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Craven K, De Dios Pérez B, Holmes J, Fisher R, Radford KA. Factors influencing employers' support for employees with acquired brain injuries or mental illness to return to- and stay in work: A qualitative systematic review. Work 2024:WOR230214. [PMID: 38217562 DOI: 10.3233/wor-230214] [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: 01/15/2024] Open
Abstract
BACKGROUND People with acquired brain injuries (ABIs) often experience residual limitations and co-morbid mental illnesses that restrict work participation. Employers are key in enabling successful return-to-work and job retention. OBJECTIVE This review aimed to explore employers' perspectives of factors influencing their support for people with ABIs and/or mental illness to return to- and stay in work. Review questions focused on barriers and facilitators to their support, and contextual characteristics present at the time. METHODS Five databases were searched from October 2010 until November 2023 for relevant qualitative studies published in English. Findings from included studies (N = 25) were synthesised using thematic synthesis. RESULTS Included studies focused on employees with ABI or mental illness, rather than dually diagnosed ABI and mental illness. Employers' support was influenced by their awareness/knowledge of- and attitudes towards the employee's condition/illness; their skills and experience in supportive strategies; factors related to provision of work accommodations; and stakeholder influence. Similarities and differences in influential factors were observed across the ABI and mental illness literature. Contextual characteristics related to organisational characteristics, cultural taboo, and involvement of certain stakeholders. CONCLUSIONS ABI survivors (with and without co-morbid mental illness) and their employers may benefit from specialist support and resources to guide them through the return-to-work process. Further research is needed to investigate employers' knowledge of ABI and mental illness and supportive strategies. Exploration of the influence of other stakeholders, socio-demographic characteristics, and contextual factors on employers' return-to-work and retention support for ABI survivors with co-morbid mental illness is warranted.
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Affiliation(s)
- Kristelle Craven
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | - Blanca De Dios Pérez
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | - Jain Holmes
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | | | - Kathryn A Radford
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
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Powers KE, das Nair R, Phillips J, Farrin A, Radford KA. Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial. Int J Environ Res Public Health 2023; 20:4694. [PMID: 36981601 PMCID: PMC10048688 DOI: 10.3390/ijerph20064694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.
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Affiliation(s)
- Katie E. Powers
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Roshan das Nair
- Health Division, SINTEF, 7465 Trondheim, Norway
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Julie Phillips
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - Kathryn A. Radford
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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Hammond A, Radford KA, Ching A, Prior Y, O’Brien R, Woodbridge S, Culley J, Parker J, Holland P. The Workwell trial: protocol for the process evaluation of a randomised controlled trial of job retention vocational rehabilitation for employed people with inflammatory arthritis. Trials 2022; 23:937. [DOI: 10.1186/s13063-022-06871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The Workwell trial is a multi-centre randomised controlled trial with the aims of evaluating the effectiveness and cost-effectiveness of job retention vocational rehabilitation for employed people with inflammatory arthritis, who are experiencing work difficulties due to their arthritis. Vocational rehabilitation is delivered by health service occupational therapists, who have received additional training in providing this Workwell intervention. A process evaluation will be undertaken alongside the main trial to investigate implementation fidelity; understand key stakeholders’ perspectives of the intervention and the social and structural context in which the intervention is provided; and explore issues related to future implementation in clinical practice. This protocol describes the aims, objectives, and methodology of the Workwell trial process evaluation.
Methods
This mixed methods process evaluation will follow the Medical Research Council’s Guidance on process evaluations for complex interventions. It will be underpinned by the conceptual framework for implementation fidelity (CFIF) and normalisation process theory (NPT). We will analyse treatment records, work assessments, and treatment notes to ascertain implementation fidelity. Semi-structured interviews with trial participants, their employer/line managers, treating therapists, and their therapy service managers will be undertaken to explore perceptions of the intervention, contextual factors, and potential for future implementation in practice. Interview topic guides will be informed by NPT. Therapists’ views about Workwell training will be explored via questionnaires following training, and interviews and focus groups following treatment delivery to inform future implementation. Quantitative data will be analysed descriptively. Qualitative data will be analysed using thematic analysis. NPT will guide data analysis and interpretation. Findings from the different elements of this embedded design process evaluation will be reported separately and then the elements integrated. The process evaluation data will be analysed independently of the Workwell trial outcome evaluation. The process evaluation data will then be reviewed in the light of the trial findings.
Discussion
Few trials of job retention vocational rehabilitation in arthritis have included process evaluations. This process evaluation will assist in understanding factors influencing trial outcomes and identifying potential contextual barriers and facilitators for the potential implementation of Workwell vocational rehabilitation into clinical services.
Trial registration
ClinicalTrials.gov NCT03942783. Registered on 08 May 2019. ISRCTN Registry ISRCTN61762297. Registered on 13 May 2019. Retrospectively registered.
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Powers K, Clarke S, Phillips J, Holmes JA, Cripps R, Craven K, Farrin A, das Nair R, Radford KA. Developing an implementation fidelity checklist for a vocational rehabilitation intervention. Pilot Feasibility Stud 2022; 8:234. [PMID: 36324137 PMCID: PMC9628165 DOI: 10.1186/s40814-022-01194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite growing numbers of studies reporting the efficacy of complex interventions and their implementation, many studies fail to report information on implementation fidelity or describe how fidelity measures used within the study were developed. This study aimed to develop a fidelity checklist for measuring the implementation fidelity of an early, stroke-specialist vocational rehabilitation intervention (ESSVR) in the RETAKE trial. METHODS To develop the fidelity measure, previous checklists were reviewed to inform the assessment structure, and core intervention components were extracted from intervention descriptions into a checklist, which was ratified by eight experts in fidelity measurement and complex interventions. Guidance notes were generated to assist with checklist completion. To test the measure, two researchers independently applied the checklist to fifteen stroke survivor intervention case notes using retrospective observational case review. The scoring was assessed for interrater reliability. RESULTS A fidelity checklist containing 21 core components and 6 desirable components across 4 stages of intervention delivery was developed with corresponding guidance notes. Interrater reliability of each checklist item ranged from moderate to perfect (Cohen's kappa 0.69-1). CONCLUSIONS The resulting checklist to assess implementation fidelity is fit for assessing the delivery of vocational rehabilitation for stroke survivors using retrospective observational case review. The checklist proved its utility as a measure of fidelity and may be used to inform the design of future implementation strategies. TRIAL REGISTRATION ISRCTN, ISRCTN12464275. Registered on 13 March 2018.
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Affiliation(s)
- Katie Powers
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Sara Clarke
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Julie Phillips
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Jain A Holmes
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Rachel Cripps
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kristelle Craven
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Amanda Farrin
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Roshan das Nair
- Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK
- Health Division, SINTEF, Trondheim, Norway
| | - Kathryn A Radford
- Centre for Rehabilitation and Ageing Research, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Radford KA, McKevitt C, Clarke S, Powers K, Phillips J, Craven K, Watkins C, Farrin A, Holmes J, Cripps R, McLellan V, Sach T, Brindle R, Holloway I, Hartley S, Bowen A, O'Connor RJ, Stevens J, Walker M, Murray J, Shone A, Clarke D. RETurn to work After stroKE (RETAKE) Trial: protocol for a mixed-methods process evaluation using normalisation process theory. BMJ Open 2022; 12:e053111. [PMID: 35292493 PMCID: PMC8928258 DOI: 10.1136/bmjopen-2021-053111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This mixed-method process evaluation underpinned by normalisation process theory aims to measure fidelity to the intervention, understand the social and structural context in which the intervention is delivered and identify barriers and facilitators to intervention implementation. SETTING RETurn to work After stroKE (RETAKE) is a multicentre individual patient randomised controlled trial to determine whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care is a clinically and cost-effective therapy to facilitate return to work after stroke, compared with usual care alone. This protocol paper describes the embedded process evaluation. PARTICIPANTS AND OUTCOME MEASURES Intervention training for therapists will be observed and use of remote mentor support reviewed through documentary analysis. Fidelity will be assessed through participant questionnaires and analysis of therapy records, examining frequency, duration and content of ESSVR sessions. To understand the influence of social and structural contexts, the process evaluation will explore therapists' attitudes towards evidence-based practice, competency to deliver the intervention and evaluate potential sources of contamination. Longitudinal case studies incorporating non-participant observations will be conducted with a proportion of intervention and usual care participants. Semistructured interviews with stroke survivors, carers, occupational therapists, mentors, service managers and employers will explore their experiences as RETAKE participants. Analysis of qualitative data will draw on thematic and framework approaches. Quantitative data analysis will include regression models and descriptive statistics. Qualitative and quantitative data will be independently analysed by process evaluation and Clinical Trials Research Unit teams, respectively. Linked data, for example, fidelity and describing usual care will be synthesised by comparing and integrating quantitative descriptive data with the qualitative findings. ETHICS AND DISSEMINATION Approval obtained through the East Midlands-Nottingham 2 Research Ethics Committee (Ref: 18/EM/0019) and the National Health ServiceResearch Authority. Dissemination via journal publications, stroke conferences, social media and meetings with national Stroke clinical leads. TRIAL REGISTRATION NUMBER ISRCTN12464275.
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Affiliation(s)
- Kathryn A Radford
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- Department of Public Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Sara Clarke
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Katie Powers
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie Phillips
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Kristelle Craven
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Caroline Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | - Amanda Farrin
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Jain Holmes
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rachel Cripps
- Department of Public Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Vicki McLellan
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Richard Brindle
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit (CTRU), University of Leeds, Leeds, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Judith Stevens
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Marion Walker
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John Murray
- Centre for Rehabilitation and Ageing Research, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Angela Shone
- Research and Innovation, University of Nottingham, Nottingham, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Radford KA, Craven K, McLellan V, Sach TH, Brindle R, Holloway I, Hartley S, Bowen A, O'Connor R, Stevens J, Philips J, Walker M, Holmes J, McKevitt C, Murray J, Watkins C, Powers K, Shone A, Farrin A. An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial. Trials 2020; 21:1010. [PMID: 33298162 PMCID: PMC7724443 DOI: 10.1186/s13063-020-04883-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) is more clinically and cost-effective for supporting post-stroke RTW, than UC alone. METHODS Seven hundred sixty stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants' homes or workplaces, and outpatient/inpatient therapy settings, via telephone, email, or SMS text message. Outcome data will be collected via self-report questionnaires administered by post or online at 3, 6, and 12 months follow-up. The primary outcome will be self-reported RTW and job retention at 12 months (minimum 2 h/week). Secondary outcomes will include mood, function, participation, health-related quality of life, confidence, intervention compliance, health and social care resource use, and mortality. An embedded economic evaluation will estimate cost-effectiveness and cost-utility analyses from National Health Service (NHS) and Personal Social Services (PSS) perspectives. An embedded process evaluation will employ a mixed methods approach to explore ESSVR implementation, contextual factors linked to outcome variation, and factors affecting NHS roll-out. DISCUSSION This article describes the protocol for a multi-centre RCT evaluating the clinical- and cost-effectiveness of an early vocational rehabilitation intervention aimed at supporting adults to return to work following a stroke. Evidence favouring the ESSVR intervention would support its roll-out in NHS settings. TRIAL REGISTRATION ISRCTN, ISRCTN12464275 . Registered on 26 February 2018.
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Affiliation(s)
- Kathryn A Radford
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK.
| | - Kristelle Craven
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Vicki McLellan
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Room 2.37, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Richard Brindle
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Ivana Holloway
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester MAHSC, Manchester, M13 9PL, UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Molecular Medicine, University of Leeds, Level D, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Judith Stevens
- Patient and Public Involvement Collaborator, Hampshire, UK
| | - Julie Philips
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Jain Holmes
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, 5th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - John Murray
- Different Strokes, Raphael House, Ilford, London, IG1 1YT, UK
| | - Caroline Watkins
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE, UK
| | - Katie Powers
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Angela Shone
- Research and Innovation, Jubilee Conference Centre, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Amanda Farrin
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
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Walker MF, Hoffmann TC, Brady MC, Dean CM, Eng JJ, Farrin AJ, Felix C, Forster A, Langhorne P, Lynch EA, Radford KA, Sunnerhagen KS, Watkins CL. Improving the development, monitoring and reporting of stroke rehabilitation research: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2018; 12:472-479. [PMID: 28697706 DOI: 10.1177/1747493017711815] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 01/20/2023]
Abstract
Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n = 182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
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Affiliation(s)
- Marion F Walker
- 1 School of Medicine, University of Nottingham, Nottingham, UK
| | - Tammy C Hoffmann
- 2 Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia
| | - Marian C Brady
- 3 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Catherine M Dean
- 4 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Janice J Eng
- 5 Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Amanda J Farrin
- 6 Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Cynthia Felix
- 7 The George Institute for Global Health, Hyderabad, India
| | - Anne Forster
- 6 Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Langhorne
- 8 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth A Lynch
- 9 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Parkville, Australia and University of Adelaide, Adelaide, Australia
| | | | - Katharina S Sunnerhagen
- 10 Department of Clinical Neuroscience at the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Caroline L Watkins
- 11 University of Central Lancashire, Preston, UK and Australian Catholic University, Sydney, Australia
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8
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Walker MF, Hoffmann TC, Brady MC, Dean CM, Eng JJ, Farrin AJ, Felix C, Forster A, Langhorne P, Lynch EA, Radford KA, Sunnerhagen KS, Watkins CL. Improving the Development, Monitoring and Reporting of Stroke Rehabilitation Research: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2017; 31:877-884. [DOI: 10.1177/1545968317732686] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
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Affiliation(s)
| | - Tammy C. Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Catherine M. Dean
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Amanda J. Farrin
- Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Cynthia Felix
- The George Institute for Global Health, Hyderabad, India
| | - Anne Forster
- Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth A. Lynch
- NHMRC Centre of Research Excellence, Florey Institute of Neuroscience and Mental Health, Parkville, Australia and University of Adelaide, Adelaide, Australia
| | | | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience at the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Caroline L. Watkins
- University of Central Lancashire, Preston, UK and Australian Catholic University, Sydney, Australia
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Morris RPG, Fletcher-Smith JC, Radford KA. A systematic review of peer mentoring interventions for people with traumatic brain injury. Clin Rehabil 2016; 31:1030-1038. [DOI: 10.1177/0269215516676303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This systematic review sought evidence concerning the effectiveness of peer mentoring for people with traumatic brain injury. Data sources: Fourteen electronic databases were searched, including PsycINFO, MEDLINE, CINAHL, EMBASE and the Cochrane Library, from inception to September 21 2016. Ten grey literature databases, PROSPERO, two trials registers, reference lists and author citations were also searched. Review methods: Studies which employed a model of one-to-one peer mentoring between traumatic brain injury survivors were included. Two reviewers independently screened all titles and abstracts before screening full texts of shortlisted studies. A third reviewer resolved disagreements. Two reviewers independently extracted data and assessed studies for quality and risk of bias. Results: The search returned 753 records, including one identified through hand searching. 495 records remained after removal of duplicates and 459 were excluded after screening. Full texts were assessed for the remaining 36 studies and six met the inclusion criteria. All were conducted in the United States between 1996 and 2012 and employed a variety of designs including two randomised controlled trials. A total of 288 people with traumatic brain injury participated in the studies. No significant improvements in social activity level or social network size were found, but significant improvements were shown in areas including behavioural control, mood, coping and quality of life. Conclusion: There is limited evidence for the effectiveness of peer mentoring after traumatic brain injury. The available evidence comes from small-scale studies, of variable quality, without detailed information on the content of sessions or the ‘active ingredient’ of the interventions.
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Affiliation(s)
- Richard PG Morris
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Joanna C Fletcher-Smith
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Kathryn A Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
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Logan PA, Murphy A, Drummond AER, Bailey S, Radford KA, Gladman JRF, Walker MF, Robertson K, Edmans JA, Conroy S. An Investigation of the Number and Cost of Assistive Devices Used by Older People Who Had Fallen and Called a 999 Ambulance. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - A Murphy
- Nottingham City Primary Care Trust
| | | | - S Bailey
- Nottingham Integrated Community Equipment Service
| | | | | | | | - K Robertson
- Nottinghamshire County Teaching Primary Care Trust
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Abstract
The objectives of this research were to survey the use of transport by stroke patients in the community and study its relationship to their activities of daily living and mood. The records of 90 consecutive stroke patients receiving community occupational therapy in a rehabilitation trial were surveyed for entries of therapy related to transport. A further 50 stroke patients in the same study were surveyed about their use of transport one year after discharge from hospital. In the survey of occupational therapy notes, a transport assessment had been recorded for all 90 patients. Of these, 22 patients had been given leaflets describing the range of transport options locally but had been unable to use these options. In the survey of transport use, 42/50 (84%) patients surveyed at one year responded. Twenty-one (50%) had used transport on their own, six of whom scored <26/66 on the Extended Activities of Daily Living scale (indicating that they needed help in most activities of daily living). Twenty-one (50%) patients had not travelled alone, four of whom scored >48/66 on the Extended Activities of Daily Living scale (very able in activities of daily living). Only 1 (2%) patient had used specialist transport and 22 (52%) reported that they did not get out as much as they wished. Despite receiving advice, these patients did not use specialist transport options, yet many still wanted to get out more. The reason for this is unclear but it is not due simply to physical disability.
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Radford KA, Phillips J, Jones T, Gibson A, Sutton C, Watkins C, Sach T, Duley L, Walker M, Drummond A, Hoffman K, O'Connor R, Forshaw D, Shakespeare D. Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2015; 1:24. [PMID: 27965803 PMCID: PMC5154052 DOI: 10.1186/s40814-015-0017-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 12/19/2014] [Accepted: 05/29/2015] [Indexed: 11/29/2022] Open
Abstract
Background Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial. Trial registration The trial is registered ISRCTN Number 38581822. Electronic supplementary material The online version of this article (doi:10.1186/s40814-015-0017-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathryn A Radford
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | - Julie Phillips
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | | | - Ali Gibson
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Chris Sutton
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Caroline Watkins
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, CD Annex 1.13, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, QMC, Nottingham, NG7 2UH UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham Queen's Medical Centre (QMC), A Floor, Nottingham, NG7 2UH UK
| | - Karen Hoffman
- Trauma Science, Royal London Hospital, Ward 12D, Whitechapel, E1 1BB London UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Molecular Medicine, University of Leeds, Level D, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX UK
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - David Shakespeare
- Preston Neuro-Rehab Unit, Lancashire Teaching Hospitals NHS Trust, 32A Watling St, Preston, Lancashire PR2 8DY UK
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Lincoln NB, Taylor J, Radford KA. Inter-rater reliability of the Nottingham Neurological Driving Assessment for people with dementia - a preliminary evaluation. Clin Rehabil 2012; 26:836-9. [PMID: 22531717 DOI: 10.1177/0269215512442413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose was to examine the inter-rater reliability of the Nottingham Neurological Driving Assessment. PARTICIPANTS Six drivers with dementia (mean age 78 years, 5 men). INTERVENTIONS Participants were assessed for their safety to drive on a set route while being observed by two driving assessors, who were experienced in assessing safety to drive in people with dementia. MAIN MEASURES Performance was rated in terms of overall safety to drive and 25 items were recorded as correct, minor error (not compromising safety) and major error (compromising safety). RESULTS Four drivers were found to be probably safe to drive and two definitely unsafe to drive. There was perfect agreement in the overall decisions about safety to drive. There were significant discrepancies between correct or minor error and major error on six of the 25 items of the road test involving three participants. CONCLUSIONS Two experienced driving assessors agreed on the overall safety to drive of six participants with dementia. There were discrepancies about safety on six out of 150 observations (4%).
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Abstract
AbstractStroke has a marked impact on the ability to return to work. However, the stroke and its residual cognitive, physical and language deficits do not fully explain return-to-work success. While those with very severe deficits are less likely to return to work, and presence of disability is important, other extrinsic and intrinsic factors, such as having a job to go back to, beliefs and attitudes about work, job markets and the benefits system all play an important part. Vocational rehabilitation services developed with the stroke service user in mind are scarce in the United Kingdom. However, recent government interest in vocational rehabilitation and a recognition that evidence to support poststroke vocational rehabilitation is lacking have prompted efforts to develop new vocational rehabilitation services. People with stroke need specialist vocational rehabilitation services delivered by those who have an in-depth understanding of stroke and its effects. Service developers need to acknowledge and address factors that enable or impede return to work after stroke in service design. Research is needed to evaluate vocational rehabilitation interventions aimed specifically at the needs of stroke patients.
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Lincoln NB, Taylor JL, Vella K, Bouman WP, Radford KA. A prospective study of cognitive tests to predict performance on a standardised road test in people with dementia. Int J Geriatr Psychiatry 2010; 25:489-96. [PMID: 19718699 DOI: 10.1002/gps.2367] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous work by Lincoln and colleagues produced a cognitive test battery for predicting safety to drive in people with dementia. The aim was to check the accuracy of this battery and assess whether it could be improved by shortening it, including additional cognitive tests, and a measure of previous driving. METHODS Participants with dementia, who were driving, were recruited. They were assessed on cognitive tests including measures of concentration, executive function, visuospatial perception, verbal recognition memory, and speed of information processing. Patients were then assessed on the Nottingham Neurological Driving Assessment (NNDA) by an approved driving instructor (ADI), blind to cognitive test results. RESULTS Seventy-five patients were recruited and completed the cognitive tests. Of these, 65 were assessed on the road. These participants were aged 59-88 (mean = 75.2, SD = 6.8) and 49 were men. Time driving varied from 19 to 73 years (mean = 52.5, SD = 10.0). Thirteen participants were unsafe and 52 safe to drive. Using a cut-off of > 0 to indicate safety to drive, the original predictive equations correctly classified 48 (76.2%) of 63 participants with complete data. Logistic regression including additional tests reduced misclassifications. CONCLUSIONS A lower proportion of participants were found to be unsafe on the road than in previous studies. Nevertheless, the previously identified equation predicted safety to drive in most patients. Including additional tests reduced the misclassification rate but requires independent validation. We suggest that the cognitive test battery might be used in clinical practice to identify patients with dementia who would benefit from on-road assessment.
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Abstract
Cognitive impairments resulting from brain injury affect driving performance. The question of fitness to drive often arises during rehabilitation. Healthcare professionals need reliable criteria against which decisions about driving fitness can be made. Nouri et al. developed the Stroke Drivers Screening Assessment (SDSA), which was found predictive of on-road driving performance in stroke patients. The purpose of this study was to determine whether the SDSA, either alone or combined with other tests, predicted fitness to drive in brain injured people. Fifty-two participants were assessed on the SDSA plus additional cognitive tests. Their fitness to drive was examined on the public road. The SDSA predictions based on equations developed for stroke patients were not an accurate predictor of road test performance. Discriminant analysis was used to identify tests predictive of fitness to drive. Results indicated that a combination of the SDSA, the Stroop and the AMIPB Information Processing tasks correctly classified 87% of cases and may be useful predictors of driving fitness following brain injury. However, cross-validation on an independent sample of people with brain injury is required.
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Affiliation(s)
- K A Radford
- School of Psychology, Nottingham University, Nottingham, UK.
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Affiliation(s)
| | | | - Walter P. Bouman
- Mental Health Services for Older PeopleThe CourtyardUniversity HospitalNottinghamUnited Kingdom
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Abstract
OBJECTIVE To investigate the frequency of somatosensory impairment in stroke patients within different somatosensory modalities and different body areas, and their recovery. DESIGN Prospective observational study. SETTING Two stroke rehabilitation units. SUBJECTS Seventy patients with a first stroke (36 men, 34 women; average age, 71, SD 10.00 years; average time since stroke onset, 15 days) were assessed on admission and two, four and six months after stroke. INTERVENTIONS Not applicable. MAIN MEASURE Nottingham Sensory Assessment. RESULTS Somatosensory impairment was common after stroke; 7-53% had impaired tactile sensations, 31-89% impaired stereognosis, and 34-64% impaired proprioception. When comparing somatosensory modalities within body areas the kappa values were low (kappa values<0.54). Recovery occurred over time, though not significantly in lower limb tactile sensations. Stroke severity was the main factor influencing initial somatosensory impairment, but accounted for a small amount of the variance (21-41%). Initial somatosensory impairment was significantly related to somatosensory ability at six months, accounting for 46-71% of the variance. CONCLUSIONS Proprioception and stereognosis were more frequently impaired than tactile sensations. The different somatosensory modalities showed only slight agreement between impairment within the same body areas, suggesting that the modalities are independent of each other and all should be assessed. High agreements were found between different body areas for each somatosensory modality. Somatosensory impairment was associated with stroke severity, however low variance indicated other factors were involved.
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Affiliation(s)
- L A Connell
- Division of Rehabilitation and Ageing, Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK.
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Lincoln NB, Radford KA, Game FL, Jeffcoate WJ. Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia 2008; 51:1954-61. [PMID: 18758747 DOI: 10.1007/s00125-008-1110-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 07/02/2008] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS This observer-blind, randomised controlled trial was designed to determine the effect of a foot care education programme in the secondary prevention of foot ulcers. METHODS People with newly healed foot ulcers attending one of three specialist clinics were allocated to receive either targeted, one-to-one education or usual care, using a computer-generated random allocation sequence that had been prepared in advance but which was concealed from the clinical researcher. The primary outcome was ulcer incidence at 12 months. Secondary outcomes were ulcer incidence at 6 months and incidence of amputation, mood (Hospital Anxiety and Depression Scale) and quality of life (Diabetic Foot Ulcer Scale) at 6 and 12 months. Protective foot care behaviours (Nottingham Assessment of Functional Footcare) were assessed at 12 months. RESULTS There were 87 (mean [SD] age 63.5 [12.1] years) patients in the intervention group and 85 control patients (mean [SD] age 64.9 [10.9] years). The groups were comparable at baseline. No significant differences (p > 0.05) were observed between groups in ulcer incidence at either 6 months (intervention 30%, control 21%) or 12 months (intervention 41%, control 41%). Recommended foot care behaviours at 12 months were better in the intervention than in the control group (p = 0.03), but education had no significant (p > 0.05) effect on mood, quality of life or amputations. CONCLUSIONS/INTERPRETATION Even though the intervention was associated with improved foot care behaviour, there was no evidence that this programme of targeted education was associated with clinical benefit in this population when compared with usual care. The usefulness and optimal delivery of education to such a high-risk group requires further evaluation. TRIAL REGISTRATION ClinicalTrials.gov NCT00729456 FUNDING: Diabetes UK project grant RD02/0002535.
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Affiliation(s)
- N B Lincoln
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK
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Abstract
Cognitive impairments resulting from multiple sclerosis (MS) may affect driving performance. The purpose was to determine whether cognitive tests predict safety to drive in people with MS. Participants were recruited from people referred to Derby Regional Mobility Centre for assessment of their fitness to drive. They were assessed on tests of cognitive abilities related to driving including: the Stroke Drivers Screening Assessment, Paced Auditory Serial Addition Test, Stroop, Motor Impersistence and Adult Memory and Information Processing Battery (AMIPB). Participants' safety to drive on the public road was tested by an approved driving instructor blind to the results of the cognitive assessment. There were 34 participants with MS, 17 were men, mean age 46 (SD 10.4) years. Safe and unsafe drivers were compared. Significant differences were found on tests of executive function (Road Sign Recognition, P<0.01), visual memory (Design Learning Interference, P<0.05) Information Processing (AMIPB Task A, P<0.05 and B, P<0.05), concentration (Dot Cancellation false positive errors, P<0.01) and visuospatial abilities (AMIPB Figure copy). An equation was generated using discriminant function analysis with an overall predictive accuracy of 88% (Sensitivity for pass 90%, Specificity 90%). Cognitive abilities were predictors of safety to drive in people with MS.
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Affiliation(s)
- N B Lincoln
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham NG7 2RD, UK.
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Lincoln NB, Jeffcoate WJ, Ince P, Smith M, Radford KA. Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF). ACTA ACUST UNITED AC 2007. [DOI: 10.1002/pdi.1099] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Radford KA, Walker L, Gladman J, Rothera I, Hewitt D. Evaluation of the Daisy Chain Service: The Role of the Specialist General Practitioner of Occupational Therapy — Executive Summary. Br J Occup Ther 2006. [DOI: 10.1177/030802260606900408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Research and Development Board was authorised by Council to commission research linked to the College of Occupational Therapists' 2002 strategy, From Interface to Integration. Proposals were invited for research projects to evaluate an integrated approach to occupational therapy in different sectors. This report is an executive summary of the project commissioned after an open bidding process. A copy of the full report is available in the College's library.
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Abstract
OBJECTIVE To determine the concurrent validity of the Stroke Drivers Screening Assessment (SDSA). DESIGN Comparison of the SDSA with criterion standards. SETTING Subjects' homes in the community in the United Kingdom. PARTICIPANTS Ninety-three stroke patients (age range, 22-83y) who were referred for assessment of fitness to drive or who had been driving before their stroke. Participants were assessed a median of 5 months post stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patients were assessed on the SDSA and tests of visuospatial ability (Visual Object and Space Perception [VOSP] Battery), executive abilities (Stroop Neuropsychological Screening Test, Trail-Making Test [TMT], Cognitive Estimates Test [CET]), and visual memory (Recognition Memory Tests [RMT], Verbal Descriptions of Road Signs [VDRS]). RESULTS The SDSA subtests all correlated significantly with the Stroop test (P<.001) and TMT (P<.001), which suggests that they measure executive abilities and attention. The SDSA Dot Cancellation (DC) also correlated significantly with the VDRS (P<.01). The SDSA Square Matrices (SM) test correlated significantly with the VOSP cube analysis (P< or =.01) and the RMT faces subtest (P<.001), which suggests that the SM test also measures visuospatial abilities and visual memory. The SDSA Road Sign Recognition (RSR) test also correlated significantly with the VOSP cube analysis (P<.05), which suggests that the RSR test also measures visuospatial abilities. Factor analysis produced a 2-factor solution with DC time, SM compass, and RSR all loading on factor 1, together with the Stroop and TMT. This factor was interpreted as "executive abilities and attention." The RMT faces subtest and CET loaded onto a second factor. CONCLUSIONS The SDSA seems to measure predominantly attention and executive abilities, which have previously been shown to be important determinants of safety to drive. This may account for the high predictive validity of the SDSA.
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Abstract
OBJECTIVE To compare methods of assessing fatigue. DESIGN Cross sectional. SETTING Community. SUBJECTS Forty Multile Sclerosis (MS) patients and 20 healthy controls. MAIN OUTCOME MEASURES Fatigue questionnaires, SDSA dot cancellation test, finger tapping test, TEA Lottery. RESULTS The MS patients had significantly higher levels of fatigue than the controls on the Task Induced Fatigue Scale, Fatigue Severity Scale and Fatigue Impact Scale. The Task Induced Fatigue Scale completed whilst imagining oneself driving and the Fatigue Assessment Instrument did not differentiate between MS patients and controls. Finger tapping differentiated between MS patients and controls but there was no significant difference between MS patients and controls on visual and auditory concentration tests. A factor analysis indicated that questionnaire measures of fatigue were interrelated but independent of objective test performance. CONCLUSIONS Questionnaire measures can be used to assess fatigue in people with MS. The FSS differentiated MS patients from controls and is relatively short. It was therefore recommended for clinical use.
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Affiliation(s)
- S Y Chipchase
- School of Psychology, University of Nottingham, University Park, UK
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Abstract
PURPOSE To examine the effect of fatigue on driving in patients with multiple sclerosis (MS). METHOD A questionnaire on driving was sent to 192 people with MS and 192 controls who were relatives or close friends of the people with MS. RESULTS Replies were received from 75 MS patients (39%) and 63 controls (32%). MS patients' ability to drive was more often affected by fatigue, leg problems, numbness and eye problems than controls. The MS group reported driving shorter distances and shorter times than controls, and that fatigue had a significant effect on their ability to drive. The driving plans of MS patients were affected by fatigue. CONCLUSION Fatigue affected the driving of MS patients, but it was not the only factor and should be considered in relation to other symptoms of MS.
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Affiliation(s)
- S Y Chipchase
- School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK
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Logan PA, Gladman JRF, Drummond AER, Radford KA. A study of interventions and related outcomes in a randomized controlled trial of occupational therapy and leisure therapy for community stroke patients. Clin Rehabil 2003; 17:249-55. [PMID: 12735531 DOI: 10.1191/0269215503cr593oa] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To undertake a detailed analysis of therapy provided in a multicentred randomized controlled trial of activities of daily living (ADL) and leisure (TOTAL), testing the hypothesis that specific interventions given in the trial affected specific aspects of outcome. SUBJECTS Three hundred and nine stroke patients who had been randomly allocated to receive either occupational therapy aimed at ADL activities (n = 156) or leisure (n = 153). MEASURES Number, duration and type of activity undertaken per patient. Barthel Index, Extended Activities of Daily Living Scale (EADL) and Nottingham Leisure Questionnaire (NLQ) six months after entry to the study. METHOD Activities that had been used in treatment were coded and categorized. Frequently used activities identified. These activities were matched to items from the six-month outcome measures. Patient independence in these outcome items was compared between the leisure and ADL groups. RESULTS Three hundred and nine therapy record forms were returned. Patients received a median of ten sessions with a median duration of 55 minutes. The ADL group received significantly more, mobility training, transfer training, cleaning, dressing, cooking and bathing training (chi-squared, p < 0.05). Sport, creative activities, games, hobbies, gardening, entertainment and shopping were used significantly more in the leisure group (chi-squared, p < 0.05) than the ADL group. Fifteen items from the outcome measures were identified as specific to these interventions. There were no statistically significant differences in outcome on these 15 items between the ADL and leisure groups (chi-squared, p > 0.05). CONCLUSIONS We found no evidence that specific ADL or leisure interventions led to improvements in specific relevant outcomes. We believe that these findings should prompt a review of the relationship between process and outcome of occupational therapy.
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Affiliation(s)
- P A Logan
- Division of General Practice, University of Nottingham, Nottingham, UK.
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Parker CJ, Gladman JR, Drummond AE, Dewey ME, Lincoln NB, Barer D, Logan PA, Radford KA. A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke. TOTAL Study Group. Trial of Occupational Therapy and Leisure. Clin Rehabil 2001; 15:42-52. [PMID: 11237160 DOI: 10.1191/026921501666968247] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effects of leisure therapy and conventional occupational therapy (OT) on the mood, leisure participation and independence in activities of daily living (ADL) of stroke patients 6 and 12 months after hospital discharge. DESIGN Multicentre randomized controlled trial. SETTING AND PARTICIPANTS Four hundred and sixty-six stroke patients from five UK centres. MAIN OUTCOME MEASURES The General Health Questionnaire (12 item), the Nottingham Extended ADL Scale and the Nottingham Leisure Questionnaire, assessed by post, with telephone clarification. RESULTS Four hundred and forty (94%) and 426 (91%) subjects were alive at 6 and 12 months, respectively. Three hundred and seventy-four (85% of survivors) and 311 (78% of survivors) responded at 6 and 12 month follow-up respectively. At six months and compared to the control group, those allocated to leisure therapy had nonsignificantly better GHQ scores (-1.2: 95% CI -2.9, +0.5), leisure scores (+0.7, 95% CI -1.1, +2.5) and Extended ADL scores (+0.4: 95% CI -3.8, +4.5): the ADL group had nonsignificantly better GHQ scores (-0.1: 95% CI -1.8, +1.7) and Extended ADL scores (+1.4: 95% CI -2.9, +5.6) and nonsignificantly worse leisure scores (-0.3: 95% CI -2.1, +1.6). The results at 12 months were similar. CONCLUSION In contrast to the findings of previous smaller trials, neither of the additional OT treatments showed a clear beneficial effect on mood, leisure activity or independence in ADL measured at 6 or 12 months.
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Affiliation(s)
- C J Parker
- Division of Rehabilitation and Ageing, University of Nottingham, UK
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Abstract
Sternal wound complications after cardiac surgery occur in 0.4% to 8% of all cases and have a mortality rate as high as 27%. Treatment varies and does not always yield favorable results. This article discusses normal wound healing versus healing by secondary intention. Risk factors and factors that delay healing are highlighted. A case study describes the utilization of the Bard absorption dressing to promote the healing process in a sternal wound complication. This treatment modality proved to be effective as a nontraditional approach to healing by secondary intention.
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