients to recover the impact quicker.

Effective Support for Caregivers of Stroke Patients

This can be a challenge to create a healthy environment at homes. This is due to a fact that families can anytime interfere with the process if something appears to them as unnecessary. Although it is of no importance that families are aware of every single process of the medical field as because they do not belong to the sector. However, a collaborative approach towards the goal without much any interruption from families will be the key to overcome the identified barrier (Bertilsson et al., 2016).

The post-stroke period is a challenge not for the medical team only but for families also. It is important that health services have the effective way out of the issue. This is important also that home setting is suitable and appropriate to support the recovery process in stroke patients. However, on a realistic note, the health service providing firms have no better option than just training. The research paper indicates that there is the need for more future studies on identifying whether rehabilitation process can be successfully intervened at homes. Moreover, it also identifies the needs for focussing on the social and psychological support for the dyad’s process (Martin et al., 2015).

Conclusion:

To conclude, home setting for caring the stroke patients in their daily living is still in the early stage. In the light of the chosen research work, this can be said that caregiver and stroke patients are both underdeveloped in terms of their social and psychological understanding for daily experience after stroke. There are very fewer research studies on the topic as well. There is still the need for more research works, so that, the systematic approach to support the stroke patients and the caregiver as stated in the research work is attained.

References

Bertilsson, A. S., Eriksson, G., Ekstam, L., Tham, K., Andersson, M., Von Koch, L., & Johansson, U. (2016). A cluster randomized controlled trial of a client-centred, activities of daily living intervention for people with stroke: One year follow-up of caregivers. Clinical rehabilitation, 30(8), 765-775. [DOI: 10.3109/11038128.2015.1115549]; Accessible at: file:///C:/Users/User/Downloads/110381282E20152E1115549.pdf

Martin, L. J., Hathaway, G., Isbester, K., Mirali, S., Acland, E. L., Niederstrasser, N., … & Sternberg, W. F. (2015). Reducing social stress elicits emotional contagion of pain in mouse and human strangers. Current Biology, 25(3), 326-332. [DOI: 10.1016/j.cub.2014.11.028]; Accessible at: https://www.sciencedirect.com/science/article/pii/S0960982214014894

Van Dyk, L. (2014). A review of telehealth service implementation frameworks. International journal of environmental research and public health, 11(2), 1279-1298. [DOI: 10.3390/ijerph110201279]; Accessible at: https://www.mdpi.com/1660-4601/11/2/1279/htm

Venable, J., Pries-Heje, J., & Baskerville, R. (2016). FEDS: a framework for evaluation in design science research. European Journal of Information Systems, 25(1), 77-89. [DOI: 10.1057/ejis.2014.36]; Accessible at: https://link.springer.com/article/10.1057/ejis.2014.36

Whalon, K. J., Conroy, M. A., Martinez, J. R., & Werch, B. L. (2015). School-based peer-related social competence interventions for children with autism spectrum disorder: A meta-analysis and descriptive review of single case research design studies. Journal of autism and developmental disorders, 45(6), 1513-1531. [DOI: 10.1007/s10803-015-2373-1]; Accessible at: https://www.researchgate.net/profile/Maureen_Conroy2/publication/271710068_School-Based_Peer-Related_Social_Competence_Interventions_for_Children_with_Autism_Spectrum_Disorder_A_Meta-Analysis_and_Descriptive_Review_of_Single_Case_Research_Design_Studies/links/54d8c9b50cf2970e4e793321/School-Based-Peer-Related-Social-Competence-Interventions-for-Children-with-Autism-Spectrum-Disorder-A-Meta-Analysis-and-Descriptive-Review-of-Single-Case-Research-Design-Studies.pdf