Dorothy Kessler

The process of re-engagement in personally valued activities during the two years following stroke

Purpose: Engagement in valued activities is often difficult for people who have experienced stroke. A deeper understanding of the process of re-engagement in personally valued activities would be helpful to those designing interventions to address participation post-stroke. Method: Six community-dwelling individuals recovering from a first stroke were interviewed at 6, 9, 12, 18 and 24 months post-stroke. A grounded theory approach was used to construct a substantive theory of re-engagement in valued activities during this period. Results: Two core concepts, social connection and being in charge were identified. Both led to activity engagement and risk taking to test abilities. These led to lowering of current expectations and activity adaptation which supported hope for recovery and further testing. Alternatively, difficulties perceived to be related to ageing led to disengagement. Conclusions: Rehabilitation practice that addresses and supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke. Implications for Rehabilitation This qualitative study shows that the process of re-engagement in valued activities during the 2 years following stroke was constructed around two core concepts: social connection and being in charge. Rehabilitation practice that supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke.

Meaning perspective transformation following stroke: the process of change

Purpose. Transformative Learning in an educational theory that posits that individuals learn and grow when their meaning perspectives (frames of reference for interpreting an experience based on knowledge, feelings, values and beliefs) are reformulated following a critical event. This theory has become quite influential in the exploration of adaptation to chronic illness. This study explored whether the change that occurs following stroke follows a process similar to transformative learning. Method. Grounded Theory approach was used to explore changes in meaning perspective among 12 people who were members of stroke support organisations, had a stroke at least 1 year prior to the study and described themselves as viewing life positively following stroke. Constant comparison analysis of interviews with these individuals was used to explore their experience following stroke. Results. Meaning perspective transformation occurred with four factors contributing to transformation: triggers, support, knowledge and choices to action. A substantive grounded theory of the process of meaning perspective transformation following stroke is presented, which illustrates the interaction of these contributing factors in initiating and facilitating the transformation process. Conclusion. Transformative learning can offer insight into how people who have experienced stroke learn, rebuild competence and re-engage in valued activities.

A Pilot Randomized Controlled Trial of Community-Based Occupational Therapy in Late Stroke Rehabilitation

Abstract Chronic participation deficits are common following stroke. We hypothesized that a brief period of occupation-focused, client-centered occupational therapy would lead to improved participation in valued activities for individuals who had experienced strokes 6 or more months previously. Sixteen individuals were randomized to the intervention or no-treatment control group. All participants identified up to five activities in which they wished to improve. Following intervention, both groups rated their performance of these activities similarly. However, those who received the intervention rated their satisfaction with these activities significantly higher than did the participants who did not receive the occupational therapy intervention. There were no differences between postintervention measures of well-being or overall participation. Further evaluation of such a program of late stroke rehabilitation is recommended.

Participation and Well-Being Poststroke: Evidence of Reciprocal Effects

OBJECTIVE To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke. DESIGN Prospective cohort study. SETTING Community. PARTICIPANTS An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income. RESULTS Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment. CONCLUSIONS Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.

Occupational performance coaching for stroke survivors: a pilot randomized controlled trial protocol.

Background. Many stroke survivors report participation challenges. Occupational Performance Coaching for stroke survivors (OPC-Stroke) is designed to assist stroke survivors to develop the ability to plan and manage engagement in occupation. This approach combines emotional support, individualized education, and goal-focused problem solving to promote occupational engagement. Purpose. This study will explore the potential efficacy of OPC-Stroke and the feasibility of the research methods for use in a larger trial. Method. A pilot randomized controlled trial will be undertaken. Participants will be randomly assigned to receive 10 sessions of OPC-Stroke or usual care. Participation, perceived goal performance, satisfaction and self-efficacy, emotional well-being, and cognition will be measured at three time points. Implications. This research will test the potential usefulness of OPC-Stroke as well as the study methods, and thereby inform the continuing development of OPC-Stroke and further studies to measure its effectiveness.

The use of coaching in occupational therapy: An integrative review

BACKGROUND/AIM Coaching has been identified as a core enablement skill of occupational therapists. Occupational therapists have begun to embrace the use of coaching as a therapeutic tool to promote client-centeredness in their practice. As the use of coaching becomes more popular it is important to examine and evaluate coaching use in occupational therapy practice to clarify what is meant by coaching and inform future research and practice in this area. METHODS An integrative literature review was conducted to examine how coaching is being used by occupational therapists, identify the similarities and differences between coaching interventions and to identify the empirical evidence for the use of coaching in occupational therapy. RESULTS The literature search resulted in 24 articles describing 11 different interventions that reported use of coaching methods by occupational therapists with various populations. Similarities among interventions included goal setting, problem solving and an educational component. Differences in the directiveness of the occupational therapist were evident. The level of research evidence for individual interventions ranges from low to moderate. CONCLUSIONS Differences are evident in the coaching theories and methods used in occupational therapy. While evidence of effectiveness of these interventions is promising, study designs used to date are vulnerable to bias and have had small sample sizes, limiting the strength of evidence. More research using clear descriptions of the coaching approach and more robust research methods is needed to better inform clinical practice.

Occupational Performance Coaching adapted for Stroke Survivors (OPC-Stroke): A Feasibility Evaluation

ABSTRACT Background: The majority of stroke survivors experience participation restrictions, that is problems with meaningful involvement in life situations. Effective interventions to promote participation following stroke are needed. Purpose: The purpose of this study was to examine the acceptability, potential effectiveness, and essential elements of Occupational Performance Coaching adapted for stroke survivors (OPC-Stroke). Methods: A case study approach was used. Four participants were recruited to receive OPC-Stroke. Outcome measures were administered pre and postintervention. Semistructured interviews were conducted postintervention to explore participants’ experiences of OPC-Stroke. Results: Two participants reported improvements in goal performance, goal satisfaction, and overall participation. Two participants appeared to have difficulty understanding the approach and withdrew from the study. Conclusion: OPC-Stroke was feasible to deliver and shows promise as an intervention for improving participation following stroke. Further research is needed to determine the effectiveness of OPC-Stroke and characteristics of stroke survivors who may benefit most from this intervention.

Occupational Performance Coaching for Stroke Survivors: A Pilot Randomized Controlled Trial

OBJECTIVE. We examined the feasibility of study procedures and explored the potential efficacy of Occupational Performance Coaching for stroke survivors (OPC–Stroke), an intervention designed to improve participation after stroke. METHOD. In this pilot randomized controlled trial, 21 participants were randomized to receive the intervention or usual care. Recruitment, retention, and outcome completion rates were calculated. Direction of change and effect sizes were examined for the outcomes of participation, goal performance and satisfaction, goal self-efficacy, emotional well-being, and cognition. RESULTS. Rates of recruitment (66%) and retention (81%) were satisfactory. Participation scores improved for both groups with different trajectories. Results showed a moderate effect of OPC–Stroke for goal performance (&eegr;2partial d = .075) and satisfaction (&eegr;2partial d = .078) and a large effect for cognition (&eegr;2partial d = .167). Other outcome measures did not change as expected. CONCLUSION. Study procedures were generally feasible. Preliminary findings support testing to examine the efficacy of OPC–Stroke.

A Review of Measures to Evaluate Participation Outcomes Post-Stroke

Background: Stroke is one of the most common disabling conditions of adulthood. Participation problems are extremely common post-stroke. Occupational therapists, by virtue of their commitment to enabling occupation, are in a strong position to help stroke survivors improve their participation. To demonstrate effectiveness, occupational therapists must be able to provide evidence of post-treatment changes in participation. Objective: The objective of this paper was to identify participation measures that have been developed for, or tested with, individuals who have experienced a stroke and to review them for use as occupational therapy outcome measures. Method: A literature review was carried out to locate relevant tools. These tools were then rated for psychometric and clinical properties that are critical for clinical outcome measurement. In addition, the theoretical fit of each evaluation with occupational therapys commitment to client-centredness was considered. Results: Ten evaluations were identified and rated. These ratings were designed to assist occupational therapists to choose a participation measure for their practice. Conclusion: Selection and use of such a measure will help occupational therapists to document its effectiveness in improving participation among stroke survivors.

Self-management support programs for persons with Parkinson’s disease: An integrative review

OBJECTIVE To identify the characteristics of self-management programs for persons with Parkinsons disease and the evidence for their effectiveness. METHODS An integrative literature review was conducted. Studies describing the provision or outcomes of self-management interventions for persons with Parkinsons disease and published in English were included. Two reviewers independently screened and evaluated articles. Interventions were described and compared, and evidence was presented using The Traffic Lighting system. RESULTS Eighteen interventions were identified, representing a variety of group- and individual-based interventions that differed in structure, components, and outcomes. Notably, 89% were designed specifically for persons with Parkinsons disease and 39% combined self-management support with other therapies. Evidence to support specific self-management programs for persons with Parkinsons disease was limited. However, a moderate quality systematic review and a good quality RCT supported self-management for improving specific domains of quality of life. CONCLUSIONS A variety of interventions have been designed to support self-management by persons with Parkinsons disease. More research is needed to identify key active ingredients and determine which programs are most effective. PRACTICE IMPLICATIONS Self-management programs embedded within rehabilitation are promising. Clinicians should ensure programs include goal setting and problem solving and consider the inclusion of caregivers and peer support.