Strength and Limitation of the Study

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Based on the case study, caregivers should focus on supporting old females suffering from a stroke in their daily activities. The article by Ekstam et al. (2015) explores the relationship between an individual with stroke and informal caregiver. The article also explores the rehabilitation process of a person with stroke, severity as well as individual factors such as age, gender and sense of coherence. Ekstam et al. (2015) also evaluate the personal experience of individuals suffering from stroke and the help received from the caregivers within a period of one year. The primary focus of this paper is to appraise Ekstam et al. (2015) arguments regarding caregiver at the old age based on the case of Sue-Anne, a 67 years old woman who had experienced stroke six months ago and she is facing difficulties in carrying out her daily activities.  

Part A:

Strength and Limitations

            The assessment is based on the cited qualifications and affiliations in the article. The primary strength of the authors is that they all work in institutions that deal with the rehabilitation of stroke victims and their rehabilitation needs. Having an understanding of how to handle stroke victims, gives the authors an expertise to present the key elements needed by strong patients. However, based their professional setting, the five authors are well suited to lead and conduct the research in the best practical manner needed due to their experience in the stroke service field. However, there may be some conflict of interest among the five authors. Among the first conflict of interest is that almost all the five specialists come from the same setting (Gosman‐Hedström & Dahlin‐Ivanoff, 2012). However, the five specialists have not only similar attachments in their jobs, but also report to the same institutions in most times of their occupations. Coming from the same environment boosts their work in that they have been cooperating long before the research, critics may point out some problem in this scenario (Ludvigsson et al., 2011). The primary limitation among the authors is lack of diversification of ideas and findings since they all come from one geographical location.

Research Questions

The primary research question is: How the people with stroke and also their caregivers perceive rehabilitation needs, as well as plausible associations between such perceptions and caregiver burden?

Ekstam et al. (2015) justify the research question by examining how the stroke epidemic affects the people next to the victim. What is the importance of the informal caregivers in handling stroke patients? What are the everyday experience and life changes of the victims of stroke? Also, there are justifications by the author on why the research was needed.  The justification is based on the results obtained from the mixed method research that presents the rehabilitation process for the stroke victims. The content analysis is presented based on the discordant and unmet rehabilitation needs. The results of the analysis indicate that there was a lower burden to the caregiver where rehabilitation needs were met. 

The study was needed to examine the association between the perception of the dyad on the severity of the stroke and the subsequent rehabilitation needs. The research was also helpful in exploring the perception of the dyad between the burden of the caregiver and the amount and extent of the informal care on the stroke patients.

 Research Design

            Based on the research question and the aim of the study, Ekstam et al. (2015) used research patterns that most applicable in the nursing field. The intention of the plan was to give a plot on how the method s of the research would be carried out (Ludvigsson et al. 2011). The first plan in the study was to observe the patients admitted in either of three stroke units that the authors preferred. During the course of their stay in the hospital, the patients received care from the occupational therapists that were professionally trained Gosman‐Hedström & Dahlin‐Ivanoff, 2012). Later, the patients were to be released to go home where the assessment was to continue in earnest. However, the study does not present research design as heading, which makes it difficult for the reader to get the scope of the design. Therefore, it would be appropriate if the author summarized their research design under a topic (Ekstam, Tham, & Borell, 2011). The aim of the design is to generally aid in getting the answers to the questions that base the research.

Research Methods


            The research uses a mixed approach that incorporates combined qualitative and quantitative data and analyses (Ekstam et al., 2015). After the patients were admitted in one of three stroke units, they were eligible for the research and the researched informed about their consent to their study. The strength of data collection is that assessment was carried out within the duration of the first week and follow-ups of from 3 to 12 months mainly during visits to the homes of the patients. The examinations were either through questionnaires or interviews carried out by the research assistants to ensure that the data is obtained directly from the participants (Gosman‐Hedström & Dahlin‐Ivanoff, 2012).  The validity of the data was achieved whereby the stroke patients were asked to identify their informal caregivers. Most of the caregivers chosen by the patients were either friends, relations or even a partner (Ludvigsson et al. 2011).


            The data on stroke severity, age and sex were mainly collected from medical records and also through interviews that did not give justifiable results. In context, stroke severity was either categorized as severe / moderate or as mild. The severe stage was given a scale of zero to forty-nine (0-49), which is a wide range that makes it difficult to analyze the data. On the other side, mild was given a score of fifty to a hundred (50-100) and the details of the caregivers were collected three months after the stroke through interviews, which may result into a biased information (Ludvigsson et al., 2011). The details collected were the age, sex, and relation to the person suffering from the stroke, while the caregiver was collected through interviews, questionnaires that made it hard to ascertain, collect and analyze data on caregivers’ perceptions. The perception includes the opinion of the need for as well as contentment with the level of healthcare services accorded to the patient with the stroke 12 months after ailing it (Ekstam et al., 2015).


            Ekstam et al. (2015) results and conclusions are based on the research questions as well as the aim of the study. For instance, the results suggest that out of the group of 349 people with stroke under the study, 55 of them were deceased a year after the stroke hit them.  Additionally, the findings indicate that 76 of the people were lost or declined to follow-up, while 117 of the people had also not identified their caregivers (Ludvigsson et al., 2011).  Based on rehabilitation experience, 15 people among the 349 declined or did not answer the statement that they had received the actual rehabilitation that their condition needed.  From the data presented,   only 86 patients of stroke and their caregivers followed up for the 12 months. Among the 86, 22 which represent 26% had experienced an earlier stroke, while 6 were children, 62 were partners among the 86 caregivers. 65 years was the mean age of the caregivers. The results successfully showed that most of the patients with mild stroke were in dyads that alleged met rehabilitation necessities paralleled to dyads that did not. Statistical analyses identified no variances in the perception of rehabilitation essentials concerning the use of services of rehabilitation, age, and sex (Ludvigsson et al., 2011). Among the strategies used by the people with stroke included engaging in a bodily exercise like going out for walks.

Part B: Application Barrier

            The application of evidence-based practice is associated with barriers based on the generic or specific measures. For example, the results do not show the specific number of the stroke patients that die during rehabilitation, which is a clear indication that evidence to practice approach does not capture specific elements of the subject being investigated (Glader et al., 2014). Factor such as poverty have not been captured well in the study and as such, the numbers may not be very accurate in the application. However, it is important to note that there are factual findings in the study that can be applied either in general or in specific measures. The study does not justify how the health of a person living with stroke depends on the caregiver (Glader et al., 2014). Therefore, it was difficult to use evidence practice to generate specific data that can be tested statistically to justify the role of caregivers on old aged stroke patients. Therefore, the evidence-practice applied in the research is not substantial to propose for the necessary mechanisms that stroke caregivers should use to ensure patients run their day-to-day activities safely.


            In summary, the study by Ekstam et al. (2015) contains some inconsistencies that can be corrected in future studies to determine relevant tools for enabling stroke patients to live a normal life. The essence of taking care of the people with stroke has been stressed in the research paper, although there are no specific recommendations stated for the improvement of the current rehabilitation systems. The future studies should address stroke cases among both old and young people and come up with a recommendation for rehabilitation services. The study findings help in understanding how to live with people with stroke by helping them run their life comfortably. The results suggest that the society should continually be made aware of the stroke pandemic for them to be on the safe side. Therefore, it is important for people to understand the cause and how to manage the stroke condition through proper rehabilitation as pointed out in the study.


Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined perceptions of people with stroke and their carers regarding rehabilitation need 1 year after stroke: a mixed methods study. BMJ Open, 5(2), e006784.

Ekstam, L., Tham, K., & Borell, L. (2011). Couples' approaches to changes in everyday life during the first year after stroke. Scandinavian Journal of Occupational Therapy, 18(1), 49-58.

Ghatnekar, O., Persson, U., Asplund, K., & Glader, E. L. (2014). Costs for stroke in Sweden 2009 and developments since 1997. International journal of technology assessment in health care, 30(2), 203-209.

Gosman‐Hedström, G., & Dahlin‐Ivanoff, S. (2012). ‘Mastering an unpredictable everyday life after stroke’–older women’s experiences of caring and living with their partners. Scandinavian journal of caring sciences, 26(3), 587-597.

Ludvigsson, J. F., Andersson, E., Ekbom, A., Feychting, M., Kim, J. L., Reuterwall, C., ... & Olausson, P. O. (2011). External review and validation of the Swedish national inpatient register. BMC public health, 11(1), 450

October 13, 2023


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