Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by th...

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

Nursing Research—Principles and Methods

Background: As Internet use grows, health interventions are increasingly being delivered online. Pioneering researchers are using the networking potential of the Internet, and several of them have evaluated these interventions. Objective: The objective was to review the reasons why health interventions have been delivered on the Internet and to reflect on the work of the pioneers in this field in order to inform future research. Methods: We conducted a qualitative systematic review of peer-reviewed evaluations of health interventions delivered to a known client/patient group using networked features of the Internet. Papers were reviewed for the reasons given for using the Internet, and these reasons were categorized. Results: We included studies evaluating 28 interventions plus 9 interventions that were evaluated in pilot studies. The interventions were aimed at a range of health conditions. Reasons for Internet delivery included low cost and resource implications due to the nature of the technology; reducing cost and increasing convenience for users; reduction of health service costs; overcoming isolation of users; the need for timely information; stigma reduction; and increased user and supplier control of the intervention. A small number of studies gave the existence of Internet interventions as the only reason for undertaking an evaluation of this mode of delivery. Conclusions: One must remain alert for the unintended effects of Internet delivery of health interventions due to the potential for reinforcing the problems that the intervention was designed to help. Internet delivery overcomes isolation of time, mobility, and geography, but it may not be a substitute for face-to-face contact. Future evaluations need to incorporate the evaluation of cost, not only to the health service but also to users and their social networks. When researchers report the outcomes of Internet-delivered health care interventions, it is important that they clearly state why they chose to use the Internet, preferably backing up their decision with theoretical models and exploratory work. Evaluation of the effectiveness of a health care intervention delivered by the Internet needs to include comparison with more traditional modes of delivery to answer the following question: What are the added benefits or disadvantages of Internet use that are particular to this mode of delivery? © Griffiths, Frances, Lindenmeyer, Antje, Powell, John, Thorogood, Margaret.

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Why Are Health Care Interventions Delivered Over the Internet? A Systematic Review of the Published Literature

i n c y h h i t i a R Last month, Alzheimer’s & Dementia: The Journal of the lzheimer’s Association received acceptance for inclusion n MEDLINE, the bibliographic database of the U.S. Naional Library of Medicine (NLM). Three years since the aunch, this achievement marks an important recognition of he Journal’s scientific merit and contribution to the field of lzheimer’s disease research. The editors, our publishing artners from Elsevier, and our sponsoring colleagues from he Alzheimer’s Association are extremely thankful to the uthors, reviewers, Editorial Board members, and readers or their many valuable contributions. As the official journal of the Alzheimer’s Association, lzheimer’s & Dementia will now be circulated to the active embers of the Association’s new International Society to dvance Alzheimer Research and Treatment (ISTAART) imonthly, as well as other subscribers and libraries. The ournal will continue to cover critical scientific, medical, ocial, and policy issues that investigators and clinicians ace every day, on matters concerning healthy brain aging to ll forms of dementia. Unlike other journals in the field, lzheimer’s & Dementia bridges new thinking across dierse areas of investigation. This interdisciplinary journal rovides the impetus for new scientific initiatives and offers

Alzheimer's & Dementia: the Journal of the Alzheimer's Association.

BACKGROUND: Interactive Health Communication Applications (IHCAs) are computer-based, usually web-based health information packages for patients that combine information with at least one of social support, decision support, or behaviour change support. These are innovations in health care and their effects on health are uncertain. OBJECTIVES: To assess the effects of IHCAs for people with chronic disease. SEARCH STRATEGY: We designed a four-part search strategy. First, we searched electronic bibliographic databases for published work; second, we searched the grey literature and third, we searched for ongoing and recently completed clinical trials in the appropriate databases. Finally, researchers of included studies were contacted, and reference lists from relevant primary and review articles were followed up. As IHCAs require relatively new technology, the search commenced at 1990 where possible. SELECTION CRITERIA: Randomised controlled trials (RCTs) of Interactive Health Communication Applications for adults and children with chronic disease. DATA COLLECTION AND ANALYSIS: One reviewer screened abstracts. Two reviewers screened all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using a random effects model and standardised mean differences (SMDs) were calculated to provide net effect sizes. MAIN RESULTS: We screened 24,757 unique citations and retrieved 958 papers for further assessment, yielding 28 RCTs involving 4042 participants. One of these had an inadequate method of concealment of allocation, and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses. Results in the abstract are from the meta-analyses excluding data from this study.IHCAs were found to have a positive effect on knowledge (SMD 0.49; 95% confidence interval (CI) 0.14 to 0.84) and on social support (SMD 0.47; 95% CI 0.28 to 0.66). IHCAs were found to have no effect on self-efficacy (SMD 0.15; 95% CI -0.13 to 0.43) or behavioural outcomes (SMD -0.09; 95% CI -0.49 to 0.32). IHCAs had a negative effect on clinical outcomes (SMD -0.32; 95% CI -0.63 to -0.02). REVIEWERS' CONCLUSIONS: The number and range of IHCAs is increasing rapidly; however there is a shortage of high quality evaluative data. Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful. However, consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present. Further research is needed to determine the reason for this negative effect on clinical outcomes, whether an optimal IHCA can achieve behaviour change and improved health outcomes, and if so, what are the essential features of such an IHCA, and the extent to which they differ according to patient group or condition.

Interactive Health Communication Applications for people with chronic disease

Purpose. We hypothesised that carers of stroke survivors who participate in the Web-based intervention, Caring∼Web©, would have higher well-being than non-Web users. We also postulated that those survivors whose carers participated in Caring∼Web would use fewer healthcare services.Method. A randomised, two-group, repeated measures design was used. Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states. Of 144 carers screened, 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group. Seventy-three subjects completed the study.Intervention. Caring∼Web was a Web-based intervention of education and support provided to the Web user group for 1 year. A bi-monthly telephone survey collected data on all carers well-being (perceived depression, life satisfaction) and survivors healthcare service use (self-reported provider and emergency department visits, hospital re-admissions...

The effect of a web-based stroke intervention on carers' well-being and survivors' use of healthcare services

The purpose of this pilot study was to test the feasibility of providing Internet-based education and support intervention to caregivers living in rural settings, including caregivers' satisfaction with the intervention. A secondary aim was to explore their experience of caring. Nine adult caregivers of persons with stroke were enrolled in this descriptive study from rehabilitation centers in northwestern Ohio and southeastern Michigan. They were given access to the intervention, Caring-Web, for three months. Data were collected from participants' bimonthly interviews, as well as e-mail communications. Procedures were tested and found valid, and caregivers were willing and able to use Caring-Web. Using Friedemann's framework of systemic organization, a coding system was developed for analyzing the qualitative data on the experience of caring. Five main themes emerged from these data. These findings help expand knowledge about caregivers dealing with stroke.

Internet-based support for rural caregivers of persons with stroke shows promise.

Purpose: This descriptive study examined problems and successes that a sample of 73 adult caregivers new to the role expressed in the first year of caring for stroke survivors. Data were collected from May 2002 to December 2005. Method: Bimonthly, trained telephone interviewers asked the participants open-ended questions to elicit their experience in caregiving. Guided by Friedemann’s framework of systemic organization, we analyzed the data using Colaizzi’s method of content analysis. Results: There were 2,455 problems and 2,687 successes reported. Three themes emerged from the problems: being frustrated in day-to-day situations (system maintenance in Friedemann’s terms), feeling inadequate and turning to others for help (coherence), and struggling and looking for “normal” in caring (system maintenance vs. change). Three themes were attributed to the successes: making it through and striving for independence (system maintenance), doing things together and seeing accomplishments in the other (coher...

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Two Sides to the Caregiving Story

Guided by Orem's self-care deficit nursing theory, the purpose of this descriptive comparative study was to examine the emotional support, physical help, and health of caregivers of stroke survivors. Seventy-three caregivers from the Midwest participated in a parent study that examined their experience of caring during the first 12 months after stroke. Caregivers were randomized to an online intervention of support and education (n = 36 Web users) or a control group (n = 37 non-Web users). A secondary analysis of data collected during telephone interviews at baseline, 3, 6, and 12 months after stroke was performed. No significant mean differences were found between Web and non-Web users in the above variables at these points in time. Consequently, the caregivers were merged into one group, and the relationships among the variables at the different points in time were analyzed. Significant, moderately positive relationships were found between emotional support and physical help at baseline, 3, and 12 months. There were also significant, moderately positive relationships between emotional support and caregiver health at 6 and 12 months. Results highlight the importance of caregivers (dependent care agents in Orem's terms) establishing an adequate self-care system that provides emotional support and physical help. Findings also denote the need for nurses (as caring agents) to assess caregiver health later in the caring process and be aware of its relationship to emotional support.

Emotional Support, Physical Help, and Health of Caregivers of Stroke Survivors

The primary aim of this feasibility study was to determine if caregivers (n = 5) were willing and able to use Caring-Web, a Web-based intervention for support, from their home Internet connection for 3 months. The caregivers' perceived health and satisfaction with caring, as well as the care recipients' use of healthcare services, were recorded. The experience of caring (problems and successes) was examined. Data were collected via weekly online surveys and e-mail discussions. Descriptive analyses revealed that the 3 caregivers who completed the study were satisfied with Caring-Web. Caregivers rated their health as average to excellent and their satisfaction with caring as good. Care recipients averaged 6 calls/visits to a medical office with one emergency room visit and subsequent hospitalization. Major problems for the caregivers included dealing with medical conditions about which they lacked knowledge. Content analysis of the e-mail discussions revealed that subjects sought information about medical conditions related to caring for the survivor of the stroke. Major successes for the caregivers involved communicating effectively with the care recipient and returning to everyday life with family and friends.

Victoria Steiner

Papers

The effect of a web-based stroke intervention on carers' well-being and survivors' use of healthcare services

Internet-based support for rural caregivers of persons with stroke shows promise.

Two Sides to the Caregiving Story

Emotional Support, Physical Help, and Health of Caregivers of Stroke Survivors

In-home online support for caregivers of survivors of stroke: a feasibility study.