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Nolan J, Bynevelt M, Godecke E, Jacques A, Dharsono F, Singer B. The association between neuroimaging data and presence of lateropulsion after stroke. Top Stroke Rehabil 2024:1-10. [PMID: 38598484 DOI: 10.1080/10749357.2024.2340339] [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] [Received: 12/12/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Post-stroke lateropulsion is prevalent and has been associated with varied lesion locations, but existing imaging studies are limited by small participant cohorts. Evidence to guide lateropulsion rehabilitation is also limited. Improved understanding of lesion localization associated with lateropulsion post-stroke may inform more targeted intervention approaches. OBJECTIVES This study investigated the associations between stroke neuroimaging data and presence of lateropulsion at inpatient rehabilitation admission. METHODS This prospective, observational study included participants aged ≥65 years, admitted for inpatient stroke rehabilitation. Using routinely collected clinical neuroimaging data, stroke type, location, and volume were reported, and their association with lateropulsion presence (Four-Point Pusher Score - 4PPS) at admission was explored. RESULTS Of 144 included participants, 82 (56.9%) had lateropulsion (4PPS ≥1). Lateropulsion presence was univariately associated with hemorrhagic stroke (p = 0.002), frontal cortical involvement (OR = 2.17, 95%CI 1.02-6.46), and white matter involvement (OR = 2.45, 95%CI 1.24-4.85), particularly frontal white matter (p = 0.021). Lesions involving the posterior limb of the internal capsule (OR = 2.88, 95% CI 1.14-7.27) and those involving the entire thalamus (OR = 1.0, p = 0.03) were associated with lateropulsion presence. When stratified by stroke type, no specific location was significantly associated with lateropulsion presence in hemorrhagic strokes. Among participants with ischemic stroke, involvement of the pre-central gyrus (OR = 2.45, 95%CI 1.05-5.76), post-central gyrus (OR = 2.76, 95%CI 1.15-6.60), inferior parietal cortex (OR = 3.95, 95%CI 1.43-10.90), and supramarginal gyrus (OR = 3.73, 95%CI 1.25-11.13) were associated with lateropulsion presence. The stroke laterality and size were not significantly associated with lateropulsion presence. CONCLUSIONS The findings indicate a role of network disconnection in the post-stroke lateropulsion presence. Future, larger-cohort lesion-network mapping studies are recommended.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
- Physiotherapy Department, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Michael Bynevelt
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Allied Health Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
- Centre of Research Excellence in Aphasia Rehabilitation, La Trobe University, Melbourne, Australia
| | - Angela Jacques
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Department of Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Ferry Dharsono
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Nolan J, Jacques A, Godecke E, Bynevelt M, Dharsono F, Singer B. Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study. Top Stroke Rehabil 2024:1-12. [PMID: 38526999 DOI: 10.1080/10749357.2024.2333186] [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] [Received: 01/17/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking. OBJECTIVES This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke. METHODS Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. RESULTS The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: <0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022). CONCLUSIONS This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
- Physiotherapy Department, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Angela Jacques
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Department of Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Allied Health Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
- Centre of Research Excellence in Aphasia Rehabilitation, La Trobe University, Melbourne, Australia
| | - Michael Bynevelt
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Ferry Dharsono
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Harvey S, Stone M, Zingelman S, Copland DA, Kilkenny MF, Godecke E, Cadilhac DA, Kim J, Olaiya MT, Rose ML, Breitenstein C, Shrubsole K, O'Halloran R, Hill AJ, Hersh D, Mainstone K, Mainstone P, Unsworth CA, Brogan E, Short KJ, Burns CL, Baker C, Wallace SJ. Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study. BMJ Open 2024; 14:e080532. [PMID: 38514146 PMCID: PMC10961567 DOI: 10.1136/bmjopen-2023-080532] [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: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.
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Affiliation(s)
- Sam Harvey
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Marissa Stone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Sally Zingelman
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Joosup Kim
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Miranda L Rose
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Robyn O'Halloran
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Annie J Hill
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Deborah Hersh
- Curtin School of Allied Health and EnAble Institute, Curtin University, Perth, Western Australia, Australia
- Australian Aphasia Association, Perth, Western Australia, Australia
| | - Kathryn Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Penelope Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carolyn A Unsworth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Emily Brogan
- Edith Cowan University, Joondalup, Western Australia, Australia
- Fiona Stanley Fremantle Hospitals Group, South Metropolitan Health Service, Palmyra, Western Australia, Australia
| | - Kylie J Short
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Clare L Burns
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Caroline Baker
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- Speech Pathology Department, Monash Health, Clayton, Victoria, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
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Kim J, Rose ML, Pierce JE, Nickels L, Copland DA, Togher L, Godecke E, Meinzer M, Rai T, Hurley M, Foster A, Carragher M, Wilcox C, Cadilhac DA. High-Intensity Aphasia Therapy Is Cost-Effective in People With Poststroke Aphasia: Evidence From the COMPARE Trial. Stroke 2024; 55:705-714. [PMID: 38328930 DOI: 10.1161/strokeaha.123.045183] [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: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Evidence from systematic reviews confirms that speech and language interventions for people with aphasia during the chronic phase after stroke (>6 months) improve word retrieval, functional communication, and communication-related quality of life. However, there is limited evidence of their cost-effectiveness. We aimed to estimate the cost per quality-adjusted life year gained from 2 speech and language therapies compared with usual care in people with aphasia during the chronic phase (median, 2.9 years) after stroke. METHODS A 3-arm, randomized controlled trial compared constraint-induced aphasia therapy plus (CIAT-Plus) and multimodality aphasia therapy (M-MAT) with usual care in 216 people with chronic aphasia. Participants were administered a standardized questionnaire before intervention and at 12 weeks after the 2-week intervention/control period to ascertain health service utilization, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020. Quality-adjusted life years were estimated using responses to the EuroQol-5 Dimension-3 Level questionnaire. To test uncertainty around the differences in costs and outcomes between groups, bootstrapping was used with the cohorts resampled 1000 times. RESULTS Overall 201/216 participants were included (mean age, 63 years, 29% moderate or severe aphasia, 61 usual care, 70 CIAT-Plus, 70 M-MAT). There were no statistically significant differences in mean total costs ($13 797 usual care, $17 478 CIAT-Plus, $11 113 M-MAT) and quality-adjusted life years (0.19 usual care, 0.20 CIAT-Plus, 0.20 M-MAT) between groups. In bootstrapped analysis of CIAT-Plus, 21.5% of iterations were likely to result in better outcomes and be cost saving (dominant) compared with usual care. In contrast, 72.4% of iterations were more favorable for M-MAT than usual care. CONCLUSIONS We observed that both treatments, but especially M-MAT, may result in better outcomes at an acceptable additional cost, or potentially with cost savings. These findings are relevant in advocating for the use of these therapies for chronic aphasia after stroke.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia (J.K., D.A. Cadilhac)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (J.K., D.A. Cadilhac)
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - John E Pierce
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Lyndsey Nickels
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia (L.N.)
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia (D.A. Copland)
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Australia (D.A. Copland)
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia (L.T.)
| | - Erin Godecke
- Edith Cowan University, Joondalup, Western Australia (E.G.)
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Germany (M.M.)
| | - Tapan Rai
- University of Technology Sydney, New South Wales, Australia (T.R.)
| | - Melanie Hurley
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Abby Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia (A.F.)
- School of Primary & Allied Health Care, Monash University, Frankston, Victoria, Australia (A.F.)
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Cassie Wilcox
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia (J.K., D.A. Cadilhac)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (J.K., D.A. Cadilhac)
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
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Kim J, Sookram G, Godecke E, Brogan E, Armstrong E, Ellery F, Rai T, Rose ML, Ciccone N, Middleton S, Holland A, Hankey GJ, Bernhardt J, Cadilhac DA. Economic evaluation of the Very Early Rehabilitation in SpEech (VERSE) intervention. Top Stroke Rehabil 2024; 31:157-166. [PMID: 37415422 DOI: 10.1080/10749357.2023.2229039] [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: 01/23/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION There is limited evidence on the costs and outcomes of patients with aphasia after stroke. The aim of this study was to estimate costs in patients with aphasia after stroke according to the aphasia therapies provided. METHODS A three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment trial conducted in Australia and New Zealand. Usual ward-based care (Usual Care) was compared to additional usual ward-based therapy (Usual Care Plus) and a prescribed and structured aphasia therapy program in addition to Usual Care (the VERSE intervention). Information about healthcare utilization and productivity were collected to estimate costs in Australian dollars for 2017-18. Multivariable regression models with bootstrapping were used to estimate differences in costs and outcomes (clinically meaningful change in aphasia severity measured by the WAB-R-AQ). RESULTS Overall, 202/246 (82%) participants completed follow-up at 26 weeks. Median costs per person were $23,322 (Q1 5,367, Q3 52,669, n = 63) for Usual Care, $26,923 (Q1 7,303, Q3 76,174, n = 70) for Usual Care Plus and $31,143 (Q1 7,001. Q3 62,390, n = 69) for VERSE. No differences in costs and outcomes were detected between groups. Usual Care Plus was inferior (i.e. more costly and less effective) in 64% of iterations, and in 18% was less costly and less effective compared to Usual Care. VERSE was inferior in 65% of samples and less costly and less effective in 12% compared to Usual Care. CONCLUSION There was limited evidence that additional intensively delivered aphasia therapy within the context of usual acute care provided was worthwhile in terms of costs for the outcomes gained.
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Affiliation(s)
- J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - G Sookram
- Health Economics Unit, Australian Institute of Health and Welfare, Canberra, Australia
| | - E Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - E Brogan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - E Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - F Ellery
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - T Rai
- School of Mathematical and Physical Sciences, University of Technology NSW, Broadway, Australia
| | - M L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - N Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - S Middleton
- Nursing Research Institute, Australian Catholic University, Darlinghurst, Australia
| | - A Holland
- University of Arizona, Tucson, AZ, USA
| | - G J Hankey
- Medical School, University of Western Australia, Perth, Australia
- Perron Institute for Neurological and Translational Science, The University of Western Australia, Nedlands, Australia
| | - J Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - D A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Stockley RC, Walker MF, Alt Murphy M, Azah Abd Aziz N, Amooba P, Churliov L, Farrin A, Fini NA, Ghaziani E, Godecke E, Gutierrez-Panchana T, Jia J, Kandasamy T, Lindsay P, Solomon J, Thijs V, Tindall T, Tippett DC, Watkins C, Lynch E. Criteria and Indicators for Centers of Clinical Excellence in Stroke Recovery and Rehabilitation: A Global Consensus Facilitated by ISRRA. Neurorehabil Neural Repair 2024; 38:87-98. [PMID: 38212946 PMCID: PMC10874109 DOI: 10.1177/15459683231222026] [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] [Indexed: 01/13/2024]
Abstract
BACKGROUND The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients. OBJECTIVES This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. These were intentionally developed to be ambitious and internationally relevant, regardless of a country's development or income status, to drive global improvement in stroke services. METHODS Criteria and specific measurable indicators for CoCE were collaboratively developed by an international panel of stroke recovery and rehabilitation experts from 10 countries and consumer groups from 5 countries. RESULTS The criteria and associated indicators, ranked in order of importance, focused upon (i) optimal outcome, (ii) research culture, (iii) working collaboratively with people living with stroke, (iv) knowledge exchange, (v) leadership, (vi) education, and (vii) advocacy. Work is currently underway to user-test the criteria and indicators in 14 rehabilitation centers in 10 different countries. CONCLUSIONS We anticipate that use of the criteria and indicators could support individual organizations to further develop their services and, more widely, provide a mechanism by which clinical excellence can be articulated and shared to generate global improvements in stroke care.
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Affiliation(s)
- Rachel C. Stockley
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | | | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Medical Faculty, National University of Malaysia (UKM), Bangi, Malaysia
| | - Philemon Amooba
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Leonid Churliov
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Natalie A. Fini
- Physiotherapy Department, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Emma Ghaziani
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg Hospital and Department of Brain and Spinal Cord Injury, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University and Sir Charles Gairdner Osborne Park Health Care Group, Joondalup, WA, Australia
| | | | - Jie Jia
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | | | | | - John Solomon
- Centre for Comprehensive Stroke Rehabilitation and Research, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Vincent Thijs
- Department of Medicine University of Melbourne, Department of Neurology Austin Health, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Tierney Tindall
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Donna C. Tippett
- Departments of Physical Medicine and Rehabilitation, Neurology, and Otolaryngology—Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Caroline Watkins
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Elizabeth Lynch
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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7
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Pierce JE, OHalloran R, Togher L, Nickels L, Copland D, Godecke E, Meinzer M, Rai T, Cadilhac DA, Kim J, Hurley M, Foster A, Carragher M, Wilcox C, Steel G, Rose ML. Acceptability, feasibility and preliminary efficacy of low-moderate intensity Constraint Induced Aphasia Therapy and Multi-Modality Aphasia Therapy in chronic aphasia after stroke. Top Stroke Rehabil 2024; 31:44-56. [PMID: 37036031 DOI: 10.1080/10749357.2023.2196765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 11/01/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND High-intensity Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) and Multi-Modality Aphasia Therapy (M-MAT) are effective interventions for chronic post-stroke aphasia but challenging to provide in clinical practice. Providing these interventions may be more feasible at lower intensities, but comparative evidence is lacking. We therefore explored feasibility, acceptability, and preliminary efficacy of the treatments at a lower intensity. METHODS A multisite, single-blinded, randomized Phase II trial was conducted within the Phase III COMPARE trial. Groups of participants with chronic aphasia from the usual care arm of the COMPARE trial were randomized to M-MAT or CIAT-Plus, delivered at the same dose as the COMPARE trial but at lower intensity (6 hours/week × 5 weeks rather than 15 hours/week × 2 weeks). Blinded assessors measured aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), word retrieval, connected speech, multimodal communication, functional communication, and quality of life immediately post interventions and after 12 weeks. Feasibility and acceptability were explored. RESULTS Of 70 eligible participants, 77% consented to the trial; 78% of randomized participants completed intervention and 98% of assessment visits were conducted. Fatigue and distress ratings were low with no related withdrawals. Adverse events related to the trial (n = 4) were mild in severity. Statistically significant treatment effects were demonstrated on word retrieval and functional communication and both interventions were equally effective. CONCLUSIONS Low-moderateintensity CIAT-Plus and M-MAT were feasible and acceptable. Both interventions show preliminary efficacy at a low-moderate intensity. These results support a powered trial investigating these interventions at a low-moderate intensity.
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Affiliation(s)
- John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Robyn OHalloran
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndsey Nickels
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Copland
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
- Surgical Treatment and Rehabilitation Service Education and Research Allience, Metro North Health, Herston, Queensland, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Western, Australia
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tapan Rai
- Graduate Research School, University of Technology Sydney, New South Wales, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Speech Pathology, Monash Health, Clayton, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Speech Pathology, Monash Health, Clayton, Victoria, Australia
| | - Melanie Hurley
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Abby Foster
- Speech Pathology, Monash Health, Clayton, Victoria, Australia
- School of Allied Health, Human Service & Sport, La Trobe University, Victoria, Australia
- School of Primary & Allied Health Care, Monash University, Victoria, Australia
| | - Marcella Carragher
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Cassie Wilcox
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Gillian Steel
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Miranda L Rose
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
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Armstrong E, Colegate K, Papertalk L, Crowe S, McAllister M, Hersh D, Ciccone N, Godecke E, Katzenellenbogen J, Coffin J. Intersectionality and Its Relevance in the Context of Aboriginal People with Brain Injury in Australia. Semin Speech Lang 2024; 45:56-70. [PMID: 37992734 DOI: 10.1055/s-0043-1776755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
In this article, we explore the benefits of recognizing the impact of intersectionality on access to, and provision of, brain injury care in a First Nations context. While disadvantage and discrimination are often associated with the intersection of culture, gender, disability, and socioeconomic disadvantage, it is only when these factors are explored together that clinicians can really understand what people need to recover and thrive following acquired brain injury. In this article, we challenge speech-language pathologists to examine their own practices, to look beyond Western models of health and constraints of many current institutional models of care and ways of framing research, to acknowledge historical and ongoing colonizing influences, and to engage with community-led solutions. We provide a model of Aboriginal-led care, where intersection of discrimination and marginalization is minimized and the multiple components of the individual, carers/communication partners, and the environment become empowering factors instead.
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Affiliation(s)
- Elizabeth Armstrong
- University Department of Rural Health, Edith Cowan University, Bunbury, Western Australia, Australia
| | - Kerri Colegate
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Lenny Papertalk
- WA Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Stuart Crowe
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Deborah Hersh
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Judith Katzenellenbogen
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Juli Coffin
- Ngangk Yira Institute for Change, Murdoch University, Broome, Western Australia, Australia
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Weerakkody A, Emmanuel R, White J, Godecke E, Singer B. Unlocking the restraint-Development of a behaviour change intervention to increase the provision of modified constraint-induced movement therapy in stroke rehabilitation. Aust Occup Ther J 2023; 70:661-677. [PMID: 37424149 DOI: 10.1111/1440-1630.12896] [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: 11/16/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Strong evidence supports the provision of modified constraint-induced movement therapy (mCIMT) to improve upper limb function after stroke. A service audit identified that very few patients received mCIMT in a large subacute, early-supported discharge rehabilitation service. A behaviour change intervention was developed to increase the provision of mCIMT following an unsuccessful 'education only' attempt. This paper aims to systematically document the steps undertaken and to provide practical guidance to clinicians and rehabilitation services to implement this complex, yet effective, rehabilitation intervention. METHODS This clinician behaviour change intervention was developed over five stages and led by a working group of neurological experts (n = 3). Data collection methods included informal discussions with clinicians and an online survey (n = 35). The staged process included reflection on why the first attempt did not improve the provision of mCIMT (stage 1), mapping barriers and enablers to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW) to guide the behaviour change techniques (stages 2 and 3), developing a suitable mCIMT protocol (stage 4), and delivering the behaviour change intervention (stage 5). RESULTS Reflection among the working group identified the need for upskilling in mCIMT delivery and the use of a behaviour change framework to guide the implementation program. Key determinants of behaviour change operated within the TDF domains of knowledge, skills, environmental context and resources, social role and identity, and social influences. Following the development of a context-specific mCIMT protocol, the BCW guided the behaviour change intervention, which included education, training, persuasion, environmental restructuring, and modelling. CONCLUSION This paper provides an example of using the TDF and BCW to support the implementation of mCIMT in a large early-supported discharge service. It outlines the suite of behaviour change techniques used to influence clinician behaviour. The success of this behaviour change intervention will be explored in future research.
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Affiliation(s)
- Ashan Weerakkody
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Robyn Emmanuel
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
- Neurotherapy Occupational Therapy Services, Perth, Australia
| | - Jocelyn White
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Sir Charles Gairdner Hospital, North Metropolitan Health Service, Department of Health, Nedlands, Australia
| | - Barby Singer
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- TRAining Centre in Subacute Care (TRACSWA), Department of Health, Fremantle, Australia
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10
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Nolan J, Jacques A, Godecke E, Abe H, Babyar S, Bergmann J, Birnbaum M, Dai S, Danells C, Edwards TGS, Gandolfi M, Jahn K, Koter R, Mansfield A, Nakamura J, Pardo V, Perennou D, Piscicelli C, Punt D, Romick-Sheldon D, Saeys W, Smania N, Vaes N, Whitt AL, Singer B. Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel. Clin Rehabil 2023; 37:1559-1574. [PMID: 37122265 PMCID: PMC10492423 DOI: 10.1177/02692155231172012] [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] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel. DESIGN This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations. PARTICIPANTS Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion. MAIN MEASURES The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses. RESULTS Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded. CONCLUSIONS These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
- Osborne Park Hospital, Stirling, Australia
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Department of Research, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Allied Health Research, Sir Charles Gairdner Hospital, Nedlands, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Hiroaki Abe
- School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Suzanne Babyar
- Department of Physical Therapy, Hunter College, New York, NY, USA
- Department of Neurology, Stroke Unit, Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Jeannine Bergmann
- Schoen Clinic Bad Aibling, Schoen Clinic, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munchen, Germany
| | - Melissa Birnbaum
- Department of Physiotherapy, St Vincent's Hospital, Melbourne, Australia
| | - Shenhao Dai
- Department of NeuroRehabilitation South Hospital, CHU Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - Cynthia Danells
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Taiza GS Edwards
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
| | - Klaus Jahn
- Schoen Clinic Bad Aibling, Schoen Clinic, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munchen, Germany
| | - Ryan Koter
- Department of Physical Therapy, Shepherd Center, Atlanta, GA, USA
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | - Junji Nakamura
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
- Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Vicky Pardo
- Physical Therapy/Health Care Sciences, Wayne State University, Detroit, MI, USA
| | - Dominic Perennou
- CHU Grenoble Alpes, Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - Celine Piscicelli
- Department of NeuroRehabilitation South Hospital, CHU Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Devra Romick-Sheldon
- Department of Physical Therapy, Schwab Rehabilitation Hospital, Chicago, IL, USA
| | - Wim Saeys
- Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, Neuromotor and Cognitive Rehabilitation Research Center (CRRNC)
| | - Nathalie Vaes
- Medicine and Health Sciences, Rehabilitation Hospital RevArte, Antwerp, Belgium
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Abigail L Whitt
- Department of Physical Therapy, ALL Whitt Physical Therapy, Alexandria, VA, USA
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, Australia
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11
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Weerakkody A, White J, Hill C, Godecke E, Singer B. Delivering constraint-induced movement therapy in stroke rehabilitation requires informed stakeholders, sufficient resources and organisational buy-in: a mixed-methods systematic review. J Physiother 2023; 69:249-259. [PMID: 37690958 DOI: 10.1016/j.jphys.2023.08.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/03/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To summarise and synthesise the qualitative literature relating to constraint-induced movement therapy (CIMT) among stroke survivors, carers, therapists and rehabilitation service managers. DESIGN Systematic review of qualitative studies. Quantitative studies using survey data were also included if they investigated perceptions and/or experiences related to CIMT. DATA SOURCES Cochrane Library, Medline, JBI, Emcare, Embase, PsycInfo, CINAHL, PEDro, OT Seeker and NICE from inception to January 2022. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from the included studies and assessed comprehensiveness of reporting using established tools. Thematic synthesis was undertaken to synthesise findings for studies using focus groups and interviews. A summary of themes from quantitative studies using survey data was compiled to complement the qualitative synthesis. RESULTS Searches yielded 1,450 titles after removal of duplicates; 60 full-text articles were assessed for eligibility and 14 studies were included (1,570 total participants). Thematic synthesis identified nine descriptive themes from which four analytical themes were developed: CIMT is challenging but support at all levels helps; therapists need the know-how, resources and staffing; CIMT is different to other interventions, and there are positives and negatives to this; and functional outcomes do not always meet high expectations. Quantitative survey themes included: knowledge, skills and confidence in delivering CIMT programs; patient factors; and institutional factors. CONCLUSIONS This review identified several determinants of implementation related to CIMT. Rehabilitation therapists need to develop their knowledge and skills to deliver CIMT, engage with organisational leaders, and develop CIMT protocols to fit the local clinical context in order to sustainably deliver CIMT in stroke rehabilitation services. Stroke survivors and carers require improved education to increase their engagement and participation. After addressing these determinants, future research should evaluate population-level outcomes and policy-level implementation in establishing CIMT as global standard rehabilitation practice. REGISTRATION CRD42021237757.
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Affiliation(s)
- Ashan Weerakkody
- Rehabilitation in the Home, South Metropolitan Health Service, Perth, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
| | - Jocelyn White
- Rehabilitation in the Home, South Metropolitan Health Service, Perth, Australia
| | - Claire Hill
- Library Services, South and East Metropolitan Health Service, Department of Health, Perth, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; Sir Charles Gairdner Hospital, Perth, Australia
| | - Barby Singer
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; TRAining Centre in Subacute Care (TRACSWA), Department of Health, Perth, Australia
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12
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Burton B, Isaacs M, Brogan E, Shrubsole K, Kilkenny MF, Power E, Godecke E, Cadilhac DA, Copland D, Wallace SJ. An updated systematic review of stroke clinical practice guidelines to inform aphasia management. Int J Stroke 2023; 18:1029-1039. [PMID: 36803248 PMCID: PMC10614176 DOI: 10.1177/17474930231161454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/04/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote high-quality service delivery and optimize patient outcomes. However, there are currently no high-quality guidelines specific to post-stroke aphasia management. AIMS To identify and evaluate recommendations from high-quality stroke guidelines that can inform aphasia management. SUMMARY OF REVIEW We conducted an updated systematic review in accordance with PRISMA guidelines to identify high-quality clinical guidelines published between January 2015 and October 2022. Primary searches were performed using electronic databases: PubMed, EMBASE, CINAHL, and Web of Science. Gray literature searches were conducted using Google Scholar, guideline databases, and stroke websites. Clinical practice guidelines were evaluated using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. Recommendations were extracted from high-quality guidelines (scored > 66.7% on Domain 3: "Rigor of Development"), classified as aphasia-specific or aphasia-related, and categorized into clinical practice areas. Evidence ratings and source citations were assessed, and similar recommendations were grouped. Twenty-three stroke clinical practice guidelines were identified and 9 (39%) met our criteria for rigor of development. From these guidelines, 82 recommendations for aphasia management were extracted: 31 were aphasia-specific, 51 aphasia-related, 67 evidence-based, and 15 consensus-based. CONCLUSION More than half of stroke clinical practice guidelines identified did not meet our criteria for rigorous development. We identified 9 high-quality guidelines and 82 recommendations to inform aphasia management. Most recommendations were aphasia-related; aphasia-specific recommendation gaps were identified in three clinical practice areas: "accessing community supports," "return to work, leisure, driving," and "interprofessional practice."
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Affiliation(s)
- Bridget Burton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Megan Isaacs
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Emily Brogan
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Monique F Kilkenny
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Emma Power
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- University of Technology Sydney, Graduate School of Health, Speech Pathology, Sydney, NSW, Australia
| | - Erin Godecke
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Dominique A Cadilhac
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - David Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
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Lynch EA, Nolan J, Bulto LN, Mitchell J, McGrath A, Lane S, Harvey G, Cadilhac DA, Harling R, Godecke E. Is learning being supported when information is provided to informal carers during inpatient stroke rehabilitation? A qualitative study. Disabil Rehabil 2023:1-9. [PMID: 37746848 DOI: 10.1080/09638288.2023.2259307] [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] [Received: 01/18/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
Purpose: To explore how health professionals provide information to informal carers during inpatient stroke rehabilitation and whether these practices align with adult learning principles.Methods: Informal carers and survivors of stroke who had completed inpatient rehabilitation, and health professionals working in inpatient stroke rehabilitation were interviewed. Directed qualitative content analysis was conducted using an adult learning model, to determine how closely reported practices aligned to adult learning principles.Results: 14 carers, 6 survivors of stroke and 17 health professionals participated. Carers (79% female, 57% spouse/partner) reported having incomplete knowledge during rehabilitation, lacking information about mechanisms of stroke recovery, rehabilitation processes, long-term effects of stroke, and navigating post-discharge services. Health professionals supported carers to address their learning needs related to safety of caring for stroke survivors. Carers indicated they were responsible for their own non-safety related learning. Health professionals tended not to check carers' understanding of information provided nor offer learning opportunities beyond written or verbal information.Conclusions: Health professionals consistently provide certain information to carers during inpatient rehabilitation, but adult learning principles are not routinely applied when information is provided. Fostering adult learning among informal carers may improve preparedness of carers to support stroke survivors after discharge from inpatient rehabilitation.
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Affiliation(s)
- Elizabeth A Lynch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jessica Nolan
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Australia
- Sir Charles Gairdner and Osborne Park HealthCare Group, Perth, Australia
| | - Lemma N Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | | | | | - Gill Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Rachel Harling
- Physiotherapy Department, Central Adelaide Local Health Network, Adelaide,Australia
| | - Erin Godecke
- Sir Charles Gairdner and Osborne Park HealthCare Group, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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14
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Nolan J, Godecke E, Spilsbury K, Singer B. Post-Stroke Lateropulsion: Resolution and Function After Discharge From Inpatient Rehabilitation - A Cohort Study. Physiother Can 2023; 75:264-268. [PMID: 37736404 PMCID: PMC10510537 DOI: 10.3138/ptc-2021-0078] [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] [Received: 07/26/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 09/23/2023]
Abstract
Purpose A person with post-stroke lateropulsion pushes their body toward their hemiparetic side and/or resists accepting weight onto their nonparetic side. Research findings regarding long-term persistence of lateropulsion and its association with function are lacking. This study reports associations between lateropulsion severity (Four Point Pusher Score - 4PPS) and functional outcome (Functional Independence Measure - FIM) at three months after discharge. Methods This prospective cohort study included 41 consecutive admissions to a stroke rehabilitation unit. Lateropulsion severity and FIM were measured at admission, discharge and three-month follow-up. Lateropulsion status at discharge, stroke laterality, ongoing physiotherapy after discharge, and demographic variables (age and sex) were tested for association with FIM change over the follow-up period. Results Complete data were available for 38 participants. Among these, 17 (44.7%) showed lateropulsion (4PPS ≥ 1) on admission, 9 (23.7%) showed persistent lateropulsion on discharge, and 7 (18.4%) showed persistent lateropulsion at three month follow-up. Improved functional status (FIM score) was seen at follow-up in those discharged with lateropulsion who had right-sided lesions but not in those with left-sided lesions. Conclusions Lateropulsion can continue to resolve after discharge from inpatient rehabilitation. Larger cohort studies are needed to further explore associations between persistent lateropulsion and long-term outcomes.
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Affiliation(s)
- Jessica Nolan
- From the:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, W.A., Australia
- Osborne Park Hospital, Stirling, W.A., Australiea
| | - Erin Godecke
- From the:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, W.A., Australia
- Sir Charles Gairdner Hospital, Nedlands, W.A., Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Vict., Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, W.A., Australia
| | - Barbara Singer
- Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, W.A., Australia
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15
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Bernhardt J, Corbett D, Dukelow S, Savitz S, Solomon JM, Stockley R, Sunnerhagen KS, Verheyden G, Walker M, Murphy MA, Bonkhoff AK, Cadilhac D, Carmichael ST, Dalton E, Dancause N, Edwards J, English C, Godecke E, Hayward K, Kamalakannan S, Kim J, Kwakkel G, Lang CE, Lannin N, Levin M, Lynch E, Mead G, Saa JP, Ward N. The International Stroke Recovery and Rehabilitation Alliance. Lancet Neurol 2023; 22:295-296. [PMID: 36931801 DOI: 10.1016/s1474-4422(23)00072-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Julie Bernhardt
- Stroke Theme, Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, VIC 3084, Australia.
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sean Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Sean Savitz
- Institute for Stroke and Cerebrovascular Disease at UTHealth-Houston, Houston, TX, USA
| | - John M Solomon
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Rachel Stockley
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Neurological Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Dominique Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Emily Dalton
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Numa Dancause
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
| | - Jodi Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Coralie English
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Kate Hayward
- Stroke Theme, Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, VIC 3084, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Sureshkumar Kamalakannan
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle, UK
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Catherine E Lang
- Department of Physical Therapy, Washington University in St Louis, St Louis, MO, USA
| | - Natasha Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mindy Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Elizabeth Lynch
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian Mead
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Juan Pablo Saa
- Stroke Theme, Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, VIC 3084, Australia
| | - Nick Ward
- Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
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16
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Nolan J, Godecke E, Spilsbury K, Wu A, Singer B. Accuracy of the Australian National Sub-Acute and Non-Acute Patient Classification in predicting rehabilitation length of stay for stroke survivors who are ≥65 years of age and have lateropulsion. Top Stroke Rehabil 2023; 30:203-211. [PMID: 35068380 DOI: 10.1080/10749357.2021.2008594] [Citation(s) in RCA: 3] [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: 02/07/2023]
Abstract
BACKGROUND Lateropulsion is a common impairment after stroke. Regardless of stroke severity, functional recovery is slower in people with lateropulsion, resulting in requirement for longer rehabilitation duration. In Australia, inpatient rehabilitation funding is determined via the Australian National Sub-Acute and Non-Acute Patient Classification (AN-SNAP). AN-SNAP class is determined using age, diagnosis, weighted Functional Independence Measure (FIM) motor score, and FIM cognitive score. OBJECTIVES To explore accuracy of the AN-SNAP to predict length of stay (LOS) for people with poststroke lateropulsion. METHODS A retrospective database audit was undertaken. AN-SNAP predicted LOS for each participant was calculated based on 2019 calendar year national benchmarks. A multivariable linear regression model estimated mean differences in reported LOS and AN-SNAP predicted LOS after adjusting for lateropulsion severity (Four Point Pusher Score). A separate logistic regression model assessed whether FIM change during admission was associated with reported LOS exceeding AN-SNAP predicted LOS. RESULTS Data were available from 1126 admissions. Reported LOS exceeding AN-SNAP predicted LOS was associated with greater lateropulsion severity on admission. Where AN-SNAP predicted LOS was longer, those with no lateropulsion on admission showed shorter reported than predicted LOS. Greater improvement in FIM during rehabilitation was associated with increased odds of reported LOS exceeding AN-SNAP predicted LOS (OR 1.02, 95%CI 1.01-1.03, p < .001). CONCLUSIONS Inclusion of a measure of poststroke lateropulsion in the AN-SNAP classification model would result in more accurate LOS predictions to inform funding. Costs of longer rehabilitation LOS may be countered by optimized long-term physical function, reducing requirement for ongoing care.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.,Physiotherapy Department, Osborne Park Hospital, Stirling, Western Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.,Allied Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia
| | - Andy Wu
- Strategy, Policy and Intergovernmental Relations Directorate, Department of Health, East Perth, Western Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.,Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, Western Australia
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17
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Hunt J, Zwicker J, Godecke E, Raynor A. Assessing children to identify developmental coordination disorder: A survey of occupational therapists in Australia. Aust Occup Ther J 2023. [PMID: 36823758 DOI: 10.1111/1440-1630.12864] [Citation(s) in RCA: 1] [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] [Received: 08/22/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Developmental coordination disorder (DCD), a prevalent neurodevelopmental disorder with motor and psychosocial consequences, can significantly impact children's quality of life. In Australia, most children with diagnosed/suspected DCD have received occupational therapy services, more so than any other health service. As such, occupational therapists are key in identification and treatment and require a sound knowledge of diagnostic criteria and the best evidence for practice. This study explored current occupational therapy services for children with DCD. Areas for development are identified to improve the identification of, and subsequent intervention for, children with DCD. METHODS In this cross-sectional study, an online survey was completed in September and October 2020 by 175 occupational therapists working in Australia. RESULTS Although all therapists worked with children who met the criteria for DCD diagnosis, 70% worked with children with no specific diagnosis and 50% worked with children with outdated diagnostic labels. Australian occupational therapists used similar models/frameworks (commonly a multisensory/sensory processing approach) to guide practice with children with DCD, regardless of therapist characteristics, practice setting (clinic/community, rural/urban), how therapy is funded, or the state where the therapists completed their training/currently practiced. Although assessment practices did not differ significantly, therapists with greater years of paediatric practice and those who studied and/or practiced in Western Australia were more likely to assess to identify DCD. Half of the therapists did not assess to identify DCD; however, 60% of assessing therapists reported best practice methods in assessment for DCD, indicating emerging best practices in the Australian context. CONCLUSION The findings from this study suggest that small adaptations to current occupational therapy practice may enhance the early identification of children with DCD in Australia. The existing gaps in evidence to practice must be addressed to improve current Australian practice and increase access to appropriate services and ultimately improve the quality of life for children with DCD.
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Affiliation(s)
- Jacqui Hunt
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jill Zwicker
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Sir Charles Gairdner Osborne Park Health Care Group, North Metropolitan Health Service, Perth, Australia
| | - Annette Raynor
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Edith Cowan University, Joondalup, Western Australia, Australia
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18
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Brogan EL, Kim J, Grimley RS, Wallace SJ, Baker C, Thayabaranathan T, Andrew NE, Kilkenny MF, Godecke E, Rose ML, Cadilhac DA. The Excess Costs of Hospitalization for Acute Stroke in People With Communication Impairment: A Stroke123 Data Linkage Substudy. Arch Phys Med Rehabil 2023:S0003-9993(23)00090-4. [PMID: 36758711 DOI: 10.1016/j.apmr.2023.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/09/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To describe the costs of hospital care for acute stroke for patients with aphasia or dysarthria. DESIGN Observational study from the Stroke123 project. SETTING Data from patients admitted with stroke (2009-2013) from 22 hospitals in Queensland participating in the Australian Stroke Clinical Registry (AuSCR) were linked to administrative datasets. PARTICIPANTS Communication impairments were identified using International Classification of Diseases, 10th Revision, Australian Modification codes. Overall, 1043 of 4195 (25%) patients were identified with aphasia (49% were women; median age 78 years; 83% with ischemic stroke), and 1005 (24%) with dysarthria (42% were women; median age 76 years; 85% with ischemic stroke). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Linked patient-level, hospital clinical costing related to the stroke, were adjusted to 2013/2014 Australian dollars (AU$, US$ conversion x 0.691) using recommended national price indices and multivariable regression analysis with clustering by hospital performed. RESULTS Compared with patients without aphasia, the median hospital costs/patient were greater for those with aphasia for medical (aphasia AU$2273 vs AU$1727, P<.001), nursing (aphasia AU$3829 vs AU$2748, P<.001) and allied health services (aphasia AU$1138 vs AU$720, P<.001). Similarly, costs were greater for patients with dysarthria compared with those without dysarthria. Adjusted median total costs were AU$2882 greater for patients with aphasia compared with patients without aphasia (95% confidence interval, AU$1880-3884), and AU$843 greater for patients with dysarthria compared with those without dysarthria (95% confidence interval, AU$-301 to 1987). CONCLUSIONS People with communication impairment after stroke incur greater hospital costs, in particular for medical, allied health, and nursing resources.
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Affiliation(s)
- Emily L Brogan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Sir Charles Gairdner Hospital, Nedlands, Perth, Australia
| | - Joosup Kim
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Rohan S Grimley
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Griffith University, Queensland, Australia
| | - Sarah J Wallace
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Caroline Baker
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Speech Pathology Department, Monash Health, Melbourne, Victoria, Australia
| | - Tharshanah Thayabaranathan
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Nadine E Andrew
- The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Monique F Kilkenny
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Sir Charles Gairdner Hospital, Nedlands, Perth, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
| | - Dominique A Cadilhac
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
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19
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Nolan J, Godecke E, Singer B. Authors' response to commentary on the article entitled, "Post-stroke lateropulsion rehabilitation outcomes: a retrospective analysis". Disabil Rehabil 2023; 45:1752-1754. [PMID: 36722342 DOI: 10.1080/09638288.2023.2172221] [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: 02/02/2023]
Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Physiotherapy and Health Sciences, University of Notre Dame Australia, Fremantle, Australia.,Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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20
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Abstract
Although language deficits are the primary area of weakness, people with poststroke aphasia often experience challenges with nonlinguistic cognitive skills, including attention processing. The purpose of this review is to synthesize the evidence for the relationship between attention deficits and language deficits in people with poststroke aphasia. Three different types of studies are reviewed: (1) studies exploring whether people with poststroke aphasia exhibit concomitant attention and language deficits, (2) studies explicitly exploring the relationship between attention and language deficits in people with poststroke aphasia, and (3) either language or attention (or both) treatment studies exploring whether treatment gains in one domain generalize to the other. In the last section, we briefly review research evidence for the neural basis of the attention-language relationship in aphasia.
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Affiliation(s)
- Maria Varkanitsa
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation, Boston, MA, USA
| | - Erin Godecke
- Edith Cowan University and Sir Charles Gairdner Hospital, Perth, Australia
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation, Boston, MA, USA
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21
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Harvey S, Rose ML, Brogan E, Pierce JE, Godecke E, Brownsett SLE, Churilov L, Copland D, Dickey MW, Dignam J, Lannin NA, Nickels L, Bernhardt J, Hayward KS. Examining Dose Frameworks to Improve Aphasia Rehabilitation Research. Arch Phys Med Rehabil 2022; 104:830-838. [PMID: 36572201 DOI: 10.1016/j.apmr.2022.12.002] [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] [Received: 05/18/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022]
Abstract
The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research-the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.
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Affiliation(s)
- Sam Harvey
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Miranda L Rose
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - Emily Brogan
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - John E Pierce
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Erin Godecke
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Sonia L E Brownsett
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Leonid Churilov
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - David Copland
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Michael Walsh Dickey
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA; Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA
| | - Jade Dignam
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Natasha A Lannin
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Brain Recovery and Rehabilitation Group, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Lyndsey Nickels
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Julie Bernhardt
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Kathryn S Hayward
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
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22
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Brady MC, Ali M, VandenBerg K, Williams LJ, Williams LR, Abo M, Becker F, Bowen A, Brandenburg C, Breitenstein C, Bruehl S, Copland DA, Cranfill TB, Pietro-Bachmann MD, Enderby P, Fillingham J, Lucia Galli F, Gandolfi M, Glize B, Godecke E, Hawkins N, Hilari K, Hinckley J, Horton S, Howard D, Jaecks P, Jefferies E, Jesus LMT, Kambanaros M, Kyoung Kang E, Khedr EM, Pak-Hin Kong A, Kukkonen T, Laganaro M, Lambon Ralph MA, Charlotte Laska A, Leemann B, Leff AP, Lima RR, Lorenz A, MacWhinney B, Shisler Marshall R, Mattioli F, Maviş İ, Meinzer M, Nilipour R, Noé E, Paik NJ, Palmer R, Papathanasiou I, Patricio B, Pavão Martins I, Price C, Prizl Jakovac T, Rochon E, Rose ML, Rosso C, Rubi-Fessen I, Ruiter MB, Snell C, Stahl B, Szaflarski JP, Thomas SA, van de Sandt-Koenderman M, van der Meulen I, Visch-Brink E, Worrall L, Harris Wright H. Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis. Int J Stroke 2022; 17:1067-1077. [PMID: 35422175 PMCID: PMC9679795 DOI: 10.1177/17474930221097477] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/01/2022] [Indexed: 09/19/2023]
Abstract
BACKGROUND Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
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Affiliation(s)
| | - Marian C Brady
- Marian C Brady, NMAHP Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
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23
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Baker C, Foster AM, D'Souza S, Godecke E, Shiggins C, Lamborn E, Lanyon L, Kneebone I, Rose ML. Management of communication disability in the first 90 days after stroke: a scoping review. Disabil Rehabil 2022; 44:8524-8538. [PMID: 34919449 DOI: 10.1080/09638288.2021.2012843] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke. PURPOSE To explore the scope of literature for the management of communication disability in the first 90 days after stroke. MATERIALS AND METHODS A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF). RESULTS A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia). CONCLUSION A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required.IMPLICATIONS FOR REHABILITATIONInterdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes.There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning.Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care).
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Affiliation(s)
- Caroline Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia
| | - Abby M Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia.,School of Primary & Allied Health Care, Monash University, Melbourne, Australia
| | - Sarah D'Souza
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,School of Health Sciences, University of East Anglia, Norwich, UK
| | - Edwina Lamborn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lucette Lanyon
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Ian Kneebone
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadlands, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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24
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D'Souza S, Ciccone N, Hersh D, Janssen H, Armstrong E, Godecke E. Staff and volunteers' perceptions of a Communication Enhanced Environment model in an acute/slow stream rehabilitation and a rehabilitation hospital ward: a qualitative description study within a before-and-after pilot study. Disabil Rehabil 2022; 44:7009-7022. [PMID: 34739348 DOI: 10.1080/09638288.2021.1977397] [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: 01/13/2023]
Abstract
PURPOSE A lack of social interaction during early stroke recovery can negatively affect neurological recovery and health-related quality of life of patients with aphasia following stroke. A Communication Enhanced Environment (CEE) model was developed to increase patient engagement in language activities early after stroke. This study aimed to examine staff (n = 20) and volunteer (n = 2) perceptions of a CEE model and factors influencing the implementation and use of the model. This study formed part of a broader study that developed and embedded a CEE model on two hospital wards. MATERIALS AND METHODS Six focus groups and one interview with hospital staff were conducted and analysed using a qualitative description approach. Feedback emailed by volunteers was included in the data set. RESULTS Staff and volunteers perceived the CEE model benefitted themselves, the hospital system and patients. Staff identified a range of factors that influenced the implementation and use of the CEE model including individual staff, volunteer and patient factors, hospital features, the ease with which the CEE model could be used, and the implementation approach. CONCLUSIONS This study provides valuable insights into staff perceptions which may inform the implementation of interventions and future iterations of a CEE model.Implications for RehabilitationA CEE model may promote efficiency and increased patient engagement in stroke rehabilitation.The CEE model information session and aphasia communication partner training, and the provision of resources, may be useful strategies to increase staff confidence in using communication supporting strategies with patients with aphasia.Behaviour change and implementation science strategies may provide a framework to address barriers and promote facilitators to embed hospital-based interventions that require individual, ward, cultural and systems level change to reduce the evidence-based gap in clinical practice.
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Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Heidi Janssen
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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25
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Armstrong E, Rai T, Hersh D, Thompson S, Coffin J, Ciccone N, Flicker L, Cadilhac D, Godecke E, Woods D, Hayward C, Hankey GJ, McAllister M, Katzenellenbogen J. Statistical analysis plan for the stepped wedge clinical trial Healing Right Way-enhancing rehabilitation services for Aboriginal Australians after brain injury. Trials 2022; 23:886. [PMID: 36273182 PMCID: PMC9587581 DOI: 10.1186/s13063-022-06800-0] [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: 03/10/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. METHODS: The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL-5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care. DISCUSSION The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018.
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Affiliation(s)
- Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Broadway, Australia
| | - Deborah Hersh
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome, Australia.,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Broome, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia
| | | | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University and Sir Charles Gairdner and Osborne Park Healthcare Group, Perth, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
| | - Colleen Hayward
- Centre for Indigenous Australian Education and Research, Kurongkurl Katitjin, Australia Edith Cowan University, Perth, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Medical and Health Sciences, University of Western Australia, Perth, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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26
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Nolan J, Jacques A, Godecke E, Abe H, Babyar S, Bergmann J, Birnbaum M, Dai S, Danells C, Edwards TG, Gandolfi M, Jahn K, Koter R, Mansfield A, Nakamura J, Pardo V, Perennou D, Piscicelli C, Punt D, Romick-Sheldon D, Saeys W, Smania N, Vaes N, Whitt AL, Singer B. Post-stroke lateropulsion terminology: pushing for agreement amongst experts. Ann Phys Rehabil Med 2022; 65:101684. [PMID: 35667626 DOI: 10.1016/j.rehab.2022.101684] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 10/16/2022]
Abstract
Post-stroke lateropulsion is prevalent. The global inconsistency in terminology used to describe the condition presents obstacles in accurately comparing research results, reaching consensus on use of measurement tools, agreeing upon a consistent approach to rehabilitation, and translating research to clinical practice. Commencing in 2021, 20 international experts undertook a Delphi Process that aimed to compile clinical practice recommendations for the rehabilitation of lateropulsion. As a part of the process, the panel agreed to aim to reach consensus regarding terminology used to describe the condition. Improved understanding of the condition could lead to improved management, which will enhance patient outcomes after stroke and increase efficiency of healthcare resource utilisation. While consensus was not reached, the panel achieved some agreement that 'lateropulsion' is the preferred term to describe the phenomenon of 'active pushing of the body across the midline toward the more affected side, and / or actively resisting weight shift toward the less affected side'. This group recommends that 'lateropulsion' is used in future research and in clinical practice.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Osborne Park Hospital, Joondalup, Stirling, Australia.
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Department of Research, Sir Charles Gairdner Hospital, Fremantle, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Sir Charles Gairdner Hospital, Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Edith Cowan University, Joondalup, Melbourne, Nedlands, Vic, Australia
| | - Hiroaki Abe
- Fukushima Medical University, Fukushima, Japan
| | - Suzanne Babyar
- Hunter College, Burke Rehabilitation Hospital, New York, White Plains, NY, United States
| | - Jeannine Bergmann
- Schoen Clinic, Ludwig-Maximilians University of Munich, German Center for Vertigo and Balance Disorders (DSGZ), Bad Aibling, Munich, Germany
| | | | - Shenhao Dai
- UMR CNRS 5105 Neuropsychology and NeuroCognition, Univ. Grenoble Alpes, CHU Grenoble Alpes, Dept of NeuroRehabilitation South Hospital, Cs 10217 - 38043 cedex 9 Grenoble, France
| | - Cynthia Danells
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Taiza Gs Edwards
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurorehabilitation Unit, AOUI Verona, Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
| | - Klaus Jahn
- Schoen Clinic, German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Bad Aibling, Munich Germany
| | - Ryan Koter
- Sherherd Center, Atlanta, GA, United States
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Junji Nakamura
- Nishiyamato Rehabilitation Hospital, Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Vicky Pardo
- Wayne State University, Detroit, MI, United States
| | - Dominic Perennou
- UMR CNRS 5105 Neuropsychology and NeuroCognition, Univ. Grenoble Alpes, CHU Grenoble Alpes, Dept of NeuroRehabilitation South Hospital, Cs 10217 - 38043 cedex 9 Grenoble, France
| | - Celine Piscicelli
- UMR CNRS 5105 Neuropsychology and NeuroCognition, Univ. Grenoble Alpes, CHU Grenoble Alpes, Dept of NeuroRehabilitation South Hospital, Cs 10217 - 38043 cedex 9 Grenoble, France
| | - David Punt
- University of Birmingham, Birmingham, UK
| | | | - Wim Saeys
- University of Antwerp, Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Nicola Smania
- Neurorehabilitation Unit, AOUI Verona, Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nathalie Vaes
- Rehabilitation Hospital RevArte, Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Antwerp, Brussels, Belgium
| | - Abigail L Whitt
- Inova Fairfax Hospital Health System, Fairfax, VA, United States
| | - Barbara Singer
- School of Medical and Health Sciences, Training Centre in Subacute Care, South Metropolitan Health Service, Edith Cowan University, Fremantle Hospital, Fremantle, Joondalup, WA, Australia
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27
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Godecke E, Brogan E, Ciccone N, Rose ML, Armstrong E, Whitworth A, Ellery F, Holland A, Middleton S, Rai T, Hankey GJ, Cadilhac D, Bernhardt J. Treatment fidelity monitoring, reporting and findings in a complex aphasia intervention trial: a substudy of the Very Early Rehabilitation in SpEech (VERSE) trial. Trials 2022; 23:501. [PMID: 35710437 PMCID: PMC9204960 DOI: 10.1186/s13063-022-06433-3] [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: 05/25/2021] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial. Methods VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. Primary outcome: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups. Results Two hundred forty-six participants were randomised to Usual Care (n=81), Usual Care-Plus (n=82), and VERSE (n=83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations. Conclusions We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies. Trial registration ACTRN 12613000776707 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06433-3.
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Affiliation(s)
- Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia. .,Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia. .,Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Emily Brogan
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia.,Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia.,Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,La Trobe University, Melbourne, Victoria, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia
| | | | - Fiona Ellery
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | | | - Sandy Middleton
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,St Vincent's Health Network Sydney, Sydney, Australia.,Australian Catholic University, Sydney, Australia
| | - Tapan Rai
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Dominique Cadilhac
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Julie Bernhardt
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
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28
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English C, Hill K, Cadilhac DA, Hackett ML, Lannin NA, Middleton S, Ranta A, Stocks NP, Davey J, Faux SG, Godecke E, Campbell BCV. Living clinical guidelines for stroke: updates, challenges and opportunities. Med J Aust 2022; 216:510-514. [PMID: 35569098 PMCID: PMC9542680 DOI: 10.5694/mja2.51520] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Dominique A Cadilhac
- Monash University Melbourne VIC
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine University of NSW Sydney NSW
- University of Central Lancashire Preston UK
| | | | - Sandy Middleton
- Nursing Research Institute Australian Catholic University and St Vincent’s Health Australia Sydney NSW
- Australian Catholic University Sydney NSW
| | | | | | | | - Steven G Faux
- St Vincent's Hospital Sydney NSW
- University of NSW Sydney NSW
| | - Erin Godecke
- Edith Cowan University Perth WA
- Sir Charles Gairdner Hospital Perth WA
| | - Bruce CV Campbell
- Melbourne Brain Centre at Royal Melbourne Hospital Melbourne VIC
- University of Melbourne Melbourne VIC
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29
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Rose ML, Nickels L, Copland D, Togher L, Godecke E, Meinzer M, Rai T, Cadilhac DA, Kim J, Hurley M, Foster A, Carragher M, Wilcox C, Pierce JE, Steel G. Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia. J Neurol Neurosurg Psychiatry 2022; 93:573-581. [PMID: 35396340 PMCID: PMC9148985 DOI: 10.1136/jnnp-2021-328422] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND While meta-analyses confirm treatment for chronic post-stroke aphasia is effective, a lack of comparative evidence for different interventions limits prescription accuracy. We investigated whether Constraint-Induced Aphasia Therapy Plus (CIAT-plus) and/or Multimodality Aphasia Therapy (M-MAT) provided greater therapeutic benefit compared with usual community care and were differentially effective according to baseline aphasia severity. METHODS We conducted a three-arm, multicentre, parallel group, open-label, blinded endpoint, phase III, randomised-controlled trial. We stratified eligible participants by baseline aphasia on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ). Groups of three participants were randomly assigned (1:1:1) to 30 hours of CIAT-Plus or M-MAT or to usual care (UC). Primary outcome was change in aphasia severity (WAB-R-AQ) from baseline to therapy completion analysed in the intention-to-treat population. Secondary outcomes included word retrieval, connected speech, functional communication, multimodal communication, quality of life and costs. RESULTS We analysed 201 participants (70 in CIAT-Plus, 70 in M-MAT and 61 in UC). Aphasia severity was not significantly different between groups at postintervention: 1.05 points (95% CI -0.78 to 2.88; p=0.36) UC group vs CIAT-Plus; 1.06 points (95% CI -0.78 to 2.89; p=0.36) UC group vs M-MAT; 0.004 points (95% CI -1.76 to 1.77; p=1.00) CIAT-Plus vs M-MAT. Word retrieval, functional communication and communication-related quality of life were significantly improved following CIAT-Plus and M-MAT. Word retrieval benefits were maintained at 12-week follow-up. CONCLUSIONS CIAT-Plus and M-MAT were effective for word retrieval, functional communication, and quality of life, while UC was not. Future studies should explore predictive characteristics of responders and impacts of maintenance doses. TRIAL REGISTRATION NUMBER ACTRN 2615000618550.
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Affiliation(s)
- Miranda L Rose
- Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia .,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Lyndsey Nickels
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Copland
- Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,Queensland Aphasia Rehabilitation Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Godecke
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tapan Rai
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Melanie Hurley
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Abby Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | - Marcella Carragher
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Cassie Wilcox
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Gillian Steel
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
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Barnden R, Cadilhac DA, Lannin NA, Kneebone I, Hersh D, Godecke E, Stolwyk R, Purvis T, Nicks R, Farquhar M, Gleeson S, Gore C, Herrmann K, Andrew NE. Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke. PEC Innov 2021; 1:100008. [PMCID: PMC10194112 DOI: 10.1016/j.pecinn.2021.100008] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 06/17/2023]
Abstract
Objective Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units. Methods A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians' perspectives captured using semi-structured focus groups post-testing. Results The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time. Conclusion The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke. Innovation We developed an innovative approach to support structured person-centred goal setting in clinical and research settings.
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Affiliation(s)
- Rebecca Barnden
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Natasha A. Lannin
- School of Allied Health, Health Sciences Building 1, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
- Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ian Kneebone
- Graduate School of Health, Building 20, University of Technology Sydney, 100 Broadway, Ultimo, NSW 2007, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Rene Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Rd, Clayton, VIC 3800, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Rebecca Nicks
- Occupational Therapy Department, Eastern Health, 5 Arnold St, Box Hill, Melbourne, VIC 3128, Australia
| | | | - Stephanie Gleeson
- Occupational Therapy Department, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Carol Gore
- Subacute Care Services, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Kelsie Herrmann
- Lung Foundation Australia, 11 Finchley St, Milton, QLD 4064, Australia
| | - Nadine E. Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
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D'Souza S, Hersh D, Godecke E, Ciccone N, Janssen H, Armstrong E. Patients' experiences of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward following stroke: a qualitative description approach. Disabil Rehabil 2021; 44:6304-6313. [PMID: 34780322 DOI: 10.1080/09638288.2021.1965226] [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: 10/19/2022]
Abstract
BACKGROUND Patients in hospital following stroke express a desire to continue therapy tasks outside of treatment activities. However, they commonly describe experiences of boredom and inactivity. An enriched environment aims to provide opportunities for physical, cognitive and social activity and informed the development of a Communication Enhanced Environment (CEE) model to promote patient engagement in language activities. PURPOSE Explore patient perceptions of a CEE model, and barriers and facilitators to engagement in the model. METHODS A qualitative description study from a larger project that implemented a CEE model into acute and rehabilitation private hospital wards in Western Australia. Semi-structured interviews were conducted with seven patients, including four with aphasia, within 22 days post-stroke who had access to the CEE model. RESULTS Patients described variable experiences accessing different elements of the CEE model which were influenced by individual patient factors, staff factors, hospital features as well as staff time pressures. Those who were able to access elements of the CEE model described positive opportunities for engagement in language activities. CONCLUSIONS While findings are encouraging, further exploration of the feasibility of a CEE model in this complex setting is indicated to inform the development of this intervention.Implications for rehabilitationPatient access to a CEE model is challenging in a hospital setting.Patients who were able to access elements of the CEE model described positive opportunities for engagement in language activities.Patients' access to the CEE model was influenced by patient factors, staff factors, hospital features as well as staff time pressures.
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Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Heidi Janssen
- School of Health Sciences, Hunter New England Local Health District, NSW Health, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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D'Souza S, Godecke E, Ciccone N, Hersh D, Armstrong E, Tucak C, Janssen H. Investigation of the implementation of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward: A before-and-after pilot study. Clin Rehabil 2021; 36:15-39. [PMID: 34749509 DOI: 10.1177/02692155211032655] [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: 11/15/2022]
Abstract
OBJECTIVES Develop and implement a Communication Enhanced Environment model and explore its effect on language activities for patients early after stroke. METHOD AND DESIGN Before-and-after pilot study. SETTING An acute/slow stream rehabilitation and a rehabilitation ward in a private hospital in Perth, Western Australia. PARTICIPANTS Fourteen patients recruited within 21 days of stroke. Seven recruited during the before-phase (control group: patients with aphasia = 3, patients without aphasia = 4) and seven recruited in the after-phase (intervention group: patients with aphasia = 4, patients without aphasia = 3). INTERVENTION The intervention group exposed to a Communication Enhanced Environment model had access to equipment, resources, planned social activities and trained communication partners. Both groups received usual stroke care. DATA COLLECTION Hospital site champions monitored the availability of the intervention. Behavioural mapping completed during the first minute of each 5-minute interval over 12 hours (between 7 am and 7 pm) determined patient engagement in language activities. RESULTS Seventy-one percent of the Communication Enhanced Environment model was available to the intervention group who engaged in higher, but not significant (95% CI), levels of language activities (600 of 816 observation time points, 73%) than the control group (551 of 835 observation time points, 66%). Unforeseen reorganisation of the acute ward occurred during the study. CONCLUSIONS Implementation of a Communication Enhanced Environment model was feasible in this specific setting and may potentially influence patients' engagement in language activities. The unforeseen contextual challenges that occurred during the study period demonstrate the challenging nature of the hospital environment and will be useful in future research planning.
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Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, VIC, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, VIC, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Claire Tucak
- Hollywood Private Hospital, Nedlands, WA, Australia
| | - Heidi Janssen
- Hunter New England Local Health District, New Lambton Heights, NSW Health, NSW, Australia.,Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
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Armstrong E, Coffin J, Hersh D, Katzenellenbogen JM, Thompson S, Flicker L, McAllister M, Cadilhac DA, Rai T, Godecke E, Hayward C, Hankey GJ, Drew N, Lin I, Woods D, Ciccone N. Healing Right Way: study protocol for a stepped wedge cluster randomised controlled trial to enhance rehabilitation services and improve quality of life in Aboriginal Australians after brain injury. BMJ Open 2021; 11:e045898. [PMID: 34588230 PMCID: PMC8479943 DOI: 10.1136/bmjopen-2020-045898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 08/31/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Despite higher incidence of brain injury among Aboriginal compared with non-Aboriginal Australians, suboptimal engagement exists between rehabilitation services and Aboriginal brain injury survivors. Aboriginal patients often feel culturally insecure in hospital and navigation of services post discharge is complex. Health professionals report feeling ill-equipped working with Aboriginal patients. This study will test the impact of a research-informed culturally secure intervention model for Aboriginal people with brain injury. METHODS AND ANALYSIS: Design: Stepped wedge cluster randomised control trial design; intervention sequentially introduced at four pairs of healthcare sites across Western Australia at 26-week intervals.Recruitment: Aboriginal participants aged ≥18 years within 4 weeks of an acute stroke or traumatic brain injury.Intervention: (1) Cultural security training for hospital staff and (2) local, trial-specific, Aboriginal Brain Injury Coordinators supporting participants.Primary outcome: Quality-of-life using EuroQOL-5D-3L (European Quality of Life scale, five dimensions, three severity levels) Visual Analogue Scale score at 26 weeks post injury. Recruitment of 312 participants is estimated to detect a difference of 15 points with 80% power at the 5% significance level. A linear mixed model will be used to assess the between-condition difference.Secondary outcome measures: Modified Rankin Scale, Functional Independence Measure, Modified Caregiver Strain Index, Hospital Anxiety and Depression Scale at 12 and 26 weeks post injury, rehabilitation occasions of service received, hospital compliance with minimum care processes by 26 weeks post injury, acceptability of Intervention Package, feasibility of Aboriginal Brain Injury Coordinator role.Evaluations: An economic evaluation will determine the potential cost-effectiveness of the intervention. Process evaluation will document fidelity to study processes and capture changing contexts including barriers to intervention implementation and acceptability/feasibility of the intervention through participant questionnaires at 12 and 26 weeks. ETHICS AND DISSEMINATION The study has approvals from Aboriginal, university and health services human research ethics committees. Findings will be disseminated through stakeholder reports, participant workshops, peer-reviewed journal articles and conference papers. TRIAL REGISTRATION NUMBER ACTRN12618000139279.
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Affiliation(s)
- Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome, Western Australia, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | | | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Colleen Hayward
- School of Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Western Australia, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
| | - Neil Drew
- School of Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Western Australia, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, University of Western Australia - Geraldton Campus, Geraldton, Western Australia, Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Abstract
PURPOSE A person with post-stroke lateropulsion actively pushes themselves toward their hemiplegic side, or resists moving onto their non-hemiplegic side. This study aimed to determine the association of lateropulsion severity with: • Change in function (Functional Independence Measure - FIM) and lateropulsion severity (Four-Point Pusher Score - 4PPS) during inpatient rehabilitation; • Inpatient rehabilitation length of stay (LOS); • Discharge destination from inpatient rehabilitation. METHODS Retrospective data for 1,087 participants (aged ≥65 years) admitted to a stroke rehabilitation unit (2005-2018) were analysed using multivariable regression models. RESULTS Complete resolution of lateropulsion was seen in 69.4% of those with mild lateropulsion on admission (n = 160), 49.3% of those with moderate lateropulsion (n = 142), and 18.8% of those with severe lateropulsion (n = 181). Average FIM change was lower in those with severe lateropulsion on admission than those with no lateropulsion (p < 0.001). Higher admission 4PPS was associated with reduced FIM efficiency (p < 0.001), longer LOS (p < 0.001), (adjusted mean LOS: 35.6 days for those with severe lateropulsion versus 27.0 days for those without), and reduced likelihood of discharge home (p < 0.001). CONCLUSION Post-stroke lateropulsion is associated with reduced functional improvement and likelihood of discharge home. However, given a longer rehabilitation duration, most stroke survivors with moderate to severe lateropulsion can achieve important functional improvement.Implications for RehabilitationWhile people with post-stroke lateropulsion can be difficult to treat and require more resources than those without lateropulsion, the majority of those affected, even in severe cases, can make meaningful recovery with appropriate rehabilitation.Although those with moderate to severe post-stroke lateropulsion may have poorer outcomes (longer LOS and reduced likelihood of discharge home) it is still important to advocate for access to rehabilitation for this patient group to give them the opportunity for optimal functional recovery.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Osborne Park Hospital, Stirling, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Sir Charles Gairdner Hospital, Nedlands, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, Australia
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D'Souza S, Godecke E, Ciccone N, Hersh D, Janssen H, Armstrong E. Hospital staff, volunteers' and patients' perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study. BMJ Open 2021; 11:e043897. [PMID: 33952543 PMCID: PMC8103362 DOI: 10.1136/bmjopen-2020-043897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/22/2022] Open
Abstract
OBJECTIVES To explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke. DESIGN A qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward. SETTING A metropolitan Australian private hospital. PARTICIPANTS Focus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted. RESULTS The key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients' functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients. CONCLUSIONS Barriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.
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Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
- Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
- Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Victoria, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
| | - Heidi Janssen
- School of Health Sciences, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
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Rose ML, Rai T, Copland D, Nickels L, Togher L, Meinzer M, Godecke E, Kim J, Cadilhac DA, Hurley M, Wilcox C, Carragher M. Statistical analysis plan for the COMPARE trial: a 3-arm randomised controlled trial comparing the effectiveness of Constraint-induced Aphasia Therapy Plus and Multi-modality Aphasia Therapy to usual care in chronic post-stroke aphasia (COMPARE). Trials 2021; 22:303. [PMID: 33892764 PMCID: PMC8062936 DOI: 10.1186/s13063-021-05238-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/17/2020] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND While high-quality meta-analyses have confirmed the effectiveness of aphasia therapy after stroke, there is limited evidence for the comparative effectiveness of different aphasia interventions. Two commonly used interventions, Constraint-induced Aphasia Therapy Plus (CIAT Plus) and Multi-modality Aphasia Therapy (M-MAT), are hypothesised to rely on diverse underlying neural mechanisms for recovery and may be differentially responsive to aphasia severity. COMPARE is a prospective randomised open-blinded end-point trial designed to determine whether, in people with chronic post-stroke aphasia living in the community, CIAT Plus and M-MAT provide greater therapeutic benefit compared to usual care, are differentially effective according to aphasia severity, and are cost-effective. This paper details the statistical analysis plan for the COMPARE trial developed prior to data analysis. METHODS Participants (n = 216) are randomised to one of three arms, CIAT Plus, M-MAT or usual care, and undertake therapy with a study trained speech pathologist in groups of three participants stratified by aphasia severity. Therapy occurs for 3 h blocks per day for 10 days across 2 weeks. The primary clinical outcome is aphasia severity as measured by the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ) immediately post intervention. Secondary outcomes include WAB-R-AQ at 12-week follow-up, and functional communication, discourse efficiency, multimodal communication, and health-related quality of life immediately post intervention and at 12-week follow-up. RESULTS Linear mixed models (LMMs) will be used to analyse differences between M-MAT and UC, and CIAT-Plus and UC on each outcome measure immediately and at 12 weeks post-intervention. The LMM for WAB-R-AQ will assess the differences in efficacy between M-MAT and CIAT-Plus. All analyses will control for baseline aphasia severity (fixed effect) and for the clustering effect of treatment groups (random effect). DISCUSSION This trial will provide relative effectiveness data for two common interventions for people with chronic post-stroke aphasia, and highlight possible differential effects based on aphasia severity. Together with the health economic analysis data, the results will enable more informed personalised prescription for aphasia therapy after stroke. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN 12615000618550 . Registered on 15 June 2016.
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Affiliation(s)
- Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University Melbourne, Kingsbury Drive, Bundoora, Victoria, 3084, Australia.
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.
| | - Tapan Rai
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David Copland
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Lyndsey Nickels
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - Joosup Kim
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- Australia School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- Australia School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
| | - Melanie Hurley
- School of Allied Health, Human Services and Sport, La Trobe University Melbourne, Kingsbury Drive, Bundoora, Victoria, 3084, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Cassie Wilcox
- School of Allied Health, Human Services and Sport, La Trobe University Melbourne, Kingsbury Drive, Bundoora, Victoria, 3084, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport, La Trobe University Melbourne, Kingsbury Drive, Bundoora, Victoria, 3084, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
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Hunt J, Zwicker JG, Godecke E, Raynor A. Awareness and knowledge of developmental coordination disorder: A survey of caregivers, teachers, allied health professionals and medical professionals in Australia. Child Care Health Dev 2021; 47:174-183. [PMID: 33140459 PMCID: PMC7894302 DOI: 10.1111/cch.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To allow for accurate and timely diagnosis of developmental coordination disorder (DCD) key stakeholders must be familiar with and be able to identify features of this disorder. No studies to date have investigated the awareness of DCD among key stakeholders in Australia. METHODS An online survey was complete by 494 Australian participants: primary caregivers (n = 153), teachers (n = 149), allied health professionals (n = 165) and medical professionals (n = 27). RESULTS DCD and related terms were among the least known childhood disorders. Approximately half of the sample were familiar with the term DCD but every stakeholder group were more familiar with the term dyspraxia. Allied health professionals demonstrated greater knowledge of the features of DCD, particularly motor features. Every stakeholder group showed poor recognition of the social and psychological effects of DCD. A relatively low percentage of allied health (53%) and medical (33%) professionals reported they had identified or diagnosed DCD and less than 20% of these felt that the DSM-5 contained adequate information to make a DCD diagnosis. Most teachers (82%) believed they should play a role in identifying early warning signs of this disorder, and 80% believed there are children in the school system who were labelled as lazy or defiant when they have motor skills impairments. Primary caregivers were supportive of a diagnosis of DCD being provided; however, only 16% were confident that a physician would provide an accurate and timely diagnosis. CONCLUSION Key stakeholders play a unique and important role in the identification of children with DCD. Though most participants acknowledge the role that they play, all stakeholder groups demonstrated poor familiarity with the term DCD and low levels of knowledge about the features of this disorder. Improved familiarity and knowledge of the disorder is needed for access to appropriate services and improved long-term outcomes for this condition.
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Affiliation(s)
- Jacqui Hunt
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Jill G Zwicker
- Department of Occupational Science & Occupational TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Brain, Behaviour, & DevelopmentBC Children's Hospital Research InstituteVancouverBritish ColumbiaCanada
- Neuromotor ProgramSunny Hill Health Centre at BC Children's HospitalVancouverBritish ColumbiaCanada
| | - Erin Godecke
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Annette Raynor
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
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Abstract
Background: Contraversive lateropulsion is a common post-stroke impairment. Rehabilitation outcomes in stroke survivors exhibiting lateropulsion may differ from those without lateropulsion.Objectives: To systematically review evidence regarding associations between:1. Presence/severity of lateropulsion after stroke and functional outcome, rehabilitation length of stay, and discharge destination;2. Stroke-related factors and resolution of lateropulsion, functional outcome, rehabilitation length of stay, and discharge destination in affected stroke survivors.Methods: Medline, CINAHL, and Embase databases were searched. Journal articles published in English reporting on resolution of lateropulsion, length of stay, functional outcome, and/or discharge destination associated with post-stroke lateropulsion were included for review. Studies that did not include a comparison group (stroke survivors without lateropulsion, or sub-groups of participants with lateropulsion based on stroke-related factors), animal studies, and studies reporting only on ipsiversive lateropulsion and/or lateral medullary syndrome were excluded. Two authors independently assessed studies for inclusion. Included studies were evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies.Results: Screening identified 133 articles. Seven articles met inclusion criteria. People with contraversive lateropulsion after stroke can achieve similar improvements in function as those without lateropulsion, increasing likelihood of discharge home, but require longer rehabilitation durations to do so.Conclusions: The finding that longer rehabilitation durations are required for people with post-stroke lateropulsion to achieve their functional potential and increase likelihood of discharge home has implications for resourcing rehabilitation services. Given an additional three to four weeks in rehabilitation, people with post-stroke lateropulsion can achieve functional improvements function similar to those without lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australian.,Physiotherapy Department, Osborne Park Hospital, Stirling, Western Australia, Australian
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australian.,Speech Pathology Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australian.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australian.,Western Australian Department of Health, Training Centre in Subacute Care WA, Fremantle, Western Australia, Australia
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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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Godecke E, Armstrong E, Rai T, Ciccone N, Rose ML, Middleton S, Whitworth A, Holland A, Ellery F, Hankey GJ, Cadilhac DA, Bernhardt J. A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study. Int J Stroke 2020; 16:556-572. [PMID: 33019888 PMCID: PMC8267088 DOI: 10.1177/1747493020961926] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 11/16/2022]
Abstract
BACKGROUND Effectiveness of early intensive aphasia rehabilitation after stroke is unknown. The Very Early Rehabilitation for SpEech trial (VERSE) aimed to determine whether intensive aphasia therapy, beginning within 14 days after stroke, improved communication recovery compared to usual care. METHODS Prospective, randomized, single-blinded trial conducted at 17 acute-care hospitals across Australia/New Zealand from 2014 to 2018. Participants with aphasia following acute stroke were randomized to receive usual care (direct usual care aphasia therapy), or one of two higher intensity regimens (20 sessions of either non-prescribed (usual care-plus or prescribed (VERSE) direct aphasia therapy). The primary outcome was improvement of communication on the Western Aphasia Battery-Revised Aphasia Quotient (AQ) at 12 weeks after stroke. Our pre-planned intention to treat analysis combined high intensity groups for the primary outcome. FINDINGS Among 13,654 acute stroke patients screened, 25% (3477) had aphasia, of whom 25% (866) were eligible and 246 randomized to usual care (n = 81; 33%), usual care-plus (n = 82; 33%) or VERSE (n = 83; 34%). At 12 weeks after stroke, the primary outcome was assessed in 217 participants (88%); 14 had died, 9 had withdrawn, and 6 were too unwell for assessment. Communication recovery was 50.3% (95% CI 45.7-54.8) in the high intensity group (n = 147) and 52.1% (95% CI 46.1-58.1) in the usual care group (n = 70; difference -1.8, 95% CI -8.7-5.0). There was no difference between groups in non-fatal or fatal adverse events (p = 0.72). INTERPRETATION Early, intensive aphasia therapy did not improve communication recovery within 12 weeks post stroke compared to usual care.
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Affiliation(s)
- Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology NSW, Broadway, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sandy Middleton
- St Vincent's Health Australia, Sydney and Australian Catholic University, Darlinghurst, Australia
| | - Anne Whitworth
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Audrey Holland
- Speech Language Pathology, University of Arizona, Tucson, AZ, USA
| | - Fiona Ellery
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Graeme J Hankey
- Medical School, The University of Western Australia, Perth, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Science at Monash Health, Monash University, Clayton, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
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Rohde A, McCracken M, Worrall L, Farrell A, O'Halloran R, Godecke E, David M, Doi SA. Inter-rater reliability, intra-rater reliability and internal consistency of the Brisbane Evidence-Based Language Test. Disabil Rehabil 2020; 44:637-645. [PMID: 32571103 DOI: 10.1080/09638288.2020.1776774] [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: 10/24/2022]
Abstract
Purpose: To examine the inter-rater reliability, intra-rater reliability, internal consistency and practice effects associated with a new test, the Brisbane Evidence-Based Language Test.Methods: Reliability estimates were obtained in a repeated-measures design through analysis of clinician video ratings of stroke participants completing the Brisbane Evidence-Based Language Test. Inter-rater reliability was determined by comparing 15 independent clinicians' scores of 15 randomly selected videos. Intra-rater reliability was determined by comparing two clinicians' scores of 35 videos when re-scored after a two-week interval.Results: Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect inter-rater reliability (0.995; 95% confidence interval: 0.990-0.998), intra-rater reliability (0.994; 95% confidence interval: 0.989-0.997) and internal consistency (Cronbach's α = 0.940 (95% confidence interval: 0.920-1.0)). Almost perfect correlations (0.998; 95% confidence interval: 0.995-0.999) between face-to-face and video ratings were obtained.Conclusion: The Brisbane Evidence-Based Language Test demonstrates almost perfect inter-rater reliability, intra-rater reliability and internal consistency. High correlation coefficients and narrow confidence intervals demonstrated minimal practice effects with scoring or influence of years of clinical experience on test scores. Almost perfect correlations between face-to-face and video scoring methods indicate these reliability estimates have direct application to everyday practice. The test is available from brisbanetest.org.Implications for RehabilitationThe Brisbane Evidence-Based Language Test is a new measure for the assessment of acquired language disorders.The Brisbane Evidence-Based Language Test demonstrated almost perfect inter-rater reliability, intra-rater reliability and internal consistency.High reliability estimates and narrow confidence intervals indicated that test ratings vary minimally when administered by clinicians of different experience levels, or different levels of familiarity with the new measure.The test is a reliable measure of language performance for use in clinical practice and research.
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Affiliation(s)
- Alexia Rohde
- Speech Pathology Department, Southern Cross University, Bilinga, Australia.,Speech Pathology Department, The University of Queensland, Brisbane, Australia
| | - Molly McCracken
- Speech Pathology Department, The University of Queensland, Brisbane, Australia
| | - Linda Worrall
- Speech Pathology Department, The University of Queensland, Brisbane, Australia
| | - Anna Farrell
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robyn O'Halloran
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
| | - Erin Godecke
- Department of Speech Pathology, Edith Cowan University, Joondalup, Australia
| | - Michael David
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Suhail A Doi
- Department of Population Medicine, Qatar University, Doha, Qatar
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42
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Rohde A, Doi SA, Worrall L, Godecke E, Farrell A, O'Halloran R, McCracken M, Lawson N, Cremer R, Wong A. Development and diagnostic validation of the Brisbane Evidence-Based Language Test. Disabil Rehabil 2020; 44:625-636. [PMID: 32571105 DOI: 10.1080/09638288.2020.1773547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/24/2022]
Abstract
Purpose: To describe the development and determine the diagnostic accuracy of the Brisbane Evidence-Based Language Test in detecting aphasia.Methods: Consecutive acute stroke admissions (n = 100; mean = 66.49y) participated in a single (assessor) blinded cross-sectional study. Index assessment was the ∼45 min Brisbane Evidence-Based Language Test. The Brisbane Evidence-Based Language Test is further divided into four 15-25 min Short Tests: two Foundation Tests (severe impairment), Standard (moderate) and High Level Test (mild). Independent reference standard included the Language Screening Test, Aphasia Screening Test, Comprehensive Aphasia Test and/or Measure for Cognitive-Linguistic Abilities, treating team diagnosis and aphasia referral post-ward discharge.Results: Brisbane Evidence-Based Language Test cut-off score of ≤157 demonstrated 80.8% (LR+ =10.9) sensitivity and 92.6% (LR- =0.21) specificity. All Short Tests reported specificities of ≥92.6%. Foundation Tests I (cut-off ≤61) and II (cut-off ≤51) reported lower sensitivity (≥57.5%) given their focus on severe conditions. The Standard (cut-off ≤90) and High Level Test (cut-off ≤78) reported sensitivities of ≥72.6%.Conclusion: The Brisbane Evidence-Based Language Test is a sensitive assessment of aphasia. Diagnostically, the High Level Test recorded the highest psychometric capabilities of the Short Tests, equivalent to the full Brisbane Evidence-Based Language Test. The test is available for download from brisbanetest.org.Implications for rehabilitationAphasia is a debilitating condition and accurate identification of language disorders is important in healthcare.Language assessment is complex and the accuracy of assessment procedures is dependent upon a variety of factors.The Brisbane Evidence-Based Language Test is a new evidence-based language test specifically designed to adapt to varying patient need, clinical contexts and co-occurring conditions.In this cross-sectional validation study, the Brisbane Evidence-Based Language Test was found to be a sensitive measure for identifying aphasia in stroke.
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Affiliation(s)
- Alexia Rohde
- Speech Pathology Department, Southern Cross University, Bilinga, Australia.,Speech Pathology Department, The University of Queensland, Brisbane, Australia
| | - Suhail A Doi
- Department of Population Medicine, Qatar University, Doha, Qatar
| | - Linda Worrall
- Speech Pathology Department, The University of Queensland, Brisbane, Australia
| | - Erin Godecke
- Department of Speech Pathology, Edith Cowan University, Joondalup, Australia
| | - Anna Farrell
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robyn O'Halloran
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
| | - Molly McCracken
- Speech Pathology Department, The University of Queensland, Brisbane, Australia
| | - Nadine Lawson
- Department of Speech Pathology, Princess Alexandra Hospital, Brisbane, Australia
| | - Rebecca Cremer
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Andrew Wong
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
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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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Mohannak N, Pattison G, Radich B, Hird K, Godecke E, Mastaglia F, Needham M. Exploring the efficacy of the expiratory muscle strength trainer to improve swallowing in inclusion body myositis: A pilot study. Neuromuscul Disord 2020; 30:294-300. [PMID: 32307229 DOI: 10.1016/j.nmd.2020.02.010] [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] [Received: 10/27/2019] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022]
Abstract
Inclusion Body Myositis (IBM) is the most common acquired myopathy in older individuals with more than two thirds of patients experiencing impaired swallowing. There are currently no standardized exercise therapies to improve or sustain swallowing despite good evidence for exercise therapy in limb muscles. Reduced upper esophageal sphincter opening is a common abnormality associated with dysphagia in IBM. This pilot study recruited IBM patients with abnormal upper esophageal sphincter function and dysphagia into an exercise program. It was hypothesized that regular practice using the Expiratory Muscle Strength Trainer (EMST) device would improve hyolaryngeal movement by strengthening suprahyoid musculature and facilitate opening of the upper esophageal sphincter thereby improving swallowing and quality of life. Overall, IBM patients who used the EMST device demonstrated no improvement in swallowing function. Consistent with that result, there was also no change in measures of quality of life. However, further studies are needed to elucidate whether it has a preventative role in the development or progression of dysphagia in IBM as there is a suggestion that patients with a shorter duration of disease may have had some benefit. This research provides pilot data and recommendations that will guide future studies on exercise therapy and swallowing in this area.
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Affiliation(s)
- Nika Mohannak
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia 6160, Australia.
| | - Gemma Pattison
- Department of Speech Pathology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Bronwyn Radich
- Department of Speech Pathology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Kathryn Hird
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia 6160, Australia
| | - Erin Godecke
- School of Medicine and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Frank Mastaglia
- The Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Merrilee Needham
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia 6160, Australia; Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
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45
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Brady MC, Ali M, VandenBerg K, Williams LJ, Williams LR, Abo M, Becker F, Bowen A, Brandenburg C, Breitenstein C, Bruehl S, Copland DA, Cranfill TB, Pietro-Bachmann MD, Enderby P, Fillingham J, Galli FL, Gandolfi M, Glize B, Godecke E, Hawkins N, Hilari K, Hinckley J, Horton S, Howard D, Jaecks P, Jefferies E, Jesus LMT, Kambanaros M, Kang EK, Khedr EM, Kong APH, Kukkonen T, Laganaro M, Ralph MAL, Laska AC, Leemann B, Leff AP, Lima RR, Lorenz A, MacWhinney B, Marshall RS, Mattioli F, Maviş I, Meinzer M, Nilipour R, Noé E, Paik NJ, Palmer R, Papathanasiou I, Patricio BF, Martins IP, Price C, Jakovac TP, Rochon E, Rose ML, Rosso C, Rubi-Fessen I, Ruiter MB, Snell C, Stahl B, Szaflarski JP, Thomas SA, van de Sandt-Koenderman M, van der Meulen I, Visch-Brink E, Worrall L, Wright HH. RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia. Aphasiology 2020; 34:137-157. [PMID: 37560459 PMCID: PMC7614912 DOI: 10.1080/02687038.2019.1643003] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. AIM To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. METHODS AND PROCEDURES We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta- and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. OUTCOMES AND RESULTS Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. CONCLUSION Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947).
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Affiliation(s)
- Marian C. Brady
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Myzoon Ali
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kathryn VandenBerg
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Linda J. Williams
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Louise R. Williams
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Frank Becker
- University of Oslo, Oslo, and Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - Audrey Bowen
- Division of Neuroscience & Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Caitlin Brandenburg
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Stefanie Bruehl
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - David A. Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | | | - Marie di Pietro-Bachmann
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Pamela Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Federica Lucia Galli
- Neurorehabilitation Clinic, Neurological Sciences Department, Marche Polytechnic University, Ancona, Italy
| | - Marialuisa Gandolfi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Bertrand Glize
- EA 4136 Handicap Activity Cognition Health, University of Bordeaux and Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, France
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Neil Hawkins
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Katerina Hilari
- Division of Language and Communication Science, City, University of London, London, UK
| | - Jacqueline Hinckley
- Department of Speech-Language Pathology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Simon Horton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Howard
- School of Education Communication and Language Sciences, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Petra Jaecks
- Faculty of Linguistics and Literary Studies, Bielefeld University, Bielefeld, Germany
| | | | - Luis M. T. Jesus
- School of Health Sciences (ESSUA) and Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Maria Kambanaros
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Eun Kyoung Kang
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Eman M. Khedr
- Department of Neurology, Assiut University Hospital, Assiut, Egypt
| | - Anthony Pak-Hin Kong
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Tarja Kukkonen
- ENT/Department of Phoniatry, Tampere University Hospital, Tampere, Finland
| | - Marina Laganaro
- Faculty of Psychology and Educational Science, University of Geneva, Geneva, Switzerland
| | | | - Ann Charlotte Laska
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Béatrice Leemann
- Neurorééducation, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexander P. Leff
- Department of Brain Repair and Rehabilitation, Institute of Neurology, UCL, London, UK
| | - Roxele R. Lima
- Department of Speech Language Pathology, Educational Association Bom Jesus – IELUSC, Santa Catarina, Brazil
| | - Antje Lorenz
- Institut für Psychologie, Humboldt University Berlin, Berlin, Germany
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Flavia Mattioli
- Neuropsychology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - ilknur Maviş
- Department of Speech and Language Therapy, Anadolu University, Eskişehir, Turkey
| | - Marcus Meinzer
- UQ Centre for Clinical Research, The University of Queensland, Hertston, Australia
| | - Reza Nilipour
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ilias Papathanasiou
- Department of Speech and Language Therapy, Technological Educational Institute of Western Greece, Patras, Greece
| | - Brigida F. Patricio
- Speech Therapy Department of Health School of Polytechnic Institute of Porto, Porto, Portugal
| | - Isabel Pavão Martins
- Laboratório de Estudos de Linguagem, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
| | - Cathy Price
- Wellcome Centre for Human Neuroimaging, UCL, London, UK
| | - Tatjana Prizl Jakovac
- Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
| | - Elizabeth Rochon
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, and Toronto Rehabilitation Institute, Toronto, Canada
| | - Miranda L. Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Charlotte Rosso
- Institut du Cerveau et del la Moelle épinière, Sorbonne University, APHP, Urgences Cérébro-Vasculaires, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Ilona Rubi-Fessen
- RehaNova Rehabilitation Hospital and Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Marina B. Ruiter
- Sint Maartenskliniek, Rehabilitation Centre and Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Claerwen Snell
- Warrington Hospital, Warrington and Halton NHS Foundation Trust, Warrington, UK
| | - Benjamin Stahl
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jerzy P. Szaflarski
- UAB Epilepsy Centre, Department of Neurology, University of Alabama at Birmingham, AL, USA
| | - Shirley A. Thomas
- Division of Rehabilitation & Ageing; School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Ineke van der Meulen
- Rijndam rehabilitation Rotterdam and Erasmus University Medical Center, Rotterdam, Netherlands
| | - Evy Visch-Brink
- Department of Neurology and Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Rose ML, Copland D, Nickels L, Togher L, Meinzer M, Rai T, Cadilhac DA, Kim J, Foster A, Carragher M, Hurley M, Godecke E. Constraint-induced or multi-modal personalized aphasia rehabilitation (COMPARE): A randomized controlled trial for stroke-related chronic aphasia. Int J Stroke 2019; 14:972-976. [PMID: 31496440 DOI: 10.1177/1747493019870401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Indexed: 11/17/2022]
Abstract
RATIONALE The comparative efficacy and cost-effectiveness of constraint-induced and multi-modality aphasia therapy in chronic stroke are unknown. AIMS AND HYPOTHESES In the COMPARE trial, we aim to determine whether Multi-Modal Aphasia Treatment (M-MAT) and Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) are superior to usual care (UC) for chronic post-stroke aphasia. Primary hypothesis: CIAT-Plus and M-MAT will reduce aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ)) compared with UC: CIAT-Plus superior for moderate aphasia; M-MAT superior for mild and severe aphasia. SAMPLE SIZE ESTIMATES A total of 216 participants (72 per arm) will provide 90% power to detect a 5-point difference on the WAB-R-AQ between CIAT-Plus or M-MAT and UC at α = 0.05. METHODS AND DESIGN Prospective, randomized, parallel group, open-label, assessor blinded trial. Participants: Stroke >6 months; aphasia severity categorized using WAB-R-AQ. Computer-generated blocked and stratified randomization by aphasia severity (mild, moderate, and severe), to 3 arms: CIAT-Plus, M-MAT (both 30 h therapy over two weeks); UC (self-reported usual community care). STUDY OUTCOMES WAB-R-AQ immediately post-intervention. Secondary outcomes: WAB-R-AQ at 12-week follow-up; naming scores, discourse measures, Communicative Effectiveness Index, Scenario Test, and Stroke and Aphasia Quality of Life Scale-39 g immediately and at 12 weeks post-intervention; incremental cost-effectiveness ratios compared with UC at 12 weeks. DISCUSSION This trial will determine whether CIAT-Plus and M-MAT are superior and more cost-effective than UC in chronic aphasia. Participant subgroups with the greatest response to CIAT-Plus and M-MAT will be described.
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Affiliation(s)
- Miranda L Rose
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - David Copland
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Lyndsey Nickels
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- ARC Centre of Excellence in Cognition and its Disorders (CCD), Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Marcus Meinzer
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tapan Rai
- Graduate Research School, University of Technology Sydney, Australia
| | - Dominique A Cadilhac
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Joosup Kim
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Abby Foster
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Speech Pathology Department, Monash Health, Clayton, Australia
| | - Marcella Carragher
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Melanie Hurley
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia
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47
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Eng JJ, Bird ML, Godecke E, Hoffmann TC, Laurin C, Olaoye OA, Solomon J, Teasell R, Watkins CL, Walker MF. Moving Stroke Rehabilitation Research Evidence into Clinical Practice: Consensus-Based Core Recommendations From the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2019; 33:935-942. [PMID: 31660783 DOI: 10.1177/1545968319886485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/15/2022]
Abstract
Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identified to help health care providers harness the necessary means to implement existing knowledge and solutions to improve service delivery. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. We recommend that health care providers, managers, and organizations determine whether the priorities we identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke.
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Affiliation(s)
- Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
| | | | - Olumide A Olaoye
- Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - John Solomon
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute and Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Caroline L Watkins
- University of Central Lancashire, Preston, UK and Australian Catholic University, Sydney, Australia
| | - Marion F Walker
- School of Medicine, University of Nottingham, Nottingham, UK
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48
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Eng JJ, Bird ML, Godecke E, Hoffmann TC, Laurin C, Olaoye OA, Solomon J, Teasell R, Watkins CL, Walker MF. Moving stroke rehabilitation research evidence into clinical practice: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14:766-773. [PMID: 31564224 DOI: 10.1177/1747493019873597] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 11/17/2022]
Abstract
Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identified to help health care providers harness the necessary means to implement existing knowledge and solutions to improve service delivery. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. We recommend that health care providers, managers, and organizations determine whether the priorities we identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke.
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Affiliation(s)
- Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
| | | | - Olumide A Olaoye
- Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - John Solomon
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute and Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Caroline L Watkins
- University of Central Lancashire, Preston, UK and Australian Catholic University, Sydney, Australia
| | - Marion F Walker
- School of Medicine, University of Nottingham, Nottingham, UK
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49
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Godecke E, Rai T, Cadilhac DA, Armstrong E, Middleton S, Ciccone N, Whitworth A, Rose ML, Holland A, Ellery F, Hankey GJ, Bernhardt J. Statistical analysis plan (SAP) for the Very Early Rehabilitation in Speech (VERSE) after stroke trial: an international 3-arm clinical trial to determine the effectiveness of early, intensive, prescribed, direct aphasia therapy. Int J Stroke 2018; 13:863-880. [PMID: 30270762 DOI: 10.1177/1747493018790055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
Background Limited evidence exists to support very early intensive aphasia rehabilitation after stroke. VERSE is a PROBE trial designed to determine whether two types of intensive aphasia therapy, beginning within 14 days of acute stroke, provide greater therapeutic and cost-effectiveness than usual care. Objective To publish the detailed statistical analysis plan for the VERSE trial prior to unblinding. This statistical analysis plan was based on the published and registered VERSE trial protocol and was developed by the blinded steering committee and management team, led by the trial statistician. This plan was developed using outcome measures and trial data collection forms. Results The VERSE statistical analysis plan is consistent with reporting standards for clinical trials and provides for clear and open reporting. Conclusions Publication of a statistical analysis plan serves to reduce potential trial reporting bias and outlines transparent pre-specified analyses. Australian New Zealand Clinical Trials Registry (ANZCTR) Registration number: ACTRN12613000776707; Universal Trial Number (UTN) is U1111-1145-4130.
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Affiliation(s)
- Erin Godecke
- 1 School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Tapan Rai
- 2 School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, Australia
| | - Dominique A Cadilhac
- 3 Stroke and Ageing Research, School of Clinical Science at Monash Health, Monash University, Melbourne, Australia.,4 Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Elizabeth Armstrong
- 1 School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Sandy Middleton
- 5 Nursing Research Institute St Vincent's Health Australia, Sydney and Australian Catholic University, Sydney, Australia
| | - Natalie Ciccone
- 1 School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Anne Whitworth
- 6 Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Miranda L Rose
- 7 School of Allied Health, La Trobe University, Melbourne, Australia
| | - Audrey Holland
- 8 Department of Speech, Language and Hearing Sciences, University of Arizona, Arizona, USA
| | - Fiona Ellery
- 4 Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Graeme J Hankey
- 9 Medical School, The University of Western Australia, Perth, Australia
| | - Julie Bernhardt
- 4 Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
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50
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Rohde A, Worrall L, Godecke E, O'Halloran R, Farrell A, Massey M. Diagnosis of aphasia in stroke populations: A systematic review of language tests. PLoS One 2018; 13:e0194143. [PMID: 29566043 PMCID: PMC5863973 DOI: 10.1371/journal.pone.0194143] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 10/09/2017] [Accepted: 02/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background and purpose Accurate aphasia diagnosis is important in stroke care. A wide range of language tests are available and include informal assessments, tests developed by healthcare institutions and commercially published tests available for purchase in pre-packaged kits. The psychometrics of these tests are often reported online or within the purchased test manuals, not the peer-reviewed literature, therefore the diagnostic capabilities of these measures have not been systematically evaluated. This review aimed to identify both commercial and non-commercial language tests and tests used in stroke care and to examine the diagnostic capabilities of all identified measures in diagnosing aphasia in stroke populations. Methods Language tests were identified through a systematic search of 161 publisher databases, professional and resource websites and language tests reported to be used in stroke care. Two independent reviewers evaluated test manuals or associated resources for cohort or cross-sectional studies reporting the tests’ diagnostic capabilities (sensitivity, specificity, likelihood ratios or diagnostic odds ratios) in differentiating aphasic and non-aphasic stroke populations. Results Fifty-six tests met the study eligibility criteria. Six “non-specialist” brief screening tests reported sensitivity and specificity information, however none of these measures reported to meet the specific diagnostic needs of speech pathologists. The 50 remaining measures either did not report validity data (n = 7); did not compare patient test performance with a comparison group (n = 17); included non-stroke participants within their samples (n = 23) or did not compare stroke patient performance against a language reference standard (n = 3). Diagnostic sensitivity analysis was completed for six speech pathology measures (WAB, PICA, CADL-2, ASHA-FACS, Adult FAVRES and EFA-4), however all studies compared aphasic performance with that of non-stroke healthy controls and were consequently excluded from the review. Conclusions No speech pathology test was found which reported diagnostic data for identifying aphasia in stroke populations. A diagnostically validated post-stroke aphasia test is needed.
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Affiliation(s)
- Alexia Rohde
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robyn O'Halloran
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Anna Farrell
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Margaret Massey
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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