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Home-Based Stroke Rehabilitation: Issues and Challenges
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Home-Based Stroke Rehabilitation: Issues and Challenges

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Aging".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 14110

Special Issue Editors

Dr. Debbie Rand

E-Mail Website
Guest Editor
Department of occupational Therapy, Tel-Aviv University, 6997801 Tel-Aviv, Israel
Interests: stroke rehabilitation; affected upper extremity; executive functions; participation
Dr. Grace Kim

E-Mail Website
Guest Editor
Department of Occupational Therapy, New York University, New York, NY 10012, USA
Interests: stroke rehabilitation; upper extremity use; mobile technology; shared decision making; behavior change

Special Issue Information

Dear Colleagues,

Stroke is considered a long-term chronic disease with acute events; therefore, there is a need to provide ongoing home-based rehabilitation services. In most cases, individuals and their families would benefit from continued rehabilitation services beyond inpatient and outpatient clinic-based rehabilitation to reintegrate back in their communities after the stroke. The adoption of mobile technologies and changes to healthcare utilization driven by the COVID-19 pandemic has highlighted the need for new models of rehabilitation delivery. 

The current healthcare climate underscores the growing importance of home-based rehabilitation, which includes structured training programs with clear objectives performed under indirect (remote) clinician supervision. Home-based stroke rehabilitation approaches are emerging with opportunities for innovation. In this Special Issue, we would like to explore key issues and challenges of home-based rehabilitation that are paramount for successful outcomes. Papers addressing this topic are invited for this Special Issue, especially those addressing methods of remote clinician supervision, the role of rehabilitation equipment and mobile technology, and methods of patient and family engagement.

Dr. Debbie Rand
Dr. Grace Kim
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • home-based interventions
  • community-based rehabilitation
  • adherence and compliance
  • tele-rehabilitation
  • mobile technology
  • outcome measures (patient reported outcome measures)
  • real-world function
  • self-management
  • perspectives of clinicians and stakeholders (client and family)

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Published Papers (4 papers)

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Research

14 pages, 339 KiB  
Article
Feasibility and Acceptability of a Remotely Delivered Executive Function Intervention That Combines Computerized Cognitive Training and Metacognitive Strategy Training in Chronic Stroke
by Abhishek Jaywant, Leah Mautner, Rachel Waldman, Michael W. O’Dell, Faith M. Gunning and Joan Toglia
Int. J. Environ. Res. Public Health 2023, 20(9), 5714; https://doi.org/10.3390/ijerph20095714 - 4 May 2023
Cited by 6 | Viewed by 3312
Abstract
Executive dysfunction after stroke is associated with limitations in daily activities and disability. Existing interventions for executive dysfunction show inconsistent transfer to everyday activities and require frequent clinic visits that can be difficult for patients with chronic mobility challenges to access. To address [...] Read more.
Executive dysfunction after stroke is associated with limitations in daily activities and disability. Existing interventions for executive dysfunction show inconsistent transfer to everyday activities and require frequent clinic visits that can be difficult for patients with chronic mobility challenges to access. To address this barrier, we developed a telehealth-based executive function intervention that combines computerized cognitive training and metacognitive strategy. The goal of this study was to describe intervention development and to provide preliminary evidence of feasibility and acceptability in three individuals who completed the treatment protocol. The three study participants were living in the community and had experienced a stroke >6 months prior. We assessed satisfaction (Client Satisfaction Questionnaire-8 [CSQ-8]), credibility (Credibility and Expectancy Questionnaire), and feasibility (percent of sessions completed). All three subjects rated the treatment in the highest satisfaction category on the CSQ-8, found the treatment to be credible, and expected improvement. Participants completed a median of 96% of computerized cognitive training sessions and 100% of telehealth-delivered metacognitive strategy training sessions. Individuals with chronic stroke may find a remotely delivered intervention that combines computerized cognitive training and metacognitive strategy training to be feasible and acceptable. Further evaluation with larger samples in controlled trials is warranted. Full article
(This article belongs to the Special Issue Home-Based Stroke Rehabilitation: Issues and Challenges)
12 pages, 1491 KiB  
Article
Functional and Cognitive Occupational Therapy (FaCoT) Improves Self-Efficacy and Behavioral–Emotional Status of Individuals with Mild Stroke; Analysis of Secondary Outcomes
by Tal Adamit, Jeffrey Shames and Debbie Rand
Int. J. Environ. Res. Public Health 2023, 20(6), 5052; https://doi.org/10.3390/ijerph20065052 - 13 Mar 2023
Cited by 7 | Viewed by 3964
Abstract
Background: Mild stroke is characterized by subtle impairments, such as low self-efficacy and emotional and behavioral symptoms, which restrict daily living. Functional and Cognitive Occupational Therapy (FaCoT) is a novel intervention, developed for individuals with mild stroke. Objectives: To examine the [...] Read more.
Background: Mild stroke is characterized by subtle impairments, such as low self-efficacy and emotional and behavioral symptoms, which restrict daily living. Functional and Cognitive Occupational Therapy (FaCoT) is a novel intervention, developed for individuals with mild stroke. Objectives: To examine the effectiveness of FaCoT compared to a control group to improve self-efficacy, behavior, and emotional status (secondary outcome measures). Material and Methods: Community-dwelling individuals with mild stroke participated in a single-blind randomized controlled trial with assessments at pre, post, and 3-month follow-up. FaCoT included 10 weekly individual sessions practicing cognitive and behavioral strategies. The control group received standard care. The New General Self-Efficacy Scale assessed self-efficacy; the Geriatric Depression Scale assessed depressive symptoms; the Dysexecutive Questionnaire assessed behavior and emotional status; and the ‘perception of self’ subscale from the Reintegration to Normal Living Index assessed participation. Results: Sixty-six participants were randomized to FaCoT (n = 33, mean (SD) age 64.6 (8.2)) and to the control (n = 33, age 64.4 (10.8)). Self-efficacy, depression, behavior, and emotional status improved significantly over time in the FaCoT group compared with the control, with small to large effect size values. Conclusion: The efficacy of FaCoT was established. FaCoT should be considered for community-dwelling individuals with mild stroke. Full article
(This article belongs to the Special Issue Home-Based Stroke Rehabilitation: Issues and Challenges)
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12 pages, 852 KiB  
Article
Perceived Facilitators and Barriers for Actual Arm Use during Everyday Activities in Community Dwelling Individuals with Chronic Stroke
by Grace J. Kim, Shir Lebovich and Debbie Rand
Int. J. Environ. Res. Public Health 2022, 19(18), 11707; https://doi.org/10.3390/ijerph191811707 - 16 Sep 2022
Cited by 5 | Viewed by 2909
Abstract
Background: Our aim was to gain a deeper understanding of perceived predictors for actual arm use during daily functional activities. Methods: Qualitative study. Semi-structured interview data collected from individuals with chronic stroke living in the community. Codebook thematic analysis used for the data [...] Read more.
Background: Our aim was to gain a deeper understanding of perceived predictors for actual arm use during daily functional activities. Methods: Qualitative study. Semi-structured interview data collected from individuals with chronic stroke living in the community. Codebook thematic analysis used for the data analysis. Results: Six participants 5–18 years post stroke with moderate to severe UE impairment. Three domains were identified: Person, Context, and Task. Themes for the Person domain included mental (cognitive effort, lack of acceptance), behavioral (routines/habits, self-evaluation), and physical (stiffness/fatigue). Themes for the Context domain included social environment (being in public, presence, and actions of others) and time constraints (being in a hurry). Themes for the task domain included necessity to complete bilateral and unilateral tasks, and safety (increased risk of accidents). Conclusion: Actual arm use is a complex construct related to the characteristics of the person, contextual environment, and the nature of the task. Facilitators included cognitive effort, routines/habits, self-evaluation, and the perceived necessity. Barriers included in lack of acceptance, stiffness/fatigue, being in public, being in a hurry, and risk of ac-cidents. Social support was both a facilitator and a barrier. Our results support the growing call to adopt a broader biopsychosocial framework into rehabilitation delivery. Full article
(This article belongs to the Special Issue Home-Based Stroke Rehabilitation: Issues and Challenges)
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19 pages, 2474 KiB  
Article
Exploring the Multidimensional Participation of Adults Living in the Community in the Chronic Phase following Acquired Brain Injury
by Aviva Beit Yosef, Nirit Refaeli, Jeremy M. Jacobs, Jeffrey Shames and Yafit Gilboa
Int. J. Environ. Res. Public Health 2022, 19(18), 11408; https://doi.org/10.3390/ijerph191811408 - 10 Sep 2022
Cited by 2 | Viewed by 2842
Abstract
This exploratory study aimed to examine multiple aspects of the participation of adults in the chronic phase following acquired brain injury (ABI), considering different disability levels. Our study included 25 adults ≥6 months after ABI (predominantly stroke), living at home, without severe cognitive [...] Read more.
This exploratory study aimed to examine multiple aspects of the participation of adults in the chronic phase following acquired brain injury (ABI), considering different disability levels. Our study included 25 adults ≥6 months after ABI (predominantly stroke), living at home, without severe cognitive decline. Primary measures included the Canadian Occupational Performance Measure (subjective participation) and the Mayo-Portland Adaptability Inventory-4 Participation Index (objective participation). The results indicated subjective participation problems in all of the International Classification of Functioning, Disability and Health participation domains. In addition, objective participation was reported as most limited in the areas of leisure and recreational activities, residence, and employment. Both subjective and objective participation profiles varied according to the disability level except for the social and leisure areas, which were found to be similar across all subgroups. However, only partial compatibility was found between the subjective and objective participation aspects. To conclude, our findings indicated that chronic ABI survivors report a variety of subjective and objective participation concerns that varied according to their disability levels. Moreover, the incongruity between the participation aspects suggests that the level of limitation may not necessarily correspond to the importance of a particular participation area. This highlights the need for comprehensive assessments to determine unique individual participation profiles in order to facilitate client-centered interventions supporting the rehabilitation of community-dwelling ABI survivors. Full article
(This article belongs to the Special Issue Home-Based Stroke Rehabilitation: Issues and Challenges)
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