Medicine and Health Sciences Commons^™

Multimodal Secondary Prevention Behavioral Interventions For Tia And Stroke: A Systematic Review And Meta-Analysis., Maggie Lawrence

Dr. Maggie Lawrence

Background Guidelines recommend implementation of multimodal interventions to help prevent recurrent TIA/stroke. We undertook a systematic review to assess the effectiveness of behavioral secondary prevention interventions.

Strategy Searches were conducted in 14 databases, including MEDLINE (1980-January 2014). We included randomized controlled trials (RCTs) testing multimodal interventions against usual care/modified usual care. All review processes were conducted in accordance with Cochrane guidelines.

Results Twenty-three papers reporting 20 RCTs (6,373 participants) of a range of multimodal behavioral interventions were included. Methodological quality was generally low. Meta-analyses were possible for physiological, lifestyle, psychosocial and mortality/recurrence outcomes. Note: all reported confidence intervals are 95%. …

A Systematic Review Of The Benefits Of Mindfulness-Based Interventions Following Transient Ischaemic Attack And Stroke., Maggie Lawrence, Jo Booth, Stewart Mercer

Dr. Maggie Lawrence

Background Recent epidemiological studies have demonstrated an association between perceived psychological stress and ischaemic stroke. A feature of stroke is recurrence; 30-40% within 5 years following first transient ischaemic attack/stroke. Equipping patients with skills and coping strategies to help reduce or manage perceived psychological stress, may represent an important secondary prevention intervention. Mindfulness-based Interventions are structured, group-based self-management programmes with potential to help people with long term conditions cope better with physical, psychological, or emotional distress. Review evidence suggests significant benefits of across a range of physical and mental health problems. However we could find no evidence synthesis relating specifically …

The Effectiveness Of Secondary Prevention Lifestyle Interventions Designed To Change Lifestyle Behavior Following Stroke: Summary Of A Systematic Review, Maggie Lawrence, Susan Kerr, Caroline Mcvey, John Godwin

Dr. Maggie Lawrence

Background A feature of stroke is that it recurs (25% within

five-years). Risk factors for stroke and recurrent stroke

include smoking, alcohol consumption, poor diet, and physical

inactivity.

Aim To evaluate the effectiveness of secondary prevention

lifestyle interventions designed to change lifestyle behavior

following stroke. This short paper presents a summary of the

systematic review process and findings.

Methods Ten major databases were searched using subject

headings and key words. Papers were screened using

review-specific criteria. Critical appraisal and data extraction

were conducted independently by two reviewers. Data were

pooled in statistical meta-analysis; where this was not possible

findings were …

Tobacco And Alcohol-Related Interventions For People With Mild-Moderate Intellectual Disabilities: A Systematic Review Of The Literature., Susan Kerr, Maggie Lawrence, Chris Darbyshire, Alan Middleton, Lorna Fitzsimmons

Dr. Maggie Lawrence

Background The behavioural determinants of health among people with mild/moderate intellectual disabilities are of increasing concern (ID). With the closure of long stay institutions, more people with ID are living in the community. As they lead more ordinary and less restricted lives, people with ID may be exposed to social and environmental pressures that encourage them to adopt behaviours that impact negatively on their health. Levels of smoking and alcohol consumption in this client group are of particular concern. Methods We undertook a mixed method review of the literature, aiming to assess the Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME) of …

Defining And Measuring Patient-Centred Care: An Example From A Mixed Methods Systematic Review Of The Stroke Literature., Maggie Lawrence, Sue Kinn

Dr. Maggie Lawrence

Background

Involving patients in the determination of their care is increasingly important, and healthcare professionals worldwide have recognised a need for clinical outcome measures and interventions that facilitate patient-centred care delivery in a range of settings.

Aim

A mixed-methods review was conducted, which aimed to identify stroke-specific patient-centred outcome measures, patient-centred interventions, and family-centred interventions.

Search strategy

Databases searched included MEDLINE and PsycINFO; search strings were based on MeSH terms and keywords associated with the terms ‘stroke’ and ‘patient-centred’.

Data extraction and analysis

Descriptive statistics were used to report quantitative data; papers included in the review were also underwent thematic …

Pirandello’S Analogy: A Source For A Better Understanding Of The Social Impact Of Stroke, M.A.C. Van Haaren, Maggie Lawrence, P.H. Goossens, B. Van Den Bossche, M.J.H. Wermer, A.A. Kaptein

Dr. Maggie Lawrence

Background: Suffering a stroke has major implications for the patient. To understand human suffering, one should understand society. Pirandello described society as a higher entity than the individual, thereby justifying human adaptability to society. We explore a qualitative finding that suggests that social trends may influence how stroke patients prioritize aspects of their rehabilitation. Methods: We compare a contemporary patient’s experience of stroke recovery with that of a fictional character from the works of Luigi Pirandello. Both patients had two main residual symptoms: hemiparesis and aphasia. Results: The rehabilitation priorities of the two patients differed, and appeared to reflect the …

Determining The Needs, Priorities, And Desired Rehabilitation Outcomes Of Young Adults Who Have Had A Stroke, Maggie Lawrence, Sue Kinn

Dr. Maggie Lawrence

Background: Guidelines state that young adults’ rehabilitation needs and priorities following stroke are different from older adults’. However, there is a lack of evidence regarding young adults’ perspectives of their needs and priorities.

Aims: To gain an understanding of young adults’ experience of stroke and associated rehabilitation needs, priorities and desired outcomes.

Methods: Longitudinal data were gathered using unstructured interviews and analysed using phenomenological reduction.

Results: Ten young adults took part in up to four interviews over two years. An overarching theme, Embodied Disorientation, and three sub-themes: Mortal Body, Situated Body, and Embodied Perception of Difference, described the young adults’ …

The Lisbeth Hockey Community Nursing Research Training Fellowship 2008. Final Report, Maggie Lawrence, Susan Kerr, Caroline Mcvey, Dorothy Ferguson

Dr. Maggie Lawrence

Background Stroke is the most common cause of adult disability in the UK; the incidence is particularly high in Scotland, with more than 12,000 new cases per year. Stroke recurs in approximately 25% of patients and may result in death or an increased risk of disability or institutionalisation. Stroke is associated with a disadvantaged socio-economic profile and lifestyle behaviours which include smoking, unhealthy diet, excessive alcohol consumption and lack of exercise. Crucially, these factors are amenable to change by means of pharmacotherapy and/or the delivery of lifestyle interventions. While the provision of lifestyle interventions has the potential to improve health …

Interventions For Post-Stroke Disturbances Of Mood And Emotional Behaviour: Recommendations From Sign 118, David Gillespie, Sara Joice, Maggie Lawrence, Janice Whittick

Dr. Maggie Lawrence

Stroke is a leading cause of death and disability. A high proportion of those who survive participate in programmes of rehabilitation. Clinical practice guidelines have come to play an increasingly important role in stroke rehabilitation, providing accessible summaries of the evidence for the management of specific consequences of the condition. Among the most common – and disabling – consequences of stroke are disorders of mood and emotional behaviour. This article reports the development of clinical practice recommendations for poststroke emotional disturbance for the Scottish Intercollegiate Guidelines Network (SIGN). SIGN 118 Management of Patients with Stroke: Rehabilitation, Prevention and Management of …

Exploring Older Peoples' Experiences Of Nocturia: A Poorly Recognised Urinary Condition That Limits Participation, Jo Booth, Maggie Lawrence, Kenneth O'Neill, Laura Mcmillan

Dr. Maggie Lawrence

This study sought to understand the experience of living and coping with nocturia, from the perspective of community-living older men and women. Individual semi-structured interviews were undertaken with 32 older people with self-reported nocturia of twice nightly or more. Four key characteristics of nocturia were identified. Nocturia was described as simultaneously debilitating, frustrating, distressing and puzzling. It impacted on sleep patterns and quality, personal relationships and increased the fear of falling among older people when rising to use the toilet at night. Previously unrecognised variability and unpredictability in the condition were highlighted features.

What Is The Evidence For Using Family Based Interventions To Prevent Stroke Recurrence?, Maggie Lawrence, Caroline Mcvey, Susan M. Kerr

Dr. Maggie Lawrence

Stroke has a devastating impact on individuals and families. Risk factors for recurrence include lifestyle behaviours such as smoking, excessive alcohol consumption, an unhealthy diet and physical inactivity. This article describes a programme of research that aims to gather and synthesise the evidence required to inform the development and evaluation of a family centred, behavioural intervention designed to address lifestyle risk factors for recurrent stroke. We present an overview of the research undertaken to develop the evidence base. This included a survey of stroke nurse practice, a focus group study with people who had had a stroke as well as …

Young Adults’ Experience Of Stroke: A Qualitative Review Of The Literature, Maggie Lawrence

Dr. Maggie Lawrence

Stroke is a life-threatening event that has a devastating impact on young adults and their families. The author conducted a systematic review of the qualitative literature to explore the experience of stroke from the perspective of young adults. Four primary research 'papers' were analyzed using the Qualitative Assessment and Review Instrument; 60 findings were extracted from the papers and merged into 13 categories, from which three synthesized findings were developed - disorientation, disrupted sense of self, and roles and relationships.

An Exploration Of Lifestyle Beliefs And Lifestyle Behaviour Following Stroke: Findings From A Focus Group Study Of Patients And Family Members, Maggie Lawrence, Susan M. Kerr, Hazel E. Watson, Gillian Paton, Graham Ellis

Dr. Maggie Lawrence

Stroke is a major cause of disability and family disruption and carries a high risk of recurrence. Lifestyle factors that increase the risk of recurrence include smoking, unhealthy diet, excessive alcohol consumption and physical inactivity. Guidelines recommend that secondary prevention interventions, which include the active provision of lifestyle information, should be initiated in hospital, and continued by community-based healthcare professionals (HCPs) following discharge. However, stroke patients report receiving little/no lifestyle information.

There is a limited evidence-base to guide the development and delivery of effective secondary prevention lifestyle interventions in the stroke field. This study, which was underpinned by the Theory …

A Summary Of The Guidance Relating To Four Lifestyle Risk Factors For Recurrent Stroke: Tobacco Use, Alcohol Consumption, Diet And Physical Activity, Maggie Lawrence, Susan Kerr, Hazel Watson, Jennie Jackson, Margaret Brownlee

Dr. Maggie Lawrence

Stroke is a major cause of mortality, disability and family disruption; yet prevalence continues to rise despite advances in prevention and treatment. Many risk factors for stroke are modifi able, including life style behaviours, i.e. tobacco and alcohol use, diet and physical activity. Patterns that infl uence lifestyle behaviour are believed to be embedded in family life. Primary and secondary prevention of stroke are important health promotion issues. The objective of this study was to summarize government recommendations and contemporary evidence-based guidelines regarding four lifestyle risk factors for recurrent stroke.

Stroke Research Questions: A Nursing Perspective., Anne Rowat, Maggie Lawrence, Dorothy Horsburgh, Lynne Legg, Lorraine Smith

Dr. Maggie Lawrence

No abstract provided.

Tobacco And Alcohol Use In People Who Have A Learning Disability: Giving Voice To Their Health Promotion Needs, Maggie Lawrence, Susan Kerr, Chris Darbyshire, Alan Midleton, Lorna Fitzsimmons

Dr. Maggie Lawrence

Aim The aim of the study was to explore the tobacco and alcohol-related health promotion needs of people with mild/moderate learning disabilities. Methodology & Methods The design of the study was grounded in the principles of the Medical Research Council’s Framework for the development and evaluation of complex healthcare interventions. Specifically, a developmental approach was adopted, where evidence was gathered and data collected and synthesised to inform the development of subsequent interventions. Systematic review methods were used to facilitate the gathering of evidence regarding the effectiveness of previous tobacco and alcohol-related interventions designed for people with learning disabilities (PwLD). Following …

The Dda A Necessary, But Not Sufficient Safeguard For People With Progressive Conditions In The Workplace? The Experiences Of Younger People With Parkinson’S Disease., Maggie Lawrence, Banks Pauline

Dr. Maggie Lawrence

No abstract provided.

Impact And Influences On Caregiver Outcomes At One Year Post-Stroke, Lorraine N. Smith, John Norrie, Susan M. Kerr, Maggie Lawrence, Peter Langhorne, Kennedy R. Lees

Dr. Maggie Lawrence

Four outcome measures of carer stress and coping at one year post-stroke were identified: carer general health, anxiety, depression and perception of stress. Each outcome was assessed using valid and reliable instruments. In addition, we collected demographic data from both carers and patients which could reasonably be expected to influence carer stress and coping (e.g. age, deprivation levels) as well as information specific to the caring role. Results: Carers were found to be more anxious than previously reported. Neither satisfaction with caring nor the adoption of helpful coping strategies were associated with positive carer outcomes but, nevertheless, carers were not …

Informal Carers’ Experience Of Caring For Stroke Survivors, Lorraine M. Smith, Maggie Lawrence, Susan M. Kerr, Peter Langhorne, Kennedy R. Lees

Dr. Maggie Lawrence

Stroke is the third most common cause of death in industrialized countries and a major cause of adult disability. However, the burden of caring for stroke survivors usually rests with family members who have neither chosen nor volunteered for the role of ‘carer’. This paper reports on a study which aimed to describe the experience of caring for a stroke survivor at one year after stroke in Scotland.