Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families.

May combine two claims.

Although not significant, those participating in the intervention group reported improved mindfulness and general comfort as compared to those in the control group.

“Although not significant, those participating in the intervention group reported improved mindfulness and general comfort as compared to those in the control group.”

• cites M. Wang et al, 2019 sourceDisputed

  In Discussion > Acceptability (page unavailable), the authors say a controlled trial is still needed to establish benefits beyond using any DVD. Their participants reported that the techniques felt beneficial, but this study does not report an intervention-versus-control comparison of mindfulness or general comfort. The Introduction describes a control-group comparison from a different study, concerning anxiety rather than these outcomes. (LLM, conf=0.84)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

One-on-one MBI was found to be acceptable and feasible.

“One-on-one MBI was found to be acceptable and feasible.”

• cites Wrapson et al, 2021 sourceSupported

May combine two claims.

Mindfulness interventions foster resilience to stress in the brain by enhancing connectivity within stress regulatory regions of the prefrontal cortex and decreasing connectivity in regions of the brain controlling the fight-or-flight stress response.

“Creswell et al 32,33 suggest that mindfulness interventions foster resilience to stress in the brain by enhancing connectivity within stress regulatory regions of the prefrontal cortex and decreasing connectivity in regions of the brain controlling the fight-or-flight stress response.”

• cites [32] 32. Marchand WR. Neural mechanisms of mindfulness and meditation: Evi- dence from neuroimaging studies. World J Radiol. 2014;6:471-479. doi: 10.4329/wjr.v6.i7.471 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [33] 33. Creswell JD, Lindsay EK, Villalba DK, Chin B. Mindfulness training and phys- ical health: mechanisms and outcomes. Psychosom Med. 2019;81:224- 232. doi: 10.1097/PSY.0000000000000675 sourceSupported

May combine two claims.

Evidence suggests that mindfulness is acceptable and feasible among stroke survivors and their caregivers.

“Evidence suggests that mindfulness is acceptable and feasible among stroke survivors and their caregivers.4,5”

• cites [4] 4. Jani BD, Simpson R, Lawrence M, Simpson S, Mercer SW. Accept- ability of mindfulness from the perspective of stroke survivors and caregivers: a qualitative study. Pilot Feasibility Stud. 2018;4:57. doi: 10.1186/s40814-018-0244-1 sourceSupported
• cites [5] 5. Merriman J, Walker-Bircham S, Easton S, Maddicks R. The development of a mindfulness group for stroke patients: a pilot study. Clin Psychol Forum. 2015;2015:26-30. sourcePartly supported

  The Conclusion reports that group mindfulness-based cognitive therapy was feasible for stroke survivors, and Group Experience says all participants described attending as positive. The Participants section identifies the four participants as stroke survivors, not caregivers; Group Experience proposes including partners in a future group. The paper therefore does not establish acceptability or feasibility among caregivers. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Mindfulness and relaxation techniques using a self-help DVD was acceptable and feasible in stroke survivors.

“Mindfulness and relaxation techniques using a self-help DVD was acceptable and feasible in stroke survivors.”

• cites X. Wang et al, 2019 sourceSupported

May combine two claims.

Mindful music listening is feasible and acceptable in stroke survivors.

“Mindful music listening is feasible and acceptable in stroke survivors.”

• cites Baylan et al, 2020 sourceSupported

May combine two claims.

Recovering Together intervention is feasible and acceptable in dyads.

“Recovering Together intervention is feasible and acceptable in dyads.”

• cites Bannon et al, 2020 sourceSupported

Classified as probably not a substantial claim.

In a systematic review of 400 studies, mindfulness interventions were recommended for chronic pain related to neuro-related pathology.

“In a systematic review of 400 studies evaluating the effect of psychological treatments on pain during neurorehabilitation, 43 mindfulness interventions were recommended for chronic pain related to neuro-related pathology.”

• cites [43] 43. Castelnuovo G, Giusti EM, Manzoni GM, Saviola D, Gatti A, Gabrielli S, Lacerenza M, Pietrabissa G, Cattivelli R, Spatola CA, et al. Psychologi- cal treatments and psychotherapies in the neurorehabilitation of pain: evidences and recommendations from the Italian Consensus Confer- ence on Pain in Neurorehabilitation. Front Psychol. 2016;7:115. doi: 10.3389/fpsyg.2016.00115 sourceSupported

May combine two claims.

Although meta-analyses have demonstrated that MBIs may improve pain in a wide variety of clinical samples, few studies have examined the effect of mindfulness on pain in stroke survivors.

“Although meta-analyses have demonstrated that MBIs may improve pain in a wide variety of clinical samples, [40][41][42] few studies have examined the effect of mindfulness on pain in stroke survivors.”

• cites [40] 40. Anheyer D, Haller H, Barth J, Lauche R, Dobos G, Cramer H. Mindful- ness-based stress reduction for treating low back pain: a systematic review and meta-analysis. Ann Intern Med. 2017;166:799-807. doi: 10.7326/M16-1997 sourceNot checked — no full text of the source
• cites [41] 41. Feng B, Hu X, Lu WW, Wang Y, Ip WY. Are mindfulness treatments effective for pain in cancer patients? A systematic review and meta-analysis. Eur J Pain. 2022;26:61-76. doi: 10.1002/ejp.1849 sourceNot checked — no full text of the source
• cites [42] 42. Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, Colaiaco B, Maher AR, Shanman RM, Sorbero ME, et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Ann Behav Med. 2017;51:199-213. doi: 10.1007/s12160-016-9844-2 sourceSupported

May combine two claims.

Participants in the ACT intervention group had greater self-rated health status, hopefulness, and mental well-being as compared to control group, but the differences were not maintained at 2-month followup.

“Participants in the ACT intervention group had greater self-rated health status, hopefulness, and mental well-being as compared to control group, but the differences were not maintained at 2-month followup.”

• cites [36] 36. Majumdar S, Morris R. Brief group-based acceptance and commit- ment therapy for stroke survivors. Br J Clin Psychol. 2019;58:70-90. doi: 10.1111/bjc.12198 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Pain is a common symptom poststroke, affecting as many as 50% of patients on a daily basis.

“Pain is a common symptom poststroke, affecting as many as 50% of patients on a daily basis.39”

• cites [39] 39. Naess H, Lunde L, Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the Bergen Stroke Study. Vasc Health Risk Manag. 2012;8:407-413. doi: 10.2147/VHRM.S32780 sourcePartly supported

  The Introduction reports pain in 20%–50% of patients with cerebral infarction at follow-up, supporting the approximate 50% figure. But the Materials and methods section asks whether patients suffer from pain, not whether they experience it daily; the daily-frequency qualifier is unsupported. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

The practice of mindfulness has been shown to improve visual short-term memory and improve cognitive flexibility.

“In addition, the practice of mindfulness has been shown to improve visual short-term memory 49 and improve cognitive flexibility.50”

• cites [49] 49. Youngs MA, Lee SE, Mireku MO, Sharma D, Kramer RSS. Mindfulness med- itation improves visual short-term memory. Psychol Rep. 2021;124:1673- 1686. doi: 10.1177/0033294120926670 sourceSupported
• cites [50] 50. Zou Y, Li P, Hofmann SG, Liu X. The mediating role of non-reactivity to mindfulness training and cognitive flexibility: a randomized controlled trial. Front Psychol. 2020;11. doi: 10.3389/fpsyg.2020.01053 sourceSupported

May combine two claims.

The pilot study demonstrated that patients reported high satisfaction, were actively engaged, and benefited from the MBSR program.

“Although a larger sample is needed to make statistical inferences about these effects, this pilot study demonstrated that patients reported high satisfaction, were actively engaged, and benefited from the MBSR program.”

• cites [8] 8. Baldo JV, Schendel K, Lwi SJ, Herron TJ, Dempsey DG, Muir J, Curran BC, Paulraj S, Chok J, Cole MA. Mindfulness-based stress reduction interven- tion in chronic stroke: a randomized, controlled pilot study. Mindfulness. 2021;12:2908-2919. doi: 10.1007/s12671-021-01751-0 sourceSupported

May combine two claims.

Mindful music listening intervention and Integrative Body-Mind Training appear to enhance mood, attention, and cognitive recovery in a variety of settings.

“Both intervention approaches appear to enhance mood, attention, and cognitive recovery in a variety of settings.”

• cites [10] 10. Baylan S, Haig C, MacDonald M, Stiles C, Easto J, Thomson M, Cullen B, Quinn TJ, Stott D, Mercer SW, et al. Measuring the effects of listening for leisure on outcome after stroke (MELLO): A pilot randomized controlled trial of mindful music listening. Int J Stroke. 2020;15:149-158. doi: 10.1177/1747493019841250 sourcePartly supported

  The Results (Effect sizes and sample size calculations for full-scale trial; page unavailable) report effect estimates favoring mindful music listening over audiobooks for story recall and attentional switching after stroke. They do not show a mood benefit: mood scores remained within the normal range across groups. The paper studied post-stroke music listening, not Integrative Body-Mind Training or outcomes across a variety of settings. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites [61] 61. Tang YY, Ma Y, Wang J, Fan Y, Feng S, Lu Q, Yu Q, Sui D, Rothbart MK, Fan M, et al. Short-term meditation training improves attention and self- regulation. Proc Natl Acad Sci U S A. 2007;104:17152-17156. doi: 10.1073/pnas.0707678104 sourceNot checked — no full text of the source

May combine two claims.

A low interactive webinar attendance and overall adherence to the program was noted.

“However, a low interactive webinar attendance and overall adherence to the program was noted.”

• cites [53] 53. Dragomanovich HM, Dhruva A, Ekman E, Schoenbeck KL, Kubo A, Van Blarigan EL, Borno HT, Esquivel M, Chee B, Campanella M, et al. Being present 2.0: online mindfulness-based program for metastatic gastrointestinal cancer patients and caregivers. Glob Adv Health Med. 2021;10:21649561211044693. doi: 10.1177/21649561211044693 sourceSupported

May combine two claims.

Several feasibility pilot studies have reported high rates of retention (>85%) and good level of engagement and satisfaction of the participants.

“Several feasibility pilot studies have reported high rates of retention (>85%) and good level of engagement and satisfaction of the participants.8”

• cites [8] 8. Baldo JV, Schendel K, Lwi SJ, Herron TJ, Dempsey DG, Muir J, Curran BC, Paulraj S, Chok J, Cole MA. Mindfulness-based stress reduction interven- tion in chronic stroke: a randomized, controlled pilot study. Mindfulness. 2021;12:2908-2919. doi: 10.1007/s12671-021-01751-0 sourcePartly supported

  The Practicality section reports good engagement and 14 of 16 MBSR participants completing the program (87.5%). The Integration and Acceptability section reports high satisfaction. But this is one pilot study, and retention was below 85% in the Brain Health group (13 of 16) and overall (27 of 32); it cannot substantiate the claim about several studies all reporting retention above 85%. Page numbers are unavailable in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

In a feasibility study of a modified MBI delivered in the home, 13 out of 15 stroke survivors completed the full course and showed reduction in symptoms of depression and anxiety.

“As a result, 13 out of 15 stroke survivors completed the full course and showed reduction in symptoms of depression and anxiety.22”

• cites [22] 22. Wrapson W, Dorrestein M, Wrapson J, Theadom A, Kayes NM, Snell DL, Rutherford S, Roche M, Babbage DR, Taylor S, et al. A feasibil- ity study of a one-to-one mindfulness-based intervention for improv- ing mood in stroke survivors. Mindfulness. 2021;12:1148-1158. doi: 10.1007/s12671-020-01583-4 sourcePartly supported

  The Procedure describes a modified, one-to-one MBI delivered in participants’ homes. The Results report that 15 of 18 participants—not 13 of 15—completed the full course, and that depression and anxiety scores decreased among the 15 completers. The study does not establish that every completer improved: one participant’s depression score increased. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

In a pretest-posttest comparison, participants reported significant reductions in distress, depressive symptoms, and sleep disturbance, as well as enhanced mindfulness.

“In a pretest-posttest comparison, participants reported significant reductions in distress, depressive symptoms, and sleep disturbance, as well as enhanced mindfulness.”

• cites [53] 53. Dragomanovich HM, Dhruva A, Ekman E, Schoenbeck KL, Kubo A, Van Blarigan EL, Borno HT, Esquivel M, Chee B, Campanella M, et al. Being present 2.0: online mindfulness-based program for metastatic gastrointestinal cancer patients and caregivers. Glob Adv Health Med. 2021;10:21649561211044693. doi: 10.1177/21649561211044693 sourceSupported

May combine two claims.

In a study of 24 stroke survivor-informal caregiver dyads in neurocritical care, dyads were interested in learning MBSR techniques in the acute setting but identified challenges to continuing postdischarge, including stress of intensive care days.

“Results suggest that the dyads were interested in learning MSBR techniques in the acute setting, but identified multiple challenges associated with continuing such practices postdischarge including the stress of intensive care days with adding in MSBR techniques.”

• cites [64] 64. McCurley JL, Funes CJ, Zale EL, Lin A, Jacobo M, Jacobs JM, Salgueiro D, Tehan T, Rosand J, Vranceanu AM. Preventing chronic emotional dis- tress in stroke survivors and their informal caregivers. Neurocrit Care. 2019;30:581-589. doi: 10.1007/s12028-018-0641-6 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Past research demonstrates that MBIs delivered via VR can help enhance person's attention and support their sense of presence in the mindfulness experience and increase state of mindfulness and psychological well-being.

“Although limited in scope, past research demonstrates that MBIs that were delivered via VR can help enhance person's attention and support their sense of presence in the mindfulness experience and increase state of mindfulness and psychological well-being.58,60”

• cites [58] 58. Chandrasiri A, Collett J, Fassbender E, De Foe A. A virtual reality approach to mindfulness skills training. Virtual Real. 2020;24:143-149. doi: 10.1007/s10055-019-00380-2 sourceNot checked — no full text of the source
• cites [60] 60. Seabrook E, Kelly R, Foley F, Theiler S, Thomas N, Wadley G, Nedeljkovic M. Understanding how virtual reality can support mindfulness prac- tice: mixed methods study. J Med Internet Res. 2020;22:e16106. doi: 10.2196/16106 sourcePartly supported

  The Discussion section ('Presence, Attention, and Agency'; page unavailable) reports that participants found presence and attentional anchors helpful, while the Results ('Quantitative Findings'; page unavailable) show increased state mindfulness and positive emotion after using the VR app. The paper does not establish an increase in psychological well-being more broadly; it reports a short-term change in positive emotion, with no significant change in negative emotion. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

The 12-week movement-based MBI developed by Thayabaranathan et al. has not been implemented, and its effectiveness is unknown.

“This intervention has not been implemented and the effectiveness of this program is unknown, but the training manual and content have been developed for future trials.”

• cites [63] 63. Thayabaranathan T, Immink MA, Hillier S, Stolwyk R, Andrew NE, Stevens P, Kilkenny MF, Gee E, Carey L, Brodtmann A, et al. Co-designing a new yoga-based mindfulness intervention for survivors of stroke: a formative evaluation. Neurol Int. 2021;14:1-10. doi: 10.3390/neurolint14010001 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Nurses suggested that an admission screening tool to identify patients who could benefit most from MBI techniques would be useful.

“Nurses also suggested that an admission screening tool to help identify patients who could benefit most from MBI techniques would be useful.64”

• cites [64] 64. McCurley JL, Funes CJ, Zale EL, Lin A, Jacobo M, Jacobs JM, Salgueiro D, Tehan T, Rosand J, Vranceanu AM. Preventing chronic emotional dis- tress in stroke survivors and their informal caregivers. Neurocrit Care. 2019;30:581-589. doi: 10.1007/s12028-018-0641-6 sourcePartly supported

  The Results section, under “Barriers to Effective Implementation,” says nurses suggested an intake screening tool to identify patients who may benefit from a psychosocial skills intervention. The Discussion lists mindfulness among several proposed skills, but the paper does not describe the screening tool as specifically identifying patients for MBI techniques. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

In a study using neuroscience ICU nurse focus groups, nurses recognized that patients need MBIs to help catalyze recovery but did not feel adequately trained to facilitate this in the acute setting.

“In a study that utilized neuroscience intensive care unit nurse focus groups as an adjunct to studying patient-caregiver dyads, nurses recognized that patients need MBIs to help catalyze their recovery, yet they did not feel they had adequate training to facilitate this process in the acute setting.64”

• cites [64] 64. McCurley JL, Funes CJ, Zale EL, Lin A, Jacobo M, Jacobs JM, Salgueiro D, Tehan T, Rosand J, Vranceanu AM. Preventing chronic emotional dis- tress in stroke survivors and their informal caregivers. Neurocrit Care. 2019;30:581-589. doi: 10.1007/s12028-018-0641-6 sourcePartly supported

  The Methods report Neuro-ICU nurse focus groups alongside patient-caregiver interviews. The Results (Barriers to Effective Implementation) say nurses supported a resiliency-skills program and wanted training to help with recruitment, referral, and communication. The program included mindfulness, but the paper does not say nurses felt inadequately trained to facilitate mindfulness-based interventions for patients in the acute setting. Page numbers were not provided. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S4 (based).

Most brief MBIs have been investigated in samples of healthy adults with mixed findings.

“Most brief MBI have been investigated in samples of healthy adults with mixed findings”

May combine two claims.

The evidence supporting MBIs for stroke survivors is less developed, and many studies are limited by small sample sizes and lack of active control groups.

“the evidence supporting MBIs for stroke survivors is less developed and many studies are limited by small sample sizes and lack of active control groups.”

Classified as probably not a substantial claim.

Investigators have begun to tailor MBIs to meet the unique needs of stroke survivors and their family caregivers.

“Investigators have also begun to tailor MBIs to meet the unique needs of stroke survivors and their family caregivers.”

Probably not a substantial claim: may not pass S4 (based).

There is strong evidence supporting the benefits of MBIs in managing pain and emotional distress in a wide variety of clinical populations.

“Although there is strong evidence supporting the benefits of MBIs in managing pain and emotional distress in a wide variety of clinical populations”

May combine two claims.

Participants in the MBSR group reported improvements in mental fatigue and performed better on neuropsychological testing than those in the control group.

“Participants in the MBSR group reported improvements in mental fatigue and performed better on neuropsychological testing than those in the control group.”

• cites Johansson et al, 2012 sourceNot checked — no full text of the source

May combine two claims.

Individuals who participated in the MBCT program demonstrated improvements in depression, trait mindfulness, social and emotional well-being, and quality of life as compared to the control group.

“Individuals who participated in the MBCT program demonstrated improvements in depression, trait mindfulness, social and emotional well-being, and quality of life as compared to the control group.”

• cites Wang et al, 2020 sourceNot checked — no full text of the source

May combine two claims.

In a qualitative study, participants reported that mindfulness helped them cope better with stress and helped them reach their rehabilitation goals.

“In a qualitative study, participants reported that mindfulness helped them cope better with stress and helped them reach their rehabilitation goals.6”

• cites [6] 6. Wrapson W, Dorrestein M, Wrapson J, Theadom A, Kayes N, Snell D, Rutherford S, Roche M, Babbage DR, Siegert RJ. Stroke survivors' expec- tations and post-intervention perceptions of mindfulness training: a qualita- tive study [published online July 19, 2021]. Neuropsychol Rehabil. 2021. doi: 10.1080/09602011.2021.1950777 sourceNot checked — no full text of the source

May combine two claims.

Mindfulness-informed interventions are feasible and acceptable within the stroke population.

“Mindfulness-informed interventions are feasible and acceptable within the stroke population and may be an important complementary treatment to help stroke survivors and their families manage the consequences of stroke.”

Probably not a substantial claim: may not pass S4 (based).

Research examining MBIs within the stroke population is in its infancy.

“However, research examining MBIs within the stroke population is in its infancy.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Fatigue is a common symptom following stroke, and is related to lower quality of life, reduced functional ability, and slower rate of recovery.

“In addition to emotional distress, fatigue is a common symptom following stroke, and is related to lower quality of life, reduced functional ability, and slower rate of recovery.37”

• cites [37] 37. Duncan F, Wu S, Mead GE. Frequency and natural history of fatigue after stroke: a systematic review of longitudinal studies. J Psychosom Res. 2012;73:18-27. doi: 10.1016/j.jpsychores.2012.04.001 sourceNot checked — no full text of the source

May combine two claims.

In a small study with a waitlist control group, participants in the meditation group were found to have some improvements in fluency immediately following the intervention, although these improvements were not statistically significant.

“In a small study with a waitlist control group examining a 5-day mindfulness meditation group training program in 8 adults with aphasia related to stroke, participants in the meditation group were found to have some improvements in fluency immediately following the intervention, although these improvements were not statistically significant.16”

• cites [16] 16. Marshall RS, Laures-Gore J, Love K. Brief mindfulness meditation group training in aphasia: exploring attention, language and psycho- physiological outcomes. Int J Lang Commun Disord. 2018;53:40-54. doi: 10.1111/1460-6984.12325 sourceNot checked — no full text of the source

May combine two claims.

The reduction in depressive symptoms was true for patients with both mild and moderate severity of neurological deficits, although greater depression scores were noted for those with greater severity.

“This was true for patients with both mild and moderate severity of neurological deficits, although greater depression scores were noted for those with greater severity.”

• cites [17] 17. Niu Y, Sheng S, Chen Y, Ding J, Li H, Shi S, Wu J, Ye D. The efficacy of group acceptance and commitment therapy for preventing post-stroke depression: a randomized controlled trial. J Stroke Cerebrovasc Dis. 2022;31:106225. doi: 10.1016/j.jstrokecerebrovasdis.2021.106225 sourceNot checked — no full text of the source

May combine two claims.

Studies have found that mindfulness meditation reduces mind wandering which is associated with improved awareness and self-regulation and executive functioning in nonclinical samples.

“Studies have found that mindfulness meditation reduces mind wandering which is associated with improved awareness and self-regulation 51,47 and executive functioning 48 in nonclinical samples.”

• cites [51] 51. Bortolla R, Galli M, Spada GE, Maffei C. Mindfulness effects on mind wandering and autonomic balance. Appl Psychophysiol Biofeedback. 2022;47:53-64. doi: 10.1007/s10484-021-09527-x sourceNot checked — no full text of the source
• cites [47] 47. Gill LN, Renault R, Campbell E, Rainville P, Khoury B. Mindfulness induc- tion and cognition: a systematic review and meta-analysis. Conscious Cogn. 2020;84:102991. doi: 10.1016/j.concog.2020.102991 sourceNot checked — no full text of the source
• cites [48] 48. Millett G, D' Amico D, Amestoy ME, Gryspeerdt C, Fiocco AJ. Do group- based mindfulness meditation programs enhance executive functioning? A systematic review and meta-analysis of the evidence. Conscious Cogn. 2021;95:103195. doi: 10.1016/j.concog.2021.103195 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The need for more robust, controlled randomized trials with active control group remains for mindfulness in poststroke recovery.

“Despite the studies that support the role of mindfulness in poststroke recovery, the need for more robust, controlled randomized trials with active control group remains.”

May combine two claims.

Mindfulness meditation is both feasible and acceptable for stroke survivors with aphasia.

“Despite these findings, the study demonstrated that mindfulness meditation is both feasible and acceptable for stroke survivors with aphasia and further exploration of mindfulness meditation in this population is warranted.”

• cites [16] 16. Marshall RS, Laures-Gore J, Love K. Brief mindfulness meditation group training in aphasia: exploring attention, language and psycho- physiological outcomes. Int J Lang Commun Disord. 2018;53:40-54. doi: 10.1111/1460-6984.12325 sourceNot checked — no full text of the source

May combine two claims.

Meta-analyses demonstrate that mindfulness meditation has small effects on improving cognitive performance in tasks requiring complex higher-order functioning and executive functioning in nonclinical samples.

“Meta-analyses demonstrate that mindfulness meditation has small effects on improving cognitive performance in tasks requiring complex higher-order functioning 47 and executive functioning 48 in nonclinical samples.”

• cites [47] 47. Gill LN, Renault R, Campbell E, Rainville P, Khoury B. Mindfulness induc- tion and cognition: a systematic review and meta-analysis. Conscious Cogn. 2020;84:102991. doi: 10.1016/j.concog.2020.102991 sourceNot checked — no full text of the source
• cites [48] 48. Millett G, D' Amico D, Amestoy ME, Gryspeerdt C, Fiocco AJ. Do group- based mindfulness meditation programs enhance executive functioning? A systematic review and meta-analysis of the evidence. Conscious Cogn. 2021;95:103195. doi: 10.1016/j.concog.2021.103195 sourceNot checked — no full text of the source

May combine two claims.

Practicing mindfulness improves the immune response to psychological stress, lowering the production of proinflammatory cytokines.

“Others have shown that practicing mindfulness improves the immune response to psychological stress, lowering the production of proinflammatory cytokines.34”

• cites [34] 34. Janusek LW, Tell D, Mathews HL. Mindfulness predicts psycho-behav- ioral improvement after breast cancer diagnosis: influence of childhood adversity. West J Nurs Res. 2020:193945920932290. doi: 10.1177/ 0193945920932290 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

As an alternative method of delivering MBIs, virtual reality may help foster feelings of self-efficacy and independence in stroke patients by reducing the degree of reliance on their caregivers.

“The adaptation of MBIs across VR platforms is in its infancy, but as an alternative method of delivering MBIs, it may help foster feelings of self-efficacy and independence in stroke patients by reducing the degree of reliance on their caregivers.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Online (web-based) delivery of MBI may reach a wider spectrum of patients.

“Online (web-based) delivery of MBI may reach a wider spectrum of patients.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Postdischarge education and training can be reinforced at outpatient clinic visits and incorporated into both inpatient and virtual stroke support group settings.

“Postdischarge education and training can be reinforced at outpatient clinic visits and incorporated into both inpatient and virtual stroke support group settings.”

May combine two claims.

The American Heart Association recognizes the dyadic nature of the survivor-caregiver relationship and supports targeting both survivor and caregiver outcomes to reduce chronic stress.

“The American Heart Association also recognizes the dyadic nature of this relationship and supports the targeting of both survivor and caregiver outcomes to reduce chronic stress.65”

• cites [65] 65. Bakas T, Clark PC, Kelly-Hayes M, King RB, Lutz BJ, Miller EL; American Heart Association Council on Cardiovascular and Stroke Nursing and the Stroke Council. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Associa- tion and American Stroke Association. Stroke. 2014;45:2836-2852. doi: 10.1161/STR.0000000000000033 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

Nurses have the potential to be influential care professionals in the successful integration of MBI techniques in stroke recovery.

“Nurses, present at all these care settings, have the potential to be influential care professionals in the successful integration of MBI techniques in stroke recovery.”

• AssumptionRests on an assumption: Nurses are present across the continuum of stroke care, from the prehospital to the postacute setting.
• AssumptionRests on an assumption: The profession of nursing has been tasked with providing holistic health care delivery that extends beyond physical needs and considers the patient's emotional and psychological health.

May combine two claims.

A recent systematic review and meta-analysis of 87 RCTs have shown that rehabilitation that incorporate VR technology improves physical function, walking ability and cadence, balance, gait velocity, as well as daily life activities as compared to conventional rehabilitation.

“For example, recent systematic review and meta-analysis of 87 RCTs have shown that rehabilitation that incorporate VR technology improves physical function, walking ability and cadence, balance, gait velocity, as well as daily life activities as compared to the conventional rehabilitation.56”

• cites [56] 56. Zhang B, Li D, Liu Y, Wang J, Xiao Q. Virtual reality for limb motor func- tion, balance, gait, cognition and daily function of stroke patients: A sys- tematic review and meta-analysis. J Adv Nurs. 2021;77:3255-3273. doi: 10.1111/jan.14800 sourceNot checked — no full text of the source

May combine two claims.

Preliminary findings demonstrated that online MBIs can reduce anxiety and stress in healthy adults, adults with posttraumatic stress disorder symptoms, and adults with multiple sclerosis.

“Preliminary findings demonstrated that online MBIs can reduce anxiety and stress in healthy adults, adults with posttraumatic stress disorder symptoms, and adults with multiple sclerosis.52”

• cites [52] 52. Sesel AL, Sharpe L, Beadnall HN, Barnett MH, Szabo M, Naismith SL. A randomized controlled trial of a web-based mindfulness programme for people with MS with and without a history of recurrent depression. Mult Scler (Houndmills, Basingstoke, England). 2022:13524585211068002. doi: 10.1177/13524585211068002 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

A more individualized approach is needed to reach those who experience more severe functional impairments.

“A more individualized approach is needed to reach those who experience more severe functional impairments.”

Probably not a substantial claim: may not pass S2 (checkable).

MBI techniques can be integrated into the daily delivery of nursing interventions.

“MBI techniques can be integrated into the daily delivery of nursing interventions.”

May combine two claims.

The standard 8-week format MBSR programs are more demanding and limited to patients with milder physical, neurological and cognitive impairments.

“The standard 8-week format MBSR programs are more demanding and limited to patients with milder physical, neurological and cognitive impairments.13”

• cites [13] 13. Johansson B, Bjuhr H, Rönnbäck L. Mindfulness-based stress reduc- tion (MBSR) improves long-term mental fatigue after stroke or trau- matic brain injury. Brain Inj. 2012;26:1621-1628. doi: 10.3109/ 02699052.2012.700082 sourceNot checked — no full text of the source

May combine two claims.

Participants in either an in-person or synchronous internet-based 8-week MBSR program reported improved mental fatigue and exhibited improvements in processing 2 temporally close targets in an attention blink test as compared to a control group.

“Investigators also found that participants in either an in-person or synchronous internet-based 8-week MBSR program reported improved mental fatigue and exhibited improvements in processing 2 temporally close targets in an attention blink test as compared to a control group.12”

• cites [12] 12. Johansson B, Bjuhr H, Karlsson M, Karlsson JO, Rönnbäck L. Mindfulness- based stress reduction (MBSR) delivered live on the internet to individuals suffering from mental fatigue after an acquired brain injury. Mindfulness. 2015;6:1356-1365. doi: 10.1007/s12671-015-0406-7 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

Nurses are well-positioned to lead future research examining MBIs in stroke populations.

“Given that nurses care for patients across the stroke continuum and their focus on providing holistic care, nurses are well-positioned to lead future research examining MBIs in stroke populations.”

• AssumptionRests on an assumption: Nurses are present across the continuum of stroke care, from the prehospital to the postacute setting.
• AssumptionRests on an assumption: The profession of nursing has been tasked with providing holistic health care delivery that extends beyond physical needs and considers the patient's emotional and psychological health.

Probably not a substantial claim: may not pass S2 (checkable).

Nurses may be able to incorporate MBIs in a variety of settings.

“Nurses are in a position in that they are present across the continuum of stroke care, from the prehospital to the postacute setting, and may be able to incorporate MBIs in a variety of settings.”

• AssumptionRests on an assumption: Nurses are present across the continuum of stroke care, from the prehospital to the postacute setting.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

It would be feasible to introduce MBI techniques to nursing students to practice with patients and to incorporate this as a demonstrated clinical element in either a simulated or in-person environment.

“It would be feasible to introduce MBI techniques to nursing students to practice with patients and to incorporate this as a demonstrated clinical element in either a simulated or in-person environment.”

• AssumptionRests on an assumption: The profession of nursing has been tasked with providing holistic health care delivery that extends beyond physical needs and considers the patient's emotional and psychological health.

Probably not a substantial claim: may not pass S4 (based).

MBIs may help enhance both physical and psychological aspects of stroke recovery.

“As MBIs may help enhance both physical and psychological aspects of stroke recovery, these interventions also holistically address the stroke survivor in a similar way that nurses do.”