Asghar Dalvandi

Life experiences after stroke among Iranian stroke survivors

BACKGROUND Stroke is a major cause of disability worldwide. It is a life-threatening and life-altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long-term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. AIM To illuminate how stroke survivors experience and perceive life after stroke. METHOD A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors. FINDINGS The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio-economical situation and life disintegration. The core concept of life after stroke was functional disturbances. CONCLUSIONS The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.

Rehabilitation Experts' Experience of Community Rehabilitation Services for Stroke Survivors in Iran

Abstract Purpose: Successful stroke rehabilitation is a complex process involving teamwork by members of several professions. The aims of this study were to explore the experiences of Iranian rehabilitation experts concerning community rehabilitation services for stroke survivors and obtain their opinions on how to further develop and improve these services. Method: A qualitative research method with grounded theory was used, including purposive and theoretical sampling. A constant comparative analysis was conducted. Data were gathered from 2 focus group discussions including 10 Iranian rehabilitation experts and 4 in-depth individual interviews. Results: Nonintegrated rehabilitation services emerged as the core concept of the study. The explored concepts were identified as deficiently allocated budget, inadequate public insurance, lack of availability of rehabilitative care, negative public opinion, lack of consistency in care, and split services and professional separation. Areas identified for potential improvement included need to change policymakers’ attitudes, need to refine rehabilitation in the health care system, need to establish a registration system, need to provide information and skills, and need to see the family as a whole. Conclusion: Experts should participate in educational rehabilitation programs to become more aware of current rehabilitation services within the community. Stroke survivors and their families should also participate in the rehabilitation programs as this would allow them to gain knowledge and skills for dealing with stroke management. This can help reduce problems, change public opinion, and eliminate mistrust between health care providers and families.

Resilience of Patients With Chronic Physical Diseases: A Systematic Review and Meta-Analysis

Context Resilience can be seen as an adaption to stress, such as that caused by health problems or disease, that attenuates the negative effects of stress. The present research performed a systematic review and meta-analysis to study resilience scores among adults diagnosed with chronic physical diseases. Evidence Acquisition Electronic databases, including Persian language (scientific information database [SID], IranMedex, Magiran, IranDoc, and Medlib) and English language (Google Scholar, Science Direct, PubMed, Pre-Quest, and Scopus), were searched. Fifteen articles were found using the keywords disease or chronic disease, resilience or resiliency, and illness, either alone or in combination, both in Persian and English languages. Data analysis was carried out through meta-analysis (random-effects model), and heterogeneity was investigated by subgroup and meta-regression analyses. The data were analyzed in STAT software (12.0). Results The mean resilience score of the chronic disease patients (n = 3369) was 74.6 (95% CI: 51.8 - 97.4). In terms of diseases, the mean resilience score of cancer patients was 79.6 (95% CI: 48.3 - 111.1), whereas it was 79.6 for cardiovascular disease patients (95% CI: 45.8 - 113.3) and 64.6 for patients with other diseases (95% CI: 6.6 - 122.7). There was no relationship between the resilience of chronic disease patients and the year of the study (P = 0.711) and the sample size in the studies (P = 0.351). Conclusions The mean resilience score of the patients was less than that of healthy individuals. As resilience can be acquired at any stage of life, irrespective of age and disease status, there is a need for training to improve resilience among patients through educational programs.

Functional Status Assessment of COPD Based on Ability to Perform Daily Living Activities: A Systematic Review of Paper and Pencil Instruments

Context: Activity of daily living (ADL) is an important predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Increasing ADL is important in patients with COPD and assessment of ADL is one of the best ways to evaluate the status of COPD patients. Objectives: The objective of this systematic review was to provide an overview of the psychometric properties of paper and pencil instruments measuring ADL in patients with COPD. Data Sources: English papers published from 1980 to 2014 regarding ADL in patients with COPD were searched in Web of Science, MEDLINE, Google Scholar, Cochrane, PubMed, ProQuest, and CINAHL databases using the following keywords: “COPD”, “ADL”, “activities of daily living”, “daily activities”, “instrument”, “questionnaire”, “paper-and-pencil instruments”, and “measure”. Following the Internet search, manual search was also done to find article references. Study Selection: A total of 186 articles were found. Of those, 31 met the inclusion criteria. Full texts of articles meeting the inclusion criteria were studied. Consensus-based standards for the selection of health measurement instruments”(COSMIN) were used to assess the quality of the studies. Data Extraction: Data extraction form based on research aims developed by researchers and psychometric experts, with 17 questions was used. Results: In these articles, 14 pen and paper instruments were identified for examining ADL in patients with COPD; of which, 4 dealt directly with ADL while 9 assessed other criteria i.e. dyspnea as ADL indicator. The majority of instruments only dealt with two main dimensions of ADL: Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL), and did not consider Advanced Activities of Daily Living (AADL), which is influenced by cultural and motivational factors. Conclusion: Despite several ADL instruments identified, complete psychometric processes have only been done in a few of them. Selection of the appropriate instrument should focus on the aim of the study and the target construct.

Health Needs of Older Adults After Natural Disasters: A Systematic Literature Review

Background: Older adults are disproportionately affected by natural disasters. The literature on the health needs of older adults after natural disasters is limited. Objectives: The aim of this study was to examine the existing evidence on the health needs of older adults after disasters. This systematic review of the literature was conducted to provide an overview of what is known about the needs of older adults after natural disasters. Methods: An electronic search of the following databases was conducted: PubMed, Cochrane, ProQuest, Web of Science, Google Scholar, and HelpAge International. The final review included 27 articles that were analyzed using qualitative content analysis to identify the health needs of older adults after natural disasters. Results: Limited and sparse literature exists pertaining to the health needs of older adults after natural disasters. In this study, six themes or features of health needs emerged: medical needs, psychosocial needs, assistance in activities of daily living, resources, informational needs, and protective needs. Furthermore, four categories including personal, organizational, socio-cultural, and disaster-related factors could affect the health needs of older adults after natural disasters. Conclusions: Planning for older adults with diverse and special needs in disasters is very important. Health care providers should consider the older adult’s health needs and capacities in the disaster recovery