BUS TRIPS—A Self-Management Program for People with Cognitive Impairments after Stroke
Abstract
:1. Introduction
2. Materials and Methods
2.1. BUS TRIPS
2.2. Participants
2.3. Study Design
2.4. Data Collection
2.4.1. Program Feasibility
2.4.2. Improved Ability to Travel by Bus Due to BUS TRIPS
2.5. Data Analysis
2.5.1. Cross Case Analysis: Program Feasibility
2.5.2. Within Case Analysis: Improved Ability to Travel by Bus Due to BUS TRIPS
3. Results
3.1. Cross Case Findings: Program Feasibility
3.1.1. Program Delivery
Appreciated Group Format despite Sessions That Are Too Short
Importance of Skilled Leaders and Motivated Participants
3.1.2. Program Content
Session Material Adequate but Needs Minor Revision to Fit the Target Group
Homework Is Valuable but Reflective Group Discussions Must Be Supported
3.2. Within Case Findings: Improved Ability to Travel by Bus Due to BUS TRIPS
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Targeted Skill | Content of Session | Homework | |
---|---|---|---|
Session 1 | Self-monitoring | Introduction, cognitive disabilities after stroke, and consequences for daily life—outdoor mobility, bus travels in urban areas | Individual identification of activities problematic for outdoor mobility and bus travels |
Session 2 | Goal-setting | Reviewing homework Goal plan and goal-setting | Setting goals for the intervention period |
Session 3 | Problem solving/Decision making | Presentation of Problem Solving Theory (PST) Teaching activity analysis and compensatory solutions (such as travel planner and mobile phones) | Use goals in rehabilitation plan—find solutions, use PST |
Sessions 4–5 | Problem solving/Decision making | Individually with OT or PT—practice bus travelling in real life context, use goal plan, practice technical devices walking techniques, etc. | Use goals—practice strategies from individual session with OT/PT 1 in other activities |
Session 6 | Communication | Share experiences from the individual sessions, Discuss communication with others | Practice communicating problems and asking for help |
Session 7 | Positive thinking | Conclusion, set long-term objectives |
Name | Elisabeth | Viola | Lennart | Carl | Kent |
---|---|---|---|---|---|
Age (year) | 64 | 77 | 71 | 82 | 67 |
Stroke type | Hemorrhage | Infarction | Infarction | Infarction | Infarction |
Living situation | Living with partner | Living with partner | Living with partner | Living with partner | Living with partner |
Type of housing | Single-family home | Apartment building | Single-family home | Single-family home | Apartment building |
Living area | Urban | Urban | Sub-rural | Sub-rural | Urban |
Mobility device | |||||
Indoor | No | No | No | Rollator | Cane or Rollator |
Outdoor | Rollator | Rollator | No | Rollator | Sticks or Rollator |
Medical recommendation not to drive due to stroke | No | No | No | Yes | No |
Access to car in the household | Yes, but do not drive herself | No | Yes, but do not drive himself | Yes, but do not drive himself | No |
Bus ride frequency prior stroke | Daily | Several times a week | Rarely | Once a month | Rarely |
TUG 1 | 16 | 18 | 12 | 13 | 24 |
CHIEF, m (range, 0–8) 2 | |||||
Attitudes/Support | 0 | 0.8 | 0 | 0 | 0.2 |
Service/Assistance | 0 | 0.6 | 0 | 0.4 | 0.9 |
Physical/Structural | 1.5 | 2 | 0 | 0.3 | 2.3 |
Work/School | 0 | 0 | 0 | 0 | 0 |
Policies | 0 | 0 | 0 | 0.5 | 0 |
Self-reported cognitive functional limitations 3 (range, 0–20) | 3 | 9 | 3 | 0 | 9 |
MoCa (range, 0–30) 4 | Normal cognition (28) | Cognitive impairment (18) | Cognitive impairment (18) | Cognitive impairment (18) | Normal cognition (26) |
GDS (range, 0–20) 5 | Possible depression (13) | Possible depression (7) | No depression (2) | No depression (1) | Possible depression (6) |
SIS, m (range, 1–5) 6 | 2.6 | 3.8 | 4.8 | 3.8 | 3.3 |
GSE (range, 10–40) 7 | 28 | 29 | 40 | 31 | 26 |
Lisat-11 Item 1 (1–6) 8 | 4 | 4 | 5 | 4 | 6 |
Aim | Feasibility of BUS TRIPS | Improved Ability to Travel by Bus Due to BUS TRIPS | ||
---|---|---|---|---|
Analysis | Cross-case | Within-case (Narratives) | ||
Sample | Participants (n = 5) | Leaders (n = 2) | Participants (n = 5) | Leaders (n = 2) |
Method (X) | Quantitative | Qualitative | Quantitative | Qualitative |
(1) Demographics | X | |||
(2) Baseline data | ||||
Activity and participation | ||||
Study specific questions on walking devices, transfer possibilities, bus travels | X | |||
TUG 1 | X | |||
Environmental barriers | ||||
CHIEF 2 | X | |||
Cognitive impairments | ||||
MoCa 3 | X | |||
Self-reported cognitive functional limitations 4 | X | |||
Depressive symptoms | ||||
GDS 5 | X | |||
(3) Assessments | ||||
SIS 6 | X | |||
GSE 7 | X | |||
LiSat-11 (Item 1) 8 | X | |||
(4) Leaders reflection notes, group sessions | X | |||
(5) Leaders reflection notes, individual session | X | |||
(6) Semi-structured group-interview | X | X | ||
(7) Individual phone survey | X | X |
Main Category | Sub-Category |
---|---|
Program delivery | -Appreciated group format despite too short sessions |
-Importance of skilled leaders and motivated participants | |
Program content | -Session material adequate but needs minor revision to fit target group |
-Homework is valuable but reflective group discussions must be supported |
Survey Questions | Median (Min–Max) |
---|---|
Were the leaders knowledgeable in the subject? | 6 (5–7) |
Could the leaders present the course material in a way you understood? | 6 (5–7) |
Did the leaders manage you to try out new strategies? | 5 (4–6) |
How was the quality of the course material? | 5 (4–6) |
How was the quality of the homework? | 5 (5–7) |
How did you experienced the feedback you received at the homework? | 4 (4–6) |
Where the leaders able to support discussions among the participants? | 4 (3–6) |
How did you experience the format of the program? | 6 (5–6) |
Overall, how much do you think this program have helped you to travel more by bus? | 5 (4–7) |
Overall, how much do you think this program have helped you become more involved in activities outside your home? | 5 (4–6) |
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Carlstedt, E.; Iwarsson, S.; Ståhl, A.; Pessah-Rasmussen, H.; Månsson Lexell, E. BUS TRIPS—A Self-Management Program for People with Cognitive Impairments after Stroke. Int. J. Environ. Res. Public Health 2017, 14, 1353. https://doi.org/10.3390/ijerph14111353
Carlstedt E, Iwarsson S, Ståhl A, Pessah-Rasmussen H, Månsson Lexell E. BUS TRIPS—A Self-Management Program for People with Cognitive Impairments after Stroke. International Journal of Environmental Research and Public Health. 2017; 14(11):1353. https://doi.org/10.3390/ijerph14111353
Chicago/Turabian StyleCarlstedt, Emma, Susanne Iwarsson, Agneta Ståhl, Hélène Pessah-Rasmussen, and Eva Månsson Lexell. 2017. "BUS TRIPS—A Self-Management Program for People with Cognitive Impairments after Stroke" International Journal of Environmental Research and Public Health 14, no. 11: 1353. https://doi.org/10.3390/ijerph14111353