Patients Expectations of Recovery Following Stroke, Article Critique Example

Substantive/Theoretical Dimensions

Stroke is one of the most common causes of hospital admissions in Britain during the present day. There is a one in five chance that a patient admitted with a diagnosis of stroke will actually have had a stroke previous to this one and will most likely suffer some degree of long term disability. Most of the research to date has indicated one of the areas patients and their families are not satisfied with has to do with the services provided to those patients who are suffering from long term disability because of a major stroke or recurrent strokes. The main concern actually is indicated towards the amount of rehabilitation the patients receive post stroke, especially in the physiotherapy phase, and this study has delved further into that topic in the form of a qualitative study.

Relevance of Research Problem and Significance

As stated above, research has indicated the most negative aspect of satisfaction with the services provided to stroke victims has been with the amount of rehabilitation and the length of that rehabilitation, especially the physiotherapy aspect of rehabilitation. The significance in the problem lies in the fact that the research performed to indicate the optimal time therapy should be performed is actually quite vague and many patients have historically expressed disappointment with therapy being withdrawn just as they were beginning to feel as if they were achieving a positive breakthrough.

This qualitative study is significant in the fact it examines the actual information exchange between the physiotherapist and patient regarding the therapy provided and details as such. The study aimed to investigate factors, in addition to the actual information given by the physiotherapist that might suggest why a patient would expect a lengthier amount of rehabilitation time.

Congruence Between Research Question and Method

There is an apt congruence between the research question and aims of the study and the method used for the study. The questions and aims were geared towards patients and their families not being satisfied with the amount of physiotherapy received after suffering from a stroke. The patients felt like just as there was a breakthrough the therapy was being withdrawn and the physiotherapists, as seen in the literature review, do not have any set standardization of determining how much therapy is needed post stroke in order for patients to be mobile again.

The methodology of this study is in line with the aims because this is a qualitative study and there were interviews conducted with patients, their physiotherapists inside and outside of the hospital, as well as audio observations and visual observations of actual therapy taking place for every patient. These methods were conducted three separate times for each patient and this would signify a thorough method of testing a qualitative analysis to achieve unbiased results.

Literature Review

Regarding the length of therapy, physiotherapists always encouraged patients to envision results over a lengthier timeframe rather than immediately. The literature review, however, notes that many of the therapists examined had different ideas about how long recovery should take for a patient to achieve optimal results. The literature review showed a large gap in the timeframe of optimal recovery, being from 6 weeks to over three years. One therapist actually made the comment that no one really knew the optimal time and the literature only gave its view of a case by case analysis of what the literature saw through the studies which were performed.  This could lead to many issues, of course negatively impacting the patient and his family, because of things such as work situations and other life circumstances.

Methodological Research Design

The design of this qualitative study was an in-depth longitudinal case analysis of 16 different stroke patients and their physiotherapists inside and outside the hospital. A set of three interviews was conducted with the sample of 16 patients. A set of three interviews was conducted with the physiotherapists, both inpatient and outpatient. Also, there was an audio session and observation performed of two sessions for every patient. In addition to these things, each patient’s motor function and psychological function were tested during the interviews using the Barthel Index, Rivermead Motor Assessment, and the Hospital Anxiety and Depression Scale. It is in my professional opinion that the methodology of this study was thoroughly structured as far as ensuring patients were being tested during various times as well as therapists being tested during various times. The audio sessions and observations are also good things because it gives an unbiased view and allows the researcher something to use if there is a question about anything later that might need clarification.

Population and Sample

Participants for the study were selected from hospitals in three Trusts in the South of England. They were recruited through local hospital physiotherapists that deemed them eligible to participate completely. Inclusion criteria used for this eligibility were a valid referral for out-patient physiotherapy, first time stroke sufferers, a motor control issue with their extremities which required therapeutic assistance to achieve function, the ability to communicate and comprehend in order to understand and answer interview questions, no other underlying illnesses or conditions such as Parkinson’s Disease or Alzheimer’s, and an age under eighty years old. Approval for this study was given by the three Research Ethics Committees where the Trusts were located and all inclusive criteria pertaining to legal issues were met prior to the onset of the study.

These conditions were set in order to achieve an overall pool of candidates who were moderately healthy sans the stroke factor. It is important to note the researchers chose a smaller study because they believed they could produce the type of results with a smaller study more effectively and thoroughly than with a much larger pool of participants. Personally, this potentially could lead to some validity issues with limitations on validity as far as the small number of participants. A sample pool of at least 25 patients would have been even more ideal than 16.

Collection Data

The data collection consisted of semi-structured interviews for every patient and the physiotherapist that assisted that patient inside and outside of the hospital. The topics covered in the interviews were obtained from literature reviews as well as an observational period between the patient and therapist prior to the interview. Some of the topics included were the understanding and expectations patients had about recovery, the information they received on recovery, their beliefs about the effectiveness of physiotherapy and what they expected during the therapy.

The topics covered in the interviews with the inpatient and outpatient physiotherapists were much the same as with the patients, but were geared more specifically towards a professional standpoint. They consisted of things such as their expectations of the patient’s recovery and their perceptions of the patient’s expectations and what the patient actually understood, the patient’s motivation willingness to continue with physiotherapy, and the expected duration of physiotherapy as deemed by the therapist. These questions are well rounded, but there is a chance of misinterpretation when a therapist begins to speak about what he feels the patient is feeling or believing. That is my only issue with the topics covered in the data collection.

Confidentiality and Informed Consent

Although it is not specifically stated, one can assume that confidentiality laws would apply to this study just as they apply to any information exchange between a patient and provider. As for informed consent, this is not specifically stated, but one can also assume the patients gave consent to participate in the studies because of their willingness to participate in the three interviews as well as be present during the audio and visual recordings which took place during their therapy.

Vulnerability of the Study Subjects

Again, the study does not specifically state vulnerability of the study subjects, but one can assume the subjects are vulnerable because of their present condition. These are stroke sufferers and they are in the midst of learning new ways of using previous extremities and other parts of their bodies to perform certain functions that were normal to them prior to their illness. This would cause a vulnerability in any person and is cause to be extra cautious with any exchange of information or legal procedures as well as sensitive discussions because of the mental factors that will accompany this new found disability.

Conclusion and Implications

The implications of this study are mostly clinical in nature and revolve around the need for communication between the provider and patient in all aspects of therapy from beginning to end. The article suggests the importance of not raising the expectancy of a patient’s expectations beyond what is feasible because this begins the miscommunication process and only leads to disappointment if those expectations are not met in the timely manner in which the patient expects. It is also suggested in the study for the physiotherapist to actively encourage the patient to find realistic goals and adhere to these; take small steps towards recovery and there will most likely come a time when the patient will see larger progress being made due to these smaller goals being met.

Also, the patient should have a smoother transition between the inpatient and outpatient part of therapy. It is important for the mental health of the patient as well as for the patient’s family. Many times the outpatient treatment is not going to provide the immediate results that inpatient treatment did and the patient should be told this up front and explained the reason for this. Communication is of utmost importance throughout the entire process in order for there to be a healthy relationship and in order for expectations to remain realistic.

Presentation and Stylistic Dimensions

The presentation and style of this study was adequate, but not exceptional. It would have been nice for the aims and objectives to be more structured and for information to be presented in a more structured format. The information presented, while adequate, was vague in much of the article and this can lead to misinterpretation of data and results. Perhaps another format style could be used instead while keeping all of the information intact.

Strengths and Limitations of the Study

There are limits to a qualitative study because they normally don’t produce results that are standard for an entire population; rather, they are more typical of the demographic or geographic location in which they are conducted. This study has a strength in the fact it did identify expectations of a group of patients as well as a group of providers and the differences in those expectations. The study proved there were differences between the two. This helped to bring to light any underlying problems and allow physiotherapists the chance to correct those problems now before patient expectations are further hindered.

A large limitation to the study was the fact the patients and physiotherapists in the outpatient clinics knew they were being audio and videotaped prior to the interviews. This, of course, was necessary for consent purposes; however, it can hinder the results to a certain degree because of the nature for humans to act a certain way when they know a camera or tape recorder is recording their every word and movement. Also, the interviews behind closed doors were not taped; therefore, all information had to be relayed via transcripts and this could lead to misinterpretation of the questions or answers from either party.

While this study did expose many things that will help physiotherapists hopefully be able to deliver care more efficiently to stroke victims, there do need to be further studies conducted over various parts of the country in different demographic and geographic locations. This study is one example of the misinterpretation that can easily happen when the language of the provider and the language of the patient do not coincide. Unfortunately, that is the case the majority of the time in the medical community.

The study did meet the objectives and aims. The limits to the study were not exceptionally high and the strengths determined can be incorporated into further studies in order to provide better care to stroke sufferers across the country. Overall, the article was pleasing and insightful. It was well written and the language was easily interpreted for someone in the healthcare community. The findings are backed by explanations and the explanations are backed by suggestions for improvements that can be made to help the families of stroke sufferers over the course of the long term.

Reference

Wiles, R., Ashburn, A., Payne, S., & Murphy, C. (2002). Patients’ expectations of recovery following stroke: A qualitative study. Disability and Rehabilitation, 24(16), 841-850.