Intervention patterns and preliminary effectiveness on Social Participation following stroke: a scoping review.

BACKGROUND: Stroke survivors suffer an overall loss of social participation. However, the interventions aiming at improving social participation have not yet been well-established. There is a need to synthesize existing knowledge on clinical interventions aiming at improving social participation among people with stroke. OBJECTIVE: To describe the patterns of intervention that have been applied to stroke survivors to improve social participation and to determine the preliminary effects of these patterns. METHODS: Eight online databases, including Cochrane Library, PubMed, Web of Science, Embase, Medline, CINAHL plus, PsycINFO, and Scoups were searched with predefined search terms from inception to September 22, 2022. References of included articles and previous reviews were also checked to identify additional studies. Two reviewers independently selected eligible studies and extracted data from the included articles. RESULTS: A total of 98 studies were included, of which only 25 studies considered social participation as primary outcome of clinical interventions. The patterns of intervention were various, consisting of exercise-based intervention, occupational therapy, self-management program, and complex intervention. Of the 25 studies, eight studies found a positive effect of relative clinical intervention on social participation for stroke survivors. Of note, the same modality of intervention such as exercise-based intervention and self-management program produced paradoxical conclusion on social participation. CONCLUSION: Exercised-based intervention, occupational therapy, self-management program, and complex intervention were important intervention modalities for the improvement of social participation among stroke survivors. Even though the preliminary effectiveness on social participation seems to be potentially positive, further high-quality researches are still required to reach a consensus to achieve optimal social participation among stroke survivors.

The effect of self-management programs on post-stroke social participation: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to identify the effectiveness of self-management programs on the improvement of social participation among stroke survivors. Data Sources: Cochrane Library, PubMed, Web of Science database, EMBASE, Medline, CINAHL plus, and APA PsycArticles were searched from their inception to December 20, 2021. METHODS: We considered randomized controlled trials and non-randomized controlled trials without language limits. Two reviewers independently screened the literature, evaluated risk of bias using the Cochrane's risk of bias tool, scored the methodological quality using criteria of the Australian Evidence-based Health Care Center, and extracted the data. The outcome was social participation. RevMan 5.3 was used, and intergroup differences were determined by calculating standardized mean difference (SMD) and 95% confidence intervals (CIs). RESULTS: Of 1894 initial studies, totally 15 studies met the eligible criteria, consisting of six randomized controlled trials and nine non-randomized controlled trials. Four randomized controlled trials showed high methodological quality and two demonstrated medium quality. The randomized controlled trials involved a total of 430 stroke survivors and were published between 2007 and 2020. The meta-analysis from five randomized controlled trials demonstrates that the overall effect of self-management programs on social participation was not statistically significant (95% CI, -0.23 to 0.40; p = 0.61). Most of the non-randomized controlled trials were pre-/post-test design with an average sample size of 15.4. The effect of self-management program on social participation in most non-randomized controlled trials was insignificant as well. CONCLUSION: The self-management programs seem not to be superior to usual care for the improvement on social participation in stroke survivors based on current evidence. Further well-designed investigation considering social participation as the primary outcome is still warranted.

Hard return: the development and transformation process of social participation in stroke survivors; a qualitative study and initial theory.

OBJECTIVES: Given the characteristic of high disability rates, the successful return of stroke patients to society is increasingly becoming a serious challenge. This study aimed developing a theory to reveal the development and transformation process of social participation among stroke survivors as a foundation for creating strategies to improve their social participation. DESIGN: A constructivist grounded theory approach using data from in-depth semi-structure interviews. SETTING: The settings were various, including the stroke follow-up clinic, rehabilitation institutions, subjects' homes, park, work unit, and rest home in Shanghai, China. SUBJECTS: In all, 36 stroke survivors who have passed through the acute phase and returned home participated in this study to share their experiences of social participation and processes of changes from September 2017 to January 2019. RESULTS: A substantive theory on the development and transformation process of social participation among stroke survivors was generated, which included four process ingredients: "in-orbit," "off-orbit," "returning orbit," and "in-orbit again." The core concept "hard return" revealed not only the tough development process but also the unsatisfactory change results. Both participation abilities and participation willingness had an important impact on social participation and also played a significant role in driving its development. CONCLUSION: This study has identified the development process of social participation in stroke survivors and "hard-return" suggests not only the tough process but also unsatisfactory results. Interventions targeted process ingredients seem to be potentially promising to improve stroke survivors' social function outcomes.

Use of mobile applications in post-stroke rehabilitation: a systematic review.

OBJECTIVE: Information technology and mobile devices are potentially beneficial and useful in the management of patients who have had stroke, including recognition, translation, assessment, and rehabilitation. The objective of this study was to determine the effectiveness of mobile applications in the rehabilitation of stroke survivors. METHODS: A literature search appraising the effectiveness of mobile applications in the rehabilitation of stroke survivors was performed on PubMed, Embase, Science Citation Index Expanded-SCIE, and EBSCO-CINAHL from their inception until May 28th, 2017. Two reviewers independently screened the literature according to eligibility criteria, evaluated study quality, and collected data from the articles included. RESULTS: Of the 3574 articles screened, 12 studies met the eligibility criteria of the systematic review. Of these, 2 studies were randomized controlled trials and the remaining 10 were before-after studies, of which only 2 had control groups. The mobile applications encompassed 5 rehabilitation areas, 5 in physical function, 4 in language function, 2 in cognitive function, and 1 risk factor reduction. Of these 12 studies, 9 reported significant improvements in function, while in 3 studies the descriptive statistics indicated favorable changes after intervention. CONCLUSIONS: Although the use of mobile applications in the rehabilitation of stroke survivors was effective, it is clear from this systematic review that more research is needed to verify their effectiveness.

Effect of co-culture with amniotic epithelial cells on biological characteristics of amniotic mesenchymal stem cells / 中国肿瘤生物治疗杂志

@# Objective: The aim of this study was to investigate the effect of co-culture with AEC (amniotic epithelial cell) on the biological characteristics of AMSC (amniotic mesenchymal stem cell), and to investigate the roles of SDF-1/CXCR4 axis in the homing and migration of AMSC. Methods: AMSC andAEC were isolated from human amnion, and then cultured, amplified and identified, respectively. TheAMSC were divided into three groups:AEC co-cultured group, serum-free cultured group and serum cultured group.After culture for 24 h, 48 h, and 72 h, the proliferation viability ofAMSC was measured by CCK-8 assay and trypan blue staining; the expression of CXCR4 mRNAwas analyzed by flow cytometry and Real-time RT-PCR, and the migration ability ofAMSC in vitro was observed by migration assay. Results: Cell viability (48 h and 72 h) and survival rate in the co-culture and serum groups were higher than those in the serum-free group (all P<0.05). The mRNA and protein expressions of CXCR4 in AMSC of the co-culture and serum-free groups were significantly higher than those of the serum group (P<0.05). The migration ability of AMSC in the co-culture and serumfree groups, which increase with the SDF-1 (stromal cell derived factor-1) concentration gradient, were higher than that in the serum group (P<0.05). Conclusion: AMSC co-cultured with AEC still have the basic biological characteristics of MSC, and showed good growth activity. Co-culture withAEC can up-regulate CXCR4 onAMSC surfaces and enhance the migration ability ofAMSC in vitro.