Critical Appraisal Of Stroke Rehabilitation By Caregivers

Given your aunt’s concerns, you feel concerned about her wellbeing and you want to find out if there is anything further you can do to help your Aunt. You found a research paper on the topic and now you need to critically appraise the research study.

How may a caregiver effectively support a (67 year old female) family member with her activities of daily living following a stroke?

Evaluating the study design and accurately evaluating various methods of data collection.

Stroke is a debilitating condition. Rehabilitating stroke patients after recovery is a good clinical practice. The American Heart Association (AHA) science advisory and coordinating committee showed that stroke rehabilitation is multifactorial (Winstein et al., 2016). Enhancing performance of daily activities with techniques such as ergonomics and holistic support to the patient is part of rehabilitation (Gillen, 2015). Hebert et al. (2016) supports the need for stroke rehabilitation. The progressive, dynamic and goal oriented procedure is aimed at optimizing the patient’s physical, cognitive, communicational, emotional, social and psychological aspects of life. For this to be achieved, you need a team comprising of family, health care providers and the community. Multidisciplinary approach to patient care has been shown to enhance patient satisfaction (Cohen et al., 2015)

A critical appraisal of the research paper by Ekstam, Johansson, Guidetti, Eriksson, & Ytterberg, 2015, regarding stroke rehabilitation by caregiver is provided below.

The author has enough expertise based on the cited qualifications and affiliations.  Being affiliated to centers that offer expertise in neurology, clinical research, occupational therapy, neuroscience and rehabilitative medicine, the author qualifies to conduct a study of this type. This is also justified by the author’s understanding of the topic in question, which is stroke and rehabilitation. There is no conflict of interests as shown by the article (Ekstam et al., 2015). It is also evident that the primary interest of research has not been influenced by a secondary factor like financial gain, since the funders have no involvement in data collection, analysis, study design and data interpretation. Despite the above strengths, there is ground for bias. This is due to lack of documentation for the sampling method and how the sample size was arrived at. Dobson, Woller-Skar & Green (2017) describe the importance of sampling in evaluating the study design and accurately evaluating various methods of data collection.

Part of the limitation of this study in relation to research question and study justification is that there is no evident documentation of the two respectively. Study justification is part and parcel of any study, as it explains the need for doing the research apart from enhancing professional development of the researcher (Ekstam et al., 2015). A study justification or rational of the study should also be able to provide any gaps in the field of study as a way of enhancing future studies on the topic. From the objectives and the research topic, a research question can be derived. The expected research question would be related on the type of support a care giver may offer an elderly woman recovering from stroke to continue with their daily activities. This is not the case. The study focuses on the perception of stroke patients rather than their actual needs. The study also lacks a predefined hypothesis. Ekstam et al. (2015) have not highlighted their broad and specific objectives. This distinction helps the researcher to focus better on the study and get a glimpse of all the things to be achieved.

Research Design

The research design used in this study is a mixed one. A combination of quantitative and qualitative approach to research has gained popularity with the development and perceived legitimacy for both qualitative and quantitative research (Creswell & Creswell, 2017). Using a mixed method of study design in this study expands the understanding of rehabilitation of stroke patients. A mixed design encompassing a qualitative and quantitative aspect if necessary to find out the perception of the study population. This is the appropriate research method for such a study. It contributes to a wider picture of the results of rehabilitation after stroke (Ekstam et al., 2015). As part of the strength of the study, the dyadic perspective ads incite on the significance of social environment and systematic approach towards rehabilitation. The study area is of a good choice. It is easier to conduct such a study in relation with hospitals and relatives since the hospital data provides accurate information regarding the subject.

Sampling is an important part of research. Dobson et al. (2017) retaliates the importance of sampling to ensure accuracy of information and determines the preferred study design. In this study, sampling techniques for arriving at the homes for conducting the study has not been shown in the report. The population size has also not been calculated by evidence based formula. The two miss outs open a ground for bias in the results, especially in the quantitative aspect. Doing a follow up on the patients at their homes after being discharged from the hospital is a strength in the research. This prevents loss of trace to data.

The study participants were of good age group but the number had not been justified on how it was arrived at. There is a good distribution between the genders of participants. However, more data from the subjects should have been obtained. For instance, it is important to know about the subject’s underlying conditions and risk factors for the stroke. This will influence the rehabilitation outcome. Various types of questionnaires exist for various types of research designs. Choice of questionnaire to use is determined by the objectives of the study (Rowley, 2014). The choice of using open end questionnaires did not provide a good ground of comparison. This is because answers from the stroke patients and their care givers were analyzed differently thus giving a good correlation between the two. Closed ended questionnaires provide an in-depth analysis of the topic being investigated. 

Strengths and Limitations

Data analysis was well done by the researchers. Anova test and Mann Whiney U test done by the authors (Ekstam et al., 2015) analyses this type of data appropriately. The team further reads through the data thoroughly, codes and group it in the desired manner. The authors then summarize the data based on categories and discuss it, then gives conclusions. Apart from this, a comparison between the quantitative and qualitative findings is made and aggregation of the data done. Coding help in improving data reliability (Krippendorff & Craggs, 2016). Analyzing data is important in structuring the findings from different data sources, breaking macro problems into smaller parts, keeping human bias away from research and providing meaningful insights out of huge data sets. This helps in reaching a certain conclusion for a given topic of research. Part of the study’s strength is the thorough data analysis, a collective process done by both authors.

The results and conclusion of the study does not answer the expected research question of how caregivers can support a family member with their daily activities as part of stroke rehabilitation. However, according to the author’s topic of study, there is a positive outcome when rehabilitation needs of stroke patients are met. These include less burden to care giver, ability to cope with daily activities and less severe types of stroke.

Conclusion

Evidenced based practice (EBP) is key in ensuring proper outcome at work. It involves integrating best research evidence with clinical expertise. (Scurlock-Evans, Upton & Upton, 2014). There has been patchy uptake and use of EBP despite its numerous benefits.  EBP is faced by a number of barriers, the most common being workload and time pressures (Scurlock-Evans et al, 2014). Others include lack of evidence in research as reading through literature is difficult for some people, negative perception towards research, inadequate knowledge, skills and preparations. Ambivalence towards membership of a certain group is also a contributing factor.

Adopting a sustainable EBP by professionals of different cadre will clear the concerns over the compatibility of its research aspects in correlation with inadequate justifications to clinical research.

References

Cohen, D. J., Balasubramanian, B. A., Davis, M., Hall, J., Gunn, R., Stange, K. C. ... & Clark, K. (2015). Understanding care integration from the ground up: Five organizing constructs that shape integrated practices. The Journal of the American Board of Family Medicine, 28(Supplement 1), S7-S20.

Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.

Dobson, C., Woller-Skar, M. M., & Green, J. (2017). An inquiry-based activity to show the importance of sample size and random sampling. Science Scope, 40(8), 76.

Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined
perceptions of people with stroke and their carers regarding rehabilitation needs 1
year after stroke: A mixed methods study. British Medical Journal, 5(2), 1?7.

Gillen, G. (2015). Stroke rehabilitation: a function-based approach. Elsevier Health Sciences.

Hebert, D., Lindsay, M. P., McIntyre, A., Kirton, A., Rumney, P. G., Bagg, S., ... & Glasser, E. (2016). Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. International Journal of Stroke, 11(4), 459-484.

Krippendorff, K., & Craggs, R. (2016). The reliability of multi-valued coding of data. Communication Methods and Measures, 10(4), 181-198.

Rowley, J. (2014). Designing and using research questionnaires. Management Research Review, 37(3), 308-330.

Scurlock-Evans, L., Upton, P., & Upton, D. (2014). Evidence-based practice in physiotherapy: a systematic review of barriers, enablers and interventions. Physiotherapy, 100(3), 208-219.

Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., ... & Lang, C. E. (2016). Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), e98-e169.