Pico questions for stroke patients

Running head: STROKE REHABILITATION 1

Running head: STROKE REHABILITATION 2

Stroke Rehabilitation

What is a stroke? A stroke, also known as a brain attack, is a condition that affects the brain and nervous system due to a lack of blood supply to the brain. It is the 5th leading cause of death and the main cause of disability in the United States. About 795,000 people in the United States suffer from a stroke each year (CDC, 2017). The three main kinds of strokes are ischemic strokes, which are the most common, hemorrhagic strokes, and transient ischemic attacks (TIA), also known as mini strokes. Strokes have a high risk of reoccurring, especially if remedial measures are not administered. Patients who have suffered from a stroke may have their function impaired in various ways, requiring acute initial care and possibly rehabilitation. A stroke may present itself in many ways such as slurred speech, change in sensation, decreased strength, paralysis, and even headache. Patients who suffer strokes will need the assistance of an entire team of health care professionals ranging from nurses, speech therapists, occupational therapists, physical therapists, neurologists, respiratory therapists, and social workers as well.

A constant concern for stroke patients is effective rehabilitation to improve their strength and regain their ability to preform daily activities of daily living (ADL). In Western medicine, treatment includes pharmacological treatments, surgical procedures, and multi-professional rehabilitation. In Eastern medicine, acupuncture and physiotherapy are used in conjunction with Western medicine to improve functional disability and reduce the risk of further complications. “Acupuncture use as a complementary or alternative therapy has increased worldwide and has become widely applied to stroke rehabilitation over the last decade, which confirms that the efficacy of acupuncture can have a great impact on stroke management” (Jun, Jian, Dhiaedin, Qinhui, Xiao, Yi, & Ma, 2017).

This paper will discuss the application of the topic and how it impacts the MSN program specialty track, supportive evidence regarding acupuncture, supportive evidence on the identification of frequency of its occurrence, a discussion of the stakeholders impacted by the issue, a statement of the PICOT/PICO question based on the evidence, and lastly conclude with a summary and a self-reflection.

Application and Impact on MSN Program Track

Nurses play an integral role in the care of patients who have suffered a stroke. The numbers of advanced practice nurses who have a Masters of Science Degree or Doctorate Degree in nursing has increased over the years and continue to grow in the nursing profession. This author has chosen to pursue the Advanced Registered Nurse Practitioners (ARNP) track. As an ARNP, the role is to not only diagnosis and treat patients, but also to educate patients on new and alternative evidence based treatment modalities focusing on prevention and wellness.

“Approximately 70% of stroke survivors experience functional disabilities, motor dysfunction being the most significant symptom” (Jun, Jian, Dhiaedin, Qinhui, Xiao, Yi, & Ma, 2017). Muscle weakness, loss of mobility, and flaccidity or weaknesses of one side of the body are some of the physical disabilities commonly experienced following a stroke. There may be varying degrees of impairment in stroke patients. Some patients will be able to regain their functioning in the acute phase of recovery, while others will spend months of time in rehabilitation settings in pursuit of greater independence in activities of daily living. Patients suffering from strokes may be unable to perform simple skills such as bed mobility, transfers, and ambulation. Many stroke patients also have a change in their body’s neurological system that can include pain, numbness, tingling, or pins and needles sensations. Beyond physical impairments, patients may exhibit changes in their cognition, memory, speech, and emotional responses. Patients with stroke experience great changes in their life, which may lead to limitations that also affect one’s family and his or her community at large. As an ARNP, the need to help the community and improve a stroke patient’s quality of life is a large not insurmountable goal. With this in mind, it is essential to collaborate and work together as a team with physicians, neurologists, physical therapists, acupuncturists, and researchers, to advocate acupuncture as part of the treatment plan for post stroke patients. There is always a need for further research to guide the evidence-based practice (EBP) of advanced practice nurses in the treatment of stroke victims.

Supportive Evidence

Acupuncture is a therapeutic holistic technique of Eastern medicine performed by trained practitioners in an effort to stimulate critical trigger points on the body by inserting thin needles though the skin. It is believed by acupuncture practitioners that the flow of energy throughout the body will become re-balanced. It is widely used in Taiwan and other eastern countries and has been a component of Traditional Chinese Medicine for 3,000 years (Huang, Wang, Yang, Liou, Chen, & Lin, 2014). The treatment of acupuncture has become more popular in the United States and is evolving into one of the most common forms of integrative interventions. “More than 10 million acupuncture treatments are administered annually in the United States alone” (Hao, & Mittelman, 2014).

It is considered a viable alternative treatment for post-stroke rehabilitation. According to Bai, Li, Hu, Xie, Wang, & Zhu (2013), a recent study in Canada showed that 87% of stroke patients were willing to accept acupuncture as treatment and 98% of stroke patients were willing to learn about acupuncture and the impact it has on stroke rehabilitation. The stakeholders who are impacted are stroke patient’s, families, healthcare providers, and third-party healthcare payers such as insurance companies, and the government. It has been observed that a acupuncture, specifically scalp acupuncture treatment, can result in 80% to 90% of patients experiencing improvement in paralysis and ataxia, and some patients showing full recovery (Hao & Mittelman, 2014).

PICOT Question

In EBP, the PICOT format is used to frame and answer health related questions (Melnyk, Fineout-Overhold, Stillwell, and Williamson, 2010). PICOT is an acronym that refers to patient, population, or problem, intervention, comparison, outcome, and time. Patient, population, or problem refers to whom is receiving the care or what problem is being addressed. Intervention refers to what the treatment or procedure is. Comparison is what the alternative intervention is. Outcome is referred to as the goal and Time is the time frame being addressed, which is optional in some cases (Melnyk, Fineout-Overhold, Stillwell, and Williamson, 2010).

This author developed a PICOT related to the nursing issue of acupuncture impacting stroke rehabilitation based on the evidence, and it is as follows: In elderly patients 65 years or older who have experienced an ischemic stroke, how effective is acupuncture in comparison to standard stroke therapy in improving mobility over a 12-week period following the event? The population is patients 65 years or older who experience an ischemic stroke, the intervention is acupuncture treatment, the comparison would be standard stroke therapy, the outcome would be to improve mobility and the time frame would be over a 12-week period.

In order to develop this question, this author had to initially think about an area of interest. Working with stroke patients and wanting to improve patients mobility post stroke, acupuncture used for stroke rehabilitation was chosen as a topic. According to the American Heart Association (2017), antiplatelet, anticoagulant, and cholesterol lowering therapies are prescribed to prevent recurrent strokes. As more and more people look to holistic or non-pharmacological treatments, understanding the effects of acupuncture on stroke and the impact it has on mobility, gives additional tools to provide resources to the patients served as an ARNP. Searching the literature, there was a lot of information found relating to the topic of acupuncture and mobility. Keywords that were used were acupuncture, stroke, and mobility, which resulted with many evidence-based findings that ensure the most effective and current treatments. Research has shown that “acupuncture helps deactivate the areas within the brain that are associated with processing pain” (Hao & Mittelman, 2014). Helping patients understand their options for the treatment of stroke related dysfunction through evidence-based research might prove helpful as alternative approaches for patients who do not respond to more conventional treatments or wish to use holistic medicine.

Conclusion

In conclusion, acupuncture does have a positive impact on the mobility of stroke patients. Since the discovery of acupuncture to recent Western acceptance of the treatment, acupuncture is a growing evidence-based practice continuously under evolving development to provide new ways and new techniques to treat patients.

This paper discussed the application of acupuncture and how it impacts the MSN program specialty track, supportive evidence regarding acupuncture and the impact it has on the mobility of stroke patients, supportive evidence on the identification of frequency of its occurrence, a discussion of the stakeholders impacted by the issue, and a statement of the PICOT/PICO question based on the evidence.

Having some prior knowledge about acupuncture and having experienced it, it has made this author realize the benefits it has on the human body. One thing that was learned was that acupuncture influences cerebral blood flow in healthy patients as well as stroke patients facilitating improved brain function post-stroke (Ratmansky, Levy, Messinger, Birg, Front, & Treger, 2016). Preforming a literature search using my PICOT question and reviewing the currently available data on the topic of acupuncture and the impact it has on the mobility of stroke patients has taught me new information that can be applied into daily practice as a nurse and in the future as an ARNP.

Reference

American Heart Association. (2017). Retrieved from www.strokeassociation.org

CDC. (2017). Stroke Facts | cdc.gov. [online] Cdc.gov. Available at: https://www.cdc.gov/stroke/facts.htm [Accessed 12 Jul. 2017].

Bai, Y., Li, L., Hu, Y., Xie, P., Wang, S., & … Zhu, B. (2013). Prospective, randomized controlled trial of physiotherapy and acupuncture on motor function and daily activities in patients with ischemic stroke. Journal of alternative & complementary medicine, 19(8), 684-689. doi:10.1089/acm.2012.0578

Huang, S., Wang, W., Yang, T., Liou, T., Chen, G., & Lin, L. (2014). The balance effect of acupuncture therapy among stroke patients. Journal of Alternative & Complementary Medicine, 20(8), 618-622. doi:10.1089/acm.2014.0003

Hao, J. J., & Mittelman, M. (2014). Acupuncture: Past, present, and future. Global Advances in Health and Medicine, 3(4), 6-8. http://doi.org/10.7453/gahmj.2014.042

Jun, W., Jian, P., Dhiaedin, K., Qinhui, F., Xiao, C., Yi, S., & Ma, Y. (2017). Acupuncture treatment on the motor area of the scalp for motor dysfunction in patients with ischemic stroke: Study protocol for a randomized controlled trial. Trials, 181-11. doi: 10.1186/s13063-017-2000-x

Melnyk, B. M., Fineout-Overhold, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence- based practice: The seven steps of evidence-based practice: Following this progressive, sequential approach will lead to improved health care and patient outcomes. American Journal of Nursing, 110(1), 51-53

Ratmansky, M., Levy, A., Messinger, A., Birg, A., Front, L., & Treger, I. (2016). The effects of acupuncture on cerebral blood flow in post-stroke patients: A randomized controlled trial. Journal of Alternative & Complementary Medicine, 22(1), 33-37