'Physical well-being is our top priority': Healthcare professionals' challenges in supporting psychosocial well-being in stroke services.

BACKGROUND: Following stroke, a sense of well-being is critical for quality of life. However, people living with stroke, and health professionals, suggest that well-being is not sufficiently addressed within stroke services, contributing to persistent unmet needs. Knowing that systems and structures shape clinical practice, this study sought to understand how health professionals address well-being, and to examine how the practice context influences care practice. METHODS: Underpinned by Interpretive Description methodology, we interviewed 28 health professionals across multiple disciplines working in stroke services (acute and rehabilitation) throughout New Zealand. Data were analysed using applied tension analysis. RESULTS: Health professionals are managing multiple lines of work in stroke care: biomedical work of investigation, intervention and prevention; clinical work of assessment, monitoring and treatment; and moving people through service. While participants reported working to support well-being, this could be deprioritised amidst the time-oriented pressures of the other lines of work that were privileged within services, rendering it unsupported and invisible. CONCLUSION: Stroke care is shaped by biomedical and organisational imperatives that privilege physical recovery and patient throughput. Health professionals are not provided with the knowledge, skills, time or culture of care that enable them to privilege well-being within their work. This has implications for the well-being of people with stroke, and the well-being of health professionals. In making these discourses and culture visible, and tracing how these impact on clinical practice, we hope to provide insight into why well-being work remains other to the 'core' work of stroke, and what needs to be considered if stroke services are to better support people's well-being. PATIENT OR PUBLIC CONTRIBUTIONS: People with stroke, family members and people who provide support to people with stroke, and health professionals set priorities for this research. They advised on study conduct and have provided feedback on wider findings from the research.

Psychosocial well-being after stroke in Aotearoa New Zealand: a qualitative metasynthesis.

PURPOSE: Psychosocial well-being is key to living well after stroke, but often significantly affected by stroke. Existing understandings consider well-being comes from positive mood, social relationships, self-identity and engagement in meaningful activities. However, these understandings are socioculturally located and not necessarily universally applicable. This qualitative metasynthesis examined how people experience well-being after a stroke in Aotearoa New Zealand. MATERIAL AND METHODS: This metasynthesis was underpinned by He Awa Whiria (Braided Rivers), a model which prompts researchers to uniquely engage with Maori and non-Maori knowledges. A systematic search identified 18 articles exploring experiences of people with stroke in Aotearoa. Articles were analysed using reflexive thematic analysis. RESULTS: We constructed three themes which reflect experiences of well-being: connection within a constellation of relationships, being grounded in one's enduring and evolving identities, and being at-home in the present whilst (re)visioning the future. CONCLUSION: Well-being is multi-faceted. In Aotearoa, it is inherently collective while also deeply personal. Well-being is collectively achieved through connections with self, others, community and culture, and embedded within personal and collective temporal worlds. These rich understandings of well-being can open up different considerations of how well-being is supported by and within stroke services.

Psychosocial well-being is critical for people living with stroke.Well-being should be a priority in rehabilitation, however people with stroke indicate they do no consistently receive psychosocial support.It is clear that well-being has strong cultural elements, and understanding what supports well-being in individuals, whanau (those within wider networks who the person with stroke considers important), and wider cultural groups is important.Supporting whanau is crucial as whanau are core to well-being both during and beyond rehabilitation, and their own well-being is impacted by stroke.

The Physical Activity and Disability Survey (PADS): reliability, validity and acceptability in people with multiple sclerosis.

OBJECTIVE: To explore the test-retest reliability and construct validity of the standardized Physical Activity and Disability Survey (PADS) and its acceptability to people with multiple sclerosis. DESIGN: Participants completed the PADS twice with seven days between repeated measures, while also wearing an Actical accelerometer. Semi-structured interview questions were used to explore the acceptability of the PADS. SUBJECTS: Thirty participants were recruited from the Multiple Sclerosis Society of Auckland, New Zealand. Mean age of participants was 54 years (range 27-76). MAIN MEASURES: Physical Activity and Disability Survey (PADS) and Actical accelerometer. RESULTS: A wide range of standardized PADS scores were recorded at each time-point (ranges 6.7-83.3 and 6.7-87.4). While standardized PADS scores between time-points had a high intraclass correlation coefficient of 0.92 (95% confidence interval (CI) 0.88, 0.98), Bland-Altman 95% limits of agreement (-17.4, 17.4) were modest. Accelerometer activity counts were not accurately predicted by standardized PADS scores (wide 95% prediction intervals). Participants reported the PADS was easy to understand and complete, enabling them to give an accurate picture of their physical activity. CONCLUSIONS: The PADS appears to be a potentially appropriate measure of activity for people with multiple sclerosis, particularly in terms of the wide range of activities it covers and its ability to detect varying levels of physical activity. We suggest the test-retest reliability and validity of the PADS could be improved with some minor revisions.