Cycling using functional electrical stimulation therapy to improve motor function and activity in post-stroke individuals in early subacute phase: a systematic review with meta-analysis.

BACKGROUND: Stroke necessitates interventions to rehabilitate individuals with disabilities, and the application of functional electrical stimulation therapy (FEST) has demonstrated potential in this regard. This study aimed to analyze the efficacy and effectiveness of cycling using FEST to improve motor function and lower limb activity in post-stroke individuals. METHODS: We performed a systematic review according to the recommendations of the PRISMA checklist, searching MEDLINE, Cochrane, EMBASE, LILACS, and PEDro databases by July 2022, without any date or language limitations. Studies were selected using the following terms: stroke, electrical stimulation therapy, cycling, and clinical trials. Randomized or quasi-randomized clinical trials that investigated the effectiveness of cycling using FEST combined with exercise programs and cycling using FEST alone for motor function and activity in subacute post-stroke individuals were included. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from eligible studies and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Five randomized clinical trials involving 187 participants were included. Moderate-quality evidence indicates that cycling using FEST combined with exercise programs promotes relevant benefits in trunk control (MD 9 points, 95% CI 0.36-17.64) and walking distance (MD 94.84 m, 95% CI 39.63-150.05, I = 0%), the other outcomes had similar benefits. Cycling using FEST alone compared to exercise programs promotes similar benefits in strength, balance, walking speed, walking distance, and activities of daily living. CONCLUSION: This systematic review provides low- to moderate-quality evidence that cycling using FEST may be an effective strategy to consider in improving motor function and activity outcomes for post-stroke individuals in the early subacute phase. REVIEW REGISTRATION: PROSPERO (CRD42022345282).

General and comparative self-rated health in chronic stroke: an important outcome measure for health professionals.

BACKGROUND: After a stroke, several aspects of health and function may influence how individuals perceive their own health. However, self-rated health (SRH), as well as its relationship with functioning, has been little explored in individuals with stroke. The aims of this study were to determine how individuals with chronic post-stroke disabilities evaluate their health, considering general, time- and age-comparative SRH questions and to investigate whether SRH measures would be influenced by the following health and functioning domains: mental/physical functions and personal factors. METHODS: Sixty-nine individuals with chronic post-stroke disabilities answered the three types of SRH questions and were assessed regarding depressive symptoms (emotional function domain), physical activity levels (physical function domain), and engagement in physical activity practice (personal factor domain). Subjects were divided into the following groups: good/poor for the general SRH question; better, similar, and "worse" for both time- and age-comparative questions. Between-group differences in the three domains for each SRH question were investigated (α = 5%). RESULTS: General SRH was rated as good by 73% of the participants. Time- and age-comparative SRH was rated as better by 36% and 47% and as similar by 31% and 28% of the subjects, respectively. Significant between-group differences in emotional function were found for both the general and age-comparative questions. For the time-comparative question, significant differences were only observed for physical function. CONCLUSION: SRH evaluation differed in individuals with chronic post-stroke disabilities according to the types of questions and health/functioning domains.

Self-rated health after stroke: a systematic review of the literature.

BACKGROUND: Self-rated health (SRH) allows for comparison and identification of the health status of various populations. The aim of this study was to conduct a systematic review of the literature to expand the understanding of SRH after stroke. METHODS: This systematic review was registered with PROSPERO (CRD42017056194) and conducted according to PRISMA guidelines. Studies published until December 2018 that evaluated the SRH of adults with stroke were included. RESULTS: Of the 2132 identified studies, 51 were included. Only four studies had experimental designs (7.8%). In 60.7% of the studies, SRH was assessed by variations on direct questions (i.e., general and comparative SRH). Analog visual scales and quality of life instruments were also used to evaluate SRH, but there is no consensus regarding whether they are appropriate for this purpose. The results of cross-sectional and longitudinal studies revealed significant associations between poor SRH and stroke as well as between SRH, function, and disability. The power of SRH to predict stroke mortality is still uncertain. Two interventions (a home-based psychoeducational program concerning stroke health care and family involvement in functional rehabilitation) effectively improved SRH. CONCLUSIONS: Direct questions are the most common method of evaluating SRH after stroke. Studies reported significant associations between the SRH of individuals with stroke and several relevant health outcomes. However, few experimental studies have evaluated SRH after stroke. Interventions involving health education and family involvement had a significant impact on SRH.

Application of the participatory design in the testing of a baropodometric insole prototype for weight-bearing asymmetry after a stroke: A qualitative study.

Introduction: Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design. Methods: We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing. Results: Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype. Conclusions: The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry.

Self-rated health determinants in post-stroke individuals.

OBJECTIVE: To investigate whether variables of function and disability, which have potential to be modified by rehabilitation, are determinants of self-rated health in post-stroke individuals in the chronic phase. DESIGN: Cross-sectional exploratory study. METHODS: The dependent variable was self-rated health. The independent variables were organized according to the International Classification of Functioning, Disability and Health components: body structure and function (emotional function and motor recovery level), activity (manual and locomotion skill), and participation (participation). Logistic regression analysis was performed to identify significant associations between the independent variables and self-rated health (?=5%). RESULTS: Sixty-three individuals were included in the study: 44 (70%) rated their own health as good (excellent/very good/good) and 19 (30%) as poor (fair/poor). Significant association with self-rated health was identified only for emotional function. Individuals with impaired emotional function were 6.6 times more likely to assess their own health as poor (odds ratio (OR) 6.56; 95% confidence interval (95% CI) 1.5328.21). CONCLUSION: Emotional function was found to be a determinant of self-rated health in post-stroke individuals in the chronic phase and, therefore, must be assessed carefully in order to help provide integral healthcare and improve clinical decision-making. Future studies should investigate whether enhancing emotional function is associated with improvements in self-rated health in post-stroke individuals.

Access to telehealth by stroke patients: which are the main barriers and how they are explained by the UTAUT theoretical model? A systematic review / Acceso de los pacientes con ACV a la telesalud: ¿cuáles son las principales barreras y cómo se explican desde el modelo teórico UTAUT? Una revisión sistemática / Acesso de pacientes com AVC à telessaúde: quais são as principais barreiras e como são explicadas pelo modelo teórico UTAUT? Uma revisão sistemática

ABSTRACT Stroke is a chronic health condition that requires monitoring. In this sense, telehealth emerges as a tool to enable better access. However, since it is related to use of technology, this modality might face new barriers. Our goal was to identify, with a systematic literature review, the perceived barriers to telehealth access by stroke patients and conceptualize them within the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The systematic review was carried out in the following electronic databases: PubMed, MEDLINE, SciELO, LILACS, and PEDro; and the combination of descriptors were: "Barriers to Access to Health Care," "Telerehabilitation," "Telehealth," "Stroke," and "Physical Therapy Modalities." The included studies focused on telehealth barriers perceived by stroke patients. Initially, 298 articles were found, 295 via databases search, and three via active search; of these, only six articles were included in this review. Overall, the articles revealed the perception of more than 220 stroke patients, with barriers categorized into eight types, most of them related to the dimensions of Effort Expectancy and Facilitating Conditions of the UTAUT model. The barriers of the Effort Expectation dimension that are related to the knowledge in the use of technologies are likely to be overcome since training can be carried out before the telehealth service. However, the barriers related to the Facilitating Conditions dimension regarding financial aspects, the internet, and home context are difficult to overcome, possibly interfering with user's acceptance of telehealth.

RESUMEN El accidente cerebrovascular (ACV) como una condición de salud requiere de monitoreo. En este contexto, la telesalud emerge como una posibilidad que permite un mejor acceso a los servicios de salud. Sin embargo, dado que esta modalidad está relacionada con el uso de la tecnología, se pueden surgir nuevas barreras. El objetivo de esta investigación fue identificar, mediante una revisión sistemática de la literatura, las barreras percibidas por los pacientes con ACV con respecto al acceso a la telesalud y conceptualizarlas dentro del modelo de la Teoría Unificada de Aceptación y Uso de la Tecnología (UTAUT). La revisión sistemática se realizó en las siguientes bases de datos electrónicas: PubMed, MEDLINE, SciELO, LILACS y PEDro; a partir de la combinación de los descriptores "barreras de acceso a la atención médica", "telerrehabilitación", "telesalud", "accidente cerebrovascular" y "modalidades de fisioterapia". Inicialmente, se encontraron 298 artículos, de los cuales se obtuvieron 295 mediante la búsqueda en la base de datos y tres por la búsqueda activa; de estos, solo seis artículos se incluyeron en la revisión. Los artículos revelaron la percepción de más de 220 sujetos que sufrieron ACV y ocho tipos de barreras; la mayoría de ellas relacionadas con las dimensiones Expectativa de Esfuerzo y Condiciones Facilitadoras del modelo UTAUT. Las barreras de la dimensión Expectativa de Esfuerzo, relacionadas con el conocimiento en el uso de tecnologías, se pueden superar mediante una capacitación previa antes de utilizar la telesalud. Sin embargo, las barreras asociadas con la dimensión de las Condiciones Facilitadoras respecto a los aspectos financieros, de Internet y el contexto del hogar son difíciles de superar y, por lo tanto, pueden interferir en la aceptación del uso de la telesalud por parte del usuario.

RESUMO O acidente vascular cerebral (AVC), como condição crônica de saúde, requer monitoramento. Nesse sentido, a telessaúde surge com o objetivo de possibilitar um melhor acesso aos serviços de saúde. Porém, por estar relacionada ao uso de tecnologia, essa modalidade pode enfrentar novas barreiras. O objetivo desta pesquisa foi identificar, por meio de uma revisão sistemática da literatura, as barreiras percebidas por pacientes com AVC quanto ao acesso à telessaúde e conceituá-las dentro do modelo da Teoria Unificada de Aceitação e Uso de Tecnologia (UTAUT). A revisão sistemática foi realizada nas seguintes bases de dados eletrônicas: PubMed, MEDLINE, SciELO, LILACS e PEDro; por meio da combinação dos descritores "barreiras de acesso aos cuidados de saúde", "telerreabilitação", "telessaúde", "acidente vascular cerebral" e "modalidades de fisioterapia". Inicialmente, foram encontrados 298 artigos, sendo 295 por meio da busca em bases de dados e três por meio de busca ativa, e, destes, apenas seis artigos foram incluídos na revisão. Somados, os artigos revelaram a percepção de mais de 220 indivíduos que sofreram AVC e oito tipos de barreiras, a maioria delas relacionadas às dimensões de Expectativa de Esforço e Condições Facilitadoras do modelo UTAUT. As barreiras da dimensão Expectativa de Esforço relacionadas ao conhecimento no uso de tecnologias são passíveis de serem superadas, pois treinamentos podem ser realizados previamente ao serviço de telessaúde. No entanto, as barreiras relacionadas à dimensão das Condições Facilitadoras no que se refere a aspectos financeiros, internet e contexto domiciliar são difíceis de superar, podendo, portanto, interferir na aceitação do usuário quanto ao uso da telessaúde.

O estágio extracurricular na formação profissional: a opinião dos estudantes de fisioterapia / The academic training for the professional education: the opinion of the Physiotherapy students

Investigar a opinião dos estudantes de Fisioterapia em relação ao estágio extracurricular e a influência dessa prática para sua formação profissional. Realizou-se um estudo transversal com alunos de Fisioterapia de uma instituição de ensino superior do estado do Ceará, Brasil. A amostra foi composta de 157 estudantes, sendo 29 homens (18,5%) e 128 mulheres (81,5%), com média de idade 22,6±4,02 anos, do segundo ao último semestre da graduação. Aplicou-se um questionário com 20 questões objetivas abordando a vivência e repercussões dessa prática. Do total de alunos pesquisados, 61 (38,9%) afirmaram ter participado de estágio extracurricular. Desses, 55 (90,2%) foram motivados pela necessidade de adquirir experiência; 53 (86,9%) realizaram intervenções nos pacientes; e 13 (21,3%) com carga horária de 15 a 20 horas/semanais. Porém, 36 acadêmicos (59,0%) o fizeram em desacordo com as normas do Conselho Federal de Fisioterapia e Terapia Ocupacional. Os acadêmicos consideraram que o estágio extracurricular foi uma ferramenta de aprimoramento para sua formação profissional, pois propiciou o exercício de procedimentos e técnicas mais comuns da atuação do fisioterapeuta. Entretanto, alerta-se para a necessidade de fiscalização dos órgãos competentes, para que o aluno exerça funções compatíveis com o seu nível de qualificação.

This study aimed to investigate the opinion of the Physiotherapy students on the extracurricular internship and the influence of this practice on their professional formation. A cross-sectional study was performed with Physical Therapy students from a higher education institution in Ceará, Brazil. The sample consisted of 157 students, 29 men (18.5%) and 128 women (81.5%), with mean age of 22.6±4.02 years, from second to last semester of graduation. A questionnaire was applied with 20 objective questions covering the experiences and repercussions of this practice. A total of 61 (38.9%) surveyed students affirmed to have participated of extracurricular internship. Out of these, 55 (90.2%) were motivated by the necessity of acquiring experience; 53 (86.9%) were performing therapeutic interventions in patients; and 13 (21.3%) had 15 to 20 working hours. However, 36 academics (59.0%) did work in disagreement with the rules of the Federal Council of Physical Therapy and Occupational Therapy. The students considered the extracurricular internship as a tool of improvement of their professional formation, because it allowed the practice of common physical therapist daily life activities procedures and techniques. There is a necessity for competent organizations to inspect these kind of activities, so that the students can practice tasks accordingly their qualification level.