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Gandhi DBC, Kamalakannan S, Dsouza JV, Montanaro V, Chawla NS, Mahmood A, Ngeh E, Zarreen S, Vijayanand PJ, Solomon JM. Research, education and practice of tele-neurorehabilitation in low and middle-income countries: A Scoping Review. NeuroRehabilitation 2024:NRE240053. [PMID: 39302387 DOI: 10.3233/nre-240053] [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: 09/22/2024]
Abstract
BACKGROUND Tele-neurorehabilitation (TNR) allows for remote delivery of rehabilitation services for those with neurological disabilities. Despite growing global interest and uptake, its adoption remains challenging in Low-and-Middle-Income-Countries (LMICs). OBJECTIVE To explore available literature on the nature of training and education, research and practice of TNR in LMICs. METHODS Following PRISMA-ScR guidelines and predefined selection criteria, four databases were screened. Quality assessment was performed using the Joanna Briggs Institute tools. Relevant data was extracted to using a data extraction form in Microsoft Excel and were narratively synthesised under Education/training, Research and Clinical Practice of TNR. RESULTS We identified no formal structured training courses/programs for TNR users/providers. Sessions were mainly delivered as part of a research project. The included studies highlighted the need to engage stakeholders in TNR research and improve digital-literacy among healthcare providers/users. Development and use of clinical decision-making-tools, models of TNR suitable for varied populations and prior area-mapping were a few suggestions for clinical/research practice. CONCLUSION There is an immense need to develop academic/structured programs for TNR to build capacity among providers/users in LMICs. Practice must adhere to principles of safety, effectiveness, and based on high quality clinical-guidelines suitable to the context to ensure optimal uptake and practice of TNR in LMICs.
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Affiliation(s)
- Dorcas B C Gandhi
- Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, India
- College of Physiotherapy, Christian Medical College & Hospital Ludhiana, Ludhiana, India
- Manipal Academy of Health Sciences, Manipal, India
| | | | - Jennifer V Dsouza
- Department of Physiotherapy, St. John's Medical College, Bengaluru, India
| | | | - Nistara S Chawla
- Department of Physiotherapy, Manipal College of Health Professions (MAHE), Manipal, India
| | - Amreen Mahmood
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Etienne Ngeh
- Research Organization for Health Education and Rehabilitation-Cameroon (ROHER-CAM), Bamenda, Cameroon
| | - Sania Zarreen
- Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, India
| | - Pranay J Vijayanand
- Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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Prichard R, Maneze D, Straiton N, Inglis SC, McDonagh J. Strategies for improving diversity, equity, and inclusion in cardiovascular research: a primer. Eur J Cardiovasc Nurs 2024; 23:313-322. [PMID: 38190724 DOI: 10.1093/eurjcn/zvae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
This paper aims to empower cardiovascular (CV) researchers by promoting diversity, equity, and inclusion (DE&I) principles throughout the research cycle. It defines DE&I and introduces practical strategies for implementation in recruitment, retention, and team dynamics within CV research. Evidence-based approaches supporting underrepresented populations' participation are outlined for each research phase. Emphasizing the significance of inclusive research environments, the paper offers guidance and resources. We invite CV researchers to actively embrace DE&I principles, enhancing research relevance and addressing longstanding CV health disparities.
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Affiliation(s)
- Roslyn Prichard
- Faculty of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, 4556 Queensland, Australia
| | - Della Maneze
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicola Straiton
- St Vincent's Health Network, Nursing Research Institute, Australian Catholic University, Sydney, New South Wales, Australia
| | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Julee McDonagh
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Centre for Chronic and Complex Care Research, Blacktown Hospital, Blacktown, New South Wales, Australia
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Bourke JA, Bragge P, River J, Sinnott Jerram KA, Arora M, Middleton JW. Shining a light on the road towards conducting principle-based co-production research in rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1386746. [PMID: 38660394 PMCID: PMC11039800 DOI: 10.3389/fresc.2024.1386746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
Moving from participatory approaches incorporating co-design to co-production in health research involves a commitment to full engagement and partnership with people with lived experience through all stages of the research process-start to finish. However, despite the increased enthusiasm and proliferation of research that involves co-production, practice remains challenging, due in part to the lack of consensus on what constitutes co-production, a lack of guidance about the practical steps of applying this approach in respect to diverse research methods from multiple paradigms, and structural barriers within academia research landscape. To navigate the challenges in conducting co-produced research, it has been recommended that attention be paid to focusing and operationalising the underpinning principles and aspirations of co-production research, to aid translation into practice. In this article, we describe some fundamental principles essential to conducting co-production research (sharing power, relational resilience, and adopting a learning mindset) and provide tangible, practical strategies, and processes to engage these values. In doing so, we hope to support rehabilitation researchers who wish to engage in co-production to foster a more equitable, ethical, and impactful collaboration with people with lived experience and those involved in their circle of care.
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Affiliation(s)
- John A. Bourke
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Faculty of Medicine and Health, The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia
| | - Jo River
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Northern Sydney Local Health District, Macquarie Hospital, Sydney, NSW, Australia
| | - K. Anne Sinnott Jerram
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Faculty of Medicine and Health, The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Faculty of Medicine and Health, The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
| | - James W. Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Faculty of Medicine and Health, The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
- Royal Rehab, Ryde, NSW, Australia
- State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, St Leonards, NSW, Australia
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Hillier S, Lodge D, Nolan J, Yandell R, Chur-Hansen A, George S, Lynch E. Clinical research imperatives: principles and priorities from the perspective of Allied Health executives and managers. AUST HEALTH REV 2024; 48:207-217. [PMID: 38447201 DOI: 10.1071/ah23262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
Objective It is widely understood that a key means of improving health systems and patient outcomes is through research - accessing, understanding, generating and applying research evidence-based practice. To promote more targeted and strategic research in Allied Health practice, this study sought to establish the principles, areas and priorities for clinical research as perceived by Allied Health leaders in the South Australian public health system. Methods The study used a mixed-methods design (full, sequential and equal model). Participants were recruited from theSouth Australian Department of Health and Wellbeing employment lists for Allied Health senior leaders. Consenting participants attended face-to-face focus groups; after an overview presentation, they discussed the principles for Allied Health research, followed by areas and priorities for research. Summaries of the responses were themed descriptively and circulated electronically so participants could confirm the research areas and ascribe priority ratings, clinical populations and services. Results A total of 28 people attended the stakeholder forum (5 online); 20 responded to the second-round electronic summary. Nine principles of research action were agreed. Fourteen research areas were identified and prioritised. There was a relatively consistent prioritisation of measuring Allied Health value, Allied Health workforce, hospital avoidance and closing the gap for Aboriginal health outcomes - whether the individuals were thinking about their own service or the state as a whole. Conclusions Allied Health leadership identified key principles and priorities for research to improve service delivery and patient outcomes. These priorities should generate further discussion and interest for novice and experienced researchers and leaders and can be used to inform granting and project plans.
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Affiliation(s)
- Susan Hillier
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Duncan Lodge
- Department of Health and Wellbeing, SA Health and Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Jo Nolan
- Allied and Scientific Health Office, SA Health and Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Rosalie Yandell
- Department of Health and Wellbeing, SA Health and Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Elizabeth Lynch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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English C, Ramage ER, Attia J, Bernhardt J, Bonevski B, Burke M, Galloway M, Hankey GJ, Janssen H, Lindley R, Lynch E, Oldmeadow C, Said CM, Spratt NJ, Zacharia K, MacDonald-Wicks L, Patterson A. Secondary prevention of stroke. A telehealth-delivered physical activity and diet pilot randomized trial (ENAbLE-pilot). Int J Stroke 2024; 19:199-208. [PMID: 37658738 PMCID: PMC10811968 DOI: 10.1177/17474930231201360] [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: 07/16/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Improving physical activity levels and diet quality are important for secondary stroke prevention. AIM To test the feasibility and safety of 6-month, co-designed telehealth-delivered interventions to increase physical activity and improve diet quality. METHODS A 2 × 2 factorial trial (physical activity (PA); diet (DIET); PA + DIET; control) randomized, open-label, blinded endpoint trial. Primary outcomes were feasibility and safety. Secondary outcomes included stroke risk factors (blood pressure, self-report PA (International Physical Activity Questionnaire (IPAQ)) and diet quality (Australian Recommended Food Score (ARFS)), and quality of life. Between-group differences were analyzed using linear-mixed models. RESULTS Over 23 months, 99 people were screened for participation and 40 (40%) randomized (3 months to 10 years post-stroke, mean age 59 (16) years). Six participants withdrew, and an additional five were lost to follow-up. Fifteen serious adverse events were reported, but none were deemed definitely or probably related to the intervention. Median attendance was 32 (of 36) PA sessions and 9 (of 10) DIET sessions. The proportion of missing primary outcome data (blood pressure) was 3% at 3 months, 11% at 6 months, and 14% at 12 months. Between-group 95% confidence intervals showed promising, clinically relevant differences in support of the interventions across the range of PA, diet quality, and blood pressure outcomes. CONCLUSION Our telehealth PA and diet interventions were safe and feasible and may have led to significant behavior change. TRIAL REGISTRATION ACTRN12620000189921.
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Affiliation(s)
- Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation, University of Sydney, Sydney, NSW, Australia
| | - Emily R Ramage
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Allied Health, Western Health, Melbourne, VIC, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Division of Medicine, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | | | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Meredith Burke
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Margaret Galloway
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Heidi Janssen
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Hunter Stroke Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Richard Lindley
- Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation, University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Lynch
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Chris Oldmeadow
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Catherine M Said
- Physiotherapy, Western Health, St Albans, VIC, Australia
- Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - Neil J Spratt
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Karly Zacharia
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Food and Nutrition Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Food and Nutrition Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Amanda Patterson
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Food and Nutrition Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Willingham TB, Stowell J, Collier G, Backus D. Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:79. [PMID: 38248542 PMCID: PMC10815484 DOI: 10.3390/ijerph21010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024]
Abstract
Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.
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Affiliation(s)
- T. Bradley Willingham
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - Julie Stowell
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - George Collier
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
| | - Deborah Backus
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
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Clancy B, Bonevski B, English C, Callister R, Baker AL, Collins C, Pollack M, Magin P, Turner A, Faulkner J, Guillaumier A. Health risk factors in Australian Stroke Survivors: A latent class analysis. Health Promot J Austr 2024; 35:37-44. [PMID: 36799087 PMCID: PMC10952979 DOI: 10.1002/hpja.706] [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] [Received: 03/01/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
ISSUES ADDRESSED To (i) determine the prevalence of health risk factors (physical activity, diet, alcohol, smoking, blood pressure medication use and mental health) in community-dwelling stroke survivors; and (ii) examine how these health risk factors cluster, and identify associations with physical functioning, independent living, or sociodemographic factors. METHODS A secondary analysis of data obtained during a national randomised controlled trial. Participants had experienced stroke and completed a baseline telephone survey on demographic and stroke characteristics, health risk factors, physical functioning and independence in activities of daily living. A latent class analysis was performed to determine health risk profiles. Univariate logistic regressions were performed to identify if participant characteristics were associated with resulting classes. RESULTS Data analysed from 399 participants. Two classes of health risk factors were identified: Low Mood, Food & Moves Risk (16% of participants) and Alcohol Use Risk (84% of participants). The Low Mood, Food & Moves Risk group had poorer diet quality, lower physical activity levels and higher levels of depression and anxiety. Lower levels of independence and physical functioning were predictor variables for this group. In contrast, the Alcohol Use Risk group had better physical activity and diet scores, significantly lower probability of depression and anxiety, but a higher probability of risky drinking. CONCLUSIONS We identified two distinct health risk factor groups in our population. SO WHAT?: Future interventions may benefit from targeting the specific needs and requirements of people who have experienced stroke based on their distinct risk group. Alcohol consumption in poststroke populations requires further attention.
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Affiliation(s)
- Brigid Clancy
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders UniversityBedford ParkSAAustralia
| | - Coralie English
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
- School of Health Sciences, College of Health Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
| | - Robin Callister
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
| | - Amanda L. Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Clare Collins
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
- School of Health Sciences, College of Health Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter New England Local Health District, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Michael Pollack
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter New England Local Health District, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Parker Magin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
| | - Alyna Turner
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongVic.Australia
| | - Jack Faulkner
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
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English C, Ramage E. Secondary stroke prevention: more questions than answers. Lancet Neurol 2023; 22:770-771. [PMID: 37506718 DOI: 10.1016/s1474-4422(23)00278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Coralie English
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Emily Ramage
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia; Western Health, St Albans, VIC 3021, Australia
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Thurston C, Bezuidenhout L, Humphries S, Johansson S, von Koch L, Häger CK, Holmlund L, Sundberg CJ, Garcia-Ptacek S, Kwak L, Nilsson M, English C, Conradsson DM. Mobile health to promote physical activity in people post stroke or transient ischemic attack - study protocol for a feasibility randomised controlled trial. BMC Neurol 2023; 23:124. [PMID: 36978045 PMCID: PMC10043533 DOI: 10.1186/s12883-023-03163-0] [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: 11/24/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND- Let's get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden. METHODS One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments. DISCUSSION We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.
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Affiliation(s)
- Charlotte Thurston
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, Stockholm, Sweden
| | - Lucian Bezuidenhout
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, Stockholm, Sweden
| | - Sophia Humphries
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, Stockholm, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Science and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- Theme Heart & Vascular and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Lisa Holmlund
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Sundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Lydia Kwak
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Michael Nilsson
- Heart and Stroke Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
- The Centre for Rehab Innovations (CRI), College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Coralie English
- Heart and Stroke Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
- The Centre for Rehab Innovations (CRI), College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, Stockholm, Sweden.
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
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Talevski J, Kulnik ST, Jessup RL, Falls R, Cvetanovska N, Beauchamp A. Use of co-design methodology in the development of cardiovascular disease secondary prevention interventions: A scoping review. Health Expect 2022; 26:16-29. [PMID: 36366855 PMCID: PMC9854329 DOI: 10.1111/hex.13633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/29/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is growing evidence to support the use of co-design in developing interventions across many disciplines. This scoping review aims to examine how co-design methodology has been used in the development of cardiovascular disease (CVD) secondary prevention interventions within health and community settings. METHODS We searched four academic databases for studies that used the co-design approach to develop their intervention. Studies were included if consumers (adults with CVD) and key stakeholders (e.g. clinicians, service providers) were involved in the co-design process. The review focused on methodology rather than traditional study outcomes; therefore, co-design processes and activities were extracted and evaluated against a selected co-design framework. RESULTS Twenty-two studies were included in this review. Studies were implemented across various settings with consumers and stakeholder groups most frequently consisting of patients and healthcare professionals, respectively. Most studies specifically stated that they used a 'co-design' approach (n = 10); others used terms such as participatory action research (n = 3), user-centred design (n = 3) and community-based participatory research (n = 2). Although there was variability in terminology, co-design processes, and participants, all studies adhered to the key principles of consumer engagement. Predominant co-design activities included semistructured interviews, focus groups, co-design/development workshops and advisory group meetings. Intervention effectiveness was assessed in eight studies showing mixed results. CONCLUSIONS This review provides an overview of how the co-design approach has previously been used in the development of CVD secondary prevention interventions. These findings provide methodological considerations that can guide researchers and healthcare services when implementing co-design to develop feasible and acceptable interventions that can improve outcomes for CVD populations. PATIENT OR PUBLIC CONTRIBUTION No patients, service users, caregivers, people with lived experience or members of the public were involved in this scoping review. This review article was written by academics who have undertaken a significant amount of co-design work with consumers and stakeholders.
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Affiliation(s)
- Jason Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia,School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthSt AlbansVictoriaAustralia
| | - Stefan T. Kulnik
- Ludwig Boltzmann Institute for Digital Health and PreventionSalzburgAustria,Faculty of Health, Social Care and EducationKingston University and St George's University of LondonLondonUK
| | - Rebecca L. Jessup
- School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Academic and Research Collaborative in HealthLa Trobe UniversityBundooraVictoriaAustralia,Allied Health Research, Northern HealthEppingVictoriaAustralia
| | - Roman Falls
- Western Centre for Health Research and Education, Sunshine HospitalSt AlbansVictoriaAustralia
| | - Natali Cvetanovska
- School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Office of Research, Northern HealthEppingVictoriaAustralia
| | - Alison Beauchamp
- School of Rural HealthMonash UniversityWarragulVictoriaAustralia,Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthSt AlbansVictoriaAustralia,Victorian Heart InstituteMonash UniversityClaytonVictoriaAustralia
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Moore SA, Boyne P, Fulk G, Verheyden G, Fini NA. Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice. Stroke 2022; 53:3494-3505. [PMID: 36069185 PMCID: PMC9613533 DOI: 10.1161/strokeaha.122.038956] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life and future health. This narrative review explores the state of the science in walking recovery after stroke and potential for development. The importance of targeting walking capacity and performance is explored in relation to individual stroke survivor gait recovery, applying a common language, measurement, classification, prediction, current and future intervention development, and health care delivery. Findings are summarized in a model of current and future stroke walking recovery research and a mission statement is set for researchers and clinicians to drive the field forward to improve the lives of stroke survivors and their carers.
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Affiliation(s)
- Sarah A Moore
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK, and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (S.A.M.)
| | - Pierce Boyne
- Department of Rehabilitation Exercise and Nutritional Science, University of Cincinnati, OH (P.B.)
| | - George Fulk
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA (G.F.)
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Belgium (G.V.)
| | - Natalie A Fini
- Medicine Dentistry and Health Sciences, The University of Melbourne, Australia (N.A.F.)
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12
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Gallegos-Rejas VM, Thomas EE, Kelly JT, Smith AC. A multi-stakeholder approach is needed to reduce the digital divide and encourage equitable access to telehealth. J Telemed Telecare 2022; 29:73-78. [PMID: 35733379 DOI: 10.1177/1357633x221107995] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the COVID-19 pandemic onset, there has been exponential growth in the uptake of telehealth, globally. However, evidence suggests that people living in lower socioeconomic areas, cultural and linguistically diverse communities, people with disabilities, and with low health literacy are less likely to receive telehealth services. These population groups have disproportionately higher health needs and face additional barriers to healthcare access. Barriers that reduce access to telehealth further exacerbate existing gaps in care delivery. To improve equity of access to telehealth, we need to reduce the digital divide through a multi-stakeholder approach. This article proposes practical steps to reduce the digital divide and encourage equitable access to telehealth. Enabling more equitable access to telehealth requires improvements in digital health literacy, workforce training in clinical telehealth, co-design of new telehealth-enabled models of care, change management, advocacy for culturally appropriate services, and sustainable funding models.
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Affiliation(s)
- Victor M Gallegos-Rejas
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia.,Centre for Innovative Medical Technology, 6174University of Southern Denmark, Odense, Denmark
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