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Said CM, Ramage E, McDonald CE, Bicknell E, Hitch D, Fini NA, Bower KJ, Lynch E, Vogel AP, English K, McKay G, English C. Co-designing resources for rehabilitation via telehealth for people with moderate to severe disability post stroke. Physiotherapy 2024; 123:109-117. [PMID: 38458033 DOI: 10.1016/j.physio.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES The COVID-19 pandemic necessitated rapid transition to telehealth. Telehealth presents challenges for rehabilitation of stroke survivors with moderate-to-severe physical disability, which traditionally relies on physical interactions. The objective was to co-design resources to support delivery of rehabilitation via telehealth for this cohort. DESIGN Four-stage integrated knowledge translation co-design approach. Stage 1: Research team comprising researchers, clinicians and stroke survivors defined the research question and approach. Stage 2: Workshops and interviews were conducted with knowledge users (participants) to identify essential elements of the program. Stage 3: Resources developed by the research team. Stage 4: Resources reviewed by knowledge users and adapted. PARTICIPANTS Twenty-one knowledge users (clinicians n = 11, stroke survivors n = 7, caregivers n = 3) RESULTS: All stakeholders emphasised the complexities of telehealth rehabilitation for stroke and the need for individualised programs. Shared decision-making was identified as critical. Potential risks and benefits of telehealth were acknowledged and strategies to ameliorate risks and deliver effective rehabilitation were identified. Four freely available online resources were co-designed; three resources to support clinicians with shared decision-making and risk management and a decision-aid to support stroke survivors and caregivers throughout the process. Over six months, 1129 users have viewed the webpage; clinician resources were downloaded 374 times and the decision-aid was downloaded 570 times. CONCLUSIONS The co-design process identified key elements for delivery of telehealth rehabilitation to stroke survivors with moderate-to-severe physical disability and led to development of resources to support development of an individualised telehealth rehabilitation plan. Future research should evaluate the effectiveness of these resources. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Catherine M Said
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Physiotherapy, Western Health, St Albans, Australia; Australian Institute of Musculoskeletal Sciences, St Albans, Australia.
| | - Emily Ramage
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Physiotherapy, Western Health, St Albans, Australia; School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia; Allied Health Strategy, Planning, Innovation, Research and Education Unit, Western Health, St Albans, Australia.
| | - Cassie E McDonald
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia; Allied Health, Alfred Health, Melbourne, Australia.
| | - Erin Bicknell
- Physiotherapy, Western Health, St Albans, Australia; Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia.
| | - Danielle Hitch
- Allied Health Strategy, Planning, Innovation, Research and Education Unit, Western Health, St Albans, Australia; School of Health and Social Development, Deakin University, Geelong, Australia.
| | - Natalie A Fini
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Kelly J Bower
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Elizabeth Lynch
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.
| | - Adam P Vogel
- Audiology and Speech Pathology, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Redenlab Inc, Melbourne, Australia.
| | | | - Gary McKay
- Consumer Representative, Melbourne, Australia.
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia.
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Breitenstein C, Wallace SJ, Gilmore N, Finch E, Pettigrove K, Brady MC. Invaluable Benefits of 10 Years of the International Collaboration of Aphasia Trialists (CATs). Stroke 2024; 55:1129-1135. [PMID: 38527148 DOI: 10.1161/strokeaha.124.046487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
Aphasia research has traditionally been considered a (unidisciplinary) niche topic in medical science. The international Collaboration of Aphasia Trialists (CATs) is a global collaboration of multidisciplinary aphasia researchers. Over the past 10 years, CATs has collectively taken a rigorous approach to systematically address persistent challenges to aphasia research quality. This article summarizes the achievements over the past decade. CATs' achievements include: standardizing terminology, advancing aphasia research design by aphasia expert consensus recommendations, developing a core data set and intervention descriptors, facilitating the involvement of people with the language impairment aphasia in the research process, translating, and adapting assessment tools into global languages, encouraging data sharing, developing innovative secondary data analysis methodologies and promoting the transparency and accessibility of high quality aphasia research reports. CATs' educational and scientific achievements over the past 10 years far exceed what individual researchers in the field could have ever achieved.
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Affiliation(s)
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, Brisbane, Australia (S.J.W.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA (N.G.)
| | - Emma Finch
- Research and Innovation, West Moreton Health, Ipswich, Australia (E.F.)
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia (E.F.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Kathryn Pettigrove
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia (K.P.)
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia (K.P.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom (M.C.B.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
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Hayward KS, Bernhardt J, Kwakkel G. What's on the recovery and rehabilitation horizon? The third international Stroke Recovery and Rehabilitation Roundtable (SRRR3) initiative. Int J Stroke 2024; 19:130-132. [PMID: 38270098 DOI: 10.1177/17474930231218329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
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Longo D, Santini G, Cherubini G, Melchiorre D, Ferrarello F, Bagni MA. The muscle shortening maneuver in individuals with stroke: a consideration-of-concept randomized pilot trial. Top Stroke Rehabil 2023; 30:807-819. [PMID: 36398746 DOI: 10.1080/10749357.2022.2145741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE The Muscle Shortening Maneuver (MSM) is derived from Feldman's λ model of motor control, and seems to induce a more balanced agonist- antagonist-muscular action. The hypothesized mechanism of action is a modulation of the Tonic Stretch Reflex Threshold (TSRT). We designed a pilot, randomized trial aimed to explore the mechanisms of action of the technique. An ancillary objective was to research the implementation of the MSM as a stroke rehabilitation intervention. METHODS A sample of 10 participants with chronic stroke was enrolled and randomly assigned to MSM (n, 5) or conventional physical therapy (CPT) (n, 5) treatments. The TSRTs were assessed by the Montreal Spasticity Measure device. A selection of clinical and instrumental outcome measures was taken to investigate function and activity levels. Data were collected at baseline, end-of-treatment, and one month after the end-of-treatment. RESULTS No adverse events were observed. In both between- and within-group post-treatment assessments, in the affected ankle the MSM group showed decreased TSRTs of the plantar flexor, increased strength of the dorsiflexor and active range of motion; also, the time needed to perform the Timed Up and Go test decreased. No changes were evident across assessments in the CPT group. DISCUSSION AND CONCLUSIONS The MSM seems able to modulate the TSRTs in individuals with stroke. Although with the limitations due to the pilot design, the variation in participants' responses appear to be promising. Many methodological issues have to be clarified and specified conceiving the progression toward a confirmatory trial.
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Affiliation(s)
- Diego Longo
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Guido Santini
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Daniela Melchiorre
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Ferrarello
- Department of Functional Rehabilitation activities, Azienda USL Toscana Centro, Prato, Italy
| | - Maria Angela Bagni
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Johansson JF, Shannon R, Mossabir R, Airlie J, Ozer S, Moreau LA, Farrin A, Mead G, English C, Fitzsimons CF, Clarke DJ, Forster A. Intervention to reduce sedentary behaviour and improve outcomes after stroke (Get Set Go): a study protocol for the process evaluation of a pilot cluster randomised controlled trial (RECREATE). BMJ Open 2023; 13:e075363. [PMID: 37699629 PMCID: PMC10503356 DOI: 10.1136/bmjopen-2023-075363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Stroke survivors spend long periods of time engaging in sedentary behaviour (SB) even when their functional recovery is good. In the RECREATE programme, an intervention aimed at reducing SB ('Get Set Go') will be implemented and evaluated in a pragmatic external pilot cluster randomised controlled trial with embedded process and economic evaluations. We report the protocol for the process evaluation which will address the following objectives: (1) describe and clarify causal assumptions about the intervention, and its mechanisms of impact; (2) assess implementation fidelity; (3) explore views, perceptions and acceptability of the intervention to staff, stroke survivors and their carers; (4) establish the contextual factors that influence implementation, intervention mechanisms and outcomes. METHODS AND ANALYSIS This pilot trial will be conducted in 15 UK-based National Health Service stroke services. This process evaluation study, underpinned by the Medical Research Council guidance, will be undertaken in six of the randomised services (four intervention, two control). Data collection includes the following: observations of staff training sessions, non-participant observations in inpatient and community settings, semi-structured interviews with staff, patients and carers, and documentary analysis of key intervention components. Additional quantitative implementation data will be collected in all sites. Training observations and documentary analysis data will be summarised, with other observational and interview data analysed using thematic analysis. Relevant theories will be used to interpret the findings, including the theoretical domains framework, normalisation process theory and the theoretical framework of acceptability. Anticipated outputs include the following: recommendations for intervention refinements (both content and implementation); a revised implementation plan and a refined logic model. ETHICS AND DISSEMINATION The study was approved by Yorkshire & The Humber - Bradford Leeds Research Ethics Committee (REC reference: 19/YH/0403). Findings will be disseminated via peer review publications, and national and international conference presentations. TRIAL REGISTRATION NUMBER ISRCTN82280581.
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Affiliation(s)
- Jessica Faye Johansson
- Academic Unit of Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Academic Unit of Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosie Shannon
- Academic Unit of Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rahena Mossabir
- Academic Unit of Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jennifer Airlie
- Academic Unit of Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Seline Ozer
- Academic Unit of Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lauren A Moreau
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
- Heart and Stroke Research Program, The University of Newcastle Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Claire F Fitzsimons
- Physical Activity for Health and Research Centre, Institute for Sport Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - David J Clarke
- Academic Unit of Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Academic Unit of Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anne Forster
- Academic Unit of Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Academic Unit of Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Johnson L, Mardo J, Demain S. Understanding implementation of a complex intervention in a stroke rehabilitation research trial: A qualitative evaluation using Normalisation Process Theory. PLoS One 2023; 18:e0282612. [PMID: 37682841 PMCID: PMC10490858 DOI: 10.1371/journal.pone.0282612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The Implicit Learning in Stroke study was a pilot cluster randomised controlled trial, investigating the use of different motor learning strategies in acute stroke rehabilitation. Participating Stroke Units (n = 8) were from the South East/West regions of the UK, with the experimental intervention (implicit learning) being delivered by clinical teams. It required therapists to change how they gave instructions and feedback to patients during rehabilitation. This paper reports the processes underpinning implementation of the implicit learning intervention. The evaluation aimed to i) understand how therapists made sense of, engaged with and interpreted the effects of the intervention; ii) compare this to the experience reported by patients; iii) extrapolate learning of broader relevance to the design and conduct of research involving complex interventions in stroke rehabilitation. METHODS Qualitative evaluation, with data collected through focus groups with clinical staff (n = 20) and semi structured interviews with people with stroke (n = 19). Mixed inductive and theory driven analysis, underpinned by Normalisation Process Theory. RESULTS How therapists made sense of and experienced the intervention impacted how it was implemented. The intervention was delivered by individual therapists, and was influenced by their individual values, beliefs and concerns. However, how teams worked together to build a shared (team) understanding, also played a key role. Teams with a more "flexible" interpretation, reported the view that the intervention could have benefits in a wide range of scenarios. Those with a more fixed, "rule based" interpretation, found it harder to implement, and perceived the benefits to be more limited. Therapists' concerns that the intervention may impair therapeutic relationships and patient learning were not reflected in how patients experienced it. CONCLUSIONS Changing practice, whether in a research study or in the "real world", is complex. Understanding the process of implementation is crucial to effective research delivery. Implementation frameworks facilitate understanding, and subsequently the systematic and iterative development of strategies for this to be addressed. How teams (rather than individuals) work together is central to how complex interventions are understood and implemented. It is possible that new complex interventions work best in contexts where there are 'flexible' cultures. Researchers should consider, and potentially measure this, before they can effectively implement and evaluate an intervention. TRIAL REGISTRATION Clinical Trials - NCT03792126.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, United Kingdom
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Julia Mardo
- Dorset Healthcare NHS Foundation Trust, Yeatman Hospital, Hospital Lane, Sherborne, Dorset, United Kingdom
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Galloway M, Marsden DL, Callister R, Erickson KI, Nilsson M, English C. How little is enough? The feasibility of conducting a dose-escalation study for exercise training in people with stroke. J Stroke Cerebrovasc Dis 2023; 32:107190. [PMID: 37216752 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
QUESTION Is it feasible and safe to conduct an exercise dose-finding study in people with stroke? Is it possible to determine a minimal dose of exercise required to see clinically meaningful improvements in cardiorespiratory fitness? METHODS Dose-escalation study. Twenty people with stroke (n=5 per cohort) who were able to walk independently participated in home-based, telehealth-supervised aerobic exercise sessions 3 d/week at moderate-vigorous intensity for 8 weeks. Dose parameters of frequency (3 d/week), intensity (55-85% of heart rate peak) and program length (8 weeks) were kept constant. The duration of exercise sessions was increased by 5 min per session from Dose 1 (10 min/session) to Dose 4 (25 min/session). Doses were escalated if safe and tolerable (< 33% of a cohort reaching a dose-limiting threshold). Doses were efficacious if ≥ 67% of a cohort increased peak oxygen consumption ≥ 2mL/kg/min. RESULTS Target exercise doses were well adhered to, and the intervention was safe (480 exercise sessions delivered; one fall resulting in minor laceration) and tolerable (no participants met the dose-limiting threshold). None of the exercise doses met our criterion for efficacy. CONCLUSIONS It is possible to conduct a dose-escalation trial for people with stroke. The small cohort sizes may have limited the ability to determine an efficacious minimum dose of exercise. Providing supervised exercise session at these prescribed doses via telehealth was safe. REGISTRATION The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000460303).
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Affiliation(s)
- Margaret Galloway
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Heart and Stroke Program, Hunter Medical Research Institute, NSW, Australia
| | - Dianne L Marsden
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Heart and Stroke Program, Hunter Medical Research Institute, NSW, Australia; Hunter Stroke Service, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Heart and Stroke Program, Hunter Medical Research Institute, NSW, Australia
| | - Kirk I Erickson
- AdventHealth Research Institute, Neuroscience Institute, Orlando, FL, United States; Department of Psychology, University of Pittsburgh, Pittsburgh PA, United States; PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Michael Nilsson
- Centre for Rehab Innovations (CRI), College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Heart and Stroke Program, Hunter Medical Research Institute, NSW, Australia.
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Lipson-Smith R, Zeeman H, Muns L, Jeddi F, Simondson J, Bernhardt J. The role of the physical environment in stroke recovery: Evidence-based design principles from a mixed-methods multiple case study. PLoS One 2023; 18:e0280690. [PMID: 37294748 PMCID: PMC10256226 DOI: 10.1371/journal.pone.0280690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/05/2023] [Indexed: 06/11/2023] Open
Abstract
Hospital design can impact patient outcomes, but there is very little healthcare design evidence specific to stroke rehabilitation facilities. Our aim was to explore, from the patient perspective, the role of the physical environment in factors crucial to stroke recovery, namely, stroke survivor activity (physical, cognitive, social), sleep, emotional well-being, and safety. We conducted a mixed-methods multiple-case study at two inpatient rehabilitation facilities in Victoria, Australia, (n = 20 at Case 1, n = 16 at Case 2) using "walk-through" semi-structured interviews, behavioural mapping, questionnaires, and retrospective audit. Four interrelated themes emerged: 1) entrapment and escape; 2) power, dependency, and identity in an institutional environment; 3) the rehabilitation facility is a shared space; and 4) the environment should be legible and patient-centred. Quantitative data revealed patterns in patient activity; stroke survivors spent over 75% of their time in bedrooms and were often inactive. Convergent mixed methods analysis was used to generate a new conceptual model of the role of the physical environment in stroke survivors' behaviour and well-being, highlighting the importance of variety and interest, privacy without isolation, and patient-centred design. This model can be used by designers, healthcare providers, and policy makers to inform the design of rehabilitation environments.
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Affiliation(s)
- Ruby Lipson-Smith
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Leanne Muns
- Bendigo Health, Clinical Operations, Bendigo, Victoria, Australia
| | - Faraz Jeddi
- Bendigo Health, Department of Integrated Medicine, Bendigo, Victoria, Australia
| | - Janine Simondson
- St Vincent’s Hospital Melbourne, Physiotherapy and Rehabilitation Unit, St George’s Hospital, Kew, Victoria, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Abstract
BACKGROUND Stroke is a neurological disorder and one of the leading causes of disability worldwide. The patient may lose the ability to adequately move the extremities, perceive sensations, or ambulate independently. Recent experimental studies have reported the beneficial influence of virtual reality training strategies on improving overall functional abilities for stroke survivors. METHODS Conducted a systematic review of the literature using the following keywords to retrieve the data: stroke, virtual reality, motor deficits, neurorehabilitation, cognitive impairments, and sensory deficits. A random-effect meta-analysis was performed for seven scales - one cognitive (MMSE) and six motor (Fugl-Meyer, Berg Balance Scale, Time up and go, Wolf motor function, 10 m walk, Brunnstrom score). OBJECTIVE To organize and compare all the available data regarding the effectiveness of virtual reality for stroke rehabilitation. RESULTS This literature reviewed 150 studies and included 46 for qualitative and 27 for quantitative analysis. There was no statistically significant difference between groups in MMSE score (MD = 0.24, 95%CI = ((-0.42) -(0.9)), p = .47, I2 = 0%) and Fugl-Meyer score (MD = (-0.38), 95%CI = ((-12.88)-(12.11)), p = .95, I2 = 98%) . The statistical significance was not reached in any of the other outcomes. CONCLUSIONS This review supports that stroke rehabilitation programs incorporating virtual reality are associated with improved functional outcomes, but there is no statistically significant difference compared to standard therapy.
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Affiliation(s)
- Azka Khan
- Faculty of Rehabilitation and Allied Health Sciences Islamabad, Riphah International University, Rawalpindi, Pakistan
| | - Anna Podlasek
- Neuroscience and Vascular Simulation, School of Medicine, Anglia Ruskin University, Chelmsford, Essex, UK.,Nihr Nottingham Brc, University of Nottingham, Nottingham, UK.,Clinical Radiology,Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fahad Somaa
- King Abdulaziz University,Occupational Therapy Department, Faculty of Medical Rehabilitation Sciences, King AbdulAziz University Jeddah, Saudi, Arabia
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Singh H, Nelson MLA, Martyniuk J, Colquhoun H, Munce S, Cameron JI, Kokorelias KM, Pakkal O, Kuluski K. Scoping review protocol of the use of codesign methods in stroke intervention development. BMJ Open 2022; 12:e065150. [PMID: 36410803 PMCID: PMC9680189 DOI: 10.1136/bmjopen-2022-065150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Codesign is an emerging research method to enhance intervention development by actively engaging non-researchers (eg, people who have had a stroke, caregivers and clinicians) in research. The involvement of non-researchers in research is becoming increasingly popular within health studies as it may produce more relevant and effective findings. The stroke population commonly exhibits challenges such as aphasia and cognitive changes that may limit their participation in codesign. However, the use of codesign within the stroke literature has not been comprehensively reviewed. This scoping review will determine: (1) what is the extent, range and nature of stroke research that has used codesign methods? (2) What codesign methods have been used to develop stroke interventions? (3) What considerations for codesigning interventions with people who have stroke are not captured in the findings? METHODS AND ANALYSIS This is a protocol for a scoping review to identify the literature relating to stroke, and codesign will be conducted on OVID Medline, OVID Embase, OVID PsychINFO, EBSCO CINAHL, the Cochrane Library, Scopus, PEDro-Physiotherapy Evidence Database and Global Index Medicus. Studies of any design and publication date will be included. Title and abstract and full-text review will be conducted independently by two reviewers. Data will be extracted, collated and then summarised descriptively using quantitative (eg, numerical descriptions) and qualitative (eg, textual descriptions) methods. Numerical summaries will map the extent (eg, number of studies), range (eg, types of studies) and nature (eg, types of interventions developed) of the literature on this topic. A thematic analysis will provide insights into the codesign methods (eg, activities, non-researchers), including heterogeneity across and within studies. ETHICS AND DISSEMINATION This review protocol does not require ethics approval as data has not been collected/analysed. The findings will highlight opportunities and recommendations to inform future codesign research in stroke and other populations who exhibit similar challenges/disabilities, and they will be disseminated via publications, presentations and stakeholder meetings. TRIAL REGISTRATION NUMBERREGISTRATION Open Science Framework: 10.17605/OSF.IO/NSD2W.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle LA Nelson
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristina Marie Kokorelias
- Geriatric Medicine, Department of Medicine, Sinai Health System/University Health Network, Toronto, ON, Canada
| | - Oya Pakkal
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Powers K, Clarke S, Phillips J, Holmes JA, Cripps R, Craven K, Farrin A, das Nair R, Radford KA. Developing an implementation fidelity checklist for a vocational rehabilitation intervention. Pilot Feasibility Stud 2022; 8:234. [PMID: 36324137 PMCID: PMC9628165 DOI: 10.1186/s40814-022-01194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite growing numbers of studies reporting the efficacy of complex interventions and their implementation, many studies fail to report information on implementation fidelity or describe how fidelity measures used within the study were developed. This study aimed to develop a fidelity checklist for measuring the implementation fidelity of an early, stroke-specialist vocational rehabilitation intervention (ESSVR) in the RETAKE trial. METHODS To develop the fidelity measure, previous checklists were reviewed to inform the assessment structure, and core intervention components were extracted from intervention descriptions into a checklist, which was ratified by eight experts in fidelity measurement and complex interventions. Guidance notes were generated to assist with checklist completion. To test the measure, two researchers independently applied the checklist to fifteen stroke survivor intervention case notes using retrospective observational case review. The scoring was assessed for interrater reliability. RESULTS A fidelity checklist containing 21 core components and 6 desirable components across 4 stages of intervention delivery was developed with corresponding guidance notes. Interrater reliability of each checklist item ranged from moderate to perfect (Cohen's kappa 0.69-1). CONCLUSIONS The resulting checklist to assess implementation fidelity is fit for assessing the delivery of vocational rehabilitation for stroke survivors using retrospective observational case review. The checklist proved its utility as a measure of fidelity and may be used to inform the design of future implementation strategies. TRIAL REGISTRATION ISRCTN, ISRCTN12464275. Registered on 13 March 2018.
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Affiliation(s)
- Katie Powers
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Sara Clarke
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Julie Phillips
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Jain A Holmes
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Rachel Cripps
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kristelle Craven
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Amanda Farrin
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Roshan das Nair
- Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK
- Health Division, SINTEF, Trondheim, Norway
| | - Kathryn A Radford
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Wingfield M, Fini NA, Brodtmann A, Williams G, Churilov L, Hayward KS. Upper-Limb Motor Intervention Elements That Drive Improvement in Biomarkers and Clinical Measures Post-Stroke: A Systematic Review in a Systems Paradigm. Neurorehabil Neural Repair 2022; 36:726-739. [DOI: 10.1177/15459683221129273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To use a systems paradigm to examine upper limb (UL) motor intervention elements driving biomarker and clinical measure improvement after stroke. Methods Databases were searched up to March 2022. Eligibility screening was completed by 2 authors. Studies using biomarkers and clinical measures pre- and post-upper limb intervention were included. Studies of adjunct interventions (eg, brain stimulation) were excluded. Cochrane Risk-of-Bias tools and Template for Intervention Description and Replication were used to rate studies. Studies were synthesized using a systems paradigm: intervention outcome was considered an emergent property of the systemic interactions of 4 intervention elements (demographics, type, quality, and dose) characterized by individual dimensions. Results Sixty-four studies (n = 1814 participants) containing 106 intervention groups (66 experimental; 40 control) were included. Combined biomarker and clinical outcomes defined 3 scenarios: restitution, mixed, and unchanged. The restitution scenario included more moderate-to-severely impaired participants in earlier recovery phases (<6 months). Interventions with graded difficulty were more frequently used in the restitution scenario compared with the unchanged scenario. No difference in quality or amount of therapy was identified when examining scenarios that demonstrated restitution compared to those that did not (mixed and unchanged). Conclusions A systems paradigm may be one of many approaches to understand UL motor restitution. This review found no single element consistently delivered improvements in biomarkers and clinical measures in the examined intervention groups. Complex patterns formed by multiple interacting intervention elements were observed in participants with and without restitution.
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Affiliation(s)
- Matthew Wingfield
- Department of Physiotherapy, University of Melbourne; Epworth Healthcare, Melbourne, Victoria, Australia
| | - Natalie A. Fini
- Department of Physiotherapy, University of Melbourne; Epworth Healthcare, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gavin Williams
- Department of Physiotherapy, University of Melbourne; Epworth Healthcare, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Kathryn S. Hayward
- Departments of Physiotherapy, Medicine & Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Holmes JA, Fletcher-Smith JC, Merchán-Baeza JA, Phillips J, Radford K. Developing a method to assess fidelity to a complex vocational rehabilitation intervention in the FRESH trial: a feasibility study. Pilot Feasibility Stud 2022; 8:160. [PMID: 35906683 PMCID: PMC9335967 DOI: 10.1186/s40814-022-01111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Determining whether complex rehabilitation interventions are delivered with fidelity is important. Implementation fidelity can differ between sites, therapists delivering interventions and, over time, threatening trial outcomes and increasing the risk of type II and III errors. This study aimed to develop a method of assessing occupational therapists’ fidelity to deliver a complex, individually tailored vocational rehabilitation (VR) intervention to people with traumatic brain injury (TBI) and assess the feasibility of its use in a randomised controlled trial. Methods Using mixed methods and drawing on the intervention logic model, we developed data collection tools to measure fidelity to early specialist TBI VR (ESTVR). Fidelity was measured quantitatively using intervention case report forms (CRF), fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with intervention therapists, participants with TBI, employers and NHS staff at trial sites explored moderators of implementation fidelity. The conceptual framework of implementation fidelity (CFIF) guided measurement and analysis of and factors affecting fidelity. Data were triangulated and benchmarked against an earlier cohort study. Results Fidelity to a complex individually tailored VR intervention could be measured. Overall, OTs delivered ESTVR with fidelity. Different fidelity measures answered different questions, offering unique insights into fidelity. Fidelity was best assessed using a fidelity checklist, intervention CRFs and clinical notes. The OT clinical notes and mentoring records were best at identifying fidelity moderating factors. Interviews added little insight into fidelity moderating factors over and above mentoring or clinical records. Data triangulation offered a comprehensive assessment of fidelity, highlighting limitations of measurement methods and learning for future trials but was resource intensive. Interviews, fidelity visits and analysing clinical notes were also resource intense. Comparing fidelity data to a benchmark and using CFIF as a framework for organising the fidelity assessment helped. Conclusions OTs delivered the VR intervention with fidelity. A fidelity checklist and benchmark plus mentoring may offer a practical and effective way of measuring fidelity and identifying fidelity moderating factors in trials of complex individually-tailored rehabilitation interventions. Mentoring provided real-time indicators of and reasons for fidelity deviations. These methods require further evaluation. Trial registration ISRCTN Registry, ISRCTN38581822 (Registered: 02/01/2014). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01111-2.
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Affiliation(s)
- Jain Anne Holmes
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Joanna Clare Fletcher-Smith
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Jose Antonio Merchán-Baeza
- Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), 08500, Vic, Spain
| | - Julie Phillips
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Kathryn Radford
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
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14
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Zhu H. A Large-Scale Prospective Study on Functional Ability and Mortality Following Stroke Based on HRS Data Set: Implications for Rehabilitation. Front Psychol 2022; 13:915653. [PMID: 35899010 PMCID: PMC9311379 DOI: 10.3389/fpsyg.2022.915653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
According to the WHO, 15 million people worldwide suffer a stroke annually. Of these, 5 million die and another 5 million are left permanently disabled. Patients endure the impacts of strokes during their rehabilitation and afterward, placing economical and emotional burdens on family and community. Using data from the Health and Retirement Study (HRS) of the USA, the research performed a large-scale prospective analysis to examine how demographics, socioeconomic factors, cognition, emotion, and physical activity predict functional impairment and mortality. Multiple regression was employed to identify statistically significant variables that predict longitudinal Activities of Daily Life (ADLs). The least absolute shrinkage and selection operator (LASSO) logistic regression, a supervised machine learning approach, was deliberately chosen to obtain the subset of predictors that provide the best possible classification for the dependent variable. The LASSO regression produced a model with a fair mean Area Under the Curve (AUC) of 0.75 in predicting the risk of the patient's mortality. My findings also uncovered the important roles of BMI, mobility, muscle strength, memory, mental status, and socioeconomic status play in the long-term ADLs and survival of patients with stroke.
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15
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Ranganathan R, Doherty C, Gussert M, Kaplinski E, Koje M, Krishnan C. Scientific basis and active ingredients of current therapeutic interventions for stroke rehabilitation. Restor Neurol Neurosci 2022; 40:97-107. [DOI: 10.3233/rnn-211243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Despite tremendous advances in the treatment and management of stroke, restoring motor and functional outcomes after stroke continues to be a major clinical challenge. Given the wide range of approaches used in motor rehabilitation, several commentaries have highlighted the lack of a clear scientific basis for different interventions as one critical factor that has led to suboptimal study outcomes. Objective: To understand the content of current therapeutic interventions in terms of their active ingredients. Methods: We conducted an analysis of randomized controlled trials in stroke rehabilitation over a 2-year period from 2019-2020. Results: There were three primary findings: (i) consistent with prior reports, most studies did not provide an explicit rationale for why the treatment would be expected to work, (ii) most therapeutic interventions mentioned multiple active ingredients and there was not a close correspondence between the active ingredients mentioned versus the active ingredients measured in the study, and (iii) multimodal approaches that involved more than one therapeutic approach tended to be combined in an ad-hoc fashion, indicating the lack of a targeted approach. Conclusion: These results highlight the need for strengthening cross-disciplinary connections between basic science and clinical studies, and the need for structured development and testing of therapeutic approaches to find more effective treatment interventions.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Carson Doherty
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Michael Gussert
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Eva Kaplinski
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Mary Koje
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Radford KA, McKevitt C, Clarke S, Powers K, Phillips J, Craven K, Watkins C, Farrin A, Holmes J, Cripps R, McLellan V, Sach T, Brindle R, Holloway I, Hartley S, Bowen A, O'Connor RJ, Stevens J, Walker M, Murray J, Shone A, Clarke D. RETurn to work After stroKE (RETAKE) Trial: protocol for a mixed-methods process evaluation using normalisation process theory. BMJ Open 2022; 12:e053111. [PMID: 35292493 PMCID: PMC8928258 DOI: 10.1136/bmjopen-2021-053111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This mixed-method process evaluation underpinned by normalisation process theory aims to measure fidelity to the intervention, understand the social and structural context in which the intervention is delivered and identify barriers and facilitators to intervention implementation. SETTING RETurn to work After stroKE (RETAKE) is a multicentre individual patient randomised controlled trial to determine whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care is a clinically and cost-effective therapy to facilitate return to work after stroke, compared with usual care alone. This protocol paper describes the embedded process evaluation. PARTICIPANTS AND OUTCOME MEASURES Intervention training for therapists will be observed and use of remote mentor support reviewed through documentary analysis. Fidelity will be assessed through participant questionnaires and analysis of therapy records, examining frequency, duration and content of ESSVR sessions. To understand the influence of social and structural contexts, the process evaluation will explore therapists' attitudes towards evidence-based practice, competency to deliver the intervention and evaluate potential sources of contamination. Longitudinal case studies incorporating non-participant observations will be conducted with a proportion of intervention and usual care participants. Semistructured interviews with stroke survivors, carers, occupational therapists, mentors, service managers and employers will explore their experiences as RETAKE participants. Analysis of qualitative data will draw on thematic and framework approaches. Quantitative data analysis will include regression models and descriptive statistics. Qualitative and quantitative data will be independently analysed by process evaluation and Clinical Trials Research Unit teams, respectively. Linked data, for example, fidelity and describing usual care will be synthesised by comparing and integrating quantitative descriptive data with the qualitative findings. ETHICS AND DISSEMINATION Approval obtained through the East Midlands-Nottingham 2 Research Ethics Committee (Ref: 18/EM/0019) and the National Health ServiceResearch Authority. Dissemination via journal publications, stroke conferences, social media and meetings with national Stroke clinical leads. TRIAL REGISTRATION NUMBER ISRCTN12464275.
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Affiliation(s)
- Kathryn A Radford
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- Department of Public Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Sara Clarke
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Katie Powers
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie Phillips
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Kristelle Craven
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Caroline Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | - Amanda Farrin
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Jain Holmes
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rachel Cripps
- Department of Public Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Vicki McLellan
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Richard Brindle
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Judith Stevens
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Marion Walker
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John Murray
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Angela Shone
- Research and Innovation, University of Nottingham, Nottingham, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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de Goumoëns V, Ayigah K, Joye D, Ryvlin P, Ramelet AS. The Development of an Early Intervention for Supporting Families of Persons With Acquired Brain Injuries: The SAFIR © Intervention. J Fam Nurs 2022; 28:6-16. [PMID: 34617490 PMCID: PMC8814967 DOI: 10.1177/10748407211048217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Families of persons with acquired brain injuries need to be supported from the early phase of hospitalization. To date, no known early family intervention is available for this population. Using the Medical Research Council Framework, we developed a new intervention based on the Calgary Assessment and Intervention Models that includes the family preferences, clinician's expertise, and the contextual resources. This paper aims to describe the complete development process including a scoping review, an assessment of families and clinicians' needs, an evaluation of the contextual resources, and an adaptation of the theoretical framework. Using a systemic perspective, we tailored the new intervention to involve the stakeholder's preferences. The result is an early family intervention named SAFIR©, led by a clinical nurse specialist, including five core components and structured around three phases and a follow-up. The next steps will be focused on assessment of the clinical feasibility of this new intervention.
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Affiliation(s)
- Véronique de Goumoëns
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, Lausanne
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Lausanne University Hospital, (CHUV), Lausanne, Switzerland
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland
| | - Koffi Ayigah
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland
| | - Daniel Joye
- Lausanne University Hospital, (CHUV), Lausanne, Switzerland
| | | | - Anne-Sylvie Ramelet
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Lausanne University Hospital, (CHUV), Lausanne, Switzerland
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18
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Duan YJ, Hua XY, Zheng MX, Wu JJ, Xing XX, Li YL, Xu JG. Corticocortical paired associative stimulation for treating motor dysfunction after stroke: study protocol for a randomised sham-controlled double-blind clinical trial. BMJ Open 2022; 12:e053991. [PMID: 35027421 PMCID: PMC8762140 DOI: 10.1136/bmjopen-2021-053991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Stroke survivors can have a high disability rate with low quality of daily life, resulting in a heavy burden on family and society. Transcranial magnetic stimulation has been widely applied to brain injury repair, neurological disease treatment, cognition and emotion regulation and so on. However, there is still much to be desired in the theories of using these neuromodulation techniques to treat stroke-caused hemiplegia. It is generally recognised that synaptic plasticity is an important basis for functional repair after brain injury. This study protocol aims to examine the corticocortical paired associative stimulation (ccPAS) for inducing synaptic plasticity to rescue the paralysed after stroke. METHODS AND ANALYSIS The current study is designed as a 14-week double-blind randomised sham-controlled clinical trial, composed of 2-week intervention and 12-week follow-up. For the study, 42 patients who had a stroke aged 40-70 will be recruited, who are randomly assigned either to the ccPAS intervention group, or to the control group at a 1:1 ratio, hence an equal number each. In the intervention group, ccPAS is practised in conjunction with the conventional rehabilitation treatment, and in the control group, the conventional rehabilitation treatment is administered with sham stimulation. A total of 10 interventions will be made, 5 times a week for 2 weeks. The same assessors are supposed to evaluate the participants' motor function at four time points of the baseline (before 10 interventions), treatment ending (after 10 interventions), and two intervals of follow-up (1 and 3 months later, respectively). The Fugl-Meyer Assessment Upper Extremity is used for the primary outcomes. The secondary outcomes include changes in the assessment of Action Research Arm Test (ARAT), Modified Barthel Index (MBI), electroencephalogram (EEG) and functional MRI data. The adverse events are to be recorded throughout the study. ETHICS AND DISSEMINATION This study was approved by the Medical Ethics Committee of Yueyang Hospital. All ethical work was performed in accordance with the Helsinki declaration. Written informed consent was obtained from all individual participants included in the study. Study findings will be disseminated in the printed media. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry: ChiCTR2000036685.
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Affiliation(s)
- Yu-Jie Duan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang-Xin Xing
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Lin Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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19
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Kontou E, Thomas SA, Cobley C, Fisher R, Golding-Day MR, Walker MF. A Biopsychosocial Intervention for Stroke Carers (BISC): development and description of the intervention. Health Psychol Behav Med 2022; 10:92-103. [PMID: 34993008 PMCID: PMC8725872 DOI: 10.1080/21642850.2021.2016412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Family members of stroke survivors are often not supported for their caring role, with many reporting adjustment difficulties. This paper describes the development and content of a group-based intervention for informal carers of stroke survivors. Method The intervention is based on the theoretical foundation of the biopsychosocial model with the aim to understand and address the physical, psychological and social factors of caring for stroke survivors. Findings from a comprehensive literature review and a qualitative study with carers and stroke professionals were synthesized to guide the intervention development. The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework to describe the intervention. Results The intervention integrates cognitive-behavioural approaches via the identification of the biopsychosocial (physical, emotional, social) factors that can have an impact on the well-being of carers. It includes education on stroke-specific topics and advice on coping strategies. It consists of six structured two-hour group sessions facilitated in a community setting. It provides information and support on adjusting to the caring role in the first year post-stroke. Intervention materials were designed for addressing carers’ specific needs using psychological techniques, such as problem-solving, goal setting and relaxation exercises. Conclusion We have underlined the importance for describing and reporting the process of intervention development for complex interventions in the context of stroke rehabilitation. An intervention addressing the needs of informal stroke carers (Biopsychosocial Intervention for Stroke Carers; BISC) has been developed and described. BISC was further evaluated in a single-centre feasibility randomized controlled trial.
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Affiliation(s)
- Eirini Kontou
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK.,Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Shirley A Thomas
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Christine Cobley
- Department of Clinical Psychology, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Miriam R Golding-Day
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Marion F Walker
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
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20
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Thayabaranathan T, Immink MA, Hillier S, Stolwyk R, Andrew NE, Stevens P, Kilkenny MF, Gee E, Carey L, Brodtmann A, Bernhardt J, Thrift AG, Cadilhac DA. Co-Designing a New Yoga-Based Mindfulness Intervention for Survivors of Stroke: A Formative Evaluation. Neurol Int 2021; 14:1-10. [PMID: 35076591 PMCID: PMC8788460 DOI: 10.3390/neurolint14010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Movement-based mindfulness interventions (MBI) are complex, multi-component interventions for which the design process is rarely reported. For people with stroke, emerging evidence suggests benefits, but mainstream programs are generally unsuitable. We aimed to describe the processes involved and to conduct a formative evaluation of the development of a novel yoga-based MBI designed for survivors of stroke. We used the Medical Research Council complex interventions framework and principles of co-design. We purposefully approached health professionals and consumers to establish an advisory committee for developing the intervention. Members collaborated and iteratively reviewed the design and content of the program, formatted into a training manual. Four external yoga teachers independently reviewed the program. Formative evaluation included review of multiple data sources and documentation (e.g., formal meeting minutes, focus group discussions, researcher observations). The data were synthesized using inductive thematic analysis. Three broad themes emerged: (a) MBI content and terminology; (b) manual design and readability; and (c) barriers and enablers to deliver the intervention. Various perspectives and feedback on essential components guided finalizing the program. The design phase of a novel yoga-based MBI was strengthened by interdisciplinary, consumer contributions and peer review. The 12-week intervention is ready for testing among survivors of stroke.
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Affiliation(s)
- Tharshanah Thayabaranathan
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (M.F.K.); (A.G.T.); (D.A.C.)
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC 3084, Australia; (R.S.); (N.E.A.); (L.C.); (A.B.); (J.B.)
- Correspondence: ; Tel.: +61-3-8572-2646; Fax: +61-3-9902-4245
| | - Maarten A. Immink
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Susan Hillier
- IIMPACT, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
| | - Rene Stolwyk
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC 3084, Australia; (R.S.); (N.E.A.); (L.C.); (A.B.); (J.B.)
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Nadine E. Andrew
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC 3084, Australia; (R.S.); (N.E.A.); (L.C.); (A.B.); (J.B.)
- Peninsula Clinical School, Monash University, Frankston, VIC 3199, Australia
| | | | - Monique F. Kilkenny
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (M.F.K.); (A.G.T.); (D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia
| | - Emma Gee
- Survivor of Stroke, Inspirational and Motivational Speaker, Cotham, VIC 3101, Australia;
| | - Leeanne Carey
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC 3084, Australia; (R.S.); (N.E.A.); (L.C.); (A.B.); (J.B.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia
| | - Amy Brodtmann
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC 3084, Australia; (R.S.); (N.E.A.); (L.C.); (A.B.); (J.B.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia
| | - Julie Bernhardt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC 3084, Australia; (R.S.); (N.E.A.); (L.C.); (A.B.); (J.B.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia
| | - Amanda G. Thrift
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (M.F.K.); (A.G.T.); (D.A.C.)
| | - Dominique A. Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (M.F.K.); (A.G.T.); (D.A.C.)
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC 3084, Australia; (R.S.); (N.E.A.); (L.C.); (A.B.); (J.B.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia
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21
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Lee SH, Lee JH. Examining the effects of upper extremity function and arm sling type on balance, gait and fall risk in patients with hemiparesis. International Journal of Therapy and Rehabilitation 2021. [DOI: 10.12968/ijtr.2020.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Previous studies have reported conflicting results on the effects of arm slings on the balance and gait of patients with hemiparesis. These previous studies did not consider the ability to control the upper extremity on the affected side as a factor that could affect the patient's balance or gait when an arm sling was applied. Hence, the aim of this study was to investigate the effect of upper extremity function in the affected side and arm position according to the sling type on balance, gait and fall. Methods A total of 31 stroke patients participated in the study and were assigned to two groups according to upper extremity function (low-score group and high-score group). Under three conditions (no sling, forearm sling and shoulder sling), a fall risk test, postural stability test and limits of stability test were performed and speed, stride duration, step length and total time were measured. Results When the high-score group wore forearm slings, the static and dynamic balance ability decreased and the fall risk increased. When the low-score group wore forearm slings and shoulder slings, the static and dynamic balance ability increased and the fall risk decreased. The high-score group had a shorter gait time when wearing shoulder slings. When the low-score group wore forearm slings, the speed and step length increased and the total time decreased, enhancing the overall gait ability. Conclusions For stroke patients with better upper extremity control ability, shoulder slings are more appropriate. For patients with poor upper extremity control ability, forearm slings are more appropriate. Using the appropriate sling according to the upper extremity function can improve balance and gait ability and fall risk can be reduced.
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Affiliation(s)
- Seung-Hyuk Lee
- Department of Physical Therapy, Rehabilitation Center, Walkrun Hospital, Daejeon City, Republic of Korea
| | - Joon-Hee Lee
- Department of Physical Therapy, Rehabilitation Center, Walkrun Hospital, Daejeon City, Republic of Korea
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22
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Wray F, Clarke D, Cruice M, Forster A. Development of a self-management intervention for stroke survivors with aphasia using co-production and behaviour change theory: An outline of methods and processes. PLoS One 2021; 16:e0259103. [PMID: 34813602 DOI: 10.1371/journal.pone.0259103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background Self-management is a promising approach to improve quality of life after stroke. However, evidence for the appropriateness and effectiveness of self-management for stroke survivors with aphasia is limited. This article reports on the process used to develop a supported self-management intervention for stroke survivors with aphasia (SSWA) using co-production and behaviour change theory. Preparatory research included systematic reviews, and qualitative interviews and focus groups with SSWA, family members and speech and language therapists (SLTs). Materials and methods We conducted six, 2 hour long intervention development workshops with key stakeholders. The workshops were informed by principles of co-production and the intervention development process outlined by the Behaviour Change Wheel (BCW). We also incorporated the findings of our preparatory research within workshops. Each workshop included an introduction, 1–2 co-production tasks and time for feedback at the end of the session. Data were analysed on an ongoing basis so that findings could be used to feed in to subsequent workshops and intervention development. Results Workshop participants (n = 12) included; SSWA (n = 5), family members (n = 3) and SLTs (n = 4). Together, participants engaged with accessible and participatory co-production tasks which aligned with the BCW framework. Participants engaged in discussion to define self-management in behavioural terms (behavioural diagnosis) and to identify what needed to change to support self-management. Participant’s co-produced solutions for supporting self-management and discussed options to implement these in practice. Prototype materials were generated by the research team and evaluated by participants. Intervention functions and behaviour change techniques (BCTs) were mapped to the solutions generated by participants by the research team, after the final workshop. A supported self-management intervention for SSWA was developed which will be delivered by SLTs through community stroke services. Conclusions This paper reports the process we used to integrate co-production work with behaviour change theory to develop a complex self-management intervention. This is of relevance for researchers looking to harness the strengths of co-production methods and theory in intervention design. Future research will feasibility test the supported self-management intervention developed. This paper provides transparency to our intervention development process which will help others to better interpret the findings of our feasibility work.
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23
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Bacon K, Marshall J, Caute A, Monnelly K, Cruice M, Moutou C, Woolf C. Treatment fidelity of technology-enhanced reading therapy (CommuniCATE) for people with aphasia. Int J Lang Commun Disord 2021; 56:1114-1131. [PMID: 34260119 DOI: 10.1111/1460-6984.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Treatment fidelity (TF), that is, the degree to which the treatment delivery has adhered to protocol, is an important aspect of establishing treatment validity and reliability. Research has shown that establishing TF is only done in a small percentage of aphasia treatment studies. AIMS This project supports the work of the CommuniCATE study, which explored the benefits of technology-enhanced aphasia therapy on participants' reading, writing, speech and conversation skills. It examines the TF of the Reading strand of the CommuniCATE project by assessing whether the therapy adhered to the protocol. The following research questions were asked: Does treatment delivery adhere to treatment protocol? Does the degree of TF vary according to the person delivering the therapy (i.e. student therapist or qualified therapist)? Does the degree of TF vary over time (early treatment sessions compared with later treatment sessions)? Was the checklist tool reliable? METHODS & PROCEDURES This study assessed the fidelity of 38 retrospective video recordings of therapy. It used a checklist measure of criteria to which the delivery of the sessions should adhere, and against which the sessions were rated. Participants were the people with aphasia receiving therapy, the students and qualified speech and language therapists delivering therapy, and the independent raters assessing the sessions. A sample of sessions was randomly chosen, including sessions delivered by qualified therapists and by students, and sessions from different time points in the treatment process. The fidelity was rated by the first author, and the fidelity rating calculated as a percentage. Comparisons in fidelity scores for the different variables were drawn using Mann-Whitney tests. The reliability of the checklist was assessed through inter and intra-rater reliability testing, and the results were analysed using Kappa statistics. OUTCOMES & RESULTS High fidelity was found across all therapy conditions with a mean score of 98.2%. Fidelity scores were not affected by the administrator of therapy; sessions delivered by qualified and student therapists were rated equally highly. There was a small but significant effect of time, with later treatment sessions scoring more highly than earlier sessions. However, scores across both periods > 90%. Inter-rater reliability found a high percentage agreement of 93.3% and a Poor Kappa agreement level. Intra-rater agreement found a high percentage agreement of 97.3% and a Fair Kappa agreement level. CONCLUSIONS & IMPLICATIONS The CommuniCATE reading therapy was implemented as per the protocol across time points, and withstood delegation to students. The high fidelity and good reliability scores have positive implications for the study's validity and reliability, and for the study's replication. WHAT THIS PAPER ADDS What is already known on the subject TF refers to the degree to which the delivery of core components of a treatment matches the implementation guidelines, that is, the adherence to protocol. Despite the acknowledged importance of TF reporting, this is often neglected in the literature. What this paper adds to existing knowledge This paper shows that the TF assessment of the CommuniCATE study (reading strand) found a 98.2% fidelity score, and that high fidelity was not compromised across treatment conditions. This paper outlines the principles of TF and highlights the need for measures to be in place to establish TF, for example, manuals, training and supervision; and to monitor TF, for example, via the use of checklists. This paper also underlines the scarcity of TF measures and checks in aphasia research. This paper therefore serves as a model of TF practice in aphasia therapy research. What are the potential or actual clinical implications of this work? This study contributes to the findings of the CommuniCATE project (reading strand), and the high fidelity findings enhance the validity of the project and indicate that the therapy manual and training enable accurate implementation of delivery. This paper also contributes to the literature on TF evaluation in aphasia studies, which is presently lacking, and highlights the need for increased focus on the optimum strategies of TF reporting.
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Affiliation(s)
| | - Jane Marshall
- Department of Language and Communication, City University, London, UK
| | - Anna Caute
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Katie Monnelly
- Department of Language and Communication, City University, London, UK
| | - Madeline Cruice
- Department of Language and Communication, City University, London, UK
| | | | - Celia Woolf
- Department of Language and Communication, City University, London, UK
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24
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Hayward KS, Kramer SF, Dalton EJ, Hughes GR, Brodtmann A, Churilov L, Cloud G, Corbett D, Jolliffe L, Kaffenberger T, Rethnam V, Thijs V, Ward N, Lannin N, Bernhardt J. Timing and Dose of Upper Limb Motor Intervention After Stroke: A Systematic Review. Stroke 2021; 52:3706-3717. [PMID: 34601901 DOI: 10.1161/strokeaha.121.034348] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This systematic review aimed to investigate timing, dose, and efficacy of upper limb intervention during the first 6 months poststroke. Three online databases were searched up to July 2020. Titles/abstracts/full-text were reviewed independently by 2 authors. Randomized and nonrandomized studies that enrolled people within the first 6 months poststroke, aimed to improve upper limb recovery, and completed preintervention and postintervention assessments were included. Risk of bias was assessed using Cochrane reporting tools. Studies were examined by timing (recovery epoch), dose, and intervention type. Two hundred and sixty-one studies were included, representing 228 (n=9704 participants) unique data sets. The number of studies completed increased from one (n=37 participants) between 1980 and 1984 to 91 (n=4417 participants) between 2015 and 2019. Timing of intervention start has not changed (median 38 days, interquartile range [IQR], 22-66) and study sample size remains small (median n=30, IQR 20-48). Most studies were rated high risk of bias (62%). Study participants were enrolled at different recovery epochs: 1 hyperacute (<24 hours), 13 acute (1-7 days), 176 early subacute (8-90 days), 34 late subacute (91-180 days), and 4 were unable to be classified to an epoch. For both the intervention and control groups, the median dose was 45 (IQR, 600-1430) min/session, 1 (IQR, 1-1) session/d, 5 (IQR, 5-5) d/wk for 4 (IQR, 3-5) weeks. The most common interventions tested were electromechanical (n=55 studies), electrical stimulation (n=38 studies), and constraint-induced movement (n=28 studies) therapies. Despite a large and growing body of research, intervention dose and sample size of included studies were often too small to detect clinically important effects. Furthermore, interventions remain focused on subacute stroke recovery with little change in recent decades. A united research agenda that establishes a clear biological understanding of timing, dose, and intervention type is needed to progress stroke recovery research. Prospective Register of Systematic Reviews ID: CRD42018019367/CRD42018111629.
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Affiliation(s)
- Kathryn S Hayward
- Departments of Physiotherapy and Medicine, Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Heidelberg, Australia
| | - Sharon F Kramer
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, and Alfred Health Partnership, Deakin University, Burwood, Australia (S.F.K.)
| | - Emily J Dalton
- Department of Physiotherapy (E.J.D.), University of Melbourne, Heidelberg, Australia
| | - Gemma R Hughes
- Physiotherapy, Austin Health, Heidelberg, Australia (G.R.H.).,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (G.R.H., A.B., T.K., V.R., V.T., J.B.)
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (G.R.H., A.B., T.K., V.R., V.T., J.B.)
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia (L.C.)
| | - Geoffrey Cloud
- Department of Neuroscience, Central Clinical School, Monash University and Alfred Health, Melbourne, Australia (G.C., N.L.)
| | - Dale Corbett
- Cellular and Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada (D.C.)
| | - Laura Jolliffe
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia (L.J.)
| | - Tina Kaffenberger
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (G.R.H., A.B., T.K., V.R., V.T., J.B.)
| | - Venesha Rethnam
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (G.R.H., A.B., T.K., V.R., V.T., J.B.)
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (G.R.H., A.B., T.K., V.R., V.T., J.B.).,Neurology, Austin Health, Heidelberg, Australia (V.T.)
| | - Nick Ward
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom (N.W.)
| | - Natasha Lannin
- Department of Neuroscience, Central Clinical School, Monash University and Alfred Health, Melbourne, Australia (G.C., N.L.)
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (G.R.H., A.B., T.K., V.R., V.T., J.B.)
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25
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Craven K, Holmes J, Powers K, Clarke S, Cripps RL, Lindley R, Phillips J, Tyerman R, McKevitt C, Clarke D, Radford K. Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors. BMC Med Res Methodol 2021; 21:203. [PMID: 34602054 PMCID: PMC8487447 DOI: 10.1186/s12874-021-01382-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors' roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery. METHODS Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitative data were analysed thematically. RESULTS Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was provided by phone or Microsoft Teams (range: 88.6-100%), with the remainder via email and SMS (Short Message Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs' understanding of- and adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving. Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time for mentoring. CONCLUSIONS Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS would have been able to deliver the intervention without mentoring support, or how this might have impacted fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires testing in a future trial. TRIAL REGISTRATION ISRCTN, ISRCTN12464275 . Registered on 13th March 2018.
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Affiliation(s)
- Kristelle Craven
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Jain Holmes
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Katie Powers
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sara Clarke
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Rachel L Cripps
- School of Population Health & Environmental Sciences, King's College London, Addison House, London, SE1 1UL, UK
| | - Rebecca Lindley
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Julie Phillips
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Ruth Tyerman
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, King's College London, Addison House, London, SE1 1UL, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Woodhouse Lane, Leeds, LS2 9UT, UK
| | - Kathryn Radford
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.
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Ezeugwu VE, Manns PJ. Using Intervention Mapping to develop and implement a home-based sedentary behavior change intervention after stroke. Transl Behav Med 2021; 10:87-95. [PMID: 30566661 DOI: 10.1093/tbm/iby128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Prolonged sedentary behavior is a problem immediately following a stroke and it persists from the acute to chronic phases of recovery. Frequently interrupting sedentary time might help to mitigate the associated detrimental health consequences. The purpose of this article was to describe the process followed in the systematic development and implementation of a theory- and home-based sedentary behavior change intervention for people with stroke. The Intervention Mapping protocol was used to design, develop and implement a STand Up Frequently From Stroke (STUFFS) program aimed at reducing prolonged sedentary behavior after stroke. A qualitative inquiry with people with stroke (n = 13) informed the development of the intervention. The systematic approach followed in the development process including the theoretical basis, content development, and evaluation planning were described. Program reception was assessed using thematic content analysis of exit-interview data (n = 25). The 8-weeks STUFFS intervention is a home-based sedentary behavior change program that provides education about the risks of prolonged sedentary behavior and facilitates behavior change, including the use of motivational tools to empower people with stroke to reduce sedentary behavior. The program was well-received and acceptable to people with stroke (89% satisfaction). This article provides information that furthers knowledge about theory-based strategies to reduce sedentary behavior in the home environment after stroke and facilitates implementation of this type of intervention. Trial registration: This study is registered at www.clinicaltrials.gov (No. NCT02980744).
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Affiliation(s)
- Victor E Ezeugwu
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Patricia J Manns
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Behn N, Moss B, McVicker S, Roper A, Northcott S, Marshall J, Thomas S, Simpson A, Flood C, James K, Goldsmith K, Hilari K. SUpporting wellbeing through PEeR-Befriending (SUPERB) feasibility trial: fidelity of peer-befriending for people with aphasia. BMJ Open 2021; 11:e047994. [PMID: 34341046 PMCID: PMC8330561 DOI: 10.1136/bmjopen-2020-047994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/12/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate systematically the fidelity of a peer-befriending intervention for people with aphasia. DESIGN SUpporting wellbeing through Peer-befriending (SUPERB) was a feasibility randomised controlled trial comparing usual care to usual care +peer-befriending. This paper reports on the fidelity of all intervention aspects (training and supervision of providers/befrienders; intervention visits) which was evaluated across all areas of the Behaviour Change Consortium framework. SETTING Community. PARTICIPANTS People with aphasia early poststroke and low levels of distress, randomised to the intervention arm of the trial (n=28); 10 peer-befrienders at least 1-year poststroke. INTERVENTION Peer-befrienders were trained (4-6 hours); and received regular supervision (monthly group while actively befriending, and one-to-one as and when needed) in order to provide six 1-hour peer-befriending visits over 3 months. MAIN MEASURES Metrics included number and length of training, supervision sessions and visits. All training and supervision sessions and one (of six) visits per pair were rated against fidelity checklists and evaluated for inter-rater and intrarater reliability (Gwets AC1 agreement coefficient). Per-cent adherence to protocol was evaluated. RESULTS All peer-befrienders received 4-6 hours training over 2-3 days as intended. There were 25 group supervision sessions with a median number attended of 14 (IQR=8-18). Twenty-six participants agreed (92.8%) to the intervention and 21 (80.8%) received all six visits (median visit length 60 min). Adherence was high for training (91.7%-100%) and supervision (83%-100%) and moderate-to-high for befriending visits (66.7%-100%). Where calculable, inter-rater and intrarater reliability was high for training and supervision (Gwets AC1 >0.90) and moderate-to-high for intervention visits (Gwets AC1 0.44-1.0). CONCLUSION Planning of fidelity processes at the outset of the trial and monitoring throughout was feasible and ensured good-to-high fidelity for this peer-befriending intervention. The results permit confidence in other findings from the SUPERB trial. TRIAL REGISTRATION NUMBER NCT02947776.
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Affiliation(s)
- Nicholas Behn
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Becky Moss
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Sally McVicker
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Abi Roper
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Sarah Northcott
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Shirley Thomas
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Chris Flood
- School of Health and Social Care, London South Bank University, London, UK
| | - Kirsty James
- Biostatistics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Biostatistics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Katerina Hilari
- Centre for Language and Communication Science Research, City University of London, London, UK
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28
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Nomikos PA, Hall M, Fuller A, Millar B, Ogollah R, Valdes A, Doherty M, Walsh DA, das Nair R, Abhishek A. Fidelity assessment of nurse-led non-pharmacological package of care for knee pain in the package development phase of a feasibility randomised controlled trial based in secondary care: a mixed methods study. BMJ Open 2021; 11:e045242. [PMID: 34326044 PMCID: PMC8323379 DOI: 10.1136/bmjopen-2020-045242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate fidelity of delivery of a nurse-led non-pharmacological complex intervention for knee pain. SETTING Secondary care. Single-centre study. STUDY DESIGN Mixed methods study. PARTICIPANTS Eighteen adults with chronic knee pain. INCLUSION CRITERIA Age >40 years, knee pain present for longer than 3 months, knee pain for most days of the previous month, at least moderate pain in two of the five domains of Western Ontario and McMaster Universities Osteoarthritis Index pain scale. INTERVENTIONS Nurse-led non-pharmacological intervention comprising assessment, education, exercise, use of hot/cold treatments, footwear modification, walking aids and weight-loss advice (if required). OUTCOMES Primary: fidelity of delivery of intervention, secondary: nurses' experience of delivering intervention. METHODS Each intervention session with every participant was video recorded and formed part of fidelity assessment. Fidelity checklists were completed by the research nurse after each session and by an independent researcher, after viewing the video-recordings blinded to nurse ratings. Fidelity scores (%), percentage agreement and 95% Confidence Intervals (CI) were calculated. Two semi-structured interviews were conducted with the research nurse. RESULTS Fourteen participants completed all visits. 62 treatment sessions took place. Nurse self-report and assessor video rating scores for all 62 treatment sessions were included in fidelity assessment. Overall fidelity was higher on nurse self-report (97.7%) than on objective video-rating (84.2%). Percentage agreement between nurse self-report and video-rating was 73.3% (95% CI 71.3 to 75.3). Fidelity was lowest for advice on footwear and walking aids. The nurse reported difficulty advising on thermal treatments, footwear and walking aids, and did not feel confident negotiating achievable and realistic goals with participants. CONCLUSIONS A trained research nurse can deliver most components of a non-pharmacological intervention for knee pain to a high degree of fidelity. Future research should assess intervention fidelity in a routine clinical setting, and examine its clinical and cost-effectiveness. TRIAL REGISTRATION NUMBER NCT03670706.
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Affiliation(s)
- Polykarpos Angelos Nomikos
- Academic Rheumatology, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Michelle Hall
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Amy Fuller
- Academic Rheumatology, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Bonnie Millar
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Ana Valdes
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - David A Walsh
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - A Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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English C, Attia JR, Bernhardt J, Bonevski B, Burke M, Galloway M, Hankey GJ, Janssen H, Kuys S, Lindley RI, Lynch E, Marsden DL, Nilsson M, Ramage ER, Said CM, Spratt NJ, Zacharia K, Macdonald-Wicks L, Patterson A. Secondary Prevention of Stroke: Study Protocol for a Telehealth-Delivered Physical Activity and Diet Pilot Randomized Trial (ENAbLE-Pilot). Cerebrovasc Dis 2021; 50:605-611. [PMID: 33895733 DOI: 10.1159/000515689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing physical activity (PA) and improving diet quality are opportunities to improve secondary stroke prevention, but access to appropriate services is limited. Interventions co-designed with stroke survivors and delivered by telehealth are a potential solution. AIM The aim of this study is to test the feasibility, safety, and potential efficacy of a 6-month, telehealth-delivered PA and/or dietary (DIET) intervention. METHODS Pilot randomized trial. 80 adults with previous stroke who are living at home with Internet access and able to exercise will be randomized in a 2 × 2 factorial (4-arm) pilot randomized, open-label, blinded outcome assessment trial to receive PA, DIET, PA + DIET, or control interventions via telehealth. The PA intervention aims to support participants to meet the minimum recommended levels of PA (150 min/week moderate exercise), and the DIET intervention aims to support participants to follow the AusMed (Mediterranean-style) diet. The control group receives usual care plus education about PA and healthy eating. The co-primary outcomes are feasibility (proportion and characteristics of eligible participants enrolled and proportion of scheduled intervention sessions attended) and safety (adverse events) at 6 months. The secondary outcomes include recurrent stroke risk factors (blood pressure, physical activity levels, and diet quality), fatigue, mood, and quality of life. Outcomes are measured at 3, 6, and 12 months. CONCLUSION This trial will produce evidence for the feasibility, safety, and potential effect of telehealth-delivered PA and DIET interventions for people with stroke. Results will inform development of an appropriately powered trial to test effectiveness to reduce major risk factors for recurrent stroke. TRIAL REGISTRATION ACTRN12620000189921.
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Affiliation(s)
- Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John R Attia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Julie Bernhardt
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Billie Bonevski
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Meredith Burke
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia
| | - Margaret Galloway
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Washington, Australia
| | - Heidi Janssen
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Hunter Stroke Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Suzanne Kuys
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Richard I Lindley
- The George Institute for Global Health and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Lynch
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | - Dianne L Marsden
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Stroke Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Michael Nilsson
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Emily R Ramage
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Department of Physiotherapy, Western Health, St Albans, Victoria, Australia
| | - Catherine M Said
- Department of Physiotherapy, Western Health, St Albans, Victoria, Australia.,Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | - Neil J Spratt
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karly Zacharia
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia
| | - Lesley Macdonald-Wicks
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda Patterson
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia
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Zacharia K, Patterson AJ, English C, Ramage E, Galloway M, Burke M, Gray R, MacDonald-Wicks L. i-Rebound after Stroke-Eat for Health: Mediterranean Dietary Intervention Co-Design Using an Integrated Knowledge Translation Approach and the TIDieR Checklist. Nutrients 2021; 13:1058. [PMID: 33805076 DOI: 10.3390/nu13041058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/11/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Lifestyle interventions to reduce second stroke risk are complex. For effective translation into practice, interventions must be specific to end-user needs and described in detail for replication. This study used an Integrated Knowledge Translation (IKT) approach and the Template for Intervention Description and Replication (TIDieR) checklist to co-design and describe a telehealth-delivered diet program for stroke survivors. Stroke survivors and carers (n = 6), specialist dietitians (n = 6) and an IKT research team (n = 8) participated in a 4-phase co-design process. Phase 1: the IKT team developed the research questions, and identified essential program elements and workshop strategies for effective co-design. Phase 2: Participant co-design workshops used persona and journey mapping to create user profiles to identify barriers and essential program elements. Phase 3: The IKT team mapped Phase 2 data to the TIDieR checklist and developed the intervention prototype. Phase 4: Co-design workshops were conducted to refine the prototype for trial. Rigorous IKT co-design fundamentally influenced intervention development. Modifications to the protocol based on participant input included ensuring that all resources were accessible to people with aphasia, an additional support framework and resources specific to outcome of stroke. The feasibility and safety of this intervention is currently being pilot tested (randomised controlled trial; 2019/ETH11533, ACTRN12620000189921).
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Hayward KS, Churilov L, Dalton EJ, Brodtmann A, Campbell BCV, Copland D, Dancause N, Godecke E, Hoffmann TC, Lannin NA, McDonald MW, Corbett D, Bernhardt J. Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose. Stroke 2021; 52:761-769. [PMID: 33430635 DOI: 10.1161/strokeaha.120.032496] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose reporting guidelines; (2) inadequate conceptualization of dose, which is multidimensional; and (3) unclear and inconsistent terminology that incorporates the multiple dose dimensions. To address these challenges, we need a well-conceptualized and consistent approach to dose articulation that can be applied across stroke recovery domains to stimulate critical thinking about dose during intervention development, as well as promote reporting of planned intervention dose versus actually delivered dose. We followed the Design Research Paradigm to develop a framework that guides how to articulate dose, conceptualizes the multidimensional nature and systemic linkages between dose dimensions, and provides reference terminology for the field. Our framework recognizes that dose is multidimensional and comprised of a duration of days that contain individual sessions and episodes that can be active (time on task) or inactive (time off task), and each individual episode can be made up of information about length, intensity, and difficulty. Clinical utility of this framework was demonstrated via hypothetical application to preclinical and clinical domains of stroke recovery. The suitability of the framework to address dose articulation challenges was confirmed with an international expert advisory group. This novel framework provides a pathway for better articulation of nonpharmacological dose that will enable transparent and accurate description, implementation, monitoring, and reporting, in stroke recovery research.
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Affiliation(s)
- Kathryn S Hayward
- Melbourne School of Health Sciences, Florey Institute of Neuroscience and Mental Health and NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery (K.S.H.), University of Melbourne, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School (L.C.), University of Melbourne, Parkville, Australia
| | - Emily J Dalton
- Melbourne School of Health Sciences (E.J.D.), University of Melbourne, Heidelberg, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health (A.B.), University of Melbourne, Heidelberg, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital (B.C.V.C.), University of Melbourne, Parkville, Australia
| | - David Copland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia (D. Copland).,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia (D. Copland, E.G.)
| | - Numa Dancause
- Département de Neurosciences, Université de Montréal, Canada (N.D.)
| | - Erin Godecke
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia (D. Copland, E.G.).,School of Medical and Health Sciences, Edith Cowan University, and Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia (E.G.)
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia (T.C.H.)
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Alfred Health, Monash University, Melbourne, Australia (N.A.L.)
| | - Matthew W McDonald
- Cellular and Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada (M.W.M., D. Corbett)
| | - Dale Corbett
- Cellular and Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada (M.W.M., D. Corbett)
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health and NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery (J.B.), University of Melbourne, Heidelberg, Australia
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Dalton EJ, Churilov L, Lannin NA, Corbett D, Campbell BCV, Hayward KS. Early-phase dose articulation trials are underutilized for post-stroke motor recovery: A systematic scoping review. Ann Phys Rehabil Med 2021; 65:101487. [PMID: 33429089 DOI: 10.1016/j.rehab.2021.101487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To enable development of effective interventions, there is a need to complete systematic early-phase dose articulation research. This scoping review aimed to synthesize dose articulation research of behavioral motor interventions for stroke recovery. METHODS MEDLINE and EMBASE were systematically searched for dose articulation studies. Preclinical experiments and adult clinical trials were classified based on the discovery pipeline and analyzed to determine which dose dimensions were articulated (time, scheduling or intensity) and how they were investigated (unidimensional vs multidimensional approach). Reporting of dose, safety and efficacy outcomes were summarized. The intervention description, risk of bias, and quality was appraised. RESULTS We included 41 studies: 3 of preclinical dose preparation (93 rodents), 2 Phase I dose ranging (21 participants), 9 Phase IIA dose screening (198 participants), and 27 Phase IIB dose finding (1879 participants). All studies adopted a unidimensional approach. Time was the most frequent dimension investigated (53%), followed by intensity (29%), and scheduling (18%). Overall, 95% studies reported an efficacy outcome; however, only 65% reported dose and 45% reported safety. Across studies, 61% were at high risk of bias, and the average percentage reporting of intervention description and quality was 61% and 67%, respectively. CONCLUSION This review highlights a need to undertake more high-quality, early-phase studies that systematically articulate intervention doses from a multidimensional perspective in the field of behavioral motor stroke recovery. To address this gap, we need to invest in adapting early phase trial designs, especially Phase I, to support multidimensional dose articulation.
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Affiliation(s)
- Emily J Dalton
- Melbourne School of Health Sciences, University of Melbourne, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia
| | - Dale Corbett
- Cellular & Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Kathryn S Hayward
- Melbourne School of Health Sciences and Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, 3084 Heidelberg, Australia.
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Whyte J, Dijkers MP, Fasoli SE, Ferraro M, Katz LW, Norton S, Parent E, Pinto SM, Sisto SA, Van Stan JH, Wengerd L. Recommendations for Reporting on Rehabilitation Interventions. Am J Phys Med Rehabil 2021; 100:5-16. [PMID: 32889858 DOI: 10.1097/phm.0000000000001581] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ABSTRACT Clear reporting on rehabilitation treatments is critical for interpreting and replicating study results and for translating treatment research into clinical practice. This article reports the recommendations of a working group on improved reporting on rehabilitation treatments. These recommendations are intended to be combined with the efforts of other working groups, through a consensus process, to arrive at a reporting guideline for randomized controlled trials in physical medicine and rehabilitation (Randomized Controlled Trials Rehabilitation Checklist). The work group conducted a scoping review of 156 diverse guidelines for randomized controlled trial reporting, to identify themes that might be usefully applied to the field of rehabilitation. Themes were developed by identifying content that might improve or enhance existing items from the Template for Intervention Description and Replication. Guidelines addressing broad research domains tended to define reporting items generally, from the investigator's perspective of relevance, whereas those addressing more circumscribed domains provided more specific and operationalized items. Rehabilitation is a diverse field, but a clear description of the treatment's separable components, along with distinct treatment theories for each, can improve reporting of relevant information. Over time, expert consensus groups should develop more specific guideline extensions for circumscribed research domains, around coalescing bodies of treatment theory.
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Affiliation(s)
- John Whyte
- From the Moss Rehabilitation Research Institute, Einstein Healthcare Network, Elkins Park, Pennsylvania (JW, MF); Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan (MPD); MGH Institute of Health Professions, Boston, Massachusetts (SEF, JHVS); Department of Occupational Therapy, Spaulding Rehabilitation Hospital, and Sargent College of Health and Rehabilitation Sciences, Department of Occupational Therapy, Boston University, Boston, Massachusetts (LWK); Department of Neurological Rehabilitation, Scripps Memorial Hospital, Encinitas, California (SN); Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada (EP); Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina (SMP); School of Public Health and Health Professions, Department of Rehabilitation Science, University at Buffalo, Buffalo, New York (SAS); Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (JHVS); and School of Health and Rehabilitation Sciences, Division of Occupational Therapy, The Ohio State University, Columbus, Ohio (LW)
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Mikhailova AA, Koneva ES, Ivanova II. [Application of modern non-drug technologies to improve the quality of life of patients with hemiparesis]. Vopr Kurortol Fizioter Lech Fiz Kult 2021; 98:25-30. [PMID: 34965711 DOI: 10.17116/kurort20219806225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED In recent years, the improvement of the system of medical rehabilitation of patients with acute cerebrovascular accident has acquired special social significance due to the high morbidity. OBJECTIVE To study the effect of the combined use of a multifunctional platform and massage with a pulsed low-frequency electrostatic field on the motor functions of the lower limb, coordination and balance, as well as on the psychoemotional status and quality of life of patients after an ischemic stroke with hemiparesis in the late recovery period. MATERIAL AND METHODS The article presents data on the treatment of 120 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with an increase in muscle tone by the type of spasticity in the late recovery period. All patients received standard drug therapy and underwent medical rehabilitation. The patients were divided into 3 groups: the main group - 40 patients who received massage with a pulsed low-frequency electrostatic field and training on a multifunctional platform with biofeedback (BFB) - COBS (mtd-Systems, Germany), a comparison group - 40 patients who received training on a multifunctional platform with biofeedback (BFB), control group - 40 patients. RESULTS In the initial state, all patients included in the study showed an uneven distribution of the load in the protocols «normal standing position» and «standing balance» with an advantage towards the healthy leg. After the course of treatment in the patients of the main group, all the evaluated indices were normalized, in the patients of the comparison group statistically significant less pronounced results were obtained, and in the patients of the control group only a positive trend was noted. When studying the quality of life and the effectiveness of treatment according to the EQ-5D questionnaire in the examined patients in the initial state, the indicator averaged 7.8±0.8 points. After the course of treatment, the patients of the main group showed a statistically significant decrease in the indicators of the EQ-5D questionnaire from 7.8±0.8 points in the initial state to 5.1±1.1 (p<0.001), which lasted up to 6 months. In patients of the comparison group in all periods of observation, a decrease in the indicator was also noted, but less pronounced, in patients in the control group, only a positive trend. The data were supported by the Hospital Anxiety and Depression Scale (HADS) score. CONCLUSION The use of complex rehabilitation with the inclusion of a multifunctional platform with biofeedback and electrostatic massage contributes to a pronounced improvement in the functional state of muscle tone, coordination and balance, a significant decrease in the level of anxiety and depression and has a pronounced positive effect on the quality of life and assessment of the health status of patients with hemiparesis in late recovery period after ischemic stroke.
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Affiliation(s)
- A A Mikhailova
- Petrovsky Russian Scientific Center for Surgery of Ministry of Education and Science of Russia, Moscow, Russia
| | - E S Koneva
- Petrovsky Russian Scientific Center for Surgery of Ministry of Education and Science of Russia, Moscow, Russia
| | - I I Ivanova
- Petrovsky Russian Scientific Center for Surgery of Ministry of Education and Science of Russia, Moscow, Russia
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Holmes JA, Logan P, Morris R, Radford K. Factors affecting the delivery of complex rehabilitation interventions in research with neurologically impaired adults: a systematic review. Syst Rev 2020; 9:268. [PMID: 33239081 PMCID: PMC7690089 DOI: 10.1186/s13643-020-01508-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rehabilitation research does not always improve patient outcomes because of difficulties implementing complex health interventions. Identifying barriers and facilitators to implementation fidelity is critical. Not reporting implementation issues wastes research resources and risks erroneously attributing effectiveness when interventions are not implemented as planned, particularly progressing from single to multicentre trials. The Consolidated Framework for Implementation Research (CFIR) and Conceptual Framework for Implementation Fidelity (CFIF) facilitate identification of barriers and facilitators. This review sought to identify barriers and facilitators (determinants) affecting implementation in trials of complex rehabilitation interventions for adults with long-term neurological conditions (LTNC) and describe implementation issues. METHODS Implementation, complex health interventions and LTNC search terms were developed. Studies of all designs were eligible. Searches involved 11 databases, trial registries and citations. After screening titles and abstracts, two reviewers independently shortlisted studies. A third resolved discrepancies. One reviewer extracted data in two stages; 1) descriptive study data, 2) units of text describing determinants. Data were synthesised by (1) mapping determinants to CFIF and CFIR and (2) thematic analysis. RESULTS Forty-three studies, from 7434 records, reported implementation determinants; 41 reported both barriers and facilitators. Most implied determinants but five used implementation theory to inform recording. More barriers than facilitators were mapped onto CFIF and CFIR constructs. "Patient needs and resources", "readiness for implementation", "knowledge and beliefs about the intervention", "facilitation strategies", "participant responsiveness" were the most frequently mapped constructs. Constructs relating to the quality of intervention delivery, organisational/contextual aspects and trial-related issues were rarely tapped. Thematic analysis revealed the most frequently reported determinants related to adherence, intervention perceptions and attrition. CONCLUSIONS This review has described the barriers and facilitators identified in studies implementing complex interventions for people with LTNCs. Early adoption of implementation frameworks by trialists can simplify identification and reporting of factors affecting delivery of new complex rehabilitation interventions. It is vital to learn from previous experiences to prevent unnecessary repetitions of implementation failure at both trial and service provision levels. Reported facilitators can provide strategies for overcoming implementation issues. Reporting gaps may be due to the lack of standardised reporting methods, researcher ignorance and historical reporting requirements. SYSTEMIC REVIEW REGISTRATION PROSPERO CRD42015020423.
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Affiliation(s)
- Jain Anne Holmes
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
| | - Philippa Logan
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
| | - Richard Morris
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
| | - Kathryn Radford
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
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Radford K, Nilsen D. BJOT special issue: Stroke rehabilitation. Br J Occup Ther 2020. [DOI: 10.1177/0308022620972248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kathryn Radford
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Dawn Nilsen
- Programs in Occupational Therapy, Columbia University, New York, USA
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Walker MF, Birchall S, Cobley C, Condon L, Fisher R, Fletcher-Smith J, Golding-Day MR, Greensmith C, Kontou E, Matias O, Sprigg N, Thomas SA, Whitehead PJ. Biopsychosocial intervention for stroke carers (BISC): results of a feasibility randomised controlled trial and nested qualitative interview study. Clin Rehabil 2020; 34:1268-1281. [PMID: 32567356 PMCID: PMC7469713 DOI: 10.1177/0269215520937039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/02/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the feasibility of recruiting to and delivering a biopsychosocial intervention for carers of stroke survivors. DESIGN Feasibility randomised controlled study with nested qualitative interview study. SETTING The intervention was delivered in the community in either a group or one-to-one format. SUBJECTS Carers and stroke survivors within one year of stroke onset. INTERVENTIONS A carer targeted intervention delivered by a research psychologist in six structured two-hour sessions or usual care control. The intervention combined education about the biological, psychological and social effects of stroke with strategies and techniques focussing on adjustment to stroke and caregiving. Stroke survivors in both groups received baseline and follow-up assessment but no intervention. MAIN OUTCOME Recruitment rate, study attrition, fidelity of intervention delivery, acceptability and sensitivity of outcome measures used (health related quality of life, anxiety and depression and carer burden six months after randomisation). RESULTS Of the 257 carers approached, 41 consented. Six withdrew before randomisation. Eighteen participants were randomised to receive the intervention and 17 to usual care. Attendance at sessions was greater when treated one-to-one. Feedback interviews suggested that participants found the intervention acceptable and peer support particularly helpful in normalising their feelings. Thirty participants were assessed at follow-up with improvements from baseline on all health measures for both groups. CONCLUSIONS Our results suggest that a biopsychosocial intervention was acceptable to carers and can be delivered in group and one-to-one formats. Timing of approach and mode of intervention delivery is critical and requires tailoring to the carers individual needs.
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Affiliation(s)
- Marion F Walker
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Sheila Birchall
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Christine Cobley
- Department of Clinical Psychology, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Laura Condon
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Rebecca Fisher
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Joanna Fletcher-Smith
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Miriam R Golding-Day
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | | | - Eirini Kontou
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Oliver Matias
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Nikola Sprigg
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Shirley A Thomas
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Phillip J Whitehead
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle-Upon-Tyne, UK
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Boland P, Connell L, Thetford C, Janssen J. Exploring the factors influencing the use of electrically assisted bikes (e-bikes) by stroke survivors: a mixed methods multiple case study. Disabil Rehabil 2020; 44:1389-1398. [PMID: 32945706 DOI: 10.1080/09638288.2020.1817986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE E-bikes have the potential to overcome some of the barriers that stroke survivors face with regards to physical activity. This study aims to explore the factors that affect e-bike usage by stroke survivors. METHODS A mixed methods multiple case studies design, using semi-structured interviews and GPS data. Subject to GP approval, participants loaned an e-bike or e-trike for up to three months. Interviews were undertaken pre and post intervention. The COM-B behaviour change model acted as a framework for analysis. GPS data relating to journey duration and distance travelled was collected fortnightly. RESULTS Six participants were recruited; only three loaned an e-bike/e-trike (with adaptations as required). Storage, being unable to get GP approval, and safety were withdrawal reasons. Level of impairment was a factor influencing the type of e-bike used, level of support required and the motivation of the participants. CONCLUSION Stroke survivors can use e-bikes although barriers exist. Electrical assistance was a positive factor in enabling some of the participants to cycle outdoors. Due to the small sample size and the number of participants who were able to loan an e-bike, further research is required to determine whether e-bikes are a feasible and effective intervention to increase physical activity for stroke survivors.IMPLICATIONS FOR REHABILITATIONThe assistance provided by the e-bike/e-trike could provide stroke survivors the opportunity to cycle outdoors.E-bikes/e-trikes could facilitate participation of activities of everyday living such as shopping, hobbies and increase levels of physical activity.Rehabilitation could focus on physical impairment, its effects on self-confidence, and knowledge surrounding the e-bike to overcome barriers to cycling.Social support, the belief that e-bike was an enjoyable mode of physical activity that was good for their health were reported by the participants as important factors for using the e-bike/e-trike.
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Affiliation(s)
- Paul Boland
- Faculty of Health and Wellbeing, School of Nursing, University of Central Lancashire, Preston, UK
| | - Louise Connell
- Allied Health Research Unit, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Clare Thetford
- Faculty of Health and Wellbeing, School of Nursing, University of Central Lancashire, Preston, UK
| | - Jessie Janssen
- Department of Health Sciences, Institute of Therapeutic Sciences, IMC University of Applied Sciences, Krems, Austria
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40
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Bosomworth H, Rodgers H, Shaw L, Smith L, Aird L, Howel D, Wilson N, Alvarado N, Andole S, Cohen DL, Dawson J, Fernandez-Garcia C, Finch T, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Ternent L, Turner DL, Vale L, Wilkes S, Krebs HI, van Wijck F. Evaluation of the enhanced upper limb therapy programme within the Robot-Assisted Training for the Upper Limb after Stroke trial: descriptive analysis of intervention fidelity, goal selection and goal achievement. Clin Rehabil 2020; 35:119-134. [PMID: 32914639 PMCID: PMC7814096 DOI: 10.1177/0269215520953833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: To report the fidelity of the enhanced upper limb therapy programme within the Robot-Assisted Training for the Upper Limb after stroke (RATULS) randomized controlled trial, the types of goals selected and the proportion of goals achieved. Design: Descriptive analysis of data on fidelity, goal selection and achievement from an intervention group within a randomized controlled trial. Setting: Out-patient stroke rehabilitation within four UK NHS centres. Subjects: 259 participants with moderate-severe upper limb activity limitation (Action Research Arm Test 0–39) between one week and five years post first stroke. Intervention: The enhanced upper limb therapy programme aimed to provide 36 one-hour sessions, including 45 minutes of face-to-face therapy focusing on personal goals, over 12 weeks. Results: 7877/9324 (84%) sessions were attended; a median of 34 [IQR 29–36] per participant. A median of 127 [IQR 70–190] repetitions were achieved per participant per session attended. Based upon the Canadian Occupational Performance Measure, goal categories were: self-care 1449/2664 (54%); productivity 374/2664 (14%); leisure 180/2664 (7%) and ‘other’ 661/2664 (25%). For the 2051/2664 goals for which data were available, 1287 (51%) were achieved, ranging between 27% by participants more than 12 months post stroke with baseline Action Research Arm Test scores 0–7, and 88% by those less than three months after stroke with scores 8–19. Conclusions: Intervention fidelity was high. Goals relating to self-care were most commonly selected. The proportion of goals achieved varied, depending on time post stroke and baseline arm activity limitation.
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Affiliation(s)
- Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK.,Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Leanne Smith
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West Healthcare NHS Trust, Northwick Park, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Tracy Finch
- Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Gary A Ford
- Medical Sciences Division, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | | | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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41
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Scobbie L, Duncan EAS, Brady MC, Thomson K, Wyke S. Facilitators and "deal breakers": a mixed methods study investigating implementation of the Goal setting and action planning (G-AP) framework in community rehabilitation teams. BMC Health Serv Res 2020; 20:791. [PMID: 32843039 PMCID: PMC7447562 DOI: 10.1186/s12913-020-05651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation. METHODS We approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively. RESULTS We recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%, 51/55) participated in G-AP training; of those, 80% (n = 41/51) completed the training questionnaire. Training was rated as 'good' or 'very good' by almost all staff (92%, n = 37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP 'made sense'; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor 'fit' between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records. CONCLUSIONS The interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation "deal breakers". Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.
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Affiliation(s)
- Lesley Scobbie
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - Edward A. S. Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8R2 Scotland
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42
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Hall J, Morton S, Hall J, Clarke DJ, Fitzsimons CF, English C, Forster A, Mead GE, Lawton R. A co-production approach guided by the behaviour change wheel to develop an intervention for reducing sedentary behaviour after stroke. Pilot Feasibility Stud 2020; 6:115. [PMID: 32821421 PMCID: PMC7429798 DOI: 10.1186/s40814-020-00667-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke. Methods A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two-stroke services (England and Scotland). Workshop format was informed by the behaviour change wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development. Findings Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.
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Affiliation(s)
- Jennifer Hall
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK.,Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - Sarah Morton
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4A, Edinburgh, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK.,Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK
| | - Claire F Fitzsimons
- Physical Activity for Health Research Centre, St Leonards Land, Holyrood Road, Edinburgh, EH8 8AQ UK
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Bradford, BD9 6RJ UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4A, Edinburgh, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT UK
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Rethnam V, Langhorne P, Churilov L, Hayward KS, Herisson F, Poletto SR, Tong Y, Bernhardt J. Early mobilisation post-stroke: a systematic review and meta-analysis of individual participant data. Disabil Rehabil 2020; 44:1156-1163. [PMID: 32673130 DOI: 10.1080/09638288.2020.1789229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate the safety and efficacy of early mobilisation (EM) compared to usual care by meta-analysing individual participant data (IPD). MATERIALS AND METHODS IPD were sought from randomised controlled trials comparing out-of-bed mobilisation starting within 48 h from stroke onset to usual care for acute stroke patients. Six trials were sourced from a recent Cochrane review. Favourable outcome (modified Rankin Scale 0-2) and death at 3 months post-stroke were compared between both groups using mixed-effect logistic regression modelling. Adjusted odds ratios (aORs) with respective 95% confidence intervals (95%CI) were reported. RESULTS Out of 2630 participants, 1437 (54.6%) were assigned to EM and 1193 (45.4%) to usual care. Intervention protocols varied considerably between trials. The median (interquartile range) delay to starting mobilisation post-stroke onset was 20 h (14.5-23.8) for EM and 23 h (16.7-34.3) for usual care group. Fewer EM participants had a favourable outcome at 3 months post-stroke compared to the usual care group (678 [48%] vs. 611 [52%]; aOR = 0.75, 95%CI: 0.62-0.92, p = 0.005). No difference in death at 3 months post-stroke between EM and usual care was observed (102 [7%] vs. 84 [7%]; aOR = 1.46, 95%CI: 0.92-2.31, p = 0.108). CONCLUSION The commencement of mobilisation should only be considered after 24 h post-stroke. Further research is required to identify safe, optimal dose, and timing of EM post-stroke.IMPLICATIONS FOR REHABILITATIONPatients who commenced mobilisation early after stroke had worse outcome than usual care.Insufficient detail about mobilisation interventions or usual care in many studies limits any further interpretation.The commencement of mobilisation should only be considered after 24-h post-stroke.
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Affiliation(s)
- Venesha Rethnam
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, Royal Infirmary, Glasgow, UK
| | - Leonid Churilov
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Kathryn S Hayward
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia.,Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Fanny Herisson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Simone R Poletto
- Clinical School of Physiotherapy, Lutheran University of Brazil, Canoas, Brazil
| | - Yanna Tong
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Beijing, China
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
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Abstract
Little is known about how the amount of treatment a person with aphasia receives impacts aphasia recovery following stroke, yet this information is vital to ensure effective treatments are delivered efficiently. Furthermore, there is no standard dose terminology in the stroke rehabilitation or aphasia literature. This scoping review aims to systematically map the evidence regarding dose in treatments for post-stroke aphasia and to explore how treatment dose is conceptualized, measured and reported in the literature. A comprehensive search was undertaken in June 2019. One hundred and twelve intervention studies were reviewed. Treatment dose (amount of treatment) has been conceptualized as both a measure of time and a count of discrete therapeutic elements. Doses ranged from one to 100 hours, while some studies reported session doses of up to 420 therapeutic inputs per session. Studies employ a wide variety of treatment schedules (i.e., session dose, session frequency, and intervention duration) and the interaction of dose parameters may impact the dose-response relationship. High dose interventions delivered over short periods may improve treatment efficiency while maintaining efficacy. Person- and treatment-level factors that mediate tolerance of high dose interventions require further investigation. Systematic exploration of dose-response relationships in post-stroke aphasia treatment is required.
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Affiliation(s)
- Sam R Harvey
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Marcella Carragher
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Michael Walsh Dickey
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - John E Pierce
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Miranda L Rose
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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45
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McFall A, Hietamies TM, Bernard A, Aimable M, Allan SM, Bath PM, Brezzo G, Carare RO, Carswell HV, Clarkson AN, Currie G, Farr TD, Fowler JH, Good M, Hainsworth AH, Hall C, Horsburgh K, Kalaria R, Kehoe P, Lawrence C, Macleod M, McColl BW, McNeilly A, Miller AA, Miners S, Mok V, O’Sullivan M, Platt B, Sena ES, Sharp M, Strangward P, Szymkowiak S, Touyz RM, Trueman RC, White C, McCabe C, Work LM, Quinn TJ. UK consensus on pre-clinical vascular cognitive impairment functional outcomes assessment: Questionnaire and workshop proceedings. J Cereb Blood Flow Metab 2020; 40:1402-1414. [PMID: 32151228 PMCID: PMC7307003 DOI: 10.1177/0271678x20910552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/21/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
Assessment of outcome in preclinical studies of vascular cognitive impairment (VCI) is heterogenous. Through an ARUK Scottish Network supported questionnaire and workshop (mostly UK-based researchers), we aimed to determine underlying variability and what could be implemented to overcome identified challenges. Twelve UK VCI research centres were identified and invited to complete a questionnaire and attend a one-day workshop. Questionnaire responses demonstrated agreement that outcome assessments in VCI preclinical research vary by group and even those common across groups, may be performed differently. From the workshop, six themes were discussed: issues with preclinical models, reasons for choosing functional assessments, issues in interpretation of functional assessments, describing and reporting functional outcome assessments, sharing resources and expertise, and standardization of outcomes. Eight consensus points emerged demonstrating broadly that the chosen assessment should reflect the deficit being measured, and therefore that one assessment does not suit all models; guidance/standardisation on recording VCI outcome reporting is needed and that uniformity would be aided by a platform to share expertise, material, protocols and procedures thus reducing heterogeneity and so increasing potential for collaboration, comparison and replication. As a result of the workshop, UK wide consensus statements were agreed and future priorities for preclinical research identified.
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Affiliation(s)
- Aisling McFall
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Tuuli M Hietamies
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Ashton Bernard
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Margaux Aimable
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Stuart M Allan
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience,
University of Nottingham, Nottingham, UK
| | - Gaia Brezzo
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton,
UK
| | - Hilary V Carswell
- University of Strathclyde, Strathclyde Institute of Pharmacy and
Biomedical Science, Glasgow, UK
| | - Andrew N Clarkson
- The Department of Anatomy, Brain Health Research Centre and
Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Gillian Currie
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Tracy D Farr
- School of Life Sciences, University of Nottingham, Nottingham ,
UK
| | - Jill H Fowler
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Mark Good
- School of Psychology, Cardiff University, Cardiff, UK
| | - Atticus H Hainsworth
- Molecular & Clinical Sciences Research Institute, St
George’s University of London, London, UK
| | - Catherine Hall
- School of Psychology, University of Sussex, Brighton, UK
| | - Karen Horsburgh
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Rajesh Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle Upon
Tyne, UK
| | - Patrick Kehoe
- Institute of Clinical Neurosciences, University of Bristol,
Bristol, UK
| | - Catherine Lawrence
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Barry W McColl
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, Edinburgh Medical School,
University of Edinburgh, Edinburgh, UK
| | - Alison McNeilly
- School of Medicine, University of Dundee, Ninewells Hospital,
Dundee, Scotland
| | - Alyson A Miller
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Scott Miners
- Institute of Clinical Neurosciences, University of Bristol,
Bristol, UK
| | - Vincent Mok
- Gerald Choa Neuroscience Centre, Therese Pei Fong Chow Research
Centre for Prevention of Dementia, Division of Neurology, Department of Medicine
and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Michael O’Sullivan
- Faculty of Medicine, The University of Queensland, Queensland,
Australia
| | - Bettina Platt
- Institute of Medical Sciences, University of Aberdeen,
Aberdeen, Scotland
| | - Emily S Sena
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Matthew Sharp
- Faculty of Medicine, University of Southampton, Southampton,
UK
| | - Patrick Strangward
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Stefan Szymkowiak
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, Edinburgh Medical School,
University of Edinburgh, Edinburgh, UK
| | - Rhian M Touyz
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | | | - Claire White
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Chris McCabe
- Institute of Neuroscience & Psychology, College of Medical,
Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Lorraine M Work
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Terence J Quinn
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
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46
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Hall J, Morton S, Fitzsimons CF, Hall JF, Corepal R, English C, Forster A, Lawton R, Patel A, Mead G, Clarke DJ. Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers. BMC Public Health 2020; 20:967. [PMID: 32560713 PMCID: PMC7305625 DOI: 10.1186/s12889-020-09113-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. METHODS Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 h) were analysed thematically and interview data (n = 31 stroke survivors, n = 12 caregivers) were analysed using the Framework approach. RESULTS Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers' influence on, and role in influencing stroke survivors' sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers' inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. CONCLUSIONS Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.
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Affiliation(s)
- Jennifer Hall
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK. .,Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK.
| | - Sarah Morton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire F Fitzsimons
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Jessica Faye Hall
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Rekesh Corepal
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | | | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
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47
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Abstract
Aphasia research uses the length of time within rehabilitation sessions as the main measure of dosage. Few papers detail therapeutic ingredients or outline the number of times these were delivered over the treatment period. The present observational study identified therapeutic ingredients in the Very Early Rehabiltiation in SpEech (VERSE) trial and explored the dosage provided using a model of cumulative intervention intensity (CII). Therapists video recorded one therapy session per week and 53 (12%) randomly selected therapy videos were analysed. The videos were coded for number of error productions, self-corrections and type and frequency of therapist cueing. The Western Aphasia Battery Revised-Aphasia Quotient (WABR-AQ) was used for measuring patient outcome with total verbal utterances (p < 0.001) and cues used with success (p < 0.001) being independent positive predictors of WABR-AQ score at six months post stroke and hypothesized as key therapeutic ingredients. The CII was calculated by counting identified therapeutic ingredients and multiplying this by the number of sessions completed. Collectively, the key ingredients occurred on average 504 times per session and over 10,000 times per participant during the treatment period. This paper reports a novel approach for identifying key treatment ingredients and detailing the dosage delivered within an early aphasia rehabilitation trial.
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Affiliation(s)
- Emily Brogan
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Speech Pathology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Speech Pathology, Sir Charles Gairdner Hospital, Perth, Australia
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48
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Cabanas-Valdés R, Serra-Llobet P, Rodriguez-Rubio PR, López-de-Celis C, Llauró-Fores M, Calvo-Sanz J. The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis. Clin Rehabil 2020; 34:1141-1156. [PMID: 32513019 DOI: 10.1177/0269215520932196] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the effectiveness of Extracorporeal Shock Wave Therapy for reducing spasticity and improving functionality of the upper limb in stroke survivors. DATA SOURCES A systematic review of MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, REHABDATA, Scielo, Scopus, Web of Science, Tripdatabase and Epistemonikos from 1980 to April 2020 was carried out. REVIEW METHODS The bibliography was screened to identify randomized controlled clinical trials that applied extracorporeal shock waves to upper limb spastic muscles in post-stroke individuals. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the PEDro scale. The primary outcome was spasticity and functionality of the upper limb. RESULTS A total of 1,103 studies were identified and 16 randomized controlled trials were finally included (764 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on spasticity was found. The mean difference (MD) on the Modified Ashworth Scale for comparison extracorporeal shock wave versus sham was -0.28; with a 95% confidence interval (CI) from -0.54 to -0.03. The MD of the comparison of extracorporeal shock wave plus conventional physiotherapy versus conventional physiotherapy was -1.78; 95% CI from -2.02 to -1.53. The MD for upper limb motor-function using the Fugl Meyer Assessment was 0.94; 95% CI from 0.42 to 1.47 in the short term and 0.97; 95% CI from 0.19 to 1.74 in the medium term. CONCLUSION The extracorporeal shock wave therapy is effective for reducing upper limb spasticity. Adding it to conventional therapy provides an additional benefit.
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Affiliation(s)
- Rosa Cabanas-Valdés
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pol Serra-Llobet
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pere Ramón Rodriguez-Rubio
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carlos López-de-Celis
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Mercé Llauró-Fores
- Physiotherapy Department, School of Health Science Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Jordi Calvo-Sanz
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,Rehabilitation Department, Hospital Asepeyo Sant Cugat del Vallès, Barcelona, Spain
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49
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Muir KW, Bulters D, Willmot M, Sprigg N, Dixit A, Ward N, Tyrrell P, Majid A, Dunn L, Bath P, Howell J, Stroemer P, Pollock K, Sinden J. Intracerebral implantation of human neural stem cells and motor recovery after stroke: multicentre prospective single-arm study (PISCES-2). J Neurol Neurosurg Psychiatry 2020; 91:396-401. [PMID: 32041820 PMCID: PMC7147186 DOI: 10.1136/jnnp-2019-322515] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Human neural stem cell implantation may offer improved recovery from stroke. We investigated the feasibility of intracerebral implantation of the allogeneic human neural stem cell line CTX0E03 in the subacute-chronic recovery phase of stroke and potential measures of therapeutic response in a multicentre study. METHODS We undertook a prospective, multicentre, single-arm, open-label study in adults aged >40 years with significant upper limb motor deficits 2-13 months after ischaemic stroke. 20 million cells were implanted by stereotaxic injection to the putamen ipsilateral to the cerebral infarct. The primary outcome was improvement by 2 or more points on the Action Research Arm Test (ARAT) subtest 2 at 3 months after implantation. FINDINGS Twenty-three patients underwent cell implantation at eight UK hospitals a median of 7 months after stroke. One of 23 participants improved by the prespecified ARAT subtest level at 3 months, and three participants at 6 and 12 months. Improvement in ARAT was seen only in those with residual upper limb movement at baseline. Transient procedural adverse effects were seen, but no cell-related adverse events occurred up to 12 months of follow-up. Two deaths were unrelated to trial procedures. INTERPRETATION Administration of human neural stem cells by intracerebral implantation is feasible in a multicentre study. Improvements in upper limb function occurred at 3, 6 and 12 months, but not in those with absent upper limb movement at baseline, suggesting a possible target population for future controlled trials. FUNDING ReNeuron, Innovate UK (application no 32074-222145). TRIAL REGISTRATION NUMBER EudraCT Number: 2012-003482-18.
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Affiliation(s)
- Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
| | - Diederik Bulters
- Neurosurgery, Wessex Neurological Centre, Southampton, Southampton, UK
| | - Mark Willmot
- Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, Birmingham, UK
| | - Nikola Sprigg
- Stroke Trials Unit, University of Nottingham, Nottingham, UK
| | - Anand Dixit
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Nick Ward
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London, UK.,The National Hospital for Neurology and Neurosurgery, London, UK
| | - Pippa Tyrrell
- The University of Manchester, Manchester, Manchester, UK
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, Sheffield, UK
| | - Laurence Dunn
- Neurosurgery, Institute of Neurological Sciences, Glasgow, Glasgow, UK
| | - Philip Bath
- Stroke Trials Unit, University of Nottingham, Nottingham, UK
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50
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Rodgers H, Bosomworth H, van Wijck F, Krebs HI, Shaw L. Usual care: the big but unmanaged problem of rehabilitation evidence - Authors' reply. Lancet 2020; 395:337-338. [PMID: 32007165 DOI: 10.1016/s0140-6736(19)32543-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE2 4AE, UK; Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK; Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Helen Bosomworth
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE2 4AE, UK
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Lisa Shaw
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE2 4AE, UK
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