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Gutierrez-Arias R, Pieper D, Lunny C, Torres-Castro R, Aguilera-Eguía R, Oliveros MJ, Seron P. Only half of the authors of overviews of exercise-related interventions use some strategy to manage overlapping primary studies-a metaresearch study. J Clin Epidemiol 2024; 170:111328. [PMID: 38513993 DOI: 10.1016/j.jclinepi.2024.111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES The conduct of systematic reviews (SRs) and overviews share several similarities. However, because the unit of analysis for overviews is the SRs, there are some unique challenges. One of the most critical issues to manage when conducting an overview is the overlap of data across the primary studies included in the SRs. This metaresearch study aimed to describe the frequency of strategies to manage the overlap in overviews of exercise-related interventions. STUDY DESIGN AND SETTING A systematic search in MEDLINE (Ovid), Embase (Ovid), Cochrane Library, Epistemonikos, and other sources was conducted from inception to June 2022. We included overviews of SRs that considered primary studies and evaluated the effectiveness of exercise-related interventions for any health condition. The overviews were screened by two authors independently, and the extraction was performed by one author and checked by a second. We found 353 overviews published between 2005 and 2022 that met the inclusion criteria. RESULTS One hundred and sixty-four overviews (46%) used at least one strategy to visualize, quantify, or resolve overlap, with a matrix (32/164; 20%), absolute frequency (34/164; 21%), and authors' algorithms (24/164; 15%) being the most used methods, respectively. From 2016 onwards, there has been a trend toward increasing the use of some strategies to manage overlap. Of the 108 overviews that used some strategy to resolve the overlap, ie, avoiding double or multiple counting of primary study data, 79 (73%) succeeded. In overviews where no strategies to manage overlap were reported (n = 189/353; 54%), 16 overview authors (8%) recognized this as a study limitation. CONCLUSION Although there is a trend toward increasing its use, only half of the authors of the overviews of exercise-related interventions used a strategy to visualize, quantify, or resolve overlap in the primary studies' data. In the future, authors should report such strategies to communicate more valid results.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain; Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, 7591538, Chile; INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile.
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health Systems Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Carole Lunny
- Knowledge Translation Program, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Raúl Aguilera-Eguía
- Departamento de Salud Pública, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Maria-Jose Oliveros
- Universidad de La Frontera, Facultad de Medicina, Departamento de Ciencias de la Rehabilitación & CIGES, Temuco, Chile
| | - Pamela Seron
- Universidad de La Frontera, Facultad de Medicina, Departamento de Ciencias de la Rehabilitación & CIGES, Temuco, Chile
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Chow CP, Wong LY, Poon CYC, Yiu BPH, Wong TPS, Wong M, Yam KY, Ngai SPC. Functional outcome after selective dorsal rhizotomy: a retrospective case control study. Childs Nerv Syst 2024; 40:873-880. [PMID: 37979014 DOI: 10.1007/s00381-023-06213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This study examines long-term benefit on functional outcomes and quality of life after selective dorsal rhizotomy (SDR) in children with spastic diplegia in Hong Kong. METHOD This is a case control study. Individuals with spastic diplegia who were at 6 to 12 years post-SDR were recruited. Age, gender, cognition, and Gross Motor Function Classification System level-matched individuals with spastic diplegia who had not undergone SDR were recruited as controls. Outcome measures included physical level, functional level, physiological level, and quality of life. All data were compared by independent t-test. RESULTS Individuals post-SDR (n = 15) demonstrated a significantly better range of ankle dorsiflexion in knee extension by - 5.7 ± 10.9° than the control group (n = 12). No other significant differences were observed. CONCLUSION SDR is a safe, one-off procedure and provides long-term reduction in spasticity with no major complications. With the heterogeneity, we did not demonstrate between-group differences in long-term functional outcomes.
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Affiliation(s)
- C P Chow
- Child Assessment Service, Department of Health, Hong Kong SAR, China.
| | - L Y Wong
- Child Assessment Service, Department of Health, Hong Kong SAR, China
| | - C Y C Poon
- Child Assessment Service, Department of Health, Hong Kong SAR, China
| | - B P H Yiu
- Child Assessment Service, Department of Health, Hong Kong SAR, China
| | - T P S Wong
- Child Assessment Service, Department of Health, Hong Kong SAR, China
| | - M Wong
- Child Assessment Service, Department of Health, Hong Kong SAR, China
| | - K Y Yam
- Department of Neurosurgery, Tuen Mun Hospital, Hospital Authority, Hong Kong SAR, China
| | - S P C Ngai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Zhang J, He C. Evidence-based rehabilitation medicine: definition, foundation, practice and development. MEDICAL REVIEW (2021) 2024; 4:42-54. [PMID: 38515780 PMCID: PMC10954297 DOI: 10.1515/mr-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/19/2023] [Indexed: 03/23/2024]
Abstract
To determine the definition, foundation, practice, and development of evidence-based rehabilitation medicine (EBRM) and point out the development direction for EBRM. Retrieve the database of PubMed, Cochrane Library, Embase, China national knowledge infrastructure (CNKI), Wanfang, and China science and technology journal database (CSTJ). The search was conducted from the establishment of the database to June 2023. The key words are "rehabilitation medicine and evidence based" in Chinese and English. After reading the abstract or full text of the literature, a summary analysis is conducted to determine the definition, foundation, practice, and development of EBRM. A total of 127 articles were included. The development of 14 sub majors in EBRM are not balanced, evidence-based musculoskeletal rehabilitation medicine (EBMRM) (31 articles, mainly focuses on osteoarthritis, osteoporosis and musculoskeletal pain), evidence-based neurorehabilitation medicine (EBNM) (34 articles, mainly concentrated in stroke, traumatic brain injury and spinal cord injury) and evidence-based education rehabilitation medicine (EBEDRM) (17 articles, mainly focuses on educational methodology), evidence-based nursing rehabilitation medicine (EBNRM) (2 articles), evidence-based engineering rehabilitation medicine (EBENRM) (7 articles), evidence-based traditional Chinese rehabilitation medicine (EBTCRM) (3 articles), evidence-based internal rehabilitation medicine (EBIRM) (11 articles), evidence-based intensive care rehabilitation medicine (EBICRM) (4 articles), evidence-based oncology rehabilitation medicine (EBORM) (6 articles), evidence-based physical therapy medicine (EBPTM) (3 articles), evidence-based cardiopulmonary rehabilitation medicine (EBCRM) (6 articles), evidence-based speech therapy medicine (EBSTM)/evidence-based occupation therapy medicine (EBOTM)/evidence-based geriatric rehabilitation medicine (EBGRM) (1 article). The EBMRM, EBNM and EBEDRM are relatively well developed. The development of EBNRM, EBENRM, EBTCRM, EBIRM, EBICRM, EBGRM, EBORM, EBCRM, EBPTM, EBSTM and EBOTM is relatively slow, indicating these eleven fields should be pay more attention in future.
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Affiliation(s)
- Jinlong Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Gutierrez-Arias R, Pieper D, Lunny C, Torres-Castro R, Aguilera-Eguía R, Seron P. Strategies used to manage overlap of primary study data by exercise-related overviews: protocol for a systematic methodological review. BMJ Open 2023; 13:e069906. [PMID: 37080626 PMCID: PMC10124299 DOI: 10.1136/bmjopen-2022-069906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION One of the most conflicting methodological issues when conducting an overview is the overlap of primary studies across systematic reviews (SRs). Overlap in the pooled effect estimates across SRs may lead to overly precise effect estimates in the overview. SRs that focus on exercise-related interventions are often included in overviews aimed at grouping and determining the effectiveness of various interventions for managing specific health conditions. The aim of this systematic methodological review is to describe the strategies used by authors of overviews focusing on exercise-related interventions to manage the overlap of primary studies. METHODS AND ANALYSIS A comprehensive search strategy has been developed for different databases and their platforms. The databases to be consulted will be MEDLINE (Ovid), Embase (Ovid), The Cochrane Database of Systematic Reviews (Cochrane Library) and Epistemonikos. Two reviewers will independently screen the records identified through the search strategy and extract the information from the included overviews. The frequency and the type of overlap management strategies of the primary studies included in the SRs will be considered as the main outcome. In addition, the recognition of the lack of use of any overlap management strategy and the congruence between planning and conducting the overview focusing on overlap management strategies will be assessed. A subgroup analysis will be carried out according to the journal impact factor, year of publication and compliance with the Preferred Reporting Items for Overviews of Reviews statement. ETHICS AND DISSEMINATION This study will not involve human subjects and therefore does not require ethics committee approval. However, the conduct and reporting of the findings of this review will be conducted in a rigorous, systematic and transparent manner, which relates to research ethics.The findings of this review will be presented at scientific conferences and published as one or more studies in peer-review scientific journals related to rehabilitation or research methods.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Servicio de Medicina Física y Rehabilitación, Unidad de Kinesiología, Instituto Nacional del Torax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health Systems Research, Rüdersdorf, Germany
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Carole Lunny
- Knowledge Translation Program, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Raúl Aguilera-Eguía
- Departamento Salud Pública, Facultad de Medicina, Carrera de Kinesiología, Universidad Católica de la Santísima Concepción, Concepcion, Bío Bío, Chile
| | - Pamela Seron
- Departamento de Ciencias de la Rehabilitación & CIGES, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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Wang RH, Kenyon LK, McGilton KS, Miller WC, Hovanec N, Boger J, Viswanathan P, Robillard JM, Czarnuch SM. The Time Is Now: A FASTER Approach to Generate Research Evidence for Technology-Based Interventions in the Field of Disability and Rehabilitation. Arch Phys Med Rehabil 2021; 102:1848-1859. [PMID: 33992634 DOI: 10.1016/j.apmr.2021.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022]
Abstract
Current approaches for generating high-quality research evidence for technology-based interventions in the field of disability and rehabilitation are inappropriate. Prevailing approaches often focus on randomized controlled trials as standard and apply clinical trial practices designed for pharmaceuticals; such approaches are unsuitable for technology-based interventions and are counterproductive to the goals of supporting people with disabilities and creating benefits for society. This communication is designed to: (1) advocate for the use of alternative approaches to generating evidence in the development and evaluation of technology-based interventions; (2) propose an alternative framework and guiding principles; and (3) stimulate action by multiple disciplines and sectors to discuss, adopt, and promote alternative approaches. Our Framework for Accelerated and Systematic Technology-based intervention development and Evaluation Research (FASTER) is informed by established innovation design processes, complex intervention development, evaluation, and implementation concepts as well as our collective experiences in technology-based interventions research and clinical rehabilitation practice. FASTER is intended to be meaningful, timely, and practical for researchers, technology developers, clinicians, and others who develop these interventions and seek evidence. We incorporate research methods and designs that better align with creating technology-based interventions and evidence for integration into practice. We propose future activities to improve the generation of research evidence, enable the selection of research methods and designs, and create standards for evidence evaluation to support rigor and applicability for technology-based interventions. With this communication we aim to improve and advance technology-based intervention integration from conception to use, thus responsibly accelerating innovation to have greater positive benefit for people and society.
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Affiliation(s)
- Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Lisa K Kenyon
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan
| | - Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada; Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, Canada
| | - Nina Hovanec
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
| | | | - Julie M Robillard
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Stephen M Czarnuch
- Department of Electrical and Computer Engineering/Discipline of Emergency Medicine, Memorial University, St John's, Canada
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Colquhoun HL, Jesus TS, O'Brien KK, Tricco AC, Chui A, Zarin W, Lillie E, Hitzig SL, Seaton S, Engel L, Rotenberg S, Straus SE. Scoping Review on Rehabilitation Scoping Reviews. Arch Phys Med Rehabil 2020; 101:1462-1469. [PMID: 32325163 DOI: 10.1016/j.apmr.2020.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the extent, scope, and methodological quality of rehabilitation scoping reviews. DATA SOURCES A comprehensive list of scoping reviews conducted in the broader health field (inception to July 2014), with a further update of that list (up to February 2017) using similar methods, including searching 9 electronic databases. STUDY SELECTION Articles were included if they were scoping reviews within rehabilitation. Established review methods were used including (1) a PubMed filter detecting rehabilitation content and (2) title-and-abstract screening by 2 independent reviewers applied sequentially to articles from the existing list of scoping reviews and to the updated search results. Full-text articles were reviewed by 1 reviewer, with discrepancies resolved by another after pilot screening with > 80% agreement. Remaining discrepancies were resolved by external experts. DATA EXTRACTION Two independent reviewers used piloted and standardized data extraction forms. DATA SYNTHESIS We screened 1823 records, including 992 full texts, to identify 251 rehabilitation-related scoping reviews. Rehabilitation scoping reviews had an exponential yearly increase since 2008 (r2=0.89; P<.01). The literature addressed diverse topics (eg, spread over 43 condition groupings); 43% were published in Canada. Examples of methodological limitations included: 39% of reviews did not cite the use of a methodological framework, 96% did not include the appropriate flow diagram, 8% did not report eligibility criteria, and 57% did not report data extraction details. CONCLUSIONS The increasing popularity of scoping reviews in rehabilitation has not been met by high standards in methodological quality. To increase the value of rehabilitation scoping reviews, rehabilitation stakeholders need to use existing methodological standards for the conduct, reporting, and appraisal of scoping reviews.
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Affiliation(s)
- Heather L Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada.
| | - Tiago S Jesus
- Global Health and Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon, Lisbon, Portugal
| | - Kelly K O'Brien
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adora Chui
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Wasifa Zarin
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Erin Lillie
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Samantha Seaton
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Lisa Engel
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Jesus TS. Systematic Reviews and Clinical Trials in Rehabilitation: Comprehensive Analyses of Publication Trends. Arch Phys Med Rehabil 2016; 97:1853-1862.e2. [PMID: 27424809 DOI: 10.1016/j.apmr.2016.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
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Gerber LH, Nava A, Garfinkel S, Goel D, Weinstein AA, Cai C. A need for an augmented review when reviewing rehabilitation research. Disabil Health J 2016; 9:559-66. [PMID: 27522302 DOI: 10.1016/j.dhjo.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/14/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
There is a need for additional strategies for performing systematic reviews (SRs) to improve translation of findings into practice and to influence health policy. SRs critically appraise research methodology and determine level of evidence of research findings. The standard type of SR identifies randomized controlled trials (RCTs) as providing the most valid data and highest level of evidence. RCTs are not among the most frequently used research design in disability and health research. RCTs usually measure impairments for the primary research outcome rather than improved function, participation or societal integration. It forces a choice between "validity" and "utility/relevance." Other approaches have effectively been used to assess the validity of alternative research designs, whose outcomes focus on function and patient-reported outcomes. We propose that utilizing existing evaluation tools that measure knowledge, dissemination and utility of findings, may help improve the translation of findings into practice and health policy.
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Affiliation(s)
- Lynn H Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA.
| | - Andrew Nava
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | | | - Divya Goel
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | - Ali A Weinstein
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | - Cindy Cai
- American Institutes for Research, Washington DC, USA
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Seel RT, Corrigan JD, Dijkers MP, Barrett RS, Bogner J, Smout RJ, Garmoe W, Horn SD. Patient Effort in Traumatic Brain Injury Inpatient Rehabilitation: Course and Associations With Age, Brain Injury Severity, and Time Postinjury. Arch Phys Med Rehabil 2015. [PMID: 26212400 DOI: 10.1016/j.apmr.2014.10.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe patients' level of effort in occupational, physical, and speech therapy sessions during traumatic brain injury (TBI) inpatient rehabilitation and to evaluate how age, injury severity, cognitive impairment, and time are associated with effort. DESIGN Prospective, multicenter, longitudinal cohort study. SETTING Acute TBI rehabilitation programs. PARTICIPANTS Patients (N=1946) receiving 138,555 therapy sessions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Effort in rehabilitation sessions rated on the Rehabilitation Intensity of Therapy Scale, FIM, Comprehensive Severity Index brain injury severity score, posttraumatic amnesia (PTA), and Agitated Behavior Scale (ABS). RESULTS The Rehabilitation Intensity of Therapy Scale effort ratings in individual therapy sessions closely conformed to a normative distribution for all 3 disciplines. Mean Rehabilitation Intensity of Therapy Scale ratings for patients' therapy sessions were higher in the discharge week than in the admission week (P<.001). For patients who completed 2, 3, or 4 weeks of rehabilitation, differences in effort ratings (P<.001) were observed between 5 subgroups stratified by admission FIM cognitive scores and over time. In linear mixed-effects modeling, age and Comprehensive Severity Index brain injury severity score at admission, days from injury to rehabilitation admission, days from admission, and daily ratings of PTA and ABS score were predictors of level of effort (P<.0001). CONCLUSIONS Patients' level of effort can be observed and reliably rated in the TBI inpatient rehabilitation setting using the Rehabilitation Intensity of Therapy Scale. Patients who sustain TBI show varying levels of effort in rehabilitation therapy sessions, with effort tending to increase over the stay. PTA and agitated behavior are primary risk factors that substantially reduce patient effort in therapies.
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Affiliation(s)
- Ronald T Seel
- Crawford Research Institute, Shepherd Center, Atlanta, GA.
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | - Marcel P Dijkers
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan S Barrett
- Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | - Randall J Smout
- Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT
| | - William Garmoe
- Medstar National Rehabilitation Hospital, Washington, DC
| | - Susan D Horn
- Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT
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Vaughan-Graham J, Cott C, Wright FV. The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part II: intervention studies perspectives. Disabil Rehabil 2015; 37:1909-28. [PMID: 25427891 DOI: 10.3109/09638288.2014.987880] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The study's purpose was to describe the range of knowledge pertaining to the Bobath (NDT) concept in adult neurological rehabilitation, synthesizes the findings, identify knowledge gaps and develop empirically based recommendations for future research. METHODS A scoping review of research and non-research articles published from 2007 to 2012. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria for studies were electronically accessible English language literature with Bobath and/or Neurodevelopmental Therapy as the subject heading in the title/keyword/abstract/intervention comparison with respect to adult neurological conditions. Data were abstracted and summarized with respect to study design, theoretical framework, clinical application including population representation, study fidelity, intervention comparison, duration of care, measurement and findings. RESULTS Of the 33 publications identified 17 were intervention studies (11 RCT's/1 prospective parallel group design/5 N-of-1). One other paper was a systematic review. CONCLUSIONS The intervention studies, primarily RCT designs, have serious methodological concerns particularly related to study/treatment fidelity and measurement resulting in no clear clinical direction. Aspects such as theoretical framework, therapist skill, quality of movement measurement and individualized interventions require careful consideration in the design of Bobath studies. Implications for Rehabilitation Future intervention studies should be based on the current Bobath theoretical framework and key aspects of clinical practice. Study and treatment fidelity issues need to be carefully considered when interpreting the results of existing RCT's evaluating the Bobath concept. N-of-1 randomized, observational, factorial and mixed method study designs should be considered as alternative study options.
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Affiliation(s)
- Julie Vaughan-Graham
- a Department of Physical Therapy and Rehabilitation Science , University of Toronto , Toronto , Canada and
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DAMIANO DIANEL. Meaningfulness of mean group results for determining the optimal motor rehabilitation program for an individual child with cerebral palsy. Dev Med Child Neurol 2014; 56:1141-1146. [PMID: 24919877 PMCID: PMC4229436 DOI: 10.1111/dmcn.12505] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 02/04/2023]
Abstract
As research on the efficacy or effectiveness of interventions to improve motor functioning in cerebral palsy (CP) has accumulated and been incorporated into systematic reviews, the foundation for evidence-based practice in CP is growing. To determine whether an intervention is effective, clinical trials report mean group differences. However, even if a statistically significant mean group effect is found, this does not imply that this intervention was effective for each study participant or ensure positive outcomes for all with CP. A personalized approach to medical care is currently being advocated based primarily on increasingly recognized genetic variations in individual responses to medications and other therapies. A similar approach is also warranted, and perhaps more justifiable, in CP which includes a heterogeneous group of disorders. Even interventions deemed highly effective in CP demonstrate a range of individual responses along a continuum from a negative or negligible response to a strong positive effect, the bases for which remain incompletely understood. This narrative review recommends that the next critical step in advancing evidence-based practice is to implement research strategies to identify patient factors that predict treatment responses so we can not only answer the question 'what works', but also 'what works best, for whom'.
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Affiliation(s)
- DIANE L. DAMIANO
- Rehabilitation Medicine Department/Clinical Center, National Institutes of Health, Bethesda, MD, USA
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