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Aziz JR, Good SR, Horne SC, Eskes GA. A scoping review and critique of the Input-Output subtyping dimension of spatial neglect. Cortex 2024; 176:11-36. [PMID: 38729033 DOI: 10.1016/j.cortex.2024.04.005] [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: 10/22/2023] [Revised: 02/28/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
Spatial neglect is a common and debilitating disorder after stroke whereby individuals have difficulty reporting, orienting, and/or responding to the contralesional side of space. Given the heterogeneity of neglect symptom presentation, various neglect subtypes have been proposed to better characterize the disorder. This review focuses on the distinction between Input neglect (i.e., difficulty perceiving and/or attending to contralesional stimuli) and Output neglect (i.e., difficulty planning and/or executing movements toward contralesional stimuli). Conceptualizations of Input and Output neglect have varied considerably. We provide a novel summary of the terminology, measurement approaches, and neural correlates of these subtypes. A protocol detailing our systematic scoping review strategy is registered on the Open Science Framework (https://osf.io/bvtxf/). For feasibility and greater comparability across studies, we limited our inclusion criteria to tasks focused on visual stimuli and upper-limb movements. A total of 110 articles were included in the review. Subtyping tasks were categorized based on whether they mainly manipulated aspects of the input (i.e., congruence of visual input with motor output, presence of visual input) or the output (i.e., modality, goal, or direction of output) to produce an Input-Output subtype dissociation. We used our review results to identify four main critiques of this literature: 1) lack of consistency/clarity in conceptual models; 2) methodological issues of dissociating Input and Output subtypes; 3) a need for updated neural theories; and 4) barriers to clinical application. We discuss the lessons learned from this subtyping dimension that can be applied to future research on neglect subtype assessment and treatment.
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Affiliation(s)
- Jasmine R Aziz
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada.
| | - Samantha R Good
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
| | - Samantha C Horne
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada; Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Gail A Eskes
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada; Department of Psychiatry, Dalhousie University, Halifax, Canada
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Weerakkody A, Godecke E, Singer B. Investigating the acceptability of modified constraint-induced movement therapy among stroke survivors and carers: a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38835171 DOI: 10.1080/09638288.2024.2361808] [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: 12/11/2023] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To investigate the acceptability of modified constraint-induced movement therapy (mCIMT) among stroke survivors and carers within an early-supported discharge (ESD) service, and to inform further adaptations of the program to enhance acceptability. METHODS Qualitative study within a mixed methods process evaluation of mCIMT implementation. Semi-structured interviews were analysed using reflexive thematic analysis and mapped to the Capability, Opportunity, Motivation- Behaviour (COM-B) model. RESULTS Fifteen stroke survivors and ten carers participated. Five themes were generated and mapped to the COM-B. Participants attributed functional improvements to the program whilst also encountering several challenges with returning home after stroke (Capability- physical); the importance of education (Capability- psychological); the benefits afforded by the structured nature of the program (Opportunity- physical); the challenges for carers to support mCIMT programs whilst navigating new relationship roles (Opportunity- social); the desire to improve (Motivation- automatic); and the influence each of the mCIMT program's components had in facilitating long term upper limb use (Motivation- reflective). CONCLUSION mCIMT was an acceptable intervention for stroke survivors and carers within the ESD service, offering considerable benefits compared to other therapies. The findings suggest that multifaceted education strategies could increase stroke survivor preparedness. Extending the mCIMT program duration may maximise functional improvements.
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Affiliation(s)
- Ashan Weerakkody
- Department of Health, Rehabilitation in the Home, South Metropolitan Health Service, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Department of Health, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, Western Australia, Australia
| | - Barby Singer
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Kolbaşı EN, Huseyinsinoglu BE, Ozdemir Z, Bayraktaroglu Z, Soysal A. Priming constraint-induced movement therapy with intermittent theta burst stimulation to enhance upper extremity recovery in patients with stroke: protocol for a randomized controlled study. Acta Neurol Belg 2024; 124:887-893. [PMID: 38329642 DOI: 10.1007/s13760-024-02472-6] [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: 07/28/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The treatments based on motor control and motor learning principles have gained popularity in the last 20 years, as well as non-invasive brain stimulations that enhance neuroplastic changes after stroke. However, the effect of intermittent theta burst stimulation (iTBS) in addition to evidence-based, intensive neurorehabilitation approaches such as modified constraint-induced movement therapy (mCIMT) is yet to be investigated. AIM We aim to establish a protocol for a randomized controlled study investigating the efficiency of mCIMT primed with iTBS after stroke. METHODS In this randomized controlled, single-blind study, patients with stroke (N = 17) will be divided into 3 groups: (a) mCIMT + real iTBS, (b) mCIMT + sham iTBS, and (c) mCIMT alone. 600-pulse iTBS will be delivered to the primary motor cortex on the ipsilesional hemisphere, and then, patients will receive mCIMT for 1 h/session, 3 sessions/week for 5 weeks. Upper extremity recovery will be assessed with Fugl-Meyer Test-Upper Extremity and Wolf Motor Function Test. Electrophysiological assessments, such as Motor-Evoked Potentials, Resting Motor Threshold, Short-Intracortical Inhibition, and Intracortical Facilitation, will also be included. CONCLUSIONS In this study, a protocol of an ongoing intervention study investigating the effectiveness of iTBS on ipsilesional M1 prior to the mCIMT in patients with stroke is proposed. This will be the first study to research priming mCIMT with iTBS and it may have the potential to reveal the true effect of the iTBS when it is added to the high-quality neurorehabilitation approaches. TRIAL REGISTRATION Trial registration number: NCT05308667.
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Affiliation(s)
- Esma Nur Kolbaşı
- Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Istanbul, Turkey
- Institute of Graduate Studies, Physiotherapy and Rehabilitation Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Burcu Ersoz Huseyinsinoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey.
| | - Zeynep Ozdemir
- Department of Neurology, Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Zubeyir Bayraktaroglu
- Department of Physiology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
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Ghrouz A, Guillen-Sola A, Morgado-Perez A, Muñoz-Redondo E, Ramírez-Fuentes C, Curbelo Peña Y, Duarte E. The effect of a motor relearning on balance and postural control in patients after stroke: An open-label randomized controlled trial. Eur Stroke J 2024; 9:303-311. [PMID: 38158722 DOI: 10.1177/23969873231220218] [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] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Balance and postural control impairments are common in stroke patients, increasing fall risk and limiting their daily and social activities. Current research lacks comprehensive studies evaluating the efficacy and long-term effects of task-specific training on balance and postural control among stroke patients, especially when considering biomechanical and posturographic assessments. PATIENTS AND METHODS A randomized controlled trial included 63 subacute stroke patients recruited from the outpatient rehabilitation department. Participants were randomly assigned to the MRP group (n=32), receiving task-specific training based on MRP, or the CPT group (n=31), receiving conventional physical therapy. Both groups completed an 8-week intervention (3 sessions/week; 1 h./session). Balance and postural control were assessed at baseline, post-intervention, and 3-month follow-up using the Berg Balance Scale (BBS) and posturography. RESULTS The MRP group exhibited significantly larger improvements than the CPT group in both BBS scores (p=0.001, d=2.98, 95% CI [2.25, 3.70]) and Balance Index scores (p=0.001, d=2.83, 95% CI [2.12, 3.53]) after the intervention. These improvements were sustained at 3-month follow-up. DISCUSSION The findings suggest that task-specific training based on MRP is more effective than CPT for improving balance and postural control. The MRP intervention may enhance the motor learning and neural plasticity of the patients, leading to better functional outcomes. However, the study's open-label design represents a limitation, and further research with adequate blinding is needed. CONCLUSION Task-specific training based on MRP was superior to CPT for improving balance and postural control in subacute stroke patients. Participants undergoing MRP exhibited significant and clinically relevant improvements that were sustained at follow-up.
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Affiliation(s)
- Amer Ghrouz
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Anna Guillen-Sola
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Neurorehabilitation Unit, Physical Medicine and Rehabilitation Department, Hospital del Mar, Barcelona, Spain
| | - Andrea Morgado-Perez
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Elena Muñoz-Redondo
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Cindry Ramírez-Fuentes
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Yulibeth Curbelo Peña
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kokorelias KM, Cameron JI, Salbach NM, Colquhoun H, Munce SEP, Nelson MLA, Martyniuk J, Steele Gray C, Tang T, Hitzig SL, Lindsay MP, Bayley MT, Wang RH, Kaur N, Singh H. Exploring the Poststroke Experiences and Needs of South Asian Communities Living in High-Income Countries: Findings from a Scoping Review. J Racial Ethn Health Disparities 2024; 11:1345-1373. [PMID: 37382872 DOI: 10.1007/s40615-023-01613-6] [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: 11/02/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 06/30/2023]
Abstract
Despite the high prevalence of stroke among South Asian communities in high-income countries, a comprehensive understanding of their unique experiences and needs after stroke is lacking. This study aimed to synthesize the literature examining the experiences and needs of South Asian community members impacted by stroke and their family caregivers residing in high-income countries. A scoping review methodology was utilized. Data for this review were identified from seven databases and hand-searching reference lists of included studies. Study characteristics, purpose, methods, participant characteristics, results, limitations, recommendations, and conclusions were extracted. Data were analyzed using descriptive qualitative analysis. In addition, a consultative focus group exercise with six South Asian community members who had experienced a stroke and a program facilitator was conducted to inform the review interpretations. A total of 26 articles met the inclusion criteria and were analyzed. Qualitative analysis identified four descriptive categories: (1) rationale for studying the South Asian stroke population (e.g., increasing South Asian population and stroke prevalence), (2) stroke-related experiences (e.g., managing community support versus stigma and caregiving expectations), (3) stroke service challenges (e.g., language barriers), and (4) stroke service recommendations to address stroke service needs (e.g., continuity of care). Several cultural factors impacted participant experiences, including cultural beliefs about illness and caregiving. Focus group participants from our consultation activity agreed with our review findings. The clinical and research recommendations identified in this review support the need for culturally appropriate services for South Asian communities across the stroke care continuum; however, more research is necessary to inform the design and structure of culturally appropriate stroke service delivery models.
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Affiliation(s)
- Kristina M Kokorelias
- Department of Medicine, Geriatrics Program, Sinai Health System, University Health Network, Toronto, Canada
| | - Jill I Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nancy M Salbach
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah E P Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Michelle L A Nelson
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Carolyn Steele Gray
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Toronto, Canada
| | - Sander L Hitzig
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Mark T Bayley
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Rosalie H Wang
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Navaldeep Kaur
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Rodríguez-Orozco JE, Martínez-Rubio CF, Moreno-Vargas E, Peña-Ortiz A, Pizarro-Peñaranda MC, Rojo-Bustamante E, Villarreal-García DE, Bayona-Ortiz HF. Comparative global analysis of stroke rehabilitation recommendations across income levels. J Clin Epidemiol 2024; 170:111334. [PMID: 38548231 DOI: 10.1016/j.jclinepi.2024.111334] [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: 09/07/2023] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Successful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). STUDY DESIGN AND SETTING We conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P's, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. RESULTS The inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P's criteria) and integration of ethical, legal, social, and economic considerations. CONCLUSION There are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes.
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Affiliation(s)
| | - Carlos Fernando Martínez-Rubio
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad de los Andes, Cra. 7 #116-5, Bogotá, Colombia; Universidad El Bosque, Ak. 9 #131a-2, Bogotá, Colombia
| | - Eder Moreno-Vargas
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 #18-49, Cali, Valle del Cauca, Colombia
| | - Angélica Peña-Ortiz
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad de los Andes, Cra. 7 #116-5, Bogotá, Colombia
| | | | - Estefanía Rojo-Bustamante
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad El Bosque, Ak. 9 #131a-2, Bogotá, Colombia
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Razavilar N, Tran DT, Dukelow SP, Round J. Utilization of early supported discharge and outpatient rehabilitation services following inpatient stroke rehabilitation. Arch Public Health 2024; 82:80. [PMID: 38816872 PMCID: PMC11137928 DOI: 10.1186/s13690-024-01300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Studies examining factors associated with patient referral to early supported discharge (ESD)/outpatient rehabilitation (OPR) programs and utilization of ESD/OPR services after discharge from inpatient stroke rehabilitation (IPR) are scarce. Accordingly, we examined utilization of ESD/OPR services following discharge from IPR and patient factors associated with service utilization. METHODS Stroke patients discharged from IPR facilities in Alberta between April 2014 and March 2016 were included and followed for one year for ESD/OPR service utilization. Multivariable linear and negative binomial regressions were used to examine association of patients' factors with ESD/OPR use. RESULTS We included 752 patients (34.4% of 2,187 patients discharged from IPR) who had 40,772 ESD/OPR visits during one year of follow-up in the analysis. Mean and median ESD/OPR visits were 54.2 and 36 visits, respectively. Unadjusted ESD/OPR visits were lower in females and patients aged ≥ 60 years but were similar between urban and rural areas. After adjustment for patient factors, patients in urban areas and discharged home after IPR were associated with 83.5% and 61.9%, respectively, increase in ESD/OPR visits, while having a right-body stroke was associated with 23.5% increase. Older patients used ESD/OPR less than their younger counterparts (1.4% decrease per one year of older age). Available factors explained 12.3% of variation in ESD/OPR use. CONCLUSION ESD/OPR utilization after IPR in Alberta was low and varied across age and geographic locations. Factors associated with use of ESD/OPR were identified but they could not fully explain variation of ESD/OPR use.
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Affiliation(s)
| | - Dat T Tran
- Institute of Health Economics, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Jeff Round
- Institute of Health Economics, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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8
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Huynh E, Wiley E, Park S, Sakakibara BM, Tang A. Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study. Top Stroke Rehabil 2024:1-9. [PMID: 38785298 DOI: 10.1080/10749357.2024.2356407] [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: 11/08/2023] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. METHODS This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. RESULTS Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. CONCLUSION We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke.
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Affiliation(s)
- Eric Huynh
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Sarah Park
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, The University of British Columbia, Kelowna, Canada
| | - Brodie M Sakakibara
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, The University of British Columbia, Kelowna, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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9
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Mestanza Mattos FG, Bowman T, Marazzini F, Salvalaggio S, Allera Longo C, Bocini S, Bonci V, Materazzi FG, Pelosin E, Putzolu M, Turolla A, Mezzarobba S, Cattaneo D. Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study. Front Neurol 2024; 15:1368973. [PMID: 38854968 PMCID: PMC11157038 DOI: 10.3389/fneur.2024.1368973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background and purpose This study aimed to investigate the factors that influence physiotherapists' decision in choosing restorative or compensatory rehabilitation during gait training in people with neurological disorders (PwNDs) and the different treatments used in the approaches. Methods This cross-sectional analysis used the baseline data from an observational cohort study. We analyzed data from 83 PwNDs (65 people after stroke, 5 with multiple sclerosis, and 13 with Parkinson's disease) who underwent at least 10 sessions of physiotherapy (PT) focusing on gait function. Performance was quantified using the modified Dynamic Gait Index (MDGI), three impairment domains of Fugl-Meyer Assessment for lower extremity (mFM-LL), Activities-specific Balance Confidence (ABC), modified Barthel Index (mBI), Mini-Mental State Examination (MMSE), and Motivational Index (MI). Forty-three physiotherapists completed a treatment report form categorizing the rehabilitation approach and specifying treatments used (e.g., resistance training and proprioceptive exercises). Results Fifty-six subjects underwent restorative rehabilitation approach. The univariate predictors of restorative approach were being in the subacute phase with a disease onset of less than 180 days, (odds ratio [95%CI]; 3.27[1.19-9.24]), mFM-LL (1.25[1.11-1.44]), MMSE (0.85[0.67-1.00]), and number of sessions (1.03[1-1.01]). The backward stepwise analysis revealed an association between restorative and subacute phase (36.32[4.11-545.50]), mFM-LL (3.11[1.55-9.73]), mBI (1.79[1.08-3.77]), MMSE (0.46[0.25-0.71]), and the interaction between mFM-LL and mBI (0.99[0.98-1.00]). No statistically significant association between treatments used and approach was found (p = 0.46). Discussion and conclusion The restorative approach was more commonly used to improve gait. The main variables associated with this approach were: being in the subacute phase of the disease, a low level of impairment, and a high level of functional independence at baseline. However, few differences were found between the treatments used for the restorative or compensatory approaches, as similar PT treatments were used for both.
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Affiliation(s)
| | | | | | - Silvia Salvalaggio
- Laboratory of Computational Neuroimaging, IRCCS San Camillo Hospital, Venice, Italy
- Padova Neuroscience Center, Università degli Studi di Padova, Padua, Italy
| | | | - Serena Bocini
- Division of Physical and Rehabilitation Medicine, Fondazione Opera San Camillo, Presidio di Torino, Italy
| | - Viviana Bonci
- Department of Neurological Sciences, Neurorehabilitation Clinic, AOU delle Marche, Ancona, Italy
| | - Francesco G. Materazzi
- Montecatone Rehabilitation Institute, Imola (BO), Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L'Aquila, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Martina Putzolu
- Laboratory Department of Experimental Medicine (DIMES), Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Davide Cattaneo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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10
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Jarvis K, Cook J, Bavikatte G, Branscombe N, Donovan S, Haworth J, Lawrence C, Morland C, Stockley RC. A pilot exploration of staff and service-user perceptions of a novel digital health technology (Virtual Engagement Rehabilitation Assistant) in complex inpatient rehabilitation. Disabil Rehabil Assist Technol 2024:1-11. [PMID: 38743465 DOI: 10.1080/17483107.2024.2351499] [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: 10/13/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Digital health technologies have the potential to advance rehabilitation. The Virtual Engagement Rehabilitation Assistant (VERA) is a digital technology, co-designed to increase service-user engagement and promote self-management. This qualitative study explored staff and service-user perceptions of implementing VERA on a UK complex inpatient rehabilitation ward. METHODS Purposively sampled service-users were allocated to VERA for up to six weeks. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework underpinned service-user post-intervention interviews and staff focus groups, and structured analysis of the data. Seven service-users were interviewed. Nine staff contributed to focus groups. RESULTS A framework analysis identified themes (and subthemes) structured by the NASSS framework domains: 1. Nature of Clinical Condition, 2. Technology (Ease of Use, Holding Information/Resources in a single Digital Location, Appointments), 3. Value Proposition (Structuring Time, Feedback, Unexpected Benefits) 4. Adopters (Confidence in using Technology, Usefulness), 5. Wider Organisation. Ease of use and storage of key information in a single location were beneficial. Reliability, and provision of accurate and timely feedback to staff and service-users, were identified as essential. CONCLUSIONS A blended approach is required to meet staff and service-user needs. The potential for VERA in a community setting was identified and requires further investigation. Learning from VERA will support development of other digital technologies and their implementation.
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Affiliation(s)
- Kathryn Jarvis
- Stroke Research Team, University of Central Lancashire (UCLan), Preston, UK
| | - Julie Cook
- Applied Health Research Hub, University of Central Lancashire (UCLan), Preston, UK
| | | | | | | | - Jo Haworth
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Rachel C Stockley
- Stroke Research Team, University of Central Lancashire (UCLan), Preston, UK
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11
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Bennett KJ, Leese J, Davis JC, Eng JJ, Liu-Ambrose T. Exploring the experience of cognitive changes among community-dwelling stroke survivors: a qualitative study. Disabil Rehabil 2024; 46:1870-1877. [PMID: 37212368 DOI: 10.1080/09638288.2023.2210309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Cognitive deficits are common among stroke survivors and impact their functional independence. Despite the prevalence of cognitive deficits after stroke, cognitive function is largely overlooked in post-stroke care. The aim of this qualitative study was to explore the experiences of individuals living with post-stroke cognitive changes to understand the impact of these changes on their daily lives. MATERIALS AND METHODS Semi-structured interviews were conducted with a purposeful sample of thirteen community-dwelling adults 50 years and older with chronic stroke who self-identified cognitive changes post-stroke. Interviews were transcribed and an inductive thematic analysis was completed. RESULTS Four key themes were identified: 1) inability to maintain everyday activities; 2) experiencing emotional responses to living with post-stroke cognitive changes; 3) a shrinking social world and; 4) seeking care for cognitive health post-stroke. CONCLUSIONS Post-stroke cognitive changes were described by participants as a driving force behind negative shifts in their daily lives, emotional health, and social connections after stroke. Despite seeking care for their post-stroke cognitive changes, many participants were unable to find support in mainstream healthcare. There is a demonstrated need to further elucidate the gaps in care for post-stroke cognitive deficits and implement community interventions targeting cognitive health post-stroke.
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Affiliation(s)
- Kimberly J Bennett
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Jenny Leese
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research at the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer C Davis
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Applied Health Economics Laboratory, Faculty of Management, University of British Columbia-Okanagan, Kelowna, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, G. F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
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12
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Chen X, Yang X, Li Y, Zhang X, Zhu Y, Du L, Cai J, Xu X. Influencing factors of kinesiophobia among stroke patients with hemiplegia: A mixed methods study. Clin Neurol Neurosurg 2024; 240:108254. [PMID: 38579553 DOI: 10.1016/j.clineuro.2024.108254] [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: 08/28/2023] [Revised: 01/05/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES There is a scarcity of data regarding the effects of kinesiophobia on stroke patients with hemiplegia. Therefore, this paper aims to evaluate the level of kinesiophobia experienced by stroke patients with hemiplegia in China, examine the elements that influence it, and investigate the unique psychological experience of kinesiophobia combined with a qualitative study. METHODS This mixed study was conducted in two steps. Four approved scales were used to evaluate a total of 163 patients: (i) Tampa Scale of Kinesiophobia, (ii) Pain Catastrophizing Scale, (iii) Self-Efficacy for Exercise Scale, and (iv) Hospital Anxiety and Depression Scale. A multivariate linear regression model was used to evaluate the predictors of kinesiophobia in stroke patients with hemiplegia. Subsequently, semi-structured interviews with 15 stroke patients with hemiplegia were conducted using an objective sampling method, and the Colaizzi 7-step analysis process was utilized to analyze the interview data. RESULTS A total of 163 stroke patients with hemiplegia were included in this study, of them, 47.9% reported kinesiophobia. Multiple linear regression revealed that the influencing factors of kinesiophobia in stroke patients with hemiplegia were a history of falls, exaggeration, helplessness, anxiety, depression, and low exercise self-efficacy (P<0.05). The qualitative research focuses on two main topics: personal adoption of negative coping styles and insufficient external support. CONCLUSION Our study showed that the kinesiophobia in stroke patients with hemiplegia was high, with several factors influencing their kinesiophobia. Some of these factors are modifiable and should be considered when formulating kinesiophobia intervention strategies for stroke patients with hemiplegia.
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Affiliation(s)
- Xing Chen
- Medical College, Nantong University, 19th Qixiu Road, Nantong 226001, China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Xueni Yang
- Medical College, Nantong University, 19th Qixiu Road, Nantong 226001, China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Yanqing Li
- Department of Nursing, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Xiaomei Zhang
- Department of Nursing, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China.
| | - Yingqian Zhu
- Medical College, Nantong University, 19th Qixiu Road, Nantong 226001, China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Linjing Du
- Medical College, Nantong University, 19th Qixiu Road, Nantong 226001, China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Jing Cai
- Medical College, Nantong University, 19th Qixiu Road, Nantong 226001, China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Xiuqun Xu
- Department of Nursing, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China.
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13
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Hishikawa N, Sawada K, Maeda H, Ikeda T, Ohashi S, Mikami Y. One-Leg Robotic-Assisted Gait Training Efficiently Improves Gait Independence for Acute Stroke Hemiplegic Patients: A Prospective Pilot Study. Am J Phys Med Rehabil 2024; 103:444-447. [PMID: 38261760 DOI: 10.1097/phm.0000000000002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
ABSTRACT Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days from onset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional Independence Measure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measure walk score of 5 (supervision level). The primary outcome was improvement efficiency of Functional Independence Measure walk, which was the increase in Functional Independence Measure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 ( P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported during Welwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by starting Welwalk training in the early phase after stroke onset.
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Affiliation(s)
- Norikazu Hishikawa
- From the Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan (NH, KS, SO, YM); Department of Development of Multidisciplinary Promotion for Physical Activity, Kyoto Prefectural University of Medicine, Kyoto, Japan (KS); Department of Rehabilitation, Gakusai Hospital, Kyoto Interdisciplinary Institute of Community Medicine, Kyoto, Japan (HM); and Department of Rehabilitation, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan (TI)
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Teasell R, Fleet JL, Harnett A. Post Stroke Exercise Training: Intensity, Dosage, and Timing of Therapy. Phys Med Rehabil Clin N Am 2024; 35:339-351. [PMID: 38514222 DOI: 10.1016/j.pmr.2023.06.025] [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] [Indexed: 03/23/2024]
Abstract
More intense, earlier exercise in rehabilitation results in improved motor outcomes following stroke. Timing and intensity of therapy delivery vary from study to study. For more intensive therapies, there are practical challenges in implementation. However, there are also opportunities for high intensity treatment through innovative approaches and new technologies. Timing of rehabilitation is important. As time post stroke increases, the dosage of therapy required to improve motor recovery outcomes increases. Very early rehabilitation may improve motor outcomes but should be delayed for at least 24 hours post stroke.
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Affiliation(s)
- Robert Teasell
- Parkwood Institute Research, Parkwood Institute, D4-101A, 550 Wellington Road, London, Canada; St. Joseph's Health Care London, London, Canada; Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
| | - Jamie L Fleet
- Parkwood Institute Research, Parkwood Institute, D4-101A, 550 Wellington Road, London, Canada; St. Joseph's Health Care London, London, Canada; Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Amber Harnett
- Parkwood Institute Research, Parkwood Institute, B3-123, 550 Wellington Road, London, Ontario N6C 0A7, Canada
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15
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Shen G, Xia Q, Zhang X, Xue P, Wang Y, Wang J. Dysphagia screening among stroke patients in a tertiary hospital: a best practice implementation project. JBI Evid Implement 2024; 22:158-166. [PMID: 38299368 PMCID: PMC11107889 DOI: 10.1097/xeb.0000000000000408] [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] [Indexed: 02/02/2024]
Abstract
OBJECTIVES The study aimed to promote nurses' compliance with best practices for dysphagia screening in patients with stroke. INTRODUCTION Dysphagia can significantly increase the risk of complications, especially aspiration pneumonia, leading to increased risk of disability, death, and high medical expenses. Dysphagia screening can reduce aspiration risk and is recommended as a crucial step in dysphagia management; however, not all patients with stroke undergo dysphagia screening in the neurology ward. METHODS The JBI Evidence Implementation Framework was used in this study. A baseline audit was conducted by interviewing 22 nurses and reviewing 48 medical records to evaluate current practice against best practice recommendations. The JBI Getting Research into Practice (GRiP) tool was used to identify barriers and strategies for practice change. A follow-up audit of 19 nurses and 48 medical records was conducted after implementation of improvement strategies. RESULTS The follow-up audit results showed improvement in three criteria compared with the baseline audit: for Criterion 1, compliance increased by 27.3%, rising from 72.7% to 100%; for Criteria 3 and 4, compliance increased by 77.1%, rising from 20.8% to 97.9%. The difference in nurses' knowledge, attitude, and behavior scores for dysphagia screening between the baseline and follow-up audits was statistically significant (all p < 0.05). CONCLUSIONS The project showed improvements in evidence-based practice in the dysphagia screening of stroke patients in a neurology ward. However, more work needs to be done to ensure the sustainability of best practices, such as regular training for nurses, supervision from managers, and regular audits of dysphagia screening.
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Affiliation(s)
- Guojing Shen
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Qingyi Xia
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - XiaoLing Zhang
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Ping Xue
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Ying Wang
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Jue Wang
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
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Jarvis K, Thetford C, Turck E, Ogley K, Stockley RC. Understanding the Barriers and Facilitators of Digital Health Technology (DHT) Implementation in Neurological Rehabilitation: An Integrative Systematic Review. Health Serv Insights 2024; 17:11786329241229917. [PMID: 38690403 PMCID: PMC11060031 DOI: 10.1177/11786329241229917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/16/2024] [Indexed: 05/02/2024] Open
Abstract
Background Digital Health technologies (DHT) have potential to deliver intensive, novel and engaging rehabilitation for people with neurological conditions, yet health services lack a strong track record in embedding DHT into practice. The aim of this review was to synthesise factors that have been shown to influence implementation of DHT into neurological rehabilitation. Method An integrative review was undertaken. An extensive search of MEDLINE, CINAHL, AMED, EMBASE was undertaken. The title and abstract of all retrieved sources were screened against pre-defined criteria. Retained sources underwent full text review. The quality of all included sources was assessed. A meta-ethnographic synthesis explored commonalities and contradictions of the included studies. Results Fourteen studies (1 quantitative, 8 qualitative and 5 mixed methods) were included. Eleven implementation theories/models/frameworks were used across the 14 studies. Five themes were identified: (i) individual factors; (ii) user experience of the technology; (iii) the content of the intervention; (iv) access to the technology and (v) supporting use. Conclusions Key factors which appear to influence the implementation of DHT into clinical settings are highlighted. Implementation theories, models and frameworks are under-utilised in DHT rehabilitation research. This needs to be addressed if DHT are to realise their potential in neurological rehabilitation. Registration The protocol was registered and is available from PROSPERO (CRD42021268984).
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Affiliation(s)
- Kathryn Jarvis
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Clare Thetford
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Edward Turck
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Kelly Ogley
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Rachel C Stockley
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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17
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Ekenes M, Oldeide O, Wehling E. Allocating municipal services to individuals with complex rehabilitation needs - a discourse analysis of individual administrative decision letters. BMC Health Serv Res 2024; 24:460. [PMID: 38609916 PMCID: PMC11015684 DOI: 10.1186/s12913-024-10972-7] [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: 08/13/2023] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs. METHODS The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities' recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach. RESULTS The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention. CONCLUSIONS The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.
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Affiliation(s)
- Maren Ekenes
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
| | - Olin Oldeide
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Noé E, Gómez A, Bernabeu M, Quemada I, Rodríguez R, Pérez T, López C, Laxe S, Colomer C, Ríos M, Juárez-Belaúnde A, González C, Pelayo R, Ferri J. Guidelines: basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation. Neurologia 2024; 39:261-281. [PMID: 37116696 DOI: 10.1016/j.nrleng.2023.04.002] [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: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. DEVELOPMENT We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. CONCLUSIONS All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45-60minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.
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Affiliation(s)
- E Noé
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain.
| | - A Gómez
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | | | - I Quemada
- Red Menni de Daño Cerebral, Bilbao, Spain
| | | | - T Pérez
- Clínica San Vicente, Madrid, Spain
| | - C López
- Centro Lescer, Madrid, Spain
| | - S Laxe
- Hospital Clínic, Barcelona, Spain
| | - C Colomer
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
| | - M Ríos
- Unidad de Daño Cerebral, Hospital Beata María Ana, Madrid, Spain
| | | | - C González
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | - R Pelayo
- Institut Guttmann, Barcelona, Spain
| | - J Ferri
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
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Fulk G. Team. J Neurol Phys Ther 2024; 48:65. [PMID: 38377243 DOI: 10.1097/npt.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
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20
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MacDonald SL, Linkewich E, Bayley M, Jeong IJ, Fang J, Fleet JL. The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada. Int J Stroke 2024; 19:431-441. [PMID: 38078378 DOI: 10.1177/17474930231215005] [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] [Indexed: 03/26/2024]
Abstract
BACKGROUND Several studies have demonstrated improved outcomes poststroke when higher intensity rehabilitation is provided. Canadian Stroke Best Practice Recommendations advise patients receive 180 min of therapy time per day; however, the exact amount required to reach benefit is unknown. AIMS The primary aim of this study was to determine the association between rehabilitation intensity (RI) and total Functional Independence Measure (FIM) Instrument change. Secondary aims included determining the association between RI and discharge location, 90-day home time, rehabilitation effectiveness, and motor and cognitive FIM change. METHODS A retrospective cohort study was conducted using available administrative databases of acute stroke patients discharged to inpatient rehabilitation facilities in Ontario, Canada, from January 2017 to December 2021. RI was defined as number of minutes per day of direct therapy by all providers divided by rehabilitation length of stay. The association between RI and the outcomes of interest were analyzed using regression models with restricted cubic splines. RESULTS A total of 12,770 individuals were included. Mean age of the sample was 72.6 years, 46.0% of individuals were female, and 87.6% had an ischemic stroke. Mean RI was 74.7 min (range: 5-162 min) per day. Increased RI was associated with an increase in mean FIM change. However, there was diminishing incremental increase after reaching 95 min/day. Increased RI was positively associated with motor and cognitive FIM change, rehabilitation effectiveness, 90-day home time, and discharge to preadmission setting. Higher RI was associated with a lower likelihood of discharge to long-term care. CONCLUSIONS None of the patients met the recommended RI of 180 min/day based on the Canadian Stroke Best Practice Recommendations. Despite this, higher intensity was associated with better outcomes. Given that most positive associations were observed with a RI ⩾95 min/day, this may be a more feasible target.
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Affiliation(s)
- Shannon L MacDonald
- ICES, Department of Medicine, University of Toronto and Hennick Bridgepoint Hospital, Sinai Health, Toronto, ON, Canada
| | - Elizabeth Linkewich
- Department of Occupational Science and Occupational Therapy, University of Toronto and Practice Based Research, Sunnybrook Research Institute, North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark Bayley
- ICES, Department of Medicine, University of Toronto and Hennick Bridgepoint Hospital, Sinai Health, Toronto, ON, Canada
- KITE Research Institute, UHN-Toronto Rehabilitation Institute and Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Jamie L Fleet
- Department of Physical Medicine and Rehabilitation, Western University, London, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
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21
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Traxler K, Baum E, Klotz E, Reindl M, Schinabeck F, Seebacher B. Combining specific task-oriented training with manual therapy to improve balance and mobility in patients after stroke: a mixed methods pilot randomised controlled trial. Disabil Rehabil 2024; 46:1318-1329. [PMID: 37051907 DOI: 10.1080/09638288.2023.2193432] [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: 10/22/2022] [Accepted: 03/16/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE In absence of existing studies, to describe changes in balance and mobility, following specific task-oriented training (TOT), its combination with talocrural manual therapy (MT-TOT) or no intervention, in chronic stroke patients. To explore the feasibility of a full-scale randomised controlled trial (RCT) based on criteria of recruitment, retention and adherence rates, adverse events, falls and acceptability of the intervention. MATERIALS AND METHODS Using an assessor-blinded pilot RCT, 36 stroke patients were allocated to either MT-TOT, TOT, or controls. Supervised interventions were performed 45 min, 2×/weekly, for 4 weeks, and home-based practice 20 min, 4x/weekly for 4 weeks. Qualitative interviews evaluated intervention acceptability. Outcomes of balance, mobility, ankle dorsiflexion range of motion (ROM), falls and health-related quality of life (HRQoL) were assessed at baseline, post-intervention and 4-week follow-up. RESULTS Preliminary efficacy of MT-TOT and TOT was shown in improving balance (effect size 0.714), walking speed (0.683), mobility (0.265), dual-tasking mobility (0.595), falls (0.037), active and passive talocrural ROM (0.603; 0.751) and activities and social participation related HRQoL domains (0.332-0.784) in stroke patients. The feasibility of a larger RCT was confirmed. CONCLUSIONS Specific MT-TOT and TOT appeared effective and are feasible in stroke patients. A larger RCT is needed to validate the results.Trial Registration: German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068.
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Affiliation(s)
- Kristina Traxler
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
- Department for Health Sciences, Medicine and Research, Danube University Krems, Austria
| | - Eva Baum
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
| | | | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
| | - Franz Schinabeck
- Überörtliche Gemeinschaftspraxis Hohenwarth/Lam, Hohenwarth, Germany
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
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Satkunam L, Dukelow SP, Yu J, McNeil S, Luu H, Martins KJB, Vu K, Nguyen PU, Richer L, Williamson T, Klarenbach SW. Poststroke Care Pathways and Spasticity Treatment: A Retrospective Study in Alberta. Can J Neurol Sci 2024:1-10. [PMID: 38515405 DOI: 10.1017/cjn.2024.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Limited evidence exists regarding care pathways for stroke survivors who do and do not receive poststroke spasticity (PSS) treatment. METHODS Administrative data was used to identify adults who experienced a stroke and sought acute care between 2012 and 2017 in Alberta, Canada. Pathways of stroke care within the health care system were determined among those who initiated PSS treatment (PSS treatment group: outpatient pharmacy dispensation of an anti-spastic medication, focal chemo-denervation injection, or a spasticity tertiary clinic visit) and those who did not (non-PSS treatment group). Time from the stroke event until spasticity treatment initiation, and setting where treatment was initiated were reported. Descriptive statistics were performed. RESULTS Health care settings within the pathways of stroke care that the PSS (n = 1,079) and non-PSS (n = 22,922) treatment groups encountered were the emergency department (86 and 84%), acute inpatient care (80 and 69%), inpatient rehabilitation (40 and 12%), and long-term care (19 and 13%), respectively. PSS treatment was initiated a median of 291 (interquartile range 625) days after the stroke event, and most often in the community when patients were residing at home (45%), followed by "other" settings (22%), inpatient rehabilitation (18%), long-term care (11%), and acute inpatient care (4%). CONCLUSIONS To our knowledge, this is the first population based cohort study describing pathways of care among adults with stroke who subsequently did or did not initiate spasticity treatment. Areas for improvement in care may include strategies for earlier identification and treatment of PSS.
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Affiliation(s)
- Lalith Satkunam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of Adult Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jaime Yu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of Adult Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Stephen McNeil
- Department of Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Huong Luu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karen J B Martins
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Khanh Vu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phuong Uyen Nguyen
- Centre for Health Informatics, University of Calgary, Calgary, AB, Canada
| | - Lawrence Richer
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Tyler Williamson
- Centre for Health Informatics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, Libin Cardiovascular Institute, O'Brie Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Scott W Klarenbach
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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An Z, Li K, Yang X, Ke J, Xu Y, Zhang X, Meng X, Luo X, Yu L. Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience. BMC Public Health 2024; 24:740. [PMID: 38454384 PMCID: PMC10921794 DOI: 10.1186/s12889-024-18218-1] [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: 10/09/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite the growing interest in hospital rehabilitation services for communities, studies on existing community-based rehabilitation (CBR) services remain scarce owing to limitations in the development of community health services and regional cultural diversity. As a guaranteed measure for ensuring the quality of rehabilitation services and achieving the desired service outcomes, clear roles and responsibilities in multidisciplinary teams and effective service delivery are particularly important. OBJECTIVE This scoping review aimed to determine the scope of community stroke rehabilitation programs involving existing multidisciplinary teams and to analyze the implementation content and implementers' functional roles to provide guidance for future CBR programs. METHODS The scoping review design followed the methodology of the Joanna Briggs Institute and was based on the normative scoping review framework proposed by Arksey and O'Malley. The comprehensive CBR framework was proposed by World Health Organization-guided data charting and analysis. RESULTS Of the 22,849 identified citations, 74 studies were included, consisting of 6,809 patients with stroke and 49 primary caregivers, most of whom were from China. The most common working mode in CBR programs was a dual approach involving both healthcare professionals in medical institutions and community healthcare professionals. The number of programs in each discipline was in the following descending order: nursing, medical care, rehabilitation, psychology, nutrition, and public health. Among these, multidisciplinary teams comprising medical, nursing, and rehabilitation disciplines were the most common, with a total of 29 programs. Disciplinary members were mainly responsible for implementing their respective disciplinary content, with physicians providing guidance for the programs. More than 82.4% of the studies reported 2-4 intervention strategies. The intervention forms of rehabilitation content were the most diverse, whereas preventive interventions were more homogeneous than others. Physical function and socio-psychological measurements were the most commonly reported outcomes. CONCLUSION CBR services implemented by multidisciplinary teams can effectively achieve functional and emotional improvement in patients with stroke, and nurses are the most involved in implementation, especially in community settings. The results further emphasize the importance of strengthening the exploration of nurses' maximum potential to implement CBR plans in future practice. TRIAL REGISTRATION The registration information for this scoping review can be found at osf.io/pv7tg.
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Affiliation(s)
- Zifen An
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Ke Li
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xinyi Yang
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Jie Ke
- Department of General Practice, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Yuying Xu
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xi Zhang
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xianmei Meng
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
- Department of General Practice, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, 430071, Wuhan, Hubei Province, China.
| | - Xianwu Luo
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
| | - Liping Yu
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
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Takara H, Suzuki S, Satoh S, Abe Y, Miyazato S, Kohatsu Y, Minakata S, Moriya M. Association Between Early Mobilization and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Propensity Score-Matched Study. Neurocrit Care 2024:10.1007/s12028-024-01946-y. [PMID: 38429610 DOI: 10.1007/s12028-024-01946-y] [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: 06/21/2023] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Early mobilization has been shown to promote functional recovery and prevent complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy of early mobilization in patients with aSAH remains unclear. This study aimed to investigate the association between early mobilization and functional outcomes in patients with aSAH. METHODS This multicenter retrospective study was conducted in Japan and included patients with aSAH who received physical therapy with or without occupational therapy from April 2014 to March 2019. The primary outcome was the modified Rankin Scale (mRS) score, with a favorable functional outcome defined as an mRS score of 0-2 and an unfavorable outcome with an mRS score of 3-5. Patients initiating walking training within 14 days of aSAH onset were classified into the early mobilization group, whereas those initiating training after 14 days were classified into the delayed mobilization group. Propensity score matching analysis was performed to assess the association between early mobilization and favorable outcomes. RESULTS A total of 718 patients were screened, and 450 eligible patients were identified. Before matching, 229 patients (50.9%) were in the early mobilization group and 221 (49.1%) were in the delayed mobilization group. After matching, each group consisted of 122 patients, and the early mobilization group exhibited a higher proportion of favorable outcomes than did the delayed mobilization group (81.1% vs. 52.5%, risk difference 28.7%, 95% confidence interval 17.4-39.9, p < 0.001). CONCLUSIONS This multicenter retrospective study suggests that initiating walking training within 14 days of aSAH onset is associated with favorable outcomes.
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Affiliation(s)
- Hikaru Takara
- Department of Rehabilitation, Naha City Hospital, 2-31-1, Furujima, Naha City, Okinawa, 902-8511, Japan.
| | - Shota Suzuki
- Department of Rehabilitation, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shuhei Satoh
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Yoko Abe
- Department of Rehabilitation, Sapporo Shiroishi Memorial Hospital, Hokkaido, Japan
| | - Shohei Miyazato
- Department of Rehabilitation, Naha City Hospital, 2-31-1, Furujima, Naha City, Okinawa, 902-8511, Japan
| | - Yoshiki Kohatsu
- Department of Rehabilitation, Naha City Hospital, 2-31-1, Furujima, Naha City, Okinawa, 902-8511, Japan
| | - Shin Minakata
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Masamichi Moriya
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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25
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Xiao K, Wang Z, Ye Y, Teng C, Min R. PDMS-embedded wearable FBG sensors for gesture recognition and communication assistance. BIOMEDICAL OPTICS EXPRESS 2024; 15:1892-1909. [PMID: 38495686 PMCID: PMC10942691 DOI: 10.1364/boe.517104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 03/19/2024]
Abstract
This study introduces fiber Bragg grating (FBG) sensors embedded in polydimethylsiloxane (PDMS) silicone elastomer specifically engineered for recognizing intricate gestures like wrist pitch, finger bending, and mouth movement. Sensors with different PDMS patch thicknesses underwent evaluation including thermal, tensile strain, and bending deformation characterization, demonstrating a stability of at least four months. Experiments revealed the FBG sensors' accurate wrist pitch recognition across participants after calibration, confirmed by statistical metrics and Bland-Altman plots. Utilizing finger and mouth movements, the developed system shows promise in assisting post-stroke patients and individuals with disabilities, enhancing their interaction capabilities with the external surroundings.
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Affiliation(s)
- Kun Xiao
- Faculty of Arts and Sciences, Beijing Normal University, Zhuhai 519087, China
| | - Zhuo Wang
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Zhuhai 519087, China
| | - Yudong Ye
- Planetary Environmental and Astrobiological Research Laboratory, School of Atmospheric Sciences, Sun Yat-sen University, Zhuhai 519082, China
| | - Chuanxin Teng
- Photonics Research Center, Guilin University of Electronic Technology, Guilin 541004, China
| | - Rui Min
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Zhuhai 519087, China
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Wiley E, Sakakibara B, Park S, Barclay R, Bayley M, Eng JJ, Harris A, Inness E, MacKay-Lyons M, MacDermid J, Pollock C, Pooyania S, Teasell R, Yao J, Tang A. Exploring the experiences of an exercise-based telerehabilitation program among Canadian community-dwelling adults with stroke. Disabil Rehabil 2024:1-11. [PMID: 38361375 DOI: 10.1080/09638288.2024.2316772] [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: 05/18/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. METHODS An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. RESULTS Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. CONCLUSION Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance.
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Affiliation(s)
- Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Brodie Sakakibara
- Department of Occupational Science & Occupational Therapy, Centre for Chronic Disease Prevention and Management, Southern Medical Program, University of British Columbia, Kelowna, BC, Canada
| | - Sarah Park
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, BC, Canada
| | - Ruth Barclay
- Department of Physical Therapy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Mark Bayley
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia and Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
- G.F Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Anne Harris
- G.F Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Elizabeth Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- School of Physical Therapy, Western University, London, ON, Canada
| | - Courtney Pollock
- Department of Physical Therapy, University of British Columbia and Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
| | - Sepideh Pooyania
- Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Robert Teasell
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, ON, London
| | - Jennifer Yao
- G.F Strong Rehabilitation Centre, Vancouver, BC, Canada
- Department and Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Dai Y, Shi H, Ji K, Han Y, De Ala M, Wang Q. Exercise preference in stroke survivors: a concept analysis. Front Neurol 2024; 15:1326649. [PMID: 38414548 PMCID: PMC10896848 DOI: 10.3389/fneur.2024.1326649] [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: 10/30/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
Background Exercise preference in stroke survivors is related to their adherence to long-term rehabilitation regimen and functional recovery. Although explored recently, the term exercise preference still lacks a clear definition. Objective The aim of this study is to conceptualize exercise preference in stroke survivors. Methods The Walker and Avant method was applied as a framework for the conceptual analysis of exercise preference. Data from 34 publications were collected using seven databases (PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, and CBM) and applied in the analysis. The search period was from the inception of the database to April 30, 2023. Results Exercise preference in stroke survivors was defined according to four attributes: priority of choice, behavioral tendency, affective priming, and patience in adherence. The common antecedents of the concept of exercise preference in stroke survivors were classified into patient-related, therapy-related, and environmental-related categories and the consequences were classified into three categories: patient-related, rehabilitation provider-related, and rehabilitation service system-related. Conclusion Exercise preference in stroke survivors refers to the patient's choice, tendency, affective response, and attitude toward engagement in the recommended rehabilitation regimen. It is beneficial for understanding the essential attributes of exercise preference in stroke survivors by clarifying the concept. In addition, it will facilitate the development of instruments for assessing exercise preference in stroke survivors and the construction of theory-based intervention programs that can improve adherence to exercise rehabilitation.
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Affiliation(s)
- Yuting Dai
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Huiling Shi
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kangling Ji
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yuxin Han
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Minerva De Ala
- School of Nursing, Philippine Women's University, Manila, Philippines
| | - Qing Wang
- Department of Nursing, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Minga J, Rich T, Boukrina O, Chen P, Hreha K. Identifying Spatial Neglect in Chronic Right Hemisphere Stroke Survivors Using the RHDBank Outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:511-523. [PMID: 38181442 PMCID: PMC11000791 DOI: 10.1044/2023_jslhr-23-00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE The chronicity of spatial neglect (SN) and the utility of existing diagnostic measures used by speech-language pathologists remain poorly understood. In this retrospective study, we examined how the RHDBank test battery informs the identification of SN after right hemisphere brain damage (RHD) during the chronic phase of recovery. METHOD Data from 29 right hemisphere stroke survivors were extracted from the RHDBank, including SN tests, for which we performed laterality index scoring: a 51-item demographic survey, the Apples Test, the Indented Paragraph Test, and the clock drawing task from the Cognitive Linguistic Quick Test (CLQT). Two groups (SN+ and SN-) were identified using the Apples Test. A hierarchical cluster analysis explored CLQT performance clusters in association with SN, and group comparisons of demographic variables and test scores were conducted. RESULTS Ten patients were identified as having SN+ (34%) using the Apples Test. The Indented Paragraph Test and the CLQT's clock drawing test identified only two of the 20 stroke survivors with SN+. Cluster analyses showed that domain and task scores on the CLQT carried information to classify participants into SN+ and SN- in concordance with performance on the Apples Test. Participants in the SN+ cluster had moderately impaired attention and executive function skills and mildly impaired visuospatial skills. CONCLUSIONS The Apples Test differentiated SN in a group of chronic right hemisphere stroke survivors. Using multiple measures from the CLQT seemed to capture a greater range of problems than clock drawing and paragraph reading tests alone. Therefore, the RHDBank test battery as a whole-and in part the CLQT, Apples Test, and Indented Paragraph Test-can detect certain subtypes of SN in the chronic deficit profile after RHD and is a starting point for diagnostic integration by speech-language pathologists.
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Affiliation(s)
- Jamila Minga
- Department of Head and Neck Surgery & Communication Sciences and Department of Neurology, Duke University, Durham, NC
| | - Timothy Rich
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Olga Boukrina
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Kimberly Hreha
- Occupational Therapy Doctorate Division, Department of Orthopaedic Surgery, Duke University, Durham, NC
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Rijal A, Adhikari TB, Dhakal S, Maagaard M, Piri R, Nielsen EE, Neupane D, Jakobsen JC, Olsen MH. Effect of exercise on functional capacity and body weight for people with hypertension, type 2 diabetes, or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. BMC Sports Sci Med Rehabil 2024; 16:38. [PMID: 38321506 PMCID: PMC10848448 DOI: 10.1186/s13102-024-00829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Hypertension, type 2 diabetes, and cardiovascular disease affect the activities of daily living at varying degree. While the effects of aerobic exercise on functional capacity are well-documented, the extent of change for different types of exercise in these chronic conditions remains unexplored. Additionally, there is conflicting evidence regarding the role of exercise in reducing body weight. METHODS We conducted systematic review with meta-analysis and trial sequential analysis and searched various databases from inception to July 2020. We included randomised clinical trials adding any form of trialist defined exercise to usual care versus usual care in people with either hypertension, type 2 diabetes, and/or cardiovascular disease irrespective of setting, publication status, year, and language. The outcomes assessed were i) functional capacity assessed through different scales separately i.e., Maximal Oxygen Uptake (VO2max), 6-min walk test (6MWT), 10-m walk test (10MWT), and ii) body weight. RESULTS We included 950 studies out of which 444 trials randomising 20,098 participants reported on various functional outcomes (355 trials) and body weight (169 trials). The median follow-up was 3 months (Interquartile ranges (IQR): 2.25 to 6). Exercise added to the usual care, improved VO2max (Mean Difference (MD):2.72 ml/kg/min; 95% Confidence Interval (CI) 2.38 to 3.06; p < 0.01; I2 = 96%), 6MWT (MD: 42.5 m; 95%CI 34.95 to 50.06; p < 0.01; I2 = 96%), and 10MWT (MD: 0.06 m/s; 95%CI 0.03 to 0.10; p < 0.01; I2 = 93%). Dynamic aerobic and resistance exercise showed a consistent improvement across various functional outcomes, whereas body-mind therapies (MD: 3.23 ml/kg/min; 95%CI 1.97 to 4.49, p < 0.01) seemed especially beneficial for VO2max and inspiratory muscle training (MD: 59.32 m; 95%CI 33.84 to 84.80; p < 0.01) for 6MWT. Exercise yielded significant reduction in body weight for people with hypertension (MD: -1.45 kg; 95%CI -2.47 to -0.43; p < 0.01), and type 2 diabetes (MD: -1.53 kg; 95%CI -2.19 to -0.87; p < 0.01) but not for cardiovascular disease with most pronounced for combined exercise (MD: -1.73 kg; 95%CI -3.08 to -0.39; p < 0.05). The very low certainty of evidence warrants cautious interpretations of the results. CONCLUSION Exercise seemed to improve functional capacity for people with hypertension, type 2 diabetes, and/or cardiovascular disease but the effectiveness seems to vary with different forms of exercise. The potentially superior improvement in VO2max and 6MWT by body-mind therapies and inspiratory muscle training calls for further exploration. Additionally, prescribing exercise for the sole purpose of losing weight may be a potential strategy for people with hypertension and type 2 diabetes. The extent of improvement in functional capacity and body weight reduction differed with different exercise regimens hence personalised exercise prescriptions tailored to individual needs may be of importance. PROSPERO REGISTRATION: PROSPERO registration number: CRD42019142313.
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Affiliation(s)
- Anupa Rijal
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.
| | - Tara Ballav Adhikari
- Department of Public Health, Research Unit for Environment, Occupation & Health, Aarhus University, Aarhus, Denmark
| | - Sarmila Dhakal
- Center for Research on Environment, Health and Population Activities (CREPHA), Kusunti, Lalitpur, Nepal
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koge, Denmark
| | - Reza Piri
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Emil Eik Nielsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland, USA
| | - Janus Christian Jakobsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Michael Hecht Olsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
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Magalhães JP, Faria-Fortini I, Menezes KK, Lara IA, Batista LR, Sant'anna R, Faria CD. Determinants of access to rehabilitation professionals by individuals with stroke in the first six months after hospital discharge in Brazil: a study based on the Andersen model. Top Stroke Rehabil 2024:1-10. [PMID: 38319730 DOI: 10.1080/10749357.2024.2304969] [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: 10/24/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND determinants of access to rehabilitation professionals after stroke in middle-income countries, where the burden of this disease is higher, are little known. OBJECTIVES To identify the determinants of access to rehabilitation professionals by individuals with stroke at one, three, and six months after hospital discharge in Brazil and compare referral and access rates after discharge. METHODS Longitudinal and prospective study, with individuals with primary stroke, without previous disabilities. At hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. The possible determinants of access, according to Andersen's model, were: a) predisposing factors: age, sex, education levels, and belief that they could improve with treatment; b) need factors: stroke severity, levels of disability; c) enabling factors: socioeconomic status, disposable income for health care, and quality of care provided by rehabilitation professionals. One, three, and six months after hospital discharge, individuals were contacted to identify which rehabilitation professionals were accessed. Multiple linear regression model and Wilcoxon tests were used (α=5%). RESULTS 201 individuals were included. Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01) of access at one, three, and six months after hospital discharge, respectively. In all periods, there was less access than that recommended at the time of hospital discharge (p<0.01). CONCLUSION Need factors (disability levels and stroke severity) were determinants of access in all assessed periods. In addition, in all periods, the comprehensiveness of care for individuals with stroke was compromised.
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Affiliation(s)
- Jordana P Magalhães
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kênia Kp Menezes
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isadora A Lara
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ludmilla R Batista
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Romeu Sant'anna
- Department of Neurology, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Christina Dcm Faria
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Edwards JD, Dominguez-Vargas AU, Rosso C, Branscheidt M, Sheehy L, Quandt F, Zamora SA, Fleming MK, Azzollini V, Mooney RA, Stagg CJ, Gerloff C, Rossi S, Cohen LG, Celnik P, Nitsche MA, Buetefisch CM, Dancause N. A translational roadmap for transcranial magnetic and direct current stimulation in stroke rehabilitation: Consensus-based core recommendations from the third stroke recovery and rehabilitation roundtable. Int J Stroke 2024; 19:145-157. [PMID: 37824726 PMCID: PMC10811969 DOI: 10.1177/17474930231203982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND AIMS The purpose of this Third Stroke Recovery and Rehabilitation Roundtable (SRRR3) was to develop consensus recommendations to address outstanding barriers for the translation of preclinical and clinical research using the non-invasive brain stimulation (NIBS) techniques Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) and provide a roadmap for the integration of these techniques into clinical practice. METHODS International NIBS and stroke recovery experts (N = 18) contributed to the consensus process. Using a nominal group technique, recommendations were reached via a five-stage process, involving a thematic survey, two priority ranking surveys, a literature review and an in-person meeting. RESULTS AND CONCLUSIONS Results of our consensus process yielded five key evidence-based and feasibility barriers for the translation of preclinical and clinical NIBS research, which were formulated into five core consensus recommendations. Recommendations highlight an urgent need for (1) increased understanding of NIBS mechanisms, (2) improved methodological rigor in both preclinical and clinical NIBS studies, (3) standardization of outcome measures, (4) increased clinical relevance in preclinical animal models, and (5) greater optimization and individualization of NIBS protocols. To facilitate the implementation of these recommendations, the expert panel developed a new SRRR3 Unified NIBS Research Checklist. These recommendations represent a translational pathway for the use of NIBS in stroke rehabilitation research and practice.
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Affiliation(s)
- Jodi D Edwards
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Meret Branscheidt
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Lisa Sheehy
- Bruyére Research Institute, Ottawa, ON, Canada
| | - Fanny Quandt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon A Zamora
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | | | | | | | | | | | | | | - Michael A Nitsche
- Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
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Okita Y, Kawaguchi Y, Inoue Y, Ohno K, Sawada T, Levack W, Tomori K. Characteristics of goal-setting tools in adult rehabilitation: A scoping review. Clin Rehabil 2024; 38:234-250. [PMID: 37644842 PMCID: PMC10725121 DOI: 10.1177/02692155231197383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.
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Affiliation(s)
- Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Yuko Kawaguchi
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Aichi, Japan
| | - Yuki Inoue
- Central Rehabilitation Department, Yokohama Rousai Hospital, Kanagawa, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsunori Sawada
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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McGlinchey MP, Faulkner-Gurstein R, Sackley CM, McKevitt C. Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke - an ethnographic study. Disabil Rehabil 2024; 46:672-684. [PMID: 36734838 DOI: 10.1080/09638288.2023.2172463] [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: 05/30/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. MATERIAL AND METHODS An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. RESULTS Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors' clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors' treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. CONCLUSIONS Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.Implications for rehabilitationMultiple factors guide therapist decision making after severely disabling stroke, some of which result in the use of interventions that do not fully address stroke survivors' clinical needs.Therapists should critically reflect upon their personal beliefs and attitudes about severely disabling stroke to reduce potential sources of bias on decision making.Therapists should consider the timing and intensity of therapy delivery as well as their treatment approach to optimise outcomes after severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- Neurorehabilitation Service, Integrated Local Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Jeon SY, Ki M, Shin JH. Resistive versus active assisted robotic training for the upper limb after a stroke: A randomized controlled study. Ann Phys Rehabil Med 2024; 67:101789. [PMID: 38118340 DOI: 10.1016/j.rehab.2023.101789] [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: 02/25/2023] [Revised: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Selection of a suitable training modality according to the status of upper limb function can maximize the effects of robotic rehabilitation; therefore, it is necessary to identify the optimal training modality. OBJECTIVES This study aimed to compare robotic rehabilitation approaches incorporating either resistance training (RET) or active-assisted training (AAT) using the same rehabilitation robot in people with stroke and moderate impairment. METHODS In this randomized controlled trial, we randomly allocated 34 people with stroke who had moderate impairment to either the experimental group (RET, n = 18) or the control group (AAT, n = 16). Both groups performed robot-assisted therapy for 30 min, 5 days per week, for 4 weeks. The same rehabilitation robot provided resistance to the RET group and assistance to the AAT group. Body function and structure, activity, and participation outcomes were evaluated before, during, and after the intervention. RESULTS RET led to greater improvements than AAT in terms of smoothness (p = 0.006). The Fugl-Meyer Assessment (FMA)-upper extremity (p < 0.001), FMA-proximal (p < 0.001), Action Research Arm Test-gross movement (p = 0.011), and kinematic variables of joint independence (p = 0.017) and displacement (p = 0.011) also improved at the end of intervention more in the RET group. CONCLUSIONS Robotic RET was more effective than AAT in improving upper limb function, structure, and activity among participants with stroke who had moderate impairment.
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Affiliation(s)
- Sun Young Jeon
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Myung Ki
- Department of Global Community Health, Graduate School of Public Health, Korea University, Republic of Korea; BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea.
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Soares CLA, Magalhães JP, Faria-Fortini I, Batista LR, Andrea Oliveira Lima L, Faria CD. Barriers and facilitators to access post-stroke rehabilitation services in the first six months of recovery in Brazil. Disabil Rehabil 2024:1-7. [PMID: 38299553 DOI: 10.1080/09638288.2024.2310756] [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: 06/28/2023] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE To identify barriers and facilitators to accessing post-stroke rehabilitation services six months after discharge from the stroke unit of a Brazilian public hospital. MATERIALS AND METHODS This cross-sectional and descriptive study collected sociodemographic and clinical-functional data during hospitalization. Then, barriers and facilitators for accessing the post-stroke rehabilitation services were collected six months after discharge. We considered economic conditions and displacement, the quality and organization of post-stroke rehabilitation services, and personal conditions. RESULTS A total of 174 patients were included. Among the 20 aspects analyzed, 17 (85.0%) were reported as facilitators, while three (15.0%) were as barriers. The identified barriers included financial income available for healthcare (49.4%), waiting time to schedule or to be seen (47.0%), and process to scheduling (45.4%). The main facilitators (> 79.0%) were the expectation of the patient with the treatment and assistance from family and friends. Moreover, most patients indicated as facilitators all aspects related to the quality of post-stroke rehabilitation services. CONCLUSION Access to post-stroke rehabilitation services presented more facilitators than barriers. Public policies to subsidize health costs, optimize waiting time, and process for scheduling post-stroke rehabilitation services should be considered to reduce barriers. Likewise, human and financial resources must promote the facilitators.
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Affiliation(s)
- Carolina LA Soares
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jordana P Magalhães
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ludmilla Ribeiro Batista
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Christina Dcm Faria
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Ouédraogo F, Auger LP, Moreau E, Côté O, Guerrera R, Rochette A, Kairy D. Acceptability of Telerehabilitation: Experiences and Perceptions by Individuals with Stroke and Caregivers in an Early Supported Discharge Program. Healthcare (Basel) 2024; 12:365. [PMID: 38338250 PMCID: PMC10855122 DOI: 10.3390/healthcare12030365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Telerehabilitation (TR) is a promising method for facilitating the delivery and access to post-stroke rehabilitation services. OBJECTIVE The aim of this study was to explore the acceptability of TR and factors influencing its adoption by individuals with stroke and caregivers. METHODS A qualitative descriptive approach was used. Six individuals with stroke and three caregivers participated in individual online interviews. An abductive thematic analysis was employed to analyze the qualitative data, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) model. RESULTS Participants reported positive experiences with TR, resulting in improvements in functional abilities, such as manual dexterity, balance, and positive interactions with therapists. They found the technology easy to learn and use, facilitating engagement in TR. Participants' prior experiences with technology, along with support from caregivers and therapists, facilitated acceptance and the use of TR. The COVID-19 pandemic also motivated participants to accept TR. However, technical issues, unstable internet connections, and lack of feedback were barriers to the use of TR. CONCLUSION Despite existing obstacles, TR can be used to provide rehabilitation services for individuals with stroke. Addressing these barriers is necessary to promote the widespread and effective use of TR in the context of stroke recovery.
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Affiliation(s)
- Fatimata Ouédraogo
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
| | - Louis-Pierre Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montréal, QC H3G 1A1, Canada
| | - Emmanuelle Moreau
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Odile Côté
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Rosalba Guerrera
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
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Alavinia M, Farahani F, Musselman K, Plourde K, Omidvar M, Verrier MC, Aliabadi S, Craven BC. Convergent validity and responsiveness of The Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury. Front Neurol 2024; 14:1280225. [PMID: 38322795 PMCID: PMC10844483 DOI: 10.3389/fneur.2023.1280225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024] Open
Abstract
Aim This study aimed to (1) describe the use of the Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury or disease (NT-SCI/D); (2) evaluate the convergent validity of SWAT for use among inpatients with NT-SCI/D; (3) describe SWAT responsiveness; and (4) explore the relationship between hours of walking therapy and SWAT change. Methods A quality improvement project was conducted at the University Health Network between 2019 and 2022. Participants' demographics and impairments data, rehabilitation length of stay, and FIM scores were obtained from the National Rehabilitation Reporting System. The walking measure data were collected by therapists as part of routine practice. Hours of part- or whole-gait practice were abstracted from medical records. To determine convergent validity, Spearman's correlation coefficients were calculated between SWAT stages (admission and discharge) and the walking measures. The change in SWAT levels was calculated to determine responsiveness. Spearman's correlation coefficient was calculated between SWAT change and hours of walking therapy. Results Among adult NT-SCI/D participants with potential walking capacity (SWAT≥1B), the majority were classified as American Spinal Injury Association (ASIA) Impairment Scale D (AIS D) at admission. The SWAT category of 1C (N = 100, 18%) was the most frequent at admission. The most frequent SWAT stage at discharge was 3C among participants with NT-SCI/D, with positive conversions in SWAT stages from admission to discharge (N = 276, 33%). The mean change in SWAT score was 3 for participants with T-SCI and NT-SCI/D. Moderate correlations between SWAT stages and walking measures were observed. The correlation of hours of gait therapy with the SWAT change (admission to discharge) was 0.44 (p < 0001). Conclusion The SWAT has sufficient convergent validity and responsiveness for describing standing and walking recovery and communicating/monitoring rehabilitation progress among patients with NT-SCI/D.
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Affiliation(s)
- Mohammad Alavinia
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Farnoosh Farahani
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristina Plourde
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Maryam Omidvar
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Molly C. Verrier
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saina Aliabadi
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- School of Graduate Studies, University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Gonzalez-Hoelling S, Reig-García G, Bertran-Noguer C, Suñer-Soler R. The effects of rhythmic auditory stimulation on functional ambulation after stroke: a systematic review. BMC Complement Med Ther 2024; 24:45. [PMID: 38245704 PMCID: PMC10799424 DOI: 10.1186/s12906-023-04310-3] [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: 05/06/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Several studies have reported the effect of rhythmic auditory stimulation (RAS) on functional ambulation in stroke patients, yet no systematic overview has yet been published. This study aims to synthesize the available evidence describing changes in stroke patients after RAS intervention for functional ambulation and the use of walking assistive devices, and to find out if the effect of RAS and music-based RAS differs depending on the lesioned area. METHODS The PubMed, PEDro, Cochrane Central Register of Controlled Trials, Web of Science, Scopus and CINAHL electronic databases were searched for reports evaluating the effect of RAS on walking in stroke patients, applying the PICOS criteria for the inclusion of studies. RESULTS Twenty one articles were included (948 stroke survivors). Most studies were of good methodological quality according to the PEDro scale, but they had a high risk of bias. The most consistent finding was that RAS improves walking and balance parameters in stroke patients in all phases compared to baseline and versus control groups with conventional treatment. Functional ambulation and the use of walking assistive devices were inconsistently reported. Several studies also suggest that RAS may be as good as other complementary therapies (horse-riding and visual cueing). CONCLUSIONS Despite the beneficial effects of RAS, the question remains as to whether it is better than other complementary therapies. Given the heterogeneity of the interventions, the interventions in control groups, the varied durations, and the different outcome measures, we suggest that care should be taken in interpreting and generalizing findings. PROSPERO REGISTRATION CRD42021277940.
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Affiliation(s)
- Samira Gonzalez-Hoelling
- Neurorehabilitation department, Hospital Sociosanitari Mutuam Girona, 17007, Girona, Catalonia, Spain
| | - Gloria Reig-García
- Department of Nursing, Faculty of Nursing, University of Girona, 17003, Girona, Spain
| | - Carme Bertran-Noguer
- Health and Health Care Research Group, University of Girona, 17003, Girona, Spain
| | - Rosa Suñer-Soler
- Health and Health Care Research Group, University of Girona, 17003, Girona, Spain.
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Lando A, Cacciante L, Mantineo A, Baldan F, Pillastrini P, Turolla A, Pregnolato G. Multi-Modal versus Uni-Modal Treatment for the Recovery of Lower Limb Motor Function in Patients after Stroke: A Systematic Review with Meta-Analysis. Healthcare (Basel) 2024; 12:189. [PMID: 38255077 PMCID: PMC10815740 DOI: 10.3390/healthcare12020189] [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: 12/19/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The aim of this study is to evaluate whether the multimodal treatment based on both resistance and endurance training for the recovery of lower limb function in post-stroke patients is more effective than unimodal treatment. Six electronic databases were searched. The included articles were firstly analysed for methodological quality and then quantitatively analysed for the following outcomes: endurance, knee-extensor muscle strength, gait speed, and aerobic capacity. The treatment effect was analysed with the mean difference (MD) or standardised mean difference (SMD). From a total of 4439 records, 10 studies met the inclusion criteria for the qualitative analysis, whereas 7 studies were included in the quantitative analysis. There is a significant difference favourable to the group with multimodal treatment for knee-extensor muscle strength (SMD = 1.25; 95% CI 0.97, 1.53, I2 = 42%), both for the affected and the unaffected side. Multimodal treatments are a valid choice in the field of post-stroke rehabilitation. In particular, the combination of resistance and endurance training is useful to maximise the recovery of knee-extensor muscle strength, which in turn could be beneficial for achieving upright position and walking, allowing patients to improve independence levels in their activities of daily life.
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Affiliation(s)
- Alex Lando
- Rehabilitation Unit, Department of Neuroscience, General Hospital—University of Padova, 35128 Padova, Italy;
| | - Luisa Cacciante
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (A.M.); (G.P.)
| | - Alessio Mantineo
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (A.M.); (G.P.)
| | | | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, Alma Mater University of Bologna, 40128 Bologna, Italy; (P.P.); (A.T.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater University of Bologna, 40128 Bologna, Italy; (P.P.); (A.T.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giorgia Pregnolato
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (A.M.); (G.P.)
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Colovic H, Zlatanovic D, Zivkovic V, Jankovic M, Radosavljevic N, Ducic S, Ducic J, Stojkovic J, Jovanovic K, Nikolic D. A Review of Current Perspectives on Motoric Insufficiency Rehabilitation following Pediatric Stroke. Healthcare (Basel) 2024; 12:149. [PMID: 38255037 PMCID: PMC10815565 DOI: 10.3390/healthcare12020149] [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: 12/11/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Pediatric stroke (PS) is an injury caused by the occlusion or rupture of a blood vessel in the central nervous system (CNS) of children, before or after birth. Hemiparesis is the most common motoric deficit associated with PS in children. Therefore, it is important to emphasize that PS is a significant challenge for rehabilitation, especially since the consequences may also appear during the child's growth and development, reducing functional capacity. The plasticity of the child's CNS is an important predecessor of recovery, but disruption of the neural network, specific to an immature brain, can have harmful and potentially devastating consequences. In this review, we summarize the complexity of the consequences associated with PS and the possibilities and role of modern rehabilitation. An analysis of the current literature reveals that Constraint-Induced Movement Therapy, forced-use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation and robot-assisted therapy have demonstrated at least partial improvements in motor domains related to hemiparesis or hemiplegia caused by PS, but they are supported with different levels of evidence. Due to the lack of randomized controlled studies, the optimal rehabilitation treatment is still debatable, and therefore, most recommendations are primarily based on expert consensuses, opinions and an insufficient level of evidence.
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Affiliation(s)
- Hristina Colovic
- Department for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (D.Z.); (V.Z.)
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center Niš, 18000 Niš, Serbia
| | - Dragan Zlatanovic
- Department for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (D.Z.); (V.Z.)
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center Niš, 18000 Niš, Serbia
| | - Vesna Zivkovic
- Department for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (D.Z.); (V.Z.)
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center Niš, 18000 Niš, Serbia
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Natasa Radosavljevic
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia;
| | - Sinisa Ducic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Department of Pediatric Surgery, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Jovan Ducic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
| | - Jasna Stojkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Kristina Jovanovic
- Department of Pediatrics, University Children’s Hospital, 11000 Belgrade, Serbia;
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
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Bookey-Bassett S. Feasibility testing of an interprofessional education intervention to support collaborative practice in home care for older stroke survivors with multiple chronic conditions. J Interprof Care 2024; 38:121-132. [PMID: 37871996 DOI: 10.1080/13561820.2023.2262511] [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: 06/14/2022] [Accepted: 09/07/2023] [Indexed: 10/25/2023]
Abstract
This mixed-methods study examined the feasibility of implementing a new six-month, theory-based, interprofessional education intervention, and explored its effects and impact on collaborative practice among home care providers caring for older adult stroke survivors (≥65) with multiple chronic conditions. The evaluation utilized a qualitative descriptive and one group repeated measures design which included participant questionnaires, focus groups and field notes. Participants included 37 home care providers (registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators, and their supervisors) in Ontario, Canada. The intervention was feasible and acceptable to home care providers. Perceived benefits included improved communication and collaboration within teams, enhanced role understanding, increased learning with and from each other, and increased appreciation of all team members' expertise. From 3 to 6 months post initial IPE training, there was a statistically significant improvement in three domains of collaborative practice as measured by the Collaborative Practice Assessment Tool (communication/information exchange; community linkage and coordination of care; decision-making and conflict management) and one domain of collaborative practice, as measured by the 19-item Team Climate Inventory (task orientation). Implications for implementing interprofessional education in home care practice settings are described. Further testing in other populations and settings is warranted.
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Affiliation(s)
- Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
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Zhou H, Huang S, Arikawa K, Zhu J, Ye T, Dong Q. Clinical signs to predict the severity of dysphagia in Acute Ischemic Stroke patients. Clin Neurol Neurosurg 2024; 236:108091. [PMID: 38160656 DOI: 10.1016/j.clineuro.2023.108091] [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: 09/06/2023] [Revised: 10/25/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES In the current era, clinicians working in areas with limited and/or without facilities are only able to manage their patients based on clinical signs to detect dysphagia. This study assesses the performance of 5 simple clinical signs for predicting the severity of dysphagia. METHODS We systematically documented 5 targeted bedside clinical signs within 24 h after admission in 737 consecutive patients with acute stroke. We examined the median onset of each sign and calculated their ratios associated with severe dysphagia. The performance and significance of these special clinical signs were evaluated by further computation. RESULTS In total, 184 of 737 AIS patients were screened positive dysphagia by the modified V-VST. The 5 targeted bedside clinical signs were differed among the patients with and without dysphagia. Patients with serious dysphagia (n = 61,33.15%) showed higher positive percentages of larynx movement disorders than those classified as moderate (73.77% [60.99%-83.50%] vs 29.27% [21.82%-38.03%], p < 0.001). Logistic regression analyses conducted in the subsets confirmed larynx movement disorders as an independent predictor of dysphagia severity. CONCLUSIONS Larynx movement disorders is correlated with a higher probability of severe dysphagia as measured by the modified V-VST in AIS patients.
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Affiliation(s)
- Huijun Zhou
- Department of Clinical Nutrition, Huashan Hospital, Fudan University, Shanghai, China
| | - Shengyan Huang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Kinji Arikawa
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ting Ye
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
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Ghaziani E, Christensen SS, Arens CH, Wæhrens EE. Addressing ADL ability in people with poststroke cognitive impairments: A Danish survey of clinical practice. Scand J Occup Ther 2024; 31:2318204. [PMID: 38382558 DOI: 10.1080/11038128.2024.2318204] [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: 11/16/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND In Denmark, stroke represents a leading disability cause. While people with difficulties in performing activities of daily living (ADL) due to poststroke cognitive impairments are often referred to occupational therapy, limited knowledge is available on the nature of these services. AIM/OBJECTIVE To explore how Danish occupational therapists describe their practice when addressing decreased ADL ability in people with poststroke cognitive impairments in hospital and municipality settings. MATERIAL AND METHODS National, cross-sectorial, web-based public survey. RESULTS 244 occupational therapists accessed the survey; 172 were included in the analysis. Most respondents could indicate the theory guiding their reasoning; half used standardised assessments. Regarding intervention, restorative and acquisitional models were preferred; specific strategies were identified. Intensity: 30-45 min 3-4 times/week in hospitals; 30-60 min 1-2 times/week in municipalities. CONCLUSIONS Therapists report to be guided by theory in their reasoning. Standardised assessments are used to a higher extend than previously reported. Still, the results invite critical reflections on correct use of assessment instruments, content and intensity of interventions, and how therapists keep themselves updated. SIGNIFICANCE The results document the need for practice improvements and may inform the definition of standard care in future trials.
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Affiliation(s)
- E Ghaziani
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S S Christensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - C H Arens
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - E E Wæhrens
- Occupation-Centered Occupational Therapy, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Heran M, Lindsay P, Gubitz G, Yu A, Ganesh A, Lund R, Arsenault S, Bickford D, Derbyshire D, Doucette S, Ghrooda E, Harris D, Kanya-Forstner N, Kaplovitch E, Liederman Z, Martiniuk S, McClelland M, Milot G, Minuk J, Otto E, Perry J, Schlamp R, Tampieri D, van Adel B, Volders D, Whelan R, Yip S, Foley N, Smith EE, Dowlatshahi D, Mountain A, Hill MD, Martin C, Shamy M. Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7 th Edition Practice Guidelines Update, 2022. Can J Neurol Sci 2024; 51:1-31. [PMID: 36529857 DOI: 10.1017/cjn.2022.344] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The 2022 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management, 7th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by an interdisciplinary team of healthcare providers and system planners caring for persons with an acute stroke or transient ischemic attack. These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments, and management strategies, proven to reduce mortality and morbidity. The topics covered include prehospital care, emergency department care, intravenous thrombolysis and endovascular thrombectomy (EVT), prevention and management of inhospital complications, vascular risk factor reduction, early rehabilitation, and end-of-life care. These recommendations pertain primarily to an acute ischemic vascular event. Notable changes in the 7th edition include recommendations pertaining the use of tenecteplase, thrombolysis as a bridging therapy prior to mechanical thrombectomy, dual antiplatelet therapy for stroke prevention, the management of symptomatic intracerebral hemorrhage following thrombolysis, acute stroke imaging, care of patients undergoing EVT, medical assistance in dying, and virtual stroke care. An explicit effort was made to address sex and gender differences wherever possible. The theme of the 7th edition of the CSBPR is building connections to optimize individual outcomes, recognizing that many people who present with acute stroke often also have multiple comorbid conditions, are medically more complex, and require a coordinated interdisciplinary approach for optimal recovery. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca.
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Affiliation(s)
- Manraj Heran
- Division of Neuroradiology, University of British Columbia, Vancouver, Canada
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Stroke Program, Halifax, Canada
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - Amy Yu
- Division of Neurology, Department of Medicine, and Regional Stroke Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Aravind Ganesh
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Rebecca Lund
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Sacha Arsenault
- Stroke Services BC, Provincial Health Systems Authority, Vancouver, Canada
| | - Doug Bickford
- London Health Sciences Centre, London, Canada (Previous Appointment at Time of Participation)
| | - Donnita Derbyshire
- Saskatchewan College of Paramedics, Paramedic Practice Committee, Saskatoon, Canada
| | - Shannon Doucette
- Enhanced District Stroke Program, Royal Victoria Regional Health Centre, Barrie, Canada (Previous Appointment at Time of Participation)
| | - Esseddeeg Ghrooda
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Devin Harris
- Quality and Patient Safety Division, Interior Health, Kelowna, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Nick Kanya-Forstner
- Northern Ontario School of Medicine, Sudbury, Canada
- Timmins & District Hospital, Timmins, Canada
| | - Eric Kaplovitch
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Zachary Liederman
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Shauna Martiniuk
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Schwartz-Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Canada
| | | | - Genevieve Milot
- Department of Surgery, Laval University, Quebec City, Canada
| | - Jeffrey Minuk
- Division of Neurology, The Integrated Health and Social Services, University Network for West Central Montreal, Montreal, Canada
| | - Erica Otto
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Rob Schlamp
- British Columbia Emergency Health Services, Vancouver, Canada
| | | | - Brian van Adel
- Department of Neurointerventional Surgery, McMaster University, Hamilton, Canada
| | - David Volders
- Department of Radiology, Dalhousie University, Halifax, Canada
| | - Ruth Whelan
- Royal University Hospital Stroke Program, Saskatoon, Canada
| | - Samuel Yip
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Norine Foley
- WorkHORSE Consulting Group, Epidemiology, London, Canada
| | - Eric E Smith
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Dar Dowlatshahi
- Department of Neurology, University of Ottawa, Ottawa, Canada
| | - Anita Mountain
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Michael D Hill
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Chelsy Martin
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Michel Shamy
- Department of Neurology, University of Ottawa, Ottawa, Canada
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Edwards JD, Dominguez-Vargas AU, Rosso C, Branscheidt M, Sheehy L, Quandt F, Zamora SA, Fleming MK, Azzollini V, Mooney RA, Stagg CJ, Gerloff C, Rossi S, Cohen LG, Celnik P, Nitsche MA, Buetefisch CM, Dancause N. A translational roadmap for transcranial magnetic and direct current stimulation in stroke rehabilitation: Consensus-based core recommendations from the third stroke recovery and rehabilitation roundtable. Neurorehabil Neural Repair 2024; 38:19-29. [PMID: 37837350 PMCID: PMC10860359 DOI: 10.1177/15459683231209136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND AND AIMS The purpose of this Third Stroke Recovery and Rehabilitation Roundtable (SRRR3) was to develop consensus recommendations to address outstanding barriers for the translation of preclinical and clinical research using the non-invasive brain stimulation (NIBS) techniques Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) and provide a roadmap for the integration of these techniques into clinical practice. METHODS International NIBS and stroke recovery experts (N = 18) contributed to the consensus process. Using a nominal group technique, recommendations were reached via a five-stage process, involving a thematic survey, two priority ranking surveys, a literature review and an in-person meeting. RESULTS AND CONCLUSIONS Results of our consensus process yielded five key evidence-based and feasibility barriers for the translation of preclinical and clinical NIBS research, which were formulated into five core consensus recommendations. Recommendations highlight an urgent need for (1) increased understanding of NIBS mechanisms, (2) improved methodological rigor in both preclinical and clinical NIBS studies, (3) standardization of outcome measures, (4) increased clinical relevance in preclinical animal models, and (5) greater optimization and individualization of NIBS protocols. To facilitate the implementation of these recommendations, the expert panel developed a new SRRR3 Unified NIBS Research Checklist. These recommendations represent a translational pathway for the use of NIBS in stroke rehabilitation research and practice.
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Affiliation(s)
- Jodi D Edwards
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Meret Branscheidt
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Lisa Sheehy
- Bruyére Research Institute, Ottawa, ON, Canada
| | - Fanny Quandt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon A Zamora
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | | | | | | | | | | | | | | - Michael A Nitsche
- Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
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Dunn K, Finch E, Rumbach A. Aphasia associated with non-traumatic subarachnoid haemorrhage: a systematic review. Disabil Rehabil 2024; 46:199-213. [PMID: 36594360 DOI: 10.1080/09638288.2022.2157056] [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: 06/06/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Individuals with non-traumatic subarachnoid haemorrhage (SAH) are often excluded from studies of stroke populations due to differing pathophysiology and treatment pathways. Thus, aphasia presentation in the non-traumatic SAH population is potentially under-represented within existing research evidence. MATERIALS AND METHODS Five databases were systematically searched with terms related to "aphasia" and "subarachnoid haemorrhage." Studies were included if aphasia was attributed to non-traumatic SAH or its associated complications, and where at least one language assessment measure used determined the presence or absence of aphasia. Study quality was evaluated using the Mixed Methods Appraisal Tool (MMAT). RESULTS Following deduplication, 2726 articles were identified for title and abstract screening. Full text screening for 162 articles occurred, with 18 articles selected for inclusion. Aphasia incidence ranged from 5 to 24%, and was influenced by assessment measure, timing of assessment, subgroup studied, and classifications of aphasia. Many studies excluded participants with poorer clinical outcome, intracerebral complications, or severe aphasia. Few studies used comprehensive language assessment measures to examine across language domains. CONCLUSIONS Aphasia presentation is highly heterogenous following non-traumatic SAH. Future research using comprehensive language assessments at multiple time points post onset is required to better understand aphasia presentation and management needs for this population.
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Affiliation(s)
- Katrina Dunn
- Speech Pathology Department, West Moreton Health, Queensland Health, Ipswich, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Ipswich,Australia
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Egan M, Kessler D, Gurgel-Juarez N, Chopra A, Linkewich E, Sikora L, Montgomery P, Duong P. Stroke rehabilitation adaptive approaches: A theory-focused scoping review. Scand J Occup Ther 2024; 31:1-13. [PMID: 37976402 DOI: 10.1080/11038128.2023.2257228] [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: 09/22/2022] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Stroke rehabilitation consists of restorative and adaptive approaches. Multiple adaptive approaches exist. AIMS/OBJECTIVES The objective of this study was to develop a framework for categorising adaptive stroke rehabilitation interventions, based on underlying theory. MATERIAL AND METHODS We searched multiple databases to April 2020 to identify studies of interventions designed to improve participation in valued activities. We extracted the name of the intervention, underlying explicit or implicit theory, intervention elements, and anticipated outcomes. Using this information, we proposed distinct groups of interventions based on theoretical drivers. RESULTS Twenty-nine adaptive interventions were examined in at least one of 77 studies. Underlying theories included Cognitive Learning Theory, Self-determination Theory, Social Cognitive Theory, adult learning theories, and Psychological Stress and Coping Theory. Three overarching theoretical drivers were identified: learning, motivation, and coping. CONCLUSIONS At least 29 adaptive approaches exist, but each appear to be based on one of three underlying theoretical drivers. Consideration of effectiveness of these approaches by theoretical driver could help indicate underlying mechanisms and essential elements of effective adaptive approaches. SIGNIFICANCE Our framework is an important advance in understanding and evaluating adaptive approaches to stroke rehabilitation.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | | | - Anchal Chopra
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | | | - Patrick Duong
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Legasto-Mulvale JM, Inness EL, Thompson AN, Chandran N, Mathur S, Salbach NM. Adverse Events During Submaximal Aerobic Exercise Testing in People With Subacute Stroke: A Scoping Review. J Neurol Phys Ther 2024; 48:27-37. [PMID: 37184472 DOI: 10.1097/npt.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE Concern for adverse cardiovascular events and limited guidance regarding how to conduct aerobic exercise (AEx) testing for individuals poststroke are key barriers to implementation by physical therapists in stroke rehabilitation. This study aimed to describe the nature and safety of submaximal AEx testing protocols for people with subacute stroke (PwSS) and the nature of comorbidity of PwSS who underwent submaximal AEx testing. METHODS We conducted a scoping review and searched MEDLINE, EMBASE, PsycINFO, CINAHL, and SPORTDiscus from inception to October 29, 2020. Studies involving submaximal AEx testing with PwSS, reporting on participant comorbidity and on adverse events during testing, were eligible. Two reviewers independently conducted title and abstract and full-text screening. One reviewer extracted data; a second reviewer verified data. RESULTS Thirteen studies involving 452 participants and 19 submaximal AEx testing protocols (10 field test, 7 incremental, and 2 constant load) were included. Hypertension (41%), diabetes (31%), and dyslipidemia (27%) were the most common comorbidities reported. No protocols resulted in a serious adverse event. The most common test termination criterion was a heart rate (HR) limit (9 protocols); a limit of 85% age-predicted maximal HR (APM-HR) most frequently reported. Average APM-HR achieved, computed using mean age and mean peak HR, ranged from 59% to 88% across 13 protocols. DISCUSSION AND CONCLUSION Diverse submaximal AEx testing protocols with conservative test termination criteria can be safely implemented with PwSS. Results can inform clinical practice guidelines and address physical therapists' concerns with the occurrence of serious adverse events during submaximal AEx testing.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A430 ).
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Affiliation(s)
- Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute (J.M.L.M., E.L.I., A.N.T., N.C., S.M., N.M.S.) and Department of Physical Therapy (J.M.L.M., E.L.I., S.M., N.M.S), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The KITE Research Institute, Toronto Rehabilitation Institute (E.L.I., N.M.S), University Health Network, Toronto, Ontario, Canada; and School of Rehabilitation Therapy (S.M.), Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Xu Z, Zhu Y. Bibliometric Analysis of Psychological Distress in Stroke: Research Trends, Hot Spots, and Prospects- An Emphasis on China. J Multidiscip Healthc 2023; 16:4279-4291. [PMID: 38164461 PMCID: PMC10758185 DOI: 10.2147/jmdh.s434201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
Background Currently, the psychological problems of stroke patients are of great concern. It is a hot topic of clinical care research to analyze and discuss the current status and hot spots, frontiers and development trends of research on psychological distress of stroke patients, and to develop and implement psycho-social care programs to improve the quality of life of patients.However, there is an absence of visual overviews to assess the published literature systematically. Methods The Web of Science (WOS) database was used to search the relevant literature in this field, spanning the period 2009-2023, and the countries, institutions, and research keywords in this field were visualized and analyzed by CiteSpace analysis software. Results An analysis of 416 papers found that the overall trend of psychological distress in stroke patients was increasing, and the research hotspots were mainly focusing on the relationship between different risk factors and psychological distress in stroke patients, psychological distress in stroke caregivers, positive psychology in stroke patients, and interventions on psychological distress in stroke patients. In the future, the research population may gradually shift to stroke caregivers, and the research focus will be on developing and studying scales. Conclusion Visual analysis of psychological distress studies in stroke patients can provide strategies for clinical interventions and broaden thinking about clinical care.
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Affiliation(s)
- Zhiguo Xu
- Department of Pharmaceutical Engineering, School of Life and Health Sciences, Huzhou College, Huzhou, Zhejiang, People’s Republic of China
- Xiehe Union East China Stem Cell & Gene Engineering Corp., Ltd, Zhejiang Umbilical Cord Blood Hematopoietic Stem Cell Bank, Huzhou, Zhejiang, People’s Republic of China
| | - Yi Zhu
- Department of Medicine and Health, Shaoxing University Yuanpei College, Shaoxing, Zhejiang, People’s Republic of China
- Department of Nursing, Huzhou University, Huzhou, Zhejiang, People’s Republic of China
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Christie LJ, Rendell R, Fearn N, Descallar J, McCluskey A, Pearce A, Wong L, Lovarini M. Increasing the delivery of upper limb constraint-induced movement therapy programs for stroke and brain injury survivors: evaluation of the ACTIveARM project. Disabil Rehabil 2023:1-13. [PMID: 38131331 DOI: 10.1080/09638288.2023.2290687] [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: 05/02/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To increase the number of constraint-induced movement therapy (CIMT) programs provided by rehabilitation services. METHODS A before-and-after implementation study involving nine rehabilitation services. The implementation package to help change practice included file audit-feedback cycles, 2-day workshops, poster reminders, a community-of-practice and drop-in support. File audits were conducted at baseline, every three months for 1.5 years, and once after support ceased to evaluate maintenance of change. CIMT participant outcomes were collected to evaluate CIMT effectiveness and maintenance (Action Research Arm Test and Motor Activity Log). Staff focus groups explored factors influencing CIMT delivery. RESULTS CIMT adoption improved from baseline where only 2% of eligible people were offered and/or received CIMT (n = 408 files) to more than 50% over 1.5 years post-implementation (n = 792 files, 52% to 73% offered CIMT, 27%-46% received CIMT). Changes were maintained at 6-month follow-up (n = 172 files, 56% offered CIMT, 40% received CIMT). CIMT participants (n = 74) demonstrated clinically significant improvements in arm function and occupational performance. Factors influencing adoption included interdisciplinary collaboration, patient support needs, intervention adaptations, a need for continued training, and clinician support. CONCLUSIONS The implementation package helped therapists overcome an evidence-practice gap and deliver CIMT more routinely.
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Affiliation(s)
- Lauren J Christie
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, Australia
| | - Reem Rendell
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Nicola Fearn
- Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Clinical School, UNSW Sydney, Sydney, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- The StrokeEd Collaboration, Sydney, Australia
| | - Alison Pearce
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, a Joint Venture with Cancer Council NSW, The University of Sydney, Sydney, Australia
| | | | - Meryl Lovarini
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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