Biomedical subjects

Maude Rittman

Publications and source records attributed to Maude Rittman.

8 recordsLinked to original sources

PubMed2005

Constructing the stroke: sudden-onset narratives of stroke survivors.

In this article, the authors explore the narrative production of stroke from the perspectives of survivors, that is, the stroke itself, not its implications for the individual poststroke. In the vast amount of literature on both sudden onset and chronic illness, the narrative construction of the onset of the illness, for the most part, has been ignored by social scientists, most notably in qualitative research. This is certainly true of stroke. Drawing on existing literature in both chronic illness and the body, the authors extend this to explore the phenomenological construction of stroke onset. Using data gathered from in-depth interviews with 111 stroke survivors postdischarge, they suggest three narrative mechanisms are used in the construct of the sudden-onset event itself: the use of typifications to construct the body during stroke, stroke as an internal communicative act, and stroke as a physical sensation and the mechanisms used to minimize bodily concerns.

Acute Disease↗

PubMed2004

The sense of coherence, burden, and depressive symptoms in informal caregivers during the first month after stroke.

BACKGROUND: Individuals with a strong sense of coherence (SOC), which considers one's ability to respond to stressors by the appropriate use of adaptive coping resources, can avoid breakdown when confronted with stress. This study examined the associations between SOC, perceived burden (caregiver's perception of the effect of caregiving-related stress) and depressive symptoms of informal caregivers (family members and involved friends) of stroke survivors one-month after the stroke. METHODS: One-hundred and four ethnically diverse veterans who were hospitalized after experiencing an acute stroke and their informal caregivers were enrolled in the study prior to discharge. One-month after being discharged from one of five Veterans Affairs Medical Centers in Florida and Puerto Rico, comprehensive data was collected and analyzed. RESULTS: Multiple regression analyses showed that greater SOC was associated with both lower burden (p < 0.0001) and fewer depressive symptoms (p < 0.0001). Higher caregiver burden, in turn, was significantly associated with more depressive symptoms (p = 0.003). However, when depressive symptoms was regressed on both SOC and burden jointly, the previously significant association between burden and depressive symptoms was no longer significant (p = 0.80) and SOC was still strongly associated with fewer depressive symptoms (p < 0.0001). CONCLUSIONS: Determining factors that may lessen burden and depressive symptoms for caregivers of stroke survivors during the transition period after discharge to their residence are imperative for developing successful interventions. SOC appears to be an important response in alleviating the levels of perceived burden and especially in depressive symptoms.

Adaptation, Psychological↗

PubMed2004

Sudden illness and biographical flow in narratives of stroke recovery.

The conceptual framework of biographical disruption has dominated studies into the everyday experience of chronic illness. Biographical disruption assumes that the illness presents the person with an intense crisis, regardless of other mitigating factors. However, our data suggests that the lives of people who have a particular illness that is notably marked by sudden onset are not inevitably disrupted. Extensive qualitative interviews were conducted with a sample of veteran non-Hispanic white, African-American, and Puerto Rican Hispanic stroke survivors, at one month, six months and twelve months after being discharged home from hospital. Narrative excerpts are presented to describe specific discursive resources these people use that offset the disrupting connotations of stroke. Our findings suggest a biographical flow more than a biographical disruption to specific chronic illnesses once certain social indicators such as age, other health concerns and previous knowledge of the illness experience, are taken into account. This difference in biographical construction of the lived self has been largely ignored in the literature. Treating all survivor experiences as universal glosses over some important aspects of the survival experience, resulting in poorly designed interventions, and in turn, low outcomes for particular people.

Black or African American↗

PubMed2004

The experience of time in the transition from hospital to home following stroke.

This paper reports findings related to the transition from hospital to home during the first month after discharge following acute stroke. Qualitative data were obtained from in-depth, semistructured interviews with 51 male stroke survivors and their caregivers. Data were analyzed with the N6 software application, designed to assist with qualitative data analysis. Stroke survivors described experiences related to changes in the temporal order of life, disruptions in sense of self, and strategies used to manage time. Findings indicate that changes in the temporal order of life are related to functional impairments and disruption in the taken-for-granted body. At 1 month post-discharge, survivors are struggling with establishing routines in their day and coping with an increased amount of idle time. In conclusion, strategies for managing increased idle time are "passing time," "waiting on time," and "killing time."

Adaptation, Psychological↗

PubMed2004

Why ethnic designation matters for stroke rehabilitation: comparing VA administrative data and clinical records.

Using existing administrative data to look at issues of ethnic disparities in rehabilitation-related outcomes may lead to misleading results. Problems can emerge from apparently small issues of reliability that are magnified by reclassification of ethnic designation and missing data in complete-subject analyses. We compared the reliability of ethnic assignment in Department of Veterans Affairs (VA) medical rehabilitation records for stroke patients with administrative records; reclassified the racial identifier from the administrative data in two ways; and examined the different sources of ethnic information in relation to severity, length-of-stay, disability assessment, and discharge disposition. Our results show how small changes increase the potential for Type II error when describing ethnic differences in outcomes or using ethnicity as a predictor with dichotomous response variables. We discuss our results with reference to the literature on ethnic classification and underline the importance of initiatives for improved data collection on ethnicity in VA data sources and in rehabilitation research.

Databases, Factual↗

PubMed2002

The hazards of stroke case selection using administrative data.

BACKGROUND: Administrative data and ICD-9-CM diagnostic codes are frequently used in research efforts to evaluate risk adjusted patient outcomes, particularly mortality. Varying ICD-9-CM sampling algorithms have been used to identify stroke patients. OBJECTIVES: This study evaluates the effects of different sampling strategies (one high sensitivity and one high specificity) on modeling stroke mortality as a performance indicator. RESEARCH DESIGN: Risk adjustment models were developed for two stroke cohorts identified using differing ICD-9-CM algorithms. Standard mortality ratios were calculated in a validation sample as network performance measures and compared across the two stroke samples. SUBJECTS: VHA inpatients with stroke during years 1997 (model development) and 1998 (model validation) were selected from the Patient Treatment File based on cerebrovascular diagnostic codes. MEASURES: Patient mortality within 30 days of admission. RESULTS: The model development and validation for each stroke sampling method produced consistent results: c-statistics 0.74 to 0.75, R2 0.07 to 0.09, concordance 73% to 74%. However, ranking differences in network performance varied by 5 or more positions for 7 of the 22 patient networks. CONCLUSIONS: These findings highlight a potential problem when using administrative data to assess stroke mortality. In the absence of an agreed upon definition of stroke patients, results of provider profiling will vary depending on the ICD-9 algorithm used.

Algorithms↗

PubMedDate not supplied

The social organization in constraint-induced movement therapy.

Ethnographic data were collected at two rehabilitation facilities conducting ongoing research to evaluate functional and neurological outcomes of constraint-induced movement therapy (CIMT). Our findings indicate that several patterns of behavior occur during participant/therapist interaction in therapy sessions: coaching, cheerleading, reminding, changing, and contemplating. These interaction patterns indicate that learned nonuse of an affected limb does not exist in social isolation and that people who participate in CIMT routinely consider the balance of any improvement against the costs of using an affected limb that is still not fully functional. These patterns of social interaction that occur during therapy--which often influence a participant's hope for future physical progress--are an important part of CIMT that may not be fully acknowledged in the clinical training of therapists.

Activities of Daily Living↗

PubMedDate not supplied

Outcomes from stroke rehabilitation in Veterans Affairs rehabilitation units: detecting and correcting for selection bias.

This paper addresses the issue of statistical selection bias in multivariate models of functional gain estimated from observational data. Stroke patients from 20 high-volume Veterans Affairs Medical Centers (VAMCs) with acute and subacute inpatient rehabilitation treatment units were observed. Their gains in overall, motor, and cognitive functional status were measured with the use of the Functional Independence Measure (FIM). In estimating multivariate models of FIM gain during rehabilitation using these observational data, we found statistically significant evidence of selection bias, along with considerable differences in inferences between standard multivariate analyses and our selectivity-corrected models. Our results demonstrate the importance of detecting and correcting for statistical selection bias when one uses nonexperimental data to study gains in functional status.

Activities of Daily Living↗