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      Rehabilitation Needs of Stroke Survivors After Discharge From Hospital in India

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          Abstract

          Objective

          To assess the rehabilitation needs of stroke survivors in Chennai, India, after discharge from the hospital.

          Design

          Mixed-methods research design.

          Setting

          Home-based.

          Participants

          Stroke survivors (n=50; mean age ± SD, 58.9±10.5y) and primary caregivers of these stroke survivors (n=50; mean age ± SD, 43.1±11.8y) took part in the quantitative survey. A subsample of stroke survivors (n=12), primary caregivers (n=10), and health care professionals (n=8) took part in the qualitative in-depth interviews.

          Interventions

          Not applicable.

          Main Outcome Measure

          Rehabilitation needs after hospital discharge.

          Results

          About 82% of the needs expressed by stroke survivors and 92% of the needs expressed by caregivers indicated that they had a substantial need for information. The proportion of financial needs reported by the stroke survivors and the caregivers was 70% and 75%, respectively. The qualitative data revealed major gaps in access to stroke rehabilitation services. Service providers identified availability and affordability of services as key problems. Stroke survivors and their caregivers identified lack of information about stroke as major barriers to accessibility of stroke rehabilitation services. Caregivers expressed a tremendous need for support to manage family dynamics.

          Conclusions

          The study highlights a considerable unmet need for poststroke rehabilitation services. Given the lack of rehabilitation resources in India, developing an accessible, innovative, patient-centered, culturally sensitive rehabilitation intervention is of public health importance. It is crucial for low- and middle-income countries like India to develop technology-driven stroke rehabilitation strategies to meet the growing rehabilitation needs of stroke survivors.

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          Most cited references22

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          Using the framework method for the analysis of qualitative data in multi-disciplinary health research

          Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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            Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.

            This systematic review of population-based studies of the incidence and early (21 days to 1 month) case fatality of stroke is based on studies published from 1970 to 2008. Stroke incidence (incident strokes only) and case fatality from 21 days to 1 month post-stroke were analysed by four decades of study, two country income groups (high-income countries and low to middle income countries, in accordance with the World Bank's country classification) and, when possible, by stroke pathological type: ischaemic stroke, primary intracerebral haemorrhage, and subarachnoid haemorrhage. This Review shows a divergent, statistically significant trend in stroke incidence rates over the past four decades, with a 42% decrease in stroke incidence in high-income countries and a greater than 100% increase in stroke incidence in low to middle income countries. In 2000-08, the overall stroke incidence rates in low to middle income countries have, for the first time, exceeded the level of stroke incidence seen in high-income countries, by 20%. The time to decide whether or not stroke is an issue that should be on the governmental agenda in low to middle income countries has now passed. Now is the time for action.
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              The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators.

              A World Health Organization Working Group has developed a major international collaborative study with the objective of measuring over 10 years, and in many different populations, the trends in, and determinants of, cardiovascular disease. Specifically the programme focuses on trends in event rates for validated fatal and non-fatal coronary heart attacks and strokes, and on trends in cardiovascular risk factors (blood pressure, cigarette smoking and serum cholesterol) in men and women aged 25-64 in the same defined communities. By this means it is hoped both to measure changes in cardiovascular mortality and to see how far they are explained; on the one hand by changes in incidence mediated by risk factor levels; and on the other by changes in case-fatality rates, related to medical care. Population centres need to be large and numerous; to reliably establish 10-year trends in event rates within a centre 200 or more fatal events in men per year are needed, while for the collaborative study a multiplicity of internally homogeneous centres showing differing trends will provide the best test of the hypotheses. Forty-one MONICA Collaborating Centres, using a standardized protocol, are studying 118 Reporting Units (subpopulations) with a total population aged 25-64 (both sexes) of about 15 million.
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                Author and article information

                Contributors
                Journal
                Arch Phys Med Rehabil
                Arch Phys Med Rehabil
                Archives of Physical Medicine and Rehabilitation
                W.B. Saunders
                0003-9993
                1532-821X
                1 September 2016
                September 2016
                : 97
                : 9
                : 1526-1532.e9
                Affiliations
                [a ]International Center for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
                [b ]Institute for Global Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
                [c ]T.S. Srinivasan Institute of Neurological Sciences, Voluntary Health Services Hospital, Taramani, Chennai, India
                [d ]Indian Institute of Public Health Hyderabad, Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India
                [e ]Institute of Public Health–Delhi, Institutional Area, Gurgaon, Haryana, India
                Author notes
                []Corresponding author Sureshkumar Kamalakannan, PhD, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT.Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineKeppel StLondonWC1E 7HT suresh.kumar@ 123456lshtm.ac.uk
                Article
                S0003-9993(16)00138-6
                10.1016/j.apmr.2016.02.008
                5813710
                26944710
                5f4dfac1-fe7d-409f-9e1c-700cf7965f1c
                © 2016 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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                Categories
                Article

                health services research,india,needs assessment,rehabilitation,stroke,nih, national institutes of health

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