PhD student, Monash University
Effective strategies to moderate stroke risk factors and recovery in survivors of stroke
Stroke is a major cause of death and disability, causing a huge burden on the health care systems in many countries around the world. Many survivors of stroke have long-term physical impairments (e.g. reduced limb function and mobility, balance impairment, and fear of falling) as well as psychological disabilities (e.g. anxiety, depression, fatigue and cognitive disorder) that impact their quality of life. These may lead to reduced willingness to participate in usual life activities which result in a sedentary lifestyle, thereby further disruption to recovery and overall quality of life. In order to reduce disability, death and adverse events after stroke, effective clinical interventions are needed. Few interventions are available in the community to address these problems.
Behavioural therapies like mindfulness-based interventions (e.g. yoga and tai chi) may have the potential to address many of the problems reported by survivors of stroke, but research is still in its infancy. Therefore it is important to synthesize knowledge, and develop tools to investigate the effectiveness of a mindfulness-based intervention.
My research will also provide evidence for the development of a more cost-effective health care intervention to improve stroke recovery in multiple domains. My project is entirely focused on addressing cardiovascular disease in the area of stroke. Findings from my work will be applicable to other chronic diseases, including heart disease, since the risk factors are similar.
Abstract: Limited data exist on the long-term needs of community-dwelling stroke survivors. We aimed to describe factors associated with the extent to which needs were met in Australian survivors of stroke.Multifaceted strategies were used to obtain a national sample. Adults 12+ months poststroke and living in the community participated. Needs were assessed over the domains of health, everyday living, work, leisure, social support, and finances. Multivariable negative-binomial and logistic regression were used.Seven hundred sixty-five survivors completed surveys. Most (84%) reported having needs that were not being fully met (median 4 of 20, Q1, Q3: 1, 9). Variations occurred based on age, residential location, time since stroke, and disability level. Multivariable results showed that having fatigue, cognition or emotional problems, decreasing age, and increased disability were associated with increasing numbers of needs not being fully met (P < 0·001). Factors associated with needs not being fully met were as follows: (1) greater disability (adjusted odds ratio: 3·4, 95% confidence interval: 1·9, 6·0) and fatigue problems (adjusted odds ratio: 2·0, 95% confidence interval: 1·1, 3·4) (health domain); (2) greater disability (adjusted odds ratio: 7·0, 95% confidence interval: 3·0, 17·0) and being one to two-years poststroke (adjusted odds ratio: 3·4, 95% confidence interval: 1·5, 7·8) (work domain); and (3) increased disability (adjusted odds ratio: 3·8, 95% confidence interval: 2·2, 6·5) and memory problems (adjusted odds ratio: 2·1, 95% confidence interval: 1·0, 4·2) (leisure domain).The extent to which long-term needs were met was influenced by a variety of factors, particularly age, disability levels, and residential location. Changes need to be made to the way and extent to which survivors are supported following stroke.
Pub.: 22 Jul '14, Pinned: 08 Feb '18
Abstract: To investigate the personal experiences and perceived outcomes of a yoga programme for stroke survivors.This article reports on a preliminary study using qualitative methods to investigate the personal experiences and perceived outcomes of a yoga programme. Nine individuals who had experienced stroke were interviewed following a 10-week yoga programme involving movement, breathing and meditation practices. An interpretative phenomenological approach was used to determine meanings attached to yoga participation as well as perceptions of outcomes.Interpretative themes evolving from the data were organised around a bio-psychosocial model of health benefits from yoga. Emergent themes from the analysis included: greater sensation; feeling calmer and becoming connected. These themes respectively revealed perceived physical improvements in terms of strength, range of movement or walking ability, an improved sense of calmness and the possibility for reconnecting and accepting a different body.The study has generated original findings that suggest that from the perspective of people who have had a stroke yoga participation can provide a number of meaningful physical, psychological and social benefits and support the rationale for incorporating yoga and meditation-based practices into rehabilitation programmes.
Pub.: 23 Apr '11, Pinned: 08 Feb '18
Abstract: To assess the efficacy of yoga for motor function, mental health, and quality of life outcomes in persons with chronic poststroke hemiparesis.Twenty-two individuals participated in a randomized controlled trial involving assessment of task-orientated function, balance, mobility, depression, anxiety, and quality of life domains before and after either a 10-week yoga intervention (n = 11) or no treatment (n = 11).The yoga intervention did not result in any significant improvements in objective motor function measures, however there was a significant improvement in quality of life associated with perceived motor function (P = .0001) and improvements in perceived recovery approached significance (P = .072). Memory-related quality of life scores significantly improved after yoga intervention (P = .022), and those participating in the intervention exhibited clinically relevant decreases in state and trait anxiety.Preliminary results offer promise for yoga as an intervention to address mental health and quality of life in persons with stroke-related activity limitations. There is a need to more rigorously evaluate these yoga benefits with a larger randomized controlled trial, which, based on this preliminary trial, is feasible.
Pub.: 06 Jul '14, Pinned: 08 Feb '18
Abstract: Survivors of stroke have long-term physical and psychological consequences that impact their quality of life. Few interventions are available in the community to address these problems. Yoga, a type of mindfulness-based intervention, is shown to be effective in people with other chronic illnesses and may have the potential to address many of the problems reported by survivors of stroke.To date only narrative reviews have been published. We sought to perform, the first systematic review with meta-analyses of randomized controlled trials (RCTs) that investigated yoga for its potential benefit for chronic survivors of stroke.Ovid Medline, CINHAL plus, AMED, PubMed, PsychINFO, PeDro, Cochrane database, Sport Discuss, and Google Scholar were searched for papers published between January 1950 and August 2016. Reference lists of included papers, review articles and OpenGrey for Grey literature were also searched. We used a modified Cochrane tool to evaluate risk of bias. The methodological quality of RCTs was assessed using the GRADE approach, results were collated, and random effects meta-analyses performed where appropriate.The search yielded five eligible papers from four RCTs with small sample sizes (n = 17-47). Quality of RCTs was rated as low to moderate. Yoga is beneficial in reducing state anxiety symptoms and depression in the intervention group compared to the control group (mean differences for state anxiety 6.05, 95% CI:-0.02 to 12.12; p = 0.05 and standardized mean differences for depression: 0.50, 95% CI:-0.01 to 1.02; p = 0.05). Consistent but nonsignificant improvements were demonstrated for balance, trait anxiety, and overall quality of life.Yoga may be effective for ameliorating some of the long-term consequences of stroke. Large well-designed RCTs are needed to confirm these findings.
Pub.: 20 Jan '17, Pinned: 08 Feb '18