Gunilla Eriksson

BACKGROUND Stroke is currently increasing in low-income countries and hence there is an urgent need to develop modes of stroke rehabilitation adapted to the context. Information and communication technology can potentially improve stroke rehabilitation, yet it has mostly been studied in high-income countries. The increasing usage of mobile phones in the sub-Saharan region calls for studies of the implementation and use of telerehabilitation in stroke. However, research concerning health professionals’ experience regarding implementation and use of telerehabilitation for stroke survivors is lacking. OBJECTIVE This study aims to explore health professionals’ experiences of implementing a mobile phone-supported and family-centred rehabilitation after stroke, F@ce 2.0, in Uganda. An additional objective is to describe health professionals’ views on how to further develop and optimise implementation of e-health. METHODS Data were collected in semi-structured interviews with nine health professionals participating in F@ce 2.0. The data was analysed using qualitative content analysis with an inductive approach. RESULTS The intervention was delivered according to the predetermined design. The findings revealed several facilitators and challenges in the implementation process. Three categories emerged: Bridging gaps in rehabilitation, Obstacles in the implementation process and Facilitators in the implementation. An additional independent category Improving the model and enabling sustainability emerged regarding the participants’ views regarding implementation of future e-health interventions in stroke rehabilitation. CONCLUSIONS This study indicates that mobile phone–supported telerehabilitation after stroke is feasible in a sub-Saharan context as perceived positively by health professionals. Family members play a crucial role in telerehabilitation. They may act as both facilitators and barriers, underscoring the importance of actively involving and supporting families to enhance engagement, sustainability, and rehabilitation outcomes. Health professionals in the sub-Saharan context overall appear positive to implement telerehabilitation for stroke survivors. In their opinion improved implementation of programmes such as F@ce 2.0 should include a combination of physical meetings, interdisciplinary collaboration, access to medical expertise, and reliable technical support. CLINICALTRIAL ClinicalTrials.gov NCT04337034

Background: Stroke often leads to long-term effects on daily activities and participation. Consequences impact not only stroke survivors but also their close networks, and capturing their experiences is crucial for the development of effective interventions. F@ce 2.0 is a person-centered, information and communication technology (ICT)–supported stroke rehabilitation intervention currently being evaluated. Objective: This study aims to describe family members’ experiences of the F@ce 2.0 intervention from the perspective of being a caregiver to a stroke survivor. Methods: Participants were family members (n=7) of stroke survivors participating in the intervention. Semistructured interviews were conducted at 2 time points, postintervention and 6 months postbaseline, resulting in a total of 13 interviews. Data was analyzed using qualitative inductive content analysis. Results: An overarching theme was developed from 4 categories. The main theme was the potential of F@ce 2.0 as a support for family members of stroke survivors in the sudden change of life. The categories were: dialogue and partnership with the F@ce 2.0 team, resuming daily activities lowers the demand for family support, support and involvement through the ICT component of F@ce 2.0, and engagement in F@ce 2.0, leading to suggestions for development. Conclusions: This study aligns with previous research delineating the effects of stroke on family members of stroke survivors. Participants highlighted the positive impact of the focus on daily activities within the intervention. Furthermore, the ICT component was perceived as a support in structuring rehabilitation. Participants, however, suggested further development, both in terms of content and technology.

BACKGROUND Stroke often leads to long-term effects on daily activities and participation. Consequences impact not only stroke survivors but also their close networks and capturing their experiences is vital to intervention development. F@ce 2.0 is a person-centered, ICT-supported intervention for stroke rehabilitation and is currently being evaluated. OBJECTIVE The present study aims to describe family members’ experiences of being an informal caregiver to a stroke survivor participating in F@ce 2.0. METHODS Participants were family members (n=7) of stroke survivors participating in the intervention. Semi structured interviews were performed at two time-points, post intervention and at 6 months, rendering a total of 13 interviews. Data was analyzed using qualitative inductive content analysis. RESULTS Three over-arching categories were created; A change in life roles affecting activities and relationships, The importance of receiving and giving support in a time of distress and Involvement sparked by information- and communication technology. CONCLUSIONS This study aligns with previous research delineating the effects of stroke on family members of stroke survivors. Participants highlighted the positive effects of the focus on daily activities within the intervention. Furthermore, the ICT component was perceived as a support in structuring rehabilitation. Participants did however suggest further development, both in terms of content and in terms of technology. CLINICALTRIAL NCT04351178 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2021-058748

Background: Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke. Objective: This study aims to implement F@ce 2.0, a mobile phone–supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0. Methods: A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process. Results: Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025. Conclusions: This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/60955

BACKGROUND Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke. OBJECTIVE This study aims to implement F@ce 2.0, a mobile phone–supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0. METHODS A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process. RESULTS Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025. CONCLUSIONS This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/60955

Background: It has been suggested that nursing shift‐to‐shift handover should be a more team‐based dialogue with and for the patient rather than about a patient.Aim: The aim of this study was to evaluate patient participation in relation to the implementation of the person‐centered handover (PCH).Method: A pretest–posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated‐Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference‐based participation (insufficient–fair–sufficient).Results: There were no differences regarding experience or preference‐based participation between patients at pretest–posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing one's symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing one's symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning.Linking evidence to action: Most patients want to be present at PCH. Therefore, nurses should ask for the patients' preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.

Introduction: Knowledge is missing on use of information and communication technology (ICT), for example, mobile phones/tablets in rehabilitation after stroke. F@ce 2.0 is a person-centred, interdisciplinary intervention supported by ICT. The components of F@ce 2.0 intend to increase performance in daily activities and participation in everyday life for patients with stroke and their significant others. Based on previous feasibility studies, a full-scale evaluation is planned in Sweden. The aim is to implement and evaluate F@ce 2.0, regarding performance of daily activities and participation in everyday life, in comparison with ordinary rehabilitation among persons who have had stroke and significant others. Second, to increase knowledge about how the programme leads to a potential change by studying the implementation process and mechanisms of impact. Methods and analysis: Twelve rehabilitation teams (intervention n=7; control n=5) will recruit patients (n=160) who receive rehabilitation at home after stroke and their significant others. F@ce 2.0 is an 8-week intervention where patients, together with the team, formulate three activity goals regarding what they need and want to do in daily lives. The patients will receive short messages service (SMS) each morning reminding about goals, and in the evening to rate their performance during the day. Primary outcomes for patients: self-efficacy measured by the Self-Efficacy Scale; perceived performance in daily activities measured by the Canadian Occupational Performance Measure. Significant others: perceived caregiver burden measured by Caregiver Burden Scale. Qualitative interviews with team members delivering, patients receiving intervention and significant others will explore experiences of F@ce 2.0. A process evaluation applying a case-study design using mixed methods will be conducted. Ethics and dissemination: Approved by the Swedish Ethical Review Authority, Stockholm. Knowledge will be created for using ICT for rehabilitation of people after stroke in self-selected activities. Dissemination will include peer-reviewed publications, presentations at conferences, and information to stakeholders. Trial registration number details: NCT04351178 .

Fatigue is common and can be challenging after stroke.To explore how post-stroke fatigue (PSF) was experienced and handled among people with stroke in their performance of everyday activities and i...

BACKGROUND: The ReWork-Stroke program was developed to meet the need for a person-centered rehabilitation program addressing return to work after stroke and was provided by occupational therapists (OTs). OBJECTIVE: To gain knowledge on the implementation process of the ReWork-Stroke program, the mechanisms of impact, and the contextual factors that might have affected the process. METHODS: A case study design was used. Data were collected by interviews with two ReWork-Stroke providers and their logbooks of 13 clients. Content analysis was applied. RESULTS: The ReWork-Stroke program varied in duration (12–48 weeks) and was largely implemented according to plan regarding components and how they were provided. It was mostly delivered at the workplace. Mechanisms of impact were building alliances with clients, providing intervention at the workplace, informing about stroke, assigning co-workers as tutors for clients, and collaboration between stakeholders. CONCLUSIONS: The ReWork-Stroke program can be implemented according to plan and is a flexible person-centered program in which stakeholders, coordinated by an OT, plan and take actions, mostly at the workplace, for the client’s return to work. A key factor was recognizing the current work ability after stroke. Further program development includes a more structured evaluation and technical solutions for supporting stakeholders.

Background: Stroke is increasing in Africa and consequences such as limitations in the performance of activities in everyday life persist a long time. A family member might need to care for and assist the person who has had a stroke. The life situation of these caregivers thereby changes, which could lead to increased workload and new responsibilities in caring for which they lack but request knowledge. During the F@ce rehabilitation program, the caregivers received counseling, which is uncommon in the African context. The aim of the study was twofold; (1) to investigate the perceived caregiver burden and life satisfaction and, (2) to explore and describe the life situation for caregivers to persons that have had a stroke and received the mobile phone supported rehabilitation F@ce in urban areas in Uganda. Method: A mixed method design was used. Twelve caregivers took part in a semi-structured interview regarding their everyday life situation and responded to questionnaires on caregiver burden and life satisfaction. Latent qualitative content analysis was used to analyse the interviews. Results: Five categories were identified in the caregivers’ experiences of their life situation: Feels obligated but is just a natural commitment; a tightly scheduled everyday life; being the supporting relative; the caregivers´ approach as rehabilitators; and being supported by the rehabilitation intervention. The caregivers rated relatively high on the Caregiver Burden Scale and two thirds of the sample rated their satisfaction with life as a whole as dissatisfying. Further ratings on the Life Satisfaction checklist revealed that the financial, vocational, leisure and family situations were dissatisfying. Conclusions: Even if it was viewed as a natural commitment to be a caregiver when a family member had had a stroke, the life situation changed substantially for those who took on the caregiving role. Caregiving responsibilities were challenging as well as a heavy workload and a strained financial situation as many were giving up on jobs. The participants felt burdened and rated a low life satisfaction. The F@ce intervention was, however, expressed as valued and involved support and advice in their caregiving situation as well as information on stroke which relieved stress among them.