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Breitenstein C, Wallace SJ, Gilmore N, Finch E, Pettigrove K, Brady MC. Invaluable Benefits of 10 Years of the International Collaboration of Aphasia Trialists (CATs). Stroke 2024; 55:1129-1135. [PMID: 38527148 DOI: 10.1161/strokeaha.124.046487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
Aphasia research has traditionally been considered a (unidisciplinary) niche topic in medical science. The international Collaboration of Aphasia Trialists (CATs) is a global collaboration of multidisciplinary aphasia researchers. Over the past 10 years, CATs has collectively taken a rigorous approach to systematically address persistent challenges to aphasia research quality. This article summarizes the achievements over the past decade. CATs' achievements include: standardizing terminology, advancing aphasia research design by aphasia expert consensus recommendations, developing a core data set and intervention descriptors, facilitating the involvement of people with the language impairment aphasia in the research process, translating, and adapting assessment tools into global languages, encouraging data sharing, developing innovative secondary data analysis methodologies and promoting the transparency and accessibility of high quality aphasia research reports. CATs' educational and scientific achievements over the past 10 years far exceed what individual researchers in the field could have ever achieved.
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Affiliation(s)
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, Brisbane, Australia (S.J.W.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA (N.G.)
| | - Emma Finch
- Research and Innovation, West Moreton Health, Ipswich, Australia (E.F.)
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia (E.F.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Kathryn Pettigrove
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia (K.P.)
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia (K.P.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom (M.C.B.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
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Ali M, Tibble H, Brady MC, Quinn TJ, Sunnerhagen KS, Venketasubramanian N, Shuaib A, Pandyan A, Mead G. Validation of general pain scores from multidomain assessment tools in stroke. Front Neurol 2024; 15:1328832. [PMID: 38333610 PMCID: PMC10851776 DOI: 10.3389/fneur.2024.1328832] [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: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose We describe how well general pain reported in multidomain assessment tools correlated with pain-specific assessment tools; associations between general pain, activities of daily living and independence after stroke. Materials and methods Analyses of individual participant data (IPD) from the Virtual International Stroke Trials Archive (VISTA) described correlation coefficients examining (i) direct comparisons of assessments from pain-specific and multidomain assessment tools that included pain, (ii) indirect comparisons of pain assessments with the Barthel Index (BI) and modified Rankin Scale (mRS), and (iii) whether pain identification could be enhanced by accounting for reported usual activities, self-care, mobility and anxiety/depression; factors associated with pain. Results European Quality of Life 3- and 5-Level (EQ-5D-3L and EQ-5D-5L), RAND 36 Item Health Survey 1.0 (SF-36) or the 0-10 Numeric Pain Rating Scale (NPRS) were available from 10/94 studies (IPD = 10,002). The 0-10 NPRS was the only available pain-specific assessment tool and was a reference for comparison with other tools. Pearson correlation coefficients between the 0-10 NPRS and (A) the EQ-5D-3L and (B) EQ5D-5 L were r = 0.572 (n = 436) and r = 0.305 (n = 1,134), respectively. mRS was better aligned with pain by EQ-5D-3L (n = 8,966; r = 0.340) than by SF-36 (n = 623; r = 0.318). BI aligned better with pain by SF-36 (n = 623; r = -0.320). Creating a composite score using the EQ-5D 3 L and 5 L comprising pain, mobility, usual-activities, self-care and anxiety/depression did not improve correlation with the 0-10 NPRS. Discussion The EQ-5D-3L pain domain aligned better than the EQ-5D-5L with the 0-10 NPRS and may inform general pain description where resources and assessment burden hinder use of additional, pain-specific assessments.
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Affiliation(s)
- Myzoon Ali
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Holly Tibble
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marian C. Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Terence J. Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience, University of Gothenburg, Sweden and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, Poole, United Kingdom
| | - Gillian Mead
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Ali M, Tibble H, Brady MC, Quinn TJ, Sunnerhagen KS, Venketasubramanian N, Shuaib A, Pandyan A, Mead G. Prevalence, Trajectory, and Predictors of Poststroke Pain: Retrospective Analysis of Pooled Clinical Trial Data Set. Stroke 2023; 54:3107-3116. [PMID: 37916457 DOI: 10.1161/strokeaha.123.043355] [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: 03/30/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poststroke pain remains underdiagnosed and inadequately managed. To inform the optimum time to initiate interventions, we examined prevalence, trajectory, and participant factors associated with poststroke pain. METHODS Eligible studies from the VISTA (Virtual International Stroke Trials Archives) included an assessment of pain. Analyses of individual participant data examined demography, pain, mobility, independence, language, anxiety/depression, and vitality. Pain assessments were standardized to the European Quality of Life Scale (European Quality of Life 5 Dimensions 3 Level) pain domain, describing no, moderate, or extreme pain. We described pain prevalence, associations between participant characteristics, and pain using multivariable models. RESULTS From 94 studies (n>48 000 individual participant data) in VISTA, 10 (n=10 002 individual participant data) included a pain assessment. Median age was 70.0 years (interquartile range [59.0-77.1]), 5560 (55.6%) were male, baseline stroke severity was National Institutes of Health Stroke Scale score 10 (interquartile range [7-15]). Reports of extreme pain ranged between 3% and 9.5% and were highest beyond 2 years poststroke (31/328 [9.5%]); pain trajectory varied by study. Poorer independence was significantly associated with presence of moderate or extreme pain (5 weeks-3 months odds ratio [OR], 1.5 [95% CI, 1.4-1.6]; 4-6 months OR, 1.7 [95% CI, 1.3-2.1]; >6 months OR, 1.5 [95% CI, 1.2-2.0]), and increased severity of pain (5 weeks-3 months: OR, 1.2 [95% CI, 1.1-1.2]; 4-6 months OR, 1.1 [95% CI, 1.1-1.2]; >6 months, OR, 1.2 [95% CI, 1.1-1.2]), after adjusting for covariates. Anxiety/depression and lower vitality were each associated with pain severity. CONCLUSIONS Between 3% and 9.5% of participants reported extreme poststroke pain; the presence and severity of pain were independently associated with dependence at each time point. Future studies could determine whether and when interventions may reduce the prevalence and severity of poststroke pain.
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Affiliation(s)
- Myzoon Ali
- Institute of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (M.A., T.J.Q.)
- NMAHP Research Unit, Glasgow Caledonian University, United Kingdom (M.A., M.C.B.)
| | | | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, United Kingdom (M.A., M.C.B.)
| | - Terence J Quinn
- Institute of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (M.A., T.J.Q.)
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, University of Gothenburg, Sweden (K.S.S.)
- Sahlgrenska University Hospital, Gothenburg, Sweden (K.S.S.)
| | | | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (A.S.)
| | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, United Kingdom (A.P.)
| | - Gillian Mead
- Division of Health Sciences, Geriatric Medicine, University of Edinburgh, United Kingdom (G.M.)
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Miller C, Jones SP, Bangee M, Martinez-Garduno CM, Brady MC, Cadilhac DA, Dale S, McInnes E, Middleton S, Watkins CL, Lightbody CE. Hydration and nutrition care practices in stroke: findings from the UK and Australia. BMC Nurs 2023; 22:403. [PMID: 37891567 PMCID: PMC10604400 DOI: 10.1186/s12912-023-01575-4] [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: 04/21/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Dehydration and malnutrition are common in hospitalised patients following stroke leading to poor outcomes including increased mortality. Little is known about hydration and nutrition care practices in hospital to avoid dehydration or malnutrition, and how these practices vary in different countries. This study sought to capture how the hydration and nutrition needs of patients' post-stroke are assessed and managed in the United Kingdom (UK) and Australia (AUS). AIM To examine and compare current in-hospital hydration and nutrition care practice for patients with stroke in the UK and Australia. METHODS A cross-sectional survey was conducted between April and November 2019. Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing post-stroke inpatient acute care or rehabilitation. Non-respondents were contacted up to five times. RESULTS We received 150/174 (86%) completed surveys from hospitals in the UK, and 120/162 (74%) in Australia. Of the 270 responding hospitals, 96% reported undertaking assessment of hydration status during an admission, with nurses most likely to complete assessments (85%). The most common methods of admission assessment were visual assessment of the patient (UK 62%; AUS 58%), weight (UK 52%; AUS 52%), and body mass index (UK 47%; AUS 42%). Almost all (99%) sites reported that nutrition status was assessed at some point during admission, and these were mainly completed by nurses (91%). Use of standardised nutrition screening tools were more common in the UK (91%) than Australia (60%). Similar proportions of hydration management decisions were made by physicians (UK 84%; AUS 83%), and nutrition management decisions by dietitians (UK 98%; AUS 97%). CONCLUSION Despite broadly similar hydration and nutrition care practices after stroke in the UK and Australia, some variability was identified. Although nutrition assessment was more often informed by structured screening tools, the routine assessment of hydration was generally not. Nurses were responsible for assessment and monitoring, while dietitians and physicians undertook decision-making regarding management. Hydration care could be improved through the development of standardised assessment tools. This study highlights the need for increased implementation and use of evidence-based protocols in stroke hydration and nutrition care to improve patient outcomes.
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Affiliation(s)
- Colette Miller
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - Stephanie P Jones
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Munirah Bangee
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Cintia Mayel Martinez-Garduno
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, VIC, Melbourne, Australia
| | - Simeon Dale
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, VIC, Melbourne, Australia
| | - Elizabeth McInnes
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, VIC, Melbourne, Australia
| | - Sandy Middleton
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, VIC, Melbourne, Australia
| | - Caroline L Watkins
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
| | - C Elizabeth Lightbody
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Wallace SJ, Worrall L, Rose TA, Alyahya RSW, Babbitt E, Beeke S, de Beer C, Bose A, Bowen A, Brady MC, Breitenstein C, Bruehl S, Bryant L, Cheng BBY, Cherney LR, Conroy P, Copland DA, Croteau C, Cruice M, Dipper L, Hilari K, Howe T, Kelly H, Kiran S, Laska A, Marshall J, Murray LL, Patterson J, Pearl G, Quinting J, Rochon E, Rose ML, Rubi‐Fessen I, Sage K, Simmons‐Mackie N, Visch‐Brink E, Volkmer A, Webster J, Whitworth A, Dorze GL. Measuring communication as a core outcome in aphasia trials: Results of the ROMA-2 international core outcome set development meeting. Int J Lang Commun Disord 2023; 58:1017-1028. [PMID: 36583427 PMCID: PMC10946976 DOI: 10.1111/1460-6984.12840] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. AIM To establish consensus on a communication OMI for inclusion in the ROMA COS. METHODS & PROCEDURES Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. OUTCOMES & RESULTS In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living-3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. CONCLUSIONS & IMPLICATIONS Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research. WHAT THIS PAPER ADDS What is already known on this subject International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well-being. Before this study, OMIs for the constructs of communication and patient-reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work? The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices.
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Affiliation(s)
- Sarah J. Wallace
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQLDAustralia
- Queensland Aphasia Research CentreBrisbaneQLDAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationAustralia
| | - Linda Worrall
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQLDAustralia
- Queensland Aphasia Research CentreBrisbaneQLDAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationAustralia
| | - Tanya A. Rose
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQLDAustralia
- Queensland Aphasia Research CentreBrisbaneQLDAustralia
| | - Reem S. W. Alyahya
- Communication and Swallowing Disorders DepartmentKing Fahad Medical CityRiyadhSaudi Arabia
- School of Health and Psychological Sciences, CityUniversity of LondonLondonUK
| | - Edna Babbitt
- Department of Physical Medicine and Rehabilitation, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Suzanne Beeke
- Deparment of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Carola de Beer
- Faculty of Linguistics and Literary Studies & Medical School OWLUniversity of BielefeldBielefeldGermany
| | - Arpita Bose
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Audrey Bowen
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science CentreNorthern Care Alliance & University of ManchesterManchesterUK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professionals Research UnitGlasgow Caledonian UniversityGlasgowUK
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational NeurologyUniversity of MünsterMünsterGermany
| | - Stefanie Bruehl
- St. Mauritius Rehabilitation Centre, Meerbusch, Germany
- Medical Faculty, Heinrich‐Heine University Duesseldorf, Duesseldorf, Germany
- Clinical and Cognitive NeurosciencesDepartment of Neurology, RWTH Aachen UniversityGermany
| | - Lucy Bryant
- University of Technology Sydney Graduate School of Health, Faculty of HealthSydneyNSWAustralia
| | - Bonnie B. Y. Cheng
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQLDAustralia
- Queensland Aphasia Research CentreBrisbaneQLDAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationAustralia
| | - Leora R. Cherney
- Department of Physical Medicine and Rehabilitation, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Paul Conroy
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science CentreNorthern Care Alliance & University of ManchesterManchesterUK
| | - David A. Copland
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQLDAustralia
- Queensland Aphasia Research CentreBrisbaneQLDAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationAustralia
| | - Claire Croteau
- School of Speech–Language Pathology and Audiology, Centre for Interdisciplinary Research in Rehabilitation of Greater MontrealFaculty of Medicine, Université de MontréalMontrealQCCanada
| | - Madeline Cruice
- School of Health and Psychological Sciences, CityUniversity of LondonLondonUK
| | - Lucy Dipper
- School of Health and Psychological Sciences, CityUniversity of LondonLondonUK
| | - Katerina Hilari
- School of Health and Psychological Sciences, CityUniversity of LondonLondonUK
| | - Tami Howe
- School of Audiology and Speech SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Helen Kelly
- School of Clinical TherapiesUniversity College CorkCorkIreland
| | - Swathi Kiran
- Department of Speech, Language, and Hearing SciencesBoston UniversityBostonMAUSA
| | - Ann‐Charlotte Laska
- Department of Clinical SciencesKarolinska Institutet Danderyd HospitalStockholmSweden
| | - Jane Marshall
- School of Health and Psychological Sciences, CityUniversity of LondonLondonUK
| | - Laura L. Murray
- School of Communication Sciences and DisordersWestern UniversityLondonONCanada
| | - Janet Patterson
- Research ServiceVA Northern California Health Care SystemMartinezCAUSA
| | - Gill Pearl
- Speakeasy Specialist Aphasia CentreBuryUK
| | - Jana Quinting
- Speech Language Pathology, Department of Rehabilitation and Special Education, Faculty of Human SciencesUniversity of CologneCologneGermany
| | - Elizabeth Rochon
- Department of Speech–Language Pathology and Rehabilitation Sciences InstituteUniversity of TorontoToronto, ONCanada
| | - Miranda L. Rose
- Queensland Aphasia Research CentreBrisbaneQLDAustralia
- School of Allied Health, Human Services and SportLa Trobe UniversityBundooraVICAustralia
| | - Ilona Rubi‐Fessen
- Speech Language Pathology, Department of Rehabilitation and Special Education, Faculty of Human SciencesUniversity of CologneCologneGermany
- RehaNova Rehabilitation HospitalCologneGermany
| | - Karen Sage
- Faculty of Health and EducationManchester Metropolitan UniversityManchesterUK
| | - Nina Simmons‐Mackie
- Communication Sciences & DisordersSoutheastern Louisiana UniversityHammondLAUSA
| | - Evy Visch‐Brink
- Department of NeurologyErasmus UniversityRotterdamthe Netherlands
| | - Anna Volkmer
- Deparment of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Janet Webster
- School of Education, Communication and Language SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Anne Whitworth
- School of Health SciencesCollege of Health and MedicineUniversity of TasmaniaHobartAustralia
| | - Guylaine Le Dorze
- School of Speech–Language Pathology and Audiology, Centre for Interdisciplinary Research in Rehabilitation of Greater MontrealFaculty of Medicine, Université de MontréalMontrealQCCanada
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Hazelton C, Thomson K, Todhunter-Brown A, Campbell P, Chung CSY, Dorris L, Gillespie DC, Hunter SM, McGill K, Nicolson DJ, Williams LJ, Brady MC. Interventions for Perceptual Disorders in Stroke: A Systematic Review. Stroke 2023; 54:e239-e240. [PMID: 37021561 DOI: 10.1161/strokeaha.123.041957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit (C.H., K.T., A.T.-B., P.C., K.M., M.C.B.), Glasgow Caledonian University, United Kingdom
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit (C.H., K.T., A.T.-B., P.C., K.M., M.C.B.), Glasgow Caledonian University, United Kingdom
- Department of Occupational Therapy, Human Nutrition and Dietetics (K.T.), Glasgow Caledonian University, United Kingdom
| | - Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions Research Unit (C.H., K.T., A.T.-B., P.C., K.M., M.C.B.), Glasgow Caledonian University, United Kingdom
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit (C.H., K.T., A.T.-B., P.C., K.M., M.C.B.), Glasgow Caledonian University, United Kingdom
| | | | - Liam Dorris
- Paediatric Neurosciences, Royal Hospital for Children, NHS Greater Glasgow and Clyde, United Kingdom (L.D.)
| | - David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh (D.C.G.), NHS Lothian, United Kingdom
| | - Susan M Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, United Kingdom (S.M.H.)
| | - Kris McGill
- Nursing, Midwifery and Allied Health Professions Research Unit (C.H., K.T., A.T.-B., P.C., K.M., M.C.B.), Glasgow Caledonian University, United Kingdom
| | | | - Linda J Williams
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, United Kingdom (L.J.W.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit (C.H., K.T., A.T.-B., P.C., K.M., M.C.B.), Glasgow Caledonian University, United Kingdom
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7
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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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Hazelton C, Thomson K, Todhunter-Brown A, Campbell P, Chung CS, Dorris L, Gillespie DC, Hunter SM, McGill K, Nicolson DJ, Williams LJ, Brady MC. Interventions for perceptual disorders following stroke. Cochrane Database Syst Rev 2022; 11:CD007039. [PMID: 36326118 PMCID: PMC9631864 DOI: 10.1002/14651858.cd007039.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non-invasive brain stimulation, pharmacological and surgical approaches. OBJECTIVES To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. DATA COLLECTION AND ANALYSIS One review author assessed titles, with two review authors independently screening abstracts and full-text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB-1 tool, and quality of evidence using GRADE. A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. MAIN RESULTS We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch-somatosensory disorders. None addressed stroke-related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non-invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL): Somatosensory disorders: one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure. Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention. Visual perception disorders: no trials measuring ADL compared an intervention with no treatment or control. In addition, six trials reported ADL outcomes in a comparison of active intervention versus active intervention, relating to somatosensation (three trials), touch (one trial) and vision (two trials). AUTHORS' CONCLUSIONS: Following a detailed, systematic search, we identified limited RCT evidence of the effectiveness of interventions for perceptual disorders following stroke. There is insufficient evidence to support or refute the suggestion that perceptual interventions are effective. More high-quality trials of interventions for perceptual disorders in stroke are needed. They should recruit sufficient participant numbers, include a 'usual care' comparison, and measure longer-term functional outcomes, at time points beyond the initial intervention period. People with impaired perception following a stroke should continue to receive neurorehabilitation according to clinical guidelines.
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Affiliation(s)
- Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Charlie Sy Chung
- Rehabilitation Services, Fife Health and Social Care Partnership, Dunfermline, UK
| | - Liam Dorris
- Paediatric Neurosciences, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Susan M Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Kris McGill
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Linda J Williams
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Wallace SJ, Isaacs M, Ali M, Brady MC. Establishing reporting standards for participant characteristics in post-stroke aphasia research: An international e-Delphi exercise and consensus meeting. Clin Rehabil 2022; 37:199-214. [DOI: 10.1177/02692155221131241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To establish international, multidisciplinary expert consensus on minimum participant characteristic reporting standards in aphasia research (DESCRIBE project). Methods An international, three-round e-Delphi exercise and consensus meeting, involving multidisciplinary researchers, clinicians and journal editors working academically or clinically in the field of aphasia. Results Round 1 of the DESCRIBE e-Delphi exercise ( n = 156) generated 113 items, 20 of which reached consensus by round 3. The final consensus meeting ( n = 19 participants) established DESCRIBE's 14 participant characteristics that should be reported in aphasia studies: age; years of education; biological sex; language of treatment/testing; primary language; languages used; history of condition(s) known to impact communication/cognition; history of previous stroke; lesion hemisphere; time since onset of aphasia; conditions arising from the neurological event; and, for communication partner participants, age, biological sex and relationship to person with aphasia. Each characteristic has been defined and matched with standard response options to enable consistent reporting. Conclusion Aphasia research studies should report the 14 DESCRIBE participant characteristics as a minimum. Consistent adherence to the DESCRIBE minimum reporting standard will reduce research wastage and facilitate evidence-based aphasia management by enabling replication and collation of research findings, and translation of evidence into practice.
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Affiliation(s)
- Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Queensland Aphasia Research Centre, Brisbane, Australia
| | - Megan Isaacs
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Queensland Aphasia Research Centre, Brisbane, Australia
| | - Myzoon Ali
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Marian C Brady
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland
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Brown SE, Scobbie L, Worrall L, Mc Menamin R, Brady MC. Access G-AP: development of an accessible goal setting and action planning resource for stroke survivors with aphasia. Disabil Rehabil 2022:1-11. [PMID: 35695078 DOI: 10.1080/09638288.2022.2085331] [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: 11/03/2022]
Abstract
PURPOSE Goal setting is key to stroke rehabilitation, but access for people with aphasia is challenging. Based on the Goal setting and Action Planning (G-AP) framework, we developed an accessible goal setting resource (Access G-AP). METHODS Access G-AP was designed using a three-phase, user-centred design process. Phase 1: Access G-AP Draft A was designed using evidence-based recommendations. Phase 2: Draft A was reviewed by stroke survivors with aphasia (focus groups 1&2) and rehabilitation staff (questionnaire). Phase 3: Suggested recommendations informed Access G-AP Draft B, which was further reviewed by stroke survivors with aphasia (focus group 3). The final version of Access G-AP was approved by stroke survivors with aphasia at a debrief meeting. Data were analysed using content analysis. RESULTS Recommended design improvements included reducing text, adding bullet points, and diversifying images. Both participant groups highlighted that Access G-AP should be used collaboratively to support stroke survivor involvement. Staff recommended Access G-AP training and additional resources to support stroke survivors with severe aphasia. CONCLUSIONS Access G-AP was co-developed to support people with aphasia to access and engage in stroke rehabilitation goal setting. Further research is required to establish the feasibility of Access G-AP in clinical practice.IMPLICATIONS FOR REHABILITATIONEvidence-based accessible formatting strategies and an iterative design process can inform the design of accessible goal setting resources.Accessible goal setting materials should be relevant to stroke survivors with aphasia and responsive to their needs.Rehabilitation staff require training and support to use accessible goal setting resources (like Access G-AP) with stroke survivors with aphasia, especially those with severe aphasia.Evaluation of the feasibility of Access G-AP in clinical practice is now required.
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Affiliation(s)
| | - Lesley Scobbie
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | | | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Campbell P, Rooney S, Nicoll A, Brady MC, Smith CH, Deane KHO, Herd CP, Tomlinson CL, Clarke CE, Sackley CM. Speech and language therapy interventions for speech problems in Parkinson's disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd015009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Scott Rooney
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Avril Nicoll
- Health Services Research Unit; University of Aberdeen; Aberdeen UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Christina H Smith
- Division of Psychology and Language Sciences; University College London; London UK
| | | | - Clare P Herd
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - Claire L Tomlinson
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - Carl E Clarke
- Department of Neurology; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust; Birmingham UK
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Hazelton C, McGill K, Campbell P, Todhunter-Brown A, Thomson K, Nicolson DJ, Cheyne JD, Chung C, Dorris L, Gillespie DC, Hunter SM, Brady MC. Perceptual Disorders After Stroke: A Scoping Review of Interventions. Stroke 2022; 53:1772-1787. [PMID: 35468001 PMCID: PMC9022686 DOI: 10.1161/strokeaha.121.035671] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Perceptual disorders relating to hearing, smell, somatosensation, taste, touch, and vision commonly impair stroke survivors’ ability to interpret sensory information, impacting on their ability to interact with the world. We aimed to identify and summarize the existing evidence for perceptual disorder interventions poststroke and identify evidence gaps. We searched 13 electronic databases including MEDLINE and Embase and Grey literature and performed citation tracking. Two authors independently applied a priori–defined selection criteria; studies involving stroke survivors with perceptual impairments and interventions addressing those impairments were included. We extracted data on study design, population, perceptual disorders, interventions, and outcomes. Data were tabulated and synthesized narratively. Stroke survivors, carers, and clinicians were involved in agreeing definitions and organizing and interpreting data. From 91 869 records, 80 studies were identified (888 adults and 5 children); participant numbers were small (median, 3.5; range, 1–80), with a broad range of stroke types and time points. Primarily focused on vision (34/80, 42.5%) and somatosensation (28/80; 35.0%), included studies were often case reports (36/80; 45.0%) or randomized controlled trials (22/80; 27.5%). Rehabilitation approaches (78/93; 83.9%), primarily aimed to restore function, and were delivered by clinicians (30/78; 38.5%) or technology (28/78; 35.9%; including robotic interventions for somatosensory disorders). Pharmacological (6/93; 6.5%) and noninvasive brain stimulation (7/93; 7.5%) approaches were also evident. Intervention delivery was poorly reported, but most were delivered in hospital settings (56/93; 60.2%). Study outcomes failed to assess the transfer of training to daily life. Interventions for stroke-related perceptual disorders are underresearched, particularly for pediatric populations. Evidence gaps include interventions for disorders of hearing, taste, touch, and smell perception. Future studies must involve key stakeholders and report this fully. Optimization of intervention design, evaluation, and reporting is required, to support the development of effective, acceptable, and implementable interventions.
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Affiliation(s)
- Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (C.H., K.M., P.C., A.T.-B., K.T., M.C.B.)
| | - Kris McGill
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (C.H., K.M., P.C., A.T.-B., K.T., M.C.B.)
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (C.H., K.M., P.C., A.T.-B., K.T., M.C.B.)
| | - Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (C.H., K.M., P.C., A.T.-B., K.T., M.C.B.)
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (C.H., K.M., P.C., A.T.-B., K.T., M.C.B.)
| | | | - Joshua D Cheyne
- Cochrane Stroke Group, University of Edinburgh, United Kingdom (J.D.C.)
| | - Charlie Chung
- Queen Margaret Hospital, National Health Service (NHS) Fife, United Kingdom (C.C.)
| | - Liam Dorris
- Paediatric Neurosciences, Royal Hospital for Children, NHS Greater Glasgow and Clyde, United Kingdom (L.D.)
| | - David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, United Kingdom (D.C.G.)
| | - Susan M Hunter
- School of Allied Health Professions, Keele University, United Kingdom (S.M.H.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (C.H., K.M., P.C., A.T.-B., K.T., M.C.B.)
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McGill K, Sackley C, Godwin J, Gavaghan D, Ali M, Ballester BR, Brady MC. Using the Barthel Index and modified Rankin Scale as Outcome Measures for Stroke Rehabilitation Trials; A Comparison of Minimum Sample Size Requirements. J Stroke Cerebrovasc Dis 2021; 31:106229. [PMID: 34871903 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106229] [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: 08/17/2021] [Revised: 10/19/2021] [Accepted: 11/14/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Underpowered trials risk inaccurate results. Recruitment to stroke rehabilitation randomised controlled trials (RCTs) is often a challenge. Statistical simulations offer an important opportunity to explore the adequacy of sample sizes in the context of specific outcome measures. We aimed to examine and compare the adequacy of stroke rehabilitation RCT sample sizes using the Barthel Index (BI) or modified Rankin Scale (mRS) as primary outcomes. METHODS We conducted computer simulations using typical experimental event rates (EER) and control event rates (CER) based on individual participant data (IPD) from stroke rehabilitation RCTs. Event rates are the proportion of participants who experienced clinically relevant improvements in the RCT experimental and control groups. We examined minimum sample size requirements and estimated the number of participants required to achieve a number needed to treat within clinically acceptable boundaries for the BI and mRS. RESULTS We secured 2350 IPD (18 RCTs). For a 90% chance of statistical accuracy on the BI a rehabilitation RCT would require 273 participants per randomised group. Accurate interpretation of effect sizes would require 1000s of participants per group. Simulations for the mRS were not possible as a clinically relevant improvement was not detected when using this outcome measure. CONCLUSIONS Stroke rehabilitation RCTs with large sample sizes are required for accurate interpretation of effect sizes based on the BI. The mRS lacked sensitivity to detect change and thus may be unsuitable as a primary outcome in stroke rehabilitation trials.
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Affiliation(s)
- Kris McGill
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Rd, Glasgow G4 0BA, UK.
| | - Catherine Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jon Godwin
- Nuffield Department of Population Health, University of Oxford, UK
| | - David Gavaghan
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Myzoon Ali
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Rd, Glasgow G4 0BA, UK
| | - Belen Rubio Ballester
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Rd, Glasgow G4 0BA, UK
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Bangee M, Martinez-Garduno CM, Brady MC, Cadilhac DA, Dale S, Hurley MA, McInnes E, Middleton S, Patel T, Watkins CL, Lightbody E. Oral care practices in stroke: findings from the UK and Australia. BMC Nurs 2021; 20:169. [PMID: 34526030 PMCID: PMC8442320 DOI: 10.1186/s12912-021-00642-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/27/2021] [Indexed: 11/29/2022] Open
Abstract
Aims To examine current practice, perceptions of healthcare professionals and factors affecting provision for oral care post-stroke in the UK and Australia. Background Poor oral care has negative health consequences for people post-stroke. Little is known about oral care practice in hospital for people post-stroke and factors affecting provision in different countries. Design A cross-sectional survey. Methods Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing inpatient acute or rehabilitation care post-stroke. The survey was conducted between April and November 2019. Non-respondents were contacted up to five times. Results Completed questionnaires were received from 150/174 (86%) hospitals in the UK, and 120/162 (74%) in Australia. A total of 52% of UK hospitals and 30% of Australian hospitals reported having a general oral care protocol, with 53% of UK and only 13% of Australian hospitals reporting using oral care assessment tools. Of those using oral care assessment tools, 50% of UK and 38% of Australian hospitals used local hospital-specific tools. Oral care assessments were undertaken on admission in 73% of UK and 57% of Australian hospitals. Staff had received oral care training in the last year in 55% of UK and 30% of Australian hospitals. Inadequate training and education on oral care for pre-registration nurses were reported by 63% of UK and 53% of Australian respondents. Conclusion Unacceptable variability exists in oral care practices in hospital stroke care settings. Oral care could be improved by increasing training, performing individual assessments on admission, and using standardised assessment tools and protocols to guide high quality care. The study highlights the need for incorporating staff training and the use of oral care standardised assessments and protocols in stroke care in order to improve patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00642-y.
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Affiliation(s)
- Munirah Bangee
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Cintia Mayel Martinez-Garduno
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Dominique A Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, VIC, Melbourne, Australia
| | - Simeon Dale
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Margaret A Hurley
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Elizabeth McInnes
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Sandy Middleton
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Tahera Patel
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Elizabeth Lightbody
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK.
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Abstract
Supplemental Digital Content is available in the text. The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies.
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Affiliation(s)
- Jeroen C de Jonge
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (J.C.d.J., H.B.v.d.W.)
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Center, Amsterdam Neuroscience, the Netherlands (D.v.d.B.)
| | - Patrick Lyden
- Departments of Physiology and Neuroscience and Neurology, USC Keck School of Medicine, Los Angeles, CA (P.L.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (M.C.B.)
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom (P.M.B.)
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (J.C.d.J., H.B.v.d.W.)
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Scobbie L, Brady MC, Duncan EAS, Wyke S. Goal attainment, adjustment and disengagement in the first year after stroke: A qualitative study. Neuropsychol Rehabil 2021; 31:691-709. [PMID: 32412863 DOI: 10.1080/09602011.2020.1724803] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Understanding stroke survivor responses to attainable and unattainable goals is important so that rehabilitation staff can optimally support ongoing recovery and adaption. In this qualitative study, we aimed to investigate (i) stroke survivor's experiences of goal attainment, adjustment and disengagement in the first year after stroke and (ii) whether the Goal setting and Action Planning (G-AP) framework supported different pathways to goal attainment. In-depth interviews were conducted with eighteen stroke survivors' to explore their experiences and views. Interview data were transcribed verbatim and analysed using a Framework approach to examine themes within and between participants. Stroke survivors reported that attaining personal goals enabled them to resume important activities, reclaim a sense of self and enhance emotional wellbeing. Experiences of goal-related setbacks and failure facilitated understanding and acceptance of limitations and informed adjustment of, or disengagement from, unattainable goals. Use of the G-AP framework supported stroke survivors to (i) identify personal goals, (ii) initiate and sustain goal pursuit, (iii) gauge progress and (iv) make informed decisions about continued goal pursuit, adjustment or disengagement. Stroke survivor recovery involves attainment of original and adjusted or alternative goals. The G-AP framework can support these different pathways to goal attainment.
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Affiliation(s)
- L Scobbie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - M C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - E A S Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Scotland
| | - S Wyke
- Institute of Health and Wellbeing, University of Glasgow, Scotland
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Hazelton C, Pollock A, Dixon D, Taylor A, Davis B, Walsh G, Brady MC. The feasibility and effects of eye movement training for visual field loss after stroke: a mixed methods study. Br J Occup Ther 2021. [DOI: 10.1177/0308022620936052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Visual field loss affects around 20% of stroke survivors, reducing quality of life. Eye movement training is a promising rehabilitation method, and several different interventions are used by occupational therapists. This study aimed to explore the feasibility and effects of four eye movement training interventions for stroke survivors with visual field loss. Method A mixed methods study – quantitative n-of-1 with qualitative interviews. The participants were 11 home-dwelling stroke survivors with visual field loss. The interventions used were MyHappyNeuron, NVT, Rainbow Readers and VISIOcoach, delivered in a randomised order. Visual search, reading speed, activities of daily living and quality of life were assessed three times before intervention use, then immediately after each intervention; these were analysed visually. A final semi-structured interview was then analysed using framework methods. Results Evidence of effect was divergent. Quantitatively there was no measured effect, but qualitatively participants reported benefits in visual skills, daily life skills and emotions, which varied by intervention. Median training time was 3–4 hours (range 0.5–6.5) for NVT, Rainbow Readers and MyHappyNeuron, and 9.5 hours (range 2.3–16.8) for VISIOcoach. Conclusion Eye movement training interventions were feasible for stroke survivors at home. Qualitative evidence suggests that variations in the eye movements trained and delivery modality underlie variations in perceived effect.
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Affiliation(s)
- Christine Hazelton
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Diane Dixon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Anne Taylor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Bridget Davis
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Glyn Walsh
- Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
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Latimer NR, Bhadhuri A, Alshreef A, Palmer R, Cross E, Dimairo M, Julious S, Cooper C, Enderby P, Brady MC, Bowen A, Bradley E, Harrison M. Self-managed, computerised word finding therapy as an add-on to usual care for chronic aphasia post-stroke: An economic evaluation. Clin Rehabil 2021; 35:703-717. [PMID: 33233972 PMCID: PMC8073872 DOI: 10.1177/0269215520975348] [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] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the cost-effectiveness of self-managed computerised word finding therapy as an add-on to usual care for people with aphasia post-stroke. DESIGN Cost-effectiveness modelling over a life-time period, taking a UK National Health Service (NHS) and personal social service perspective. SETTING Based on the Big CACTUS randomised controlled trial, conducted in 21 UK NHS speech and language therapy departments. PARTICIPANTS Big CACTUS included 278 people with long-standing aphasia post-stroke. INTERVENTIONS Computerised word finding therapy plus usual care; usual care alone; usual care plus attention control. MAIN MEASURES Incremental cost-effectiveness ratios (ICER) were calculated, comparing the cost per quality adjusted life year (QALY) gained for each intervention. Credible intervals (CrI) for costs and QALYs, and probabilities of cost-effectiveness, were obtained using probabilistic sensitivity analysis. Subgroup and scenario analyses investigated cost-effectiveness in different subsets of the population, and the sensitivity of results to key model inputs. RESULTS Adding computerised word finding therapy to usual care had an ICER of £42,686 per QALY gained compared with usual care alone (incremental QALY gain: 0.02 per patient (95% CrI: -0.05 to 0.10); incremental costs: £732.73 per patient (95% CrI: £674.23 to £798.05)). ICERs for subgroups with mild or moderate word finding difficulties were £22,371 and £21,262 per QALY gained respectively. CONCLUSION Computerised word finding therapy represents a low cost add-on to usual care, but QALY gains and estimates of cost-effectiveness are uncertain. Computerised therapy is more likely to be cost-effective for people with mild or moderate, as opposed to severe, word finding difficulties.
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Affiliation(s)
| | | | | | | | - Elizabeth Cross
- ScHARR, The University of Sheffield, Sheffield, UK
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, UK
| | - Munyaradzi Dimairo
- ScHARR, The University of Sheffield, Sheffield, UK
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, UK
| | | | - Cindy Cooper
- ScHARR, The University of Sheffield, Sheffield, UK
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, UK
| | - Pam Enderby
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Audrey Bowen
- Division of Neuroscience & Experimental Psychology, FBMH, University of Manchester, MAHSC, Manchester, UK
| | - Ellen Bradley
- ScHARR, The University of Sheffield, Sheffield, UK
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, UK
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Brady MC. Predictors of Poststroke Aphasia Recovery: A Systematic Review-Informed Individual Participant Data Meta-Analysis. Stroke 2021; 52:1778-1787. [PMID: 33719515 PMCID: PMC8078126 DOI: 10.1161/strokeaha.120.031162] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 06/23/2020] [Revised: 10/31/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants' age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. METHODS Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. RESULTS Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4-165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3-26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0-20.9], +6.1 correct on AAT Token Test [CI, 3.2-8.9]; +9.3 Boston Naming Test points [CI, 4.7-13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5-1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9-24.4]; +5.3 correct on AAT Token Test [CI, 1.7-8.8]; +11.1 Boston Naming Test points [CI, 5.7-16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7-1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. CONCLUSIONS Earlier intervention for poststroke aphasia was crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke.
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Affiliation(s)
- Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom
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Grayson L, Brady MC, Togher L, Ali M. The impact of cognitive-communication difficulties following traumatic brain injury on the family; a qualitative, focus group study. Brain Inj 2020; 35:15-25. [PMID: 33327774 DOI: 10.1080/02699052.2020.1849800] [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: 10/22/2022]
Abstract
Primary Objective: To identify how families experience cognitive-communication difficulties following Traumatic Brain Injury (TBI). Experiences of information, training and support for managing communication changes were also explored. Research Design: Qualitative focus group methodology using thematic analysis. Method: 15 family members of individuals with cognitive-communication difficulties following severe TBI participated in the study; four parents, six spouses, three siblings and two offspring. The majority of participants were female (80%, n = 12), with a mean age of 51 (range 19-71). Four focus groups were held with family members at 0-12 months, 12-36 months and 36+ months post-injury. The data were transcribed verbatim and analyzed using NVIVO 12.Results: Cognitive-communication difficulties were found to impact upon family functioning and psychological wellbeing for several years post-injury. Changes to social cognition, insight and the "filter switch" of the person following TBI were key areas of distress. Participants highlighted the need for information about communication changes to be provided at several time points post-injury. The need for peer support from other families with experience of cognitive-communication difficulties was also identified.Conclusion: Cognitive-communication difficulties impact upon family functioning for many years following injury with families continuing to have support needs for communication well beyond the acute rehabilitation stage.
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Affiliation(s)
- Lynn Grayson
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland.,NHS Lanarkshire, Carluke, Scotland
| | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Myzoon Ali
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland
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Abstract
BACKGROUND For people with physical, sensory and cognitive limitations due to stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group. OBJECTIVES To compare the effectiveness of OHC interventions with usual care or other treatment options for ensuring oral health in people after a stroke. SEARCH METHODS We searched the Cochrane Stroke Group and Cochrane Oral Health Group trials registers, CENTRAL, MEDLINE, Embase, and six other databases in February 2019. We scanned reference lists from relevant papers and contacted authors and researchers in the field. We handsearched the reference lists of relevant articles and contacted other researchers. There were no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated one or more interventions designed to improve the cleanliness and health of the mouth, tongue and teeth in people with a stroke who received assisted OHC led by healthcare staff. We included trials with a mixed population provided we could extract the stroke-specific data. The primary outcomes were dental plaque or denture plaque. Secondary outcomes included presence of oral disease, presence of related infection and oral opportunistic pathogens related to OHC and pneumonia, stroke survivor and providers' knowledge and attitudes to OHC, and patient satisfaction and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text articles according to prespecified selection criteria, extracted data and assessed the methodological quality using the Cochrane 'Risk of bias' tool. We sought clarification from investigators when required. Where suitable statistical data were available, we combined the selected outcome data in pooled meta-analyses. We used GRADE to assess the quality of evidence for each outcome. MAIN RESULTS Fifteen RCTs (22 randomised comparisons) involving 3631 participants with data for 1546 people with stroke met the selection criteria. OHC interventions compared with usual care Seven trials (2865 participants, with data for 903 participants with stroke, 1028 healthcare providers, 94 informal carers) investigated OHC interventions compared with usual care. Multi-component OHC interventions showed no evidence of a difference in the mean score (DMS) of dental plaque one month after the intervention was delivered (DMS -0.66, 95% CI -1.40 to 0.09; 2 trials, 83 participants; I2 = 83%; P = 0.08; very low-quality evidence). Stroke survivors had less plaque on their dentures when staff had access to the multi-component OHC intervention (DMS -1.31, 95% CI -1.96 to -0.66; 1 trial, 38 participants; P < 0.0001; low-quality evidence). There was no evidence of a difference in gingivitis (DMS -0.60, 95% CI -1.66 to 0.45; 2 trials, 83 participants; I2 = 93%; P = 0.26: very low-quality evidence) or denture-induced stomatitis (DMS -0.33, 95% CI -0.92 to 0.26; 1 trial, 38 participants; P = 0.69; low-quality evidence) among participants receiving the multi-component OHC protocol compared with usual care one month after the intervention. There was no difference in the incidence of pneumonia in participants receiving a multi-component OHC intervention (99 participants; 5 incidents of pneumonia) compared with those receiving usual care (105 participants; 1 incident of pneumonia) (OR 4.17, CI 95% 0.82 to 21.11; 1 trial, 204 participants; P = 0.08; low-quality evidence). OHC training for stroke survivors and healthcare providers significantly improved their OHC knowledge at one month after training (SMD 0.70, 95% CI 0.06 to 1.35; 3 trials, 728 participants; I2 = 94%; P = 0.03; very low-quality evidence). Pooled data one month after training also showed evidence of a difference between stroke survivor and providers' oral health attitudes (SMD 0.28, 95% CI 0.01 to 0.54; 3 trials, 728 participants; I2 = 65%; P = 0.06; very low-quality evidence). OHC interventions compared with placebo Three trials (394 participants, with data for 271 participants with stroke) compared an OHC intervention with placebo. There were no data for primary outcomes. There was no evidence of a difference in the incidence of pneumonia in participants receiving an OHC intervention compared with placebo (OR 0.39, CI 95% 0.14 to 1.09; 2 trials, 242 participants; I2 = 42%; P = 0.07; low-quality evidence). However, decontamination gel reduced the incidence of pneumonia among the intervention group compared with placebo gel group (OR 0.20, 95% CI 0.05 to 0.84; 1 trial, 203 participants; P = 0.028). There was no difference in the incidence of pneumonia in participants treated with povidone-iodine compared with a placebo (OR 0.81, 95% CI 0.18 to 3.51; 1 trial, 39 participants; P = 0.77). One OHC intervention compared with another OHC intervention Twelve trials (372 participants with stroke) compared one OHC intervention with another OHC intervention. There was no difference in dental plaque scores between those participants that received an enhanced multi-component OHC intervention compared with conventional OHC interventions at three months (MD -0.04, 95% CI -0.33 to 0.25; 1 trial, 61 participants; P = 0.78; low-quality evidence). There were no data for denture plaque. AUTHORS' CONCLUSIONS We found low- to very low-quality evidence suggesting that OHC interventions can improve the cleanliness of patient's dentures and stroke survivor and providers' knowledge and attitudes. There is limited low-quality evidence that selective decontamination gel may be more beneficial than placebo at reducing the incidence of pneumonia. Improvements in the cleanliness of a patient's own teeth was limited. We judged the quality of the evidence included within meta-analyses to be low or very low quality, and this limits our confidence in the results. We still lack high-quality evidence of the optimal approach to providing OHC to people after stroke.
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Affiliation(s)
- Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Bain
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Denise Lc Furlanetto
- Public Health Department, Health Sciences Faculty, University of Brasilia, Brasilia, Brazil
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Grayson L, Brady MC, Togher L, Ali M. A survey of cognitive-communication difficulties following TBI: are families receiving the training and support they need? Int J Lang Commun Disord 2020; 55:712-723. [PMID: 32618085 DOI: 10.1111/1460-6984.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/03/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Whilst research into the wide-ranging needs of family members following traumatic brain injury (TBI) is well established, investigation into the specific needs of families in relation to supporting cognitive-communication difficulties, relationships and social participation is limited. AIMS To identify the family needs for cognitive-communication difficulties following TBI and to explore whether current services are meeting these needs. METHODS & PROCEDURES Following a successful pilot, family members from the UK and Australia were invited via posters, social media and e-mail to take part in an anonymous, communication needs survey. Data arising from the thirty two closed questions (six eligibility, nine demographic and seventeen needs questions) were analysed using SPSS descriptive statistics. Data arising from one open question were analysed using qualitative content analysis. OUTCOMES & RESULTS A total of 102 family members from the UK (n = 89, 87%) and Australia (n = 13, 13%) completed the survey. The majority of respondents were female (n = 76; 75%), between the ages of 30 and 69 (n = 88; 87%), and either a parent or a partner of the person following TBI (n = 78;76%). Respondents rated information about expected recovery from cognitive-communication difficulties and training in helpful strategies as their most important needs. The majority of respondents (more than 60%) were not satisfied that any of their cognitive-communication needs had been fully met and high levels of unmet need remained evident at three years or more post-injury. Written information, communication partner training and counselling were identified as key supports. CONCLUSIONS & IMPLICATIONS Families report high levels of unmet need for managing cognitive-communication difficulties following TBI. Access to written information and communication partner training should be available to families at various time points following TBI and not just in the early stages. What this paper adds What is already known on this subject Attempting to support a person who has cognitive-communication difficulties following TBI has been found to be highly burdensome for family members. However, few studies have asked how families perceive their needs in relation to cognitive-communication difficulties or measured how well current services are meeting their needs. What this paper adds to existing knowledge This study demonstrates that current speech and language therapy services are not yet meeting the needs of the relatives of individuals with cognitive-communication difficulties following TBI. Important insights into the information, training and support families' rate as important are identified in addition to how these needs develop over time. What are the potential or actual clinical implications of this work? Speech and language therapy service design requires to reflect the ongoing nature of familial needs for cognitive-communication difficulties following TBI. Families require access to appropriate literature, speech and language therapy support, and communication partner training in the longer term, not just in the acute phase.
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Affiliation(s)
- Lynn Grayson
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
- Community Brain Injury Team, NHS Lanarkshire, Carluke, UK
| | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Leanne Togher
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Myzoon Ali
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
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Scobbie L, Duncan EAS, Brady MC, Thomson K, Wyke S. Facilitators and "deal breakers": a mixed methods study investigating implementation of the Goal setting and action planning (G-AP) framework in community rehabilitation teams. BMC Health Serv Res 2020; 20:791. [PMID: 32843039 PMCID: PMC7447562 DOI: 10.1186/s12913-020-05651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation. METHODS We approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively. RESULTS We recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%, 51/55) participated in G-AP training; of those, 80% (n = 41/51) completed the training questionnaire. Training was rated as 'good' or 'very good' by almost all staff (92%, n = 37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP 'made sense'; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor 'fit' between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records. CONCLUSIONS The interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation "deal breakers". Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.
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Affiliation(s)
- Lesley Scobbie
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - Edward A. S. Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, Scotland
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8R2 Scotland
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Øra HP, Kirmess M, Brady MC, Sørli H, Becker F. Technical Features, Feasibility, and Acceptability of Augmented Telerehabilitation in Post-stroke Aphasia-Experiences From a Randomized Controlled Trial. Front Neurol 2020; 11:671. [PMID: 32849176 PMCID: PMC7411384 DOI: 10.3389/fneur.2020.00671] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Received: 12/17/2019] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Post-stroke aphasia is a communication disorder where existing evidence favors intensive therapy methods. Telerehabilitation represents a service model for geographically remote settings, or other barriers to clinic attendance or to facilitate an augmentation of therapy across a continuum of care. Evidence to support efficiency, feasibility, and acceptability is however still scarce. Appraising aphasia telerehabilitation in controlled trials beyond its effectiveness, by investigating feasibility and acceptability, may facilitate implementation into clinical practice. Methods: In our pilot randomized controlled trial, we investigated the feasibility and acceptability of speech and language therapy by videoconference, in addition to usual care, in people with aphasia following stroke. To improve functional, expressive language, a tailored intervention was given 1 h per day, five times per week over four consecutive weeks. Feasibility measures included evaluation of technical setup using diary logs. Acceptability was investigated by examining adherence and satisfaction with therapy alongside evaluation of data safety and privacy. Results: Feasibility and acceptability data were collected in relation to 556.5 h of telerehabilitation delivered to 30 participants over a 2-years intervention period by three speech-language pathologists. Protocol adherence was high, with a tolerable technical fault rate; 86 faults were registered over 541 video sessions. Most (80%; n = 30) of the participants experienced zero to three faults. The main cause of technical failures was flawed internet connection, causing delayed or interrupted therapy. Total satisfaction with telerehabilitation was rated good or very good by 93.1% (n = 29) of participants and two of three speech-language pathologists. Within a moderate variance of technical failure, participants experiencing more faults were more satisfied. No serious events regarding security and privacy were reported. Our model is feasibly and ready to be implemented across a range of clinical settings and contexts. Conclusions: Synchronous telerehabilitation for post-stroke aphasia is feasible and acceptable and shows tolerable technical fault rates with high satisfaction among patients and pathologists. Within a low rate of faults, satisfaction was not negatively influenced by fault frequency. Access to clinical and technical expertise is needed when developing telerehabilitation services. Telerehabilitation may be a viable service delivery model for aphasia rehabilitation. Trial Registration: ClinicalTrials.gov, ID: NCT02768922.
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Affiliation(s)
- Hege Prag Øra
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Melanie Kirmess
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Hilde Sørli
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Frank Becker
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Bolton L, Mills C, Wallace S, Brady MC. Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review. Int J Lang Commun Disord 2020; 55:629-636. [PMID: 32478950 PMCID: PMC7300802 DOI: 10.1111/1460-6984.12544] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 05/08/2023]
Affiliation(s)
- Lee Bolton
- Speech & Language Therapy ServiceImperial College Healthcare NHS TrustLondonUK
| | - Claire Mills
- Speech & Language Therapy DepartmentLeeds Teaching Hospitals NHS TrustLeedsUK
- Academic Unit of Health EconomicsUniversity of LeedsLeedsUK
| | - Sarah Wallace
- Speech & Language Therapy Department, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
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Gillespie DC, Barber M, Brady MC, Carson A, Chalder T, Chun Y, Cvoro V, Dennis M, Hackett M, Haig E, House A, Lewis S, Parker R, Wee F, Wu S, Mead G. Study protocol for POSITIF, a randomised multicentre feasibility trial of a brief cognitive-behavioural intervention plus information versus information alone for the treatment of post-stroke fatigue. Pilot Feasibility Stud 2020; 6:84. [PMID: 32549995 PMCID: PMC7296769 DOI: 10.1186/s40814-020-00622-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Approximately, half of stroke survivors experience fatigue. Fatigue may persist for many months and interferes with participation in everyday activities and has a negative impact on social and family relationships, return to work, and quality of life. Fatigue is among the top 10 priorities for 'Life after Stroke' research for stroke survivors, carers, and clinicians. We previously developed and tested in a small uncontrolled pilot study a manualised, clinical psychologist-delivered, face-to-face intervention, informed by cognitive behavioural therapy (CBT). We then adapted it for delivery by trained therapists via telephone. We now aim to test the feasibility of this approach in a parallel group, randomised controlled feasibility trial (Post Stroke Intervention Trial In Fatigue, POSITIF). Methods/design POSITIF aims to recruit 75 stroke survivors between 3 months and 2 years post-stroke who would like treatment for their fatigue. Eligible consenting stroke survivors will be randomised to either a 7-session manualised telephone-delivered intervention based on CBT principles plus information about fatigue, or information only. The aims of the intervention are to (i) provide an explanation for post-stroke fatigue, in particular that it is potentially reversible (an educational approach), (ii) encourage participants to overcome the fear of taking physical activity and challenge negative thinking (a cognitive approach) and (iii) promote a balance between daily activities, rest and sleep and then gradually increase levels of physical activity (a behavioural approach). Fatigue, mood, quality of life, return to work and putative mediators will be assessed at baseline (just before randomisation), at the end of treatment and 6 months after randomisation. POSITIF will determine the feasibility of recruitment, adherence to the intervention and the resources required to deliver the intervention in a larger trial. Discussion The POSITIF feasibility trial will recruit until 31 January 2020. Data will inform the utility and design of a future adequately powered randomised controlled trial. Trial registration ClinicalTrials.gov, NCT03551327. Registered on 11 June 2018.
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Affiliation(s)
- David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark Barber
- NHS Lanarkshire, Monklands Hospital, Coatbridge, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alan Carson
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London, London, UK
| | - Yvonne Chun
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Vera Cvoro
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Maree Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Euan Haig
- Independent Consultant, Edinburgh, UK
| | - Allan House
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Steff Lewis
- Edinburgh Clinical Trials Unit (ECTU), University of Edinburgh, Edinburgh, UK
| | - Richard Parker
- Edinburgh Clinical Trials Unit (ECTU), University of Edinburgh, Edinburgh, UK
| | - Fiona Wee
- Edinburgh Clinical Trials Unit (ECTU), University of Edinburgh, Edinburgh, UK
| | - Simiao Wu
- Department of Neurology, West China Hospital, Chengdu, China
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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McGill K, McGarry J, Sackley C, Godwin J, Nicoll A, Brady MC. Recruitment challenges in stroke rehabilitation randomized controlled trials: a qualitative exploration of trialists' perspectives using Framework analysis. Clin Rehabil 2020; 34:1122-1133. [PMID: 32493125 DOI: 10.1177/0269215520930796] [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: 11/15/2022]
Abstract
OBJECTIVE To explore the underlying reasons for recruitment difficulties to stroke rehabilitation randomized controlled trials from the perspective of trialists. DESIGN A qualitative study using semi-structured interviews and Framework analysis. PARTICIPANTS Twenty multidisciplinary stroke rehabilitation trialists across 13 countries with a range of clinical and research experience. METHODS Twenty semi-structured telephone interviews were carried out. Purposeful sampling ensured a range of opinions were gathered from across the international stroke rehabilitation research community. Using Framework analysis, the analytical framework was formed by three researchers and tested before being applied to the total dataset. RESULTS Three themes described the trialists' perception of the underlying reasons for recruitment difficulties: (i) decision making, (ii) importance of recruiters and (iii) a broken system. Trialists described frequently disregarding evidence in favour of prior research experiences when planning randomized controlled trial recruitment. All felt that the relationship between the research and clinical teams was vital to ensure recruiters prioritized and found value in recruitment to the trial. Experienced trialists were frustrated by the lack of reporting of the reality of running trials, research governance demands and the feeling that they had to deliberately underestimate recruitment timeframes to secure funding. CONCLUSION Stroke rehabilitation trialists described recruitment difficulties which may be related to their experiential based recruitment decision making, a lack of understanding of how best to incentivize and maintain relationships with recruiters and unrealistic bureaucratic expectations both in terms of gaining funding and research governance.
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Affiliation(s)
- Kris McGill
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK.,Facility of Life Sciences and Medicine, School of Population and Environmental Sciences, King's College London, London, UK
| | - Jodie McGarry
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Catherine Sackley
- Facility of Life Sciences and Medicine, School of Population and Environmental Sciences, King's College London, London, UK
| | - Jon Godwin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK.,Health Services Research Unit, University of Aberdeen, Aberdeen
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
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Brady MC, Stott DJ, Weir CJ, Chalmers C, Sweeney P, Barr J, Pollock A, Bowers N, Gray H, Bain BJ, Collins M, Keerie C, Langhorne P. A pragmatic, multi-centered, stepped wedge, cluster randomized controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with usual oral healthcare in stroke wards. Int J Stroke 2020; 15:318-323. [PMID: 31564241 PMCID: PMC7153219 DOI: 10.1177/1747493019871824] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with stroke-associated pneumonia experience poorer outcomes (increased hospital stays, costs, discharge dependency, and risk of death). High-quality, organized oral healthcare may reduce the incidence of stroke-associated pneumonia and improve oral health and quality of life. AIMS We piloted a pragmatic, stepped-wedge, cluster randomized controlled trial of clinical and cost effectiveness of enhanced versus usual oral healthcare for people in stroke rehabilitation settings. METHODS Scottish stroke rehabilitation wards were randomly allocated to stepped time-points for conversion from usual to enhanced oral healthcare. All admissions and nursing staff were eligible for inclusion. We piloted the viability of randomization, intervention, data collection, record linkage procedures, our sample size, screening, and recruitment estimates. The stepped-wedge trial design prevented full blinding of outcome assessors and staff. Predetermined criteria for progression included the validity of enhanced oral healthcare intervention (training, oral healthcare protocol, assessment, equipment), data collection, and stroke-associated pneumonia event rate and relationship between stroke-associated pneumonia and plaque. RESULTS We screened 1548/2613 (59%) admissions to four wards, recruiting n = 325 patients and n = 112 nurses. We observed marked between-site diversity in admissions, recruitment populations, stroke-associated pneumonia events (0% to 21%), training, and resource use. No adverse events were reported. Oral healthcare documentation was poor. We found no evidence of a difference in stroke-associated pneumonia between enhanced versus usual oral healthcare (P = 0.62, odds ratio = 0.61, confidence interval: 0.08 to 4.42). CONCLUSIONS Our stepped-wedge cluster randomized control trial accommodated between-site diversity. The stroke-associated pneumonia event rate did not meet our predetermined progression criteria. We did not meet our predefined progression criteria including the SAP event rate and consequently were unable to establish whether there is a relationship between SAP and plaque. A wide confidence interval did not exclude the possibility that enhanced oral healthcare may result in a benefit or detrimental effect. TRIAL REGISTRATION NCT01954212.
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Affiliation(s)
- Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - David J Stott
- Institute of Health and Wellbeing,
University of Glasgow, Glasgow, UK
| | - Christopher J Weir
- Centre for Population Health Sciences,
The University of Edinburgh, Edinburgh, UK
| | | | - Petrina Sweeney
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - John Barr
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - Alex Pollock
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - Naomi Bowers
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - Heather Gray
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | | | - Marissa Collins
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | | | - Peter Langhorne
- Institute of Health and Wellbeing,
University of Glasgow, Glasgow, UK
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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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McGill K, Sackley CM, Godwin J, McGarry J, Brady MC. A systematic review of the efficiency of recruitment to stroke rehabilitation randomised controlled trials. Trials 2020; 21:68. [PMID: 31924252 PMCID: PMC6954526 DOI: 10.1186/s13063-019-3991-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction Randomised controlled trials (RCTs) that fail to meet their recruitment target risk increasing research waste. Acute stroke RCTs experience notable recruitment issues. The efficiency of recruitment to stroke rehabilitation RCTs has not been explored. Aims and objectives To explore recruitment efficiency and the trial features associated with efficient recruitment to stroke rehabilitation RCTs. Methods A systematic review of stroke rehabilitation RCTs published between 2005 and 2015 identified in a search of the Cochrane Stroke Group (CSG) Trials Register from 35 electronic databases (e.g. Medline, CINAHL; EMBASE), clinical trial registers, and hand-searching. Inclusion criteria are stroke rehabilitation intervention, delivered by a member of the rehabilitation team, and clinically relevant environment. We extracted data on recruitment efficiency and trial features. Results We screened 12,939 titles, 1270 abstracts and 788 full texts, before extracting data from 512 included RCTs (n = 28,804 stroke survivor participants). This is the largest systematic review of recruitment to date. A third of stroke survivors screened consented to participate (median 34% (IQR 14–61), on average sites recruited 1.5 participants per site per month (IQR 0.71–3.22), and one in twenty (6% (IQR 0–13) dropped out during the RCT. Almost half (48%) of those screened in the community were recruited compared to hospital settings (27%). Similarly, almost half (47%) those screened at least 6 months after stroke participated, compared to 23% of stroke survivors screened within a month of stroke. When one recruiter screened multiple sites, a median of one stroke survivor was recruited every 2 months compared to more than two per month when there was a dedicated recruiter per site. RCT recruitment was significantly faster per site, with fewer dropouts, for trials conducted in Asia (almost three stroke survivors monthly; 2% dropout) compared to European trials (approximately one stroke survivor monthly; 7% dropout). Conclusions One third of stroke survivors screened were randomised to rehabilitation RCTs at a rate of between one and two per month, per site. One in twenty did not complete the trial. Our findings will inform recruitment plans of future stroke rehabilitation RCTs. Limited reporting of recruitment details restricted the subgroup analysis performed. Trial registration Prospective Register of Systematic Reviews, registration number CRD42016033067.
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Affiliation(s)
- Kris McGill
- Nursing Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK.
| | | | - Jon Godwin
- Glasgow Caledonian University, Glasgow, UK
| | | | - Marian C Brady
- Nursing Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
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Øra HP, Kirmess M, Brady MC, Partee I, Hognestad RB, Johannessen BB, Thommessen B, Becker F. The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia—a pilot randomized controlled trial. Clin Rehabil 2020; 34:369-381. [DOI: 10.1177/0269215519896616] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects. Design: Pilot single-blinded randomized controlled trial. Setting: Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers. Subjects: People with naming impairment due to aphasia following stroke. Intervention: Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language. Main measures: Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat. Results: No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group ( n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher ( P = 0.026) and a Verb and Sentence Test score 3 points higher ( P = 0.002) than the control group ( n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported. Conclusion: Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results.
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Affiliation(s)
- Hege Prag Øra
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Melanie Kirmess
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | | | - Randi Bjor Hognestad
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Frank Becker
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Thomson K, Pollock A, Bugge C, Brady MC. Commercial gaming devices for stroke upper limb rehabilitation: The stroke survivor experience. J Rehabil Assist Technol Eng 2020; 7:2055668320915381. [PMID: 35186319 PMCID: PMC8855408 DOI: 10.1177/2055668320915381] [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: 04/25/2017] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Approximately 30% of stroke survivors experience an upper limb impairment, which impacts on participation and quality of life. Gaming devices (Nintendo Wii) are being incorporated into rehabilitation to improve function. We explored the stroke survivor experience of gaming as an upper limb intervention. Methods Semi-structured, individual interviews with stroke survivors living within the UK were completed. Interviews were audio-recorded, transcribed verbatim and analysed using Framework methods. Transcripts were coded and summarised into thematic charts. Thematic charts were refined during analysis until the final framework emerged. Results We captured experiences of 12 stroke survivors who used Nintendo Wii. Gaming devices were found to be acceptable for all ages but varying levels of enthusiasm existed. Enthusiastic players described gaming as having a positive impact on their motivation to engage in rehabilitation. For some, this became a leisure activity, encouraging self-practice. Non-enthusiastic players preferred sports to gaming. Conclusion An in-depth account of stroke survivor experiences of gaming within upper limb rehabilitation has been captured. Suitability of gaming should be assessed individually and stroke survivor abilities and preference for interventions should be taken into consideration. There was no indication that older stroke survivors or those with no previous experience of gaming were less likely to enjoy the activity.
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Affiliation(s)
- Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Smith CH, Patel S, Woolley RL, Brady MC, Rick CE, Halfpenny R, Rontiris A, Knox-Smith L, Dowling F, Clarke CE, Au P, Ives N, Wheatley K, Sackley CM. Rating the intelligibility of dysarthic speech amongst people with Parkinson's Disease: a comparison of trained and untrained listeners. Clin Linguist Phon 2019; 33:1063-1070. [PMID: 31035809 DOI: 10.1080/02699206.2019.1604806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
Intelligibility of speech is a key outcome in speech and language therapy (SLT) and research. SLT students frequently participate as raters of intelligibility but we lack information about whether they rate intelligibility in the same way as the general public. This paper aims to determine if there is a difference in the intelligibility ratings made by SLT students (trained in speech related topics) compared to individuals from the general public (untrained). The SLT students were in year 2 of a BSc programme or the first 6 months of a MSc programme. We recorded 10 speakers with Parkinson's disease (PD) related speech reading aloud the words and sentences from the Assessment of Intelligibility of Dysarthric Speech. These speech recordings were rated for intelligibility by 'trained' raters and 'untrained' raters. The effort required to understand the speech was also reported. There were no significant differences in the measures of intelligibility from the trained and untrained raters for words or sentences after adjusting for speaker by including them as a covariate in the model. There was a slight increase in effort reported by the untrained raters for the sentences. This difference in reported effort was not evident with the words. SLT students can be recruited alongside individuals from the general public as naïve raters for evaluating intelligibility in people with speech disorders.
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Affiliation(s)
- Christina H Smith
- Division of Psychology and Language Science, University College London , London , UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham , Birmingham , UK
| | - Rebecca L Woolley
- Birmingham Clinical Trials Unit, University of Birmingham , Birmingham , UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University , Glasgow , UK
| | - Caroline E Rick
- Nottingham Clinical Trials Unit, University of Nottingham , Notthingham , UK
| | - Rhiannon Halfpenny
- Division of Psychology and Language Science, University College London , London , UK
| | - Alexia Rontiris
- Division of Psychology and Language Science, University College London , London , UK
| | - Lucy Knox-Smith
- Division of Psychology and Language Science, University College London , London , UK
| | - Francis Dowling
- Birmingham Clinical Trials Unit, University of Birmingham , Birmingham , UK
| | - Carl E Clarke
- Institute for Applied Health Research, University of Birmingham & Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK
| | - Pui Au
- Birmingham Clinical Trials Unit, University of Birmingham , Birmingham , UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham , Birmingham , UK
| | - Keith Wheatley
- Birmingham Clinical Trials Unit, University of Birmingham , Birmingham , UK
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Hazelton C, Pollock A, Taylor A, Davis B, Walsh G, Brady MC. A qualitative exploration of the effect of visual field loss on daily life in home-dwelling stroke survivors. Clin Rehabil 2019; 33:1264-1273. [PMID: 30935223 DOI: 10.1177/0269215519837580] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the effect of visual field loss on the daily life of community-dwelling stroke survivors. DESIGN A qualitative interview study. PARTICIPANTS Adult stroke survivors with visual field loss of at least six months' duration. METHODS Semi-structured interviews were conducted with a non-purposive sample of 12 stroke survivors in their own homes. These were recorded, transcribed verbatim and analyzed with the framework method, using an inductive approach. RESULTS Two key analytical themes emerged. 'Perception, experience and knowledge' describes participant's conflicted experience of having knowledge of their impaired vision but lacking perception of that visual field loss and operating under the assumption that they were viewing an intact visual scene when engaged in activities. Inability to recognize and deal with visual difficulties, and experiencing the consequences, contributed to their fear and loss of self-confidence. 'Avoidance and adaptation' were two typologies of participant response to visual field loss. Initially, all participants consciously avoided activities. Some later adapted to vision loss using self-directed head and eye scanning techniques. CONCLUSIONS Visual field loss has a marked impact on stroke survivors. Stroke survivors lack perception of their visual loss in everyday life, resulting in fear and loss of confidence. Activity avoidance is a common response, but in some, it is replaced by self-initiated adaptive techniques.
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Affiliation(s)
- Christine Hazelton
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anne Taylor
- 2 Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Bridget Davis
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Glyn Walsh
- 3 Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Marian C Brady
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Hazelton C, Pollock A, Walsh G, Brady MC. Scanning training for rehabilitation of visual field loss due to stroke: Identifying and exploring training tools in use. Br J Occup Ther 2018. [DOI: 10.1177/0308022618809900] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
IntroductionVisual field loss affects one fifth of stroke survivors, limiting daily activities and reducing quality of life. Scanning training is a commonly used intervention, but there is variation in how this is delivered. This study aimed to identify the scanning training tools used in Scotland and describe their training parameters, delivery and suitability for use with stroke survivors.MethodAn email survey identified scanning training tools used in Scotland. Two expert panel meetings gained consensus on the motor, language and cognitive skills required to use each scanning training tool. Video capture techniques gathered objective measures of training parameters.ResultsTen scanning training tools were identified. These tools used four delivery methods: paper-based, computer software, web-based and specialised equipment. They aimed to improve reading, perception or general visual skills. Fast, saccadic eye movements were most frequently targeted: two interventions also encouraged head movements. Session duration, frequency and therapist support varied considerably. The level of motor, language and cognitive skills required for each tool was determined.ConclusionScanning training tools used in Scotland vary in delivery modality, functional abilities required for use and visual skills trained. This information will support clinical decision-making and inform future research on training effectiveness and feasibility.
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Affiliation(s)
- Christine Hazelton
- Research Fellow, Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, UK
| | - Alex Pollock
- Senior Research Fellow, NMAHP Research Unit, Glasgow Caledonian University, UK
| | - Glyn Walsh
- Senior Lecturer (retired), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Marian C Brady
- Professor, NMAHP Research Unit, Glasgow Caledonian University, UK
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Brady MC, Godwin J, Kelly H, Enderby P, Elders A, Campbell P. Attention control comparisons with SLT for people with aphasia following stroke: methodological concerns raised following a systematic review. Clin Rehabil 2018; 32:1383-1395. [DOI: 10.1177/0269215518780487] [Citation(s) in RCA: 12] [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: 01/08/2023]
Abstract
Objective: Attention control comparisons in trials of stroke rehabilitation require care to minimize the risk of comparison choice bias. We compared the similarities and differences in SLT and social support control interventions for people with aphasia. Data sources: Trial data from the 2016 Cochrane systematic review of SLT for aphasia after stroke Methods: Direct and indirect comparisons between SLT, social support and no therapy controls. We double-data extracted intervention details using the template for intervention description and replication. Standardized mean differences and risk ratios (95% confidence intervals (CIs)) were calculated. Results: Seven trials compared SLT with social support ( n = 447). Interventions were matched in format, frequency, intensity, duration and dose. Procedures and materials were often shared across interventions. Social support providers received specialist training and support. Targeted language rehabilitation was only described in therapy interventions. Higher drop-out ( P = 0.005, odds ratio (OR) 0.51, 95% CI 0.32–0.81) and non-adherence to social support interventions ( P < 0.00001, OR 0.18, 95% CI 0.09–0.37) indicated an imbalance in completion rates increasing the risk of control comparison bias. Conclusion: Distinctions between social support and therapy interventions were eroded. Theoretically based language rehabilitation was the remaining difference in therapy interventions. Social support is an important adjunct to formal language rehabilitation. Therapists should continue to enable those close to the person with aphasia to provide tailored communication support, functional language stimulation and opportunities to apply rehabilitation gains. Systematic group differences in completion rates is a design-related risk of bias in outcomes observed.
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Affiliation(s)
- Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Jon Godwin
- Institutes for Applied Health and Society and Social Justice Research, Glasgow Caledonian University, Glasgow, UK
| | - Helen Kelly
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Pam Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Lyons M, Smith C, Boaden E, Brady MC, Brocklehurst P, Dickinson H, Hamdy S, Higham S, Langhorne P, Lightbody C, McCracken G, Medina-Lara A, Sproson L, Walls A, Watkins DC. Oral care after stroke: Where are we now? Eur Stroke J 2018; 3:347-354. [PMID: 31236482 DOI: 10.1177/2396987318775206] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/12/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia - a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. Methods A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities.Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. Discussion Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. Conclusion Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.
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Affiliation(s)
- Mary Lyons
- Faculty of Health and Wellbeing, University of Central Lancashire, UK.,Department of International Public Health, Liverpool School of Tropical Medicine, UK
| | - Craig Smith
- Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Department of Neurosciences, Salford Royal NHS Foundation Trust, UK
| | - Elizabeth Boaden
- Faculty of Health and Wellbeing, University of Central Lancashire, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK
| | - Paul Brocklehurst
- North Wales Organisation for Randomised Trials in Health, Bangor Institute of Health and Medical Research and Salford Royal NHS Foundation Trust, UK
| | - Hazel Dickinson
- Faculty of Health and Wellbeing, University of Central Lancashire, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Susan Higham
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | | | - Giles McCracken
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | | | - Lise Sproson
- National Institute for Health Research Devices for Dignity Healthcare Technology Cooperative, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Angus Walls
- Edinburgh Dental Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Dame Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, UK.,Faculty of Health Sciences, Australian Catholic University, Australia
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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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Øra HP, Kirmess M, Brady MC, Winsnes IE, Hansen SM, Becker F. Telerehabilitation for aphasia - protocol of a pragmatic, exploratory, pilot randomized controlled trial. Trials 2018; 19:208. [PMID: 29606148 PMCID: PMC5880095 DOI: 10.1186/s13063-018-2588-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Cochrane review on the effectiveness of speech and language therapy for aphasia following stroke suggests intensity of therapy is a key predictor for outcome. Current aphasia services cannot provide intervention at the intensity observed within trial contexts because of resource limitations. Telerehabilitation could widen access to speech-language pathologists (SLPs) in geographically remote contexts and reduce the time spent on travel by the therapist and patient. The current academic literature within this field is in its infancy, with few trials of speech and language therapy (SLT) delivered by videoconference. Our pilot randomized controlled trial (RCT) will explore feasibility aspects and effectiveness of telerehabilitation for aphasia in addition to standard SLT. METHOD/DESIGN Our study is a pragmatic, exploratory, pilot randomized controlled trial, where participants will be randomized to a telerehabilitation group or a control group. Both groups receive standard SLT (usual care) but the telerehabilitation group receives an additional 5 h of telerehabilitation per week over 4 weeks through videoconference. This additional telerehabilitation focuses on spoken language with an emphasis on word naming. We aim to include 40 patients in each group, with inclusion criteria being aphasia any time post stroke. Participants will be assessed blindly at pre-randomization (baseline), and 4 weeks and 4 months after randomization. The primary endpoint is naming ability 3 months after the completed intervention, measured by the Norwegian Basic Aphasia Assessment (NGA) naming subtest. Secondary endpoints include other subtests of the NGA, the VAST (Verb and Sentence Test) subtest sentence production, Communicative Effectiveness Index (CETI) and the Stroke and Aphasia Quality of Life scale (SAQOL-39). Experiences of patients and SLPs with telerehabilitation are assessed using questionnaires and semi-structured interviews. Statistical between group comparisons will be in line with an intention-to-treat analysis. DISCUSSION This pilot RCT of intensive language training by videoconference will contribute new scientific evidence to the field of aphasia telerehabilitation. Here, we describe our trial which will explore the feasibility of telerehabilitation for aphasia as an intervention, our choice of primary and secondary outcome measures and proposed analyses. Our trial will provide information for the development and delivery of future definitive RCTs. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02768922 . Registered on 11 May 2016. Last updated on 17 November 2017.
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Affiliation(s)
- Hege Prag Øra
- Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1450, Nesoddtangen, Norway. .,Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway.
| | - Melanie Kirmess
- Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1450, Nesoddtangen, Norway.,Department of Special Needs Education, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G40BA, Scotland
| | | | - Silje Merethe Hansen
- Department of Special Needs Education, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway
| | - Frank Becker
- Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1450, Nesoddtangen, Norway.,Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway
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Weir CJ, Butcher I, Assi V, Lewis SC, Murray GD, Langhorne P, Brady MC. Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review. BMC Med Res Methodol 2018; 18:25. [PMID: 29514597 PMCID: PMC5842611 DOI: 10.1186/s12874-018-0483-0] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [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: 09/06/2017] [Accepted: 02/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rigorous, informative meta-analyses rely on availability of appropriate summary statistics or individual participant data. For continuous outcomes, especially those with naturally skewed distributions, summary information on the mean or variability often goes unreported. While full reporting of original trial data is the ideal, we sought to identify methods for handling unreported mean or variability summary statistics in meta-analysis. METHODS We undertook two systematic literature reviews to identify methodological approaches used to deal with missing mean or variability summary statistics. Five electronic databases were searched, in addition to the Cochrane Colloquium abstract books and the Cochrane Statistics Methods Group mailing list archive. We also conducted cited reference searching and emailed topic experts to identify recent methodological developments. Details recorded included the description of the method, the information required to implement the method, any underlying assumptions and whether the method could be readily applied in standard statistical software. We provided a summary description of the methods identified, illustrating selected methods in example meta-analysis scenarios. RESULTS For missing standard deviations (SDs), following screening of 503 articles, fifteen methods were identified in addition to those reported in a previous review. These included Bayesian hierarchical modelling at the meta-analysis level; summary statistic level imputation based on observed SD values from other trials in the meta-analysis; a practical approximation based on the range; and algebraic estimation of the SD based on other summary statistics. Following screening of 1124 articles for methods estimating the mean, one approximate Bayesian computation approach and three papers based on alternative summary statistics were identified. Illustrative meta-analyses showed that when replacing a missing SD the approximation using the range minimised loss of precision and generally performed better than omitting trials. When estimating missing means, a formula using the median, lower quartile and upper quartile performed best in preserving the precision of the meta-analysis findings, although in some scenarios, omitting trials gave superior results. CONCLUSIONS Methods based on summary statistics (minimum, maximum, lower quartile, upper quartile, median) reported in the literature facilitate more comprehensive inclusion of randomised controlled trials with missing mean or variability summary statistics within meta-analyses.
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Affiliation(s)
- Christopher J. Weir
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Isabella Butcher
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Valentina Assi
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Stephanie C. Lewis
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gordon D. Murray
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Sackley CM, Smith CH, Rick CE, Brady MC, Ives N, Patel S, Woolley R, Dowling F, Patel R, Roberts H, Jowett S, Wheatley K, Kelly D, Sands G, Clarke CE. Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: a pilot randomised controlled trial (PD COMM pilot). Pilot Feasibility Stud 2018; 4:30. [PMID: 29344405 PMCID: PMC5763537 DOI: 10.1186/s40814-017-0222-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Speech-related problems are common in Parkinson's disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). METHODS The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6-8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. RESULTS Eighty-nine patients were randomised with 90% in the therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: - 12.5 points; 95% CI - 26.2, 1.2) and SLT (difference at 3 months compared with control: - 9.8 points; 95% CI - 23.2, 3.7) which needs to be confirmed in an adequately powered trial. CONCLUSION Randomisation to a three-arm trial of speech therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. registered 22 March 2012.
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Affiliation(s)
| | - Christina H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - Caroline E. Rick
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Francis Dowling
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Ramilla Patel
- Parkinson’s UK West Midlands Regional Branch, London, UK
| | - Helen Roberts
- Faculty of Medicine, University of Southampton, London, UK
| | - Sue Jowett
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Debbie Kelly
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
| | - Gina Sands
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Carl E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
| | - on behalf of the PD COMM Pilot Collaborative Group
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Parkinson’s UK West Midlands Regional Branch, London, UK
- Faculty of Medicine, University of Southampton, London, UK
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
- School of Health Sciences, University of Nottingham, Nottingham, 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. 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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Masterson-Algar P, Burton CR, Brady MC, Nicoll A, Clarke CE, Rick C, Hughes M, Au P, Smith CH, Sackley CM. The PD COMM trial: a protocol for the process evaluation of a randomised trial assessing the effectiveness of two types of SLT for people with Parkinson's disease. Trials 2017; 18:397. [PMID: 28851443 PMCID: PMC5576370 DOI: 10.1186/s13063-017-2130-1] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background The PD COMM trial is a phase III multi-centre randomised controlled trial whose aim is to evaluate the effectiveness and cost-effectiveness of two approaches to speech and language therapy (SLT) compared with no SLT intervention (control) for people with Parkinson’s disease who have self-reported or carer-reported problems with their speech or voice. Our protocol describes the process evaluation embedded within the outcome evaluation whose aim is to evaluate what happened at the time of the PD COMM intervention implementation and to provide findings that will assist in the interpretation of the PD COMM trial results. Furthermore, the aim of the PD COMM process evaluation is to investigate intervention complexity within a theoretical model of how the trialled interventions might work best and why. Methods/design Drawing from the Normalization Process Theory and frameworks for implementation fidelity, a mixed method design will be used to address process evaluation research questions. Therapists’ and participants’ perceptions and experiences will be investigated via in-depth interviews. Critical incident reports, baseline survey data from therapists, treatment record forms and home practice diaries also will be collected at relevant time points throughout the running of the PD COMM trial. Process evaluation data will be analysed independently of the outcome evaluation before the two sets of data are then combined. Discussion To date, there are a limited number of published process evaluation protocols, and few are linked to trials investigating rehabilitation therapies. Providing a strong theoretical framework underpinning design choices and being tailored to meet the complex characteristics of the trialled interventions, our process evaluation has the potential to provide valuable insight into which components of the interventions being delivered in PD COMM worked best (and what did not), how they worked well and why. Trial registration ISRCTN Registry, ISRCTN12421382. Registered on 18 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2130-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patricia Masterson-Algar
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK.
| | - Christopher R Burton
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carl E Clarke
- Institute for Applied Health Research, University of Birmingham, Vincent Drive, Birmingham, UK.,Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Caroline Rick
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Max Hughes
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Pui Au
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Edgbaston, Birmingham, UK
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Ali M, MacIsaac R, Quinn TJ, Bath PM, Veenstra DL, Xu Y, Brady MC, Patel A, Lees KR. Dependency and health utilities in stroke: Data to inform cost-effectiveness analyses. Eur Stroke J 2017; 2:70-76. [PMID: 30009266 PMCID: PMC6027777 DOI: 10.1177/2396987316683780] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 06/23/2016] [Accepted: 11/18/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Health utilities (HU) assign preference weights to specific health states and are required for cost-effectiveness analyses. Existing HU for stroke inadequately reflect the spectrum of post-stroke disability. Using international stroke trial data, we calculated HU stratified by disability to improve precision in future cost-effectiveness analyses. Materials and methods We used European Quality of Life Score (EQ-5D-3L) data from the Virtual International Stroke Trials Archive (VISTA) to calculate HU, stratified by modified Rankin Scale scores (mRS) at 3 months. We applied published value sets to generate HU, and validated these using ordinary least squares regression, adjusting for age and baseline National Institutes of Health Stroke Scale (NIHSS) scores. Results We included 3858 patients with acute ischemic stroke in our analysis (mean age: 67.5 ± 12.5, baseline NIHSS: 12 ± 5). We derived HU using value sets from 13 countries and observed significant international variation in HU distributions (Wilcoxon signed-rank test p < 0.0001, compared with UK values). For mRS = 0, mean HU ranged from 0.88 to 0.95; for mRS = 5, mean HU ranged from -0.48 to 0.22. OLS regression generated comparable HU (for mRS = 0, HU ranged from 0.9 to 0.95; for mRS = 5, HU ranged from -0.33 to 0.15). Patients' mRS scores at 3 months accounted for 65-71% of variation in the generated HU. Conclusion We have generated HU stratified by dependency level, using a common trial endpoint, and describing expected variability when applying diverse value sets to an international population. These will improve future cost-effectiveness analyses. However, care should be taken to select appropriate value sets.
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Affiliation(s)
- Myzoon Ali
- Institutes of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rachael MacIsaac
- Institutes of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Terence J Quinn
- Institutes of Cardiovascular and Medical Sciences, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | | | - Yaping Xu
- Genentech Inc., South San Francisco, CA, USA
| | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anita Patel
- Centre for Primary Care & Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Kennedy R Lees
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, BHF Cardiovascular Research Centre, Glasgow, UK
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Affiliation(s)
- Marian C. Brady
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK (M.B., H.K., P.C.); Institutes for Applied Health and Society and Social Justice Research, Glasgow Caledonian University, UK (J.G.); School of Health and Related Research, University of Sheffield, UK (P.E.); and School of Clinical Therapies, Speech and Hearing Sciences, University College Cork, Ireland (H.K.)
| | - Jon Godwin
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK (M.B., H.K., P.C.); Institutes for Applied Health and Society and Social Justice Research, Glasgow Caledonian University, UK (J.G.); School of Health and Related Research, University of Sheffield, UK (P.E.); and School of Clinical Therapies, Speech and Hearing Sciences, University College Cork, Ireland (H.K.)
| | - Pam Enderby
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK (M.B., H.K., P.C.); Institutes for Applied Health and Society and Social Justice Research, Glasgow Caledonian University, UK (J.G.); School of Health and Related Research, University of Sheffield, UK (P.E.); and School of Clinical Therapies, Speech and Hearing Sciences, University College Cork, Ireland (H.K.)
| | - Helen Kelly
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK (M.B., H.K., P.C.); Institutes for Applied Health and Society and Social Justice Research, Glasgow Caledonian University, UK (J.G.); School of Health and Related Research, University of Sheffield, UK (P.E.); and School of Clinical Therapies, Speech and Hearing Sciences, University College Cork, Ireland (H.K.)
| | - Pauline Campbell
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK (M.B., H.K., P.C.); Institutes for Applied Health and Society and Social Justice Research, Glasgow Caledonian University, UK (J.G.); School of Health and Related Research, University of Sheffield, UK (P.E.); and School of Clinical Therapies, Speech and Hearing Sciences, University College Cork, Ireland (H.K.)
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Worrall L, Simmons-Mackie N, Wallace SJ, Rose T, Brady MC, Kong APH, Murray L, Hallowell B. Let’s call it “aphasia”: Rationales for eliminating the term “dysphasia”. Int J Stroke 2016; 11:848-851. [DOI: 10.1177/1747493016654487] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health professionals, researchers, and policy makers often consider the two terms aphasia and dysphasia to be synonymous. The aim of this article is to argue the merits of the exclusive use of the term aphasia and present a strategy for creating change through institutions such as the WHO-ICD. Our contention is that one term avoids confusion, speech-language pathologists prefer aphasia, scholarly publications indicate a preference for the term aphasia, stroke clinical guidelines indicate a preference for the term aphasia, consumer organizations use the title aphasia in their name and on their websites, and languages other than English use a term similar to aphasia. The use of the term dysphasia in the broader medical community may stem from the two terms being used interchangeably in the ICD10. Aphasia United http://www.shrs.uq.edu.au/aphasiaunited , an international movement for uniting the voice of all stakeholders in aphasia within an international context, will seek to eliminate the use of the term dysphasia.
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Affiliation(s)
- Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Nina Simmons-Mackie
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond, USA
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anthony Pak Hin Kong
- Communication Sciences and Disorders, University of Central Florida, Orlando, USA
| | - Laura Murray
- Department of Speech and Hearing Science, Indiana University, Bloomington, USA
| | - Brooke Hallowell
- Communication Sciences and Disorders, Ohio University, Athens, USA
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Abstract
BACKGROUND Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia. OBJECTIVES To assess the effects of speech and language therapy (SLT) for aphasia following stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched the International Journal of Language and Communication Disorders (1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach). DATA COLLECTION AND ANALYSIS We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators. MAIN RESULTS We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in more than one comparison). Twenty-seven randomised comparisons (1620 participants) assessed SLT versus no SLT; SLT resulted in clinically and statistically significant benefits to patients' functional communication (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.49, P = 0.01), reading, writing, and expressive language, but (based on smaller numbers) benefits were not evident at follow-up. Nine randomised comparisons (447 participants) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (1242 participants) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups. Generally, trials randomised small numbers of participants across a range of characteristics (age, time since stroke, and severity profiles), interventions, and outcomes. AUTHORS' CONCLUSIONS Our review provides evidence of the effectiveness of SLT for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial. HIgh-intensity and high dose interventions may not be acceptable to all.
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Affiliation(s)
- Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 6th Floor Govan Mbeki Building, Cowcaddens Road, Glasgow, UK, G4 0BA
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Abstract
BACKGROUND Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia. OBJECTIVES To assess the effects of speech and language therapy (SLT) for aphasia following stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched the International Journal of Language and Communication Disorders (1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach). DATA COLLECTION AND ANALYSIS We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators. MAIN RESULTS We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in more than one comparison). Twenty-seven randomised comparisons (1620 participants) assessed SLT versus no SLT; SLT resulted in clinically and statistically significant benefits to patients' functional communication (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.49, P = 0.01), reading, writing, and expressive language, but (based on smaller numbers) benefits were not evident at follow-up. Nine randomised comparisons (447 participants) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (1242 participants) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups. Generally, trials randomised small numbers of participants across a range of characteristics (age, time since stroke, and severity profiles), interventions, and outcomes. AUTHORS' CONCLUSIONS Our review provides evidence of the effectiveness of SLT for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial. HIgh-intensity and high dose interventions may not be acceptable to all.
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Affiliation(s)
- Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research Unit6th Floor Govan Mbeki BuildingCowcaddens RoadGlasgowUKG4 0BA
| | - Helen Kelly
- University of StirlingNursing, Midwifery and Allied Health Professions Research UnitStirlingUK
- University College CorkSpeech and Hearing SciencesCorkIreland
| | - Jon Godwin
- Glasgow Caledonian UniversityInstitutes for Applied Health and Society and Social Justice ResearchBuchanan House, Level 3, Cowcaddens RoadGlasgowUKG4 0BA
| | - Pam Enderby
- University of SheffieldSchool of Health and Related ResearchThe Innovation Centre217 PortobelloSheffieldUKS1 4DP
| | - Pauline Campbell
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research Unit6th Floor Govan Mbeki BuildingCowcaddens RoadGlasgowUKG4 0BA
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Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016. [PMID: 27245310 DOI: 10.1002/14651858.cd000425.pub4/full] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia. OBJECTIVES To assess the effects of speech and language therapy (SLT) for aphasia following stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched the International Journal of Language and Communication Disorders (1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach). DATA COLLECTION AND ANALYSIS We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators. MAIN RESULTS We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in more than one comparison). Twenty-seven randomised comparisons (1620 participants) assessed SLT versus no SLT; SLT resulted in clinically and statistically significant benefits to patients' functional communication (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.49, P = 0.01), reading, writing, and expressive language, but (based on smaller numbers) benefits were not evident at follow-up. Nine randomised comparisons (447 participants) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (1242 participants) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups. Generally, trials randomised small numbers of participants across a range of characteristics (age, time since stroke, and severity profiles), interventions, and outcomes. AUTHORS' CONCLUSIONS Our review provides evidence of the effectiveness of SLT for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial. HIgh-intensity and high dose interventions may not be acceptable to all.
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Affiliation(s)
- Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 6th Floor Govan Mbeki Building, Cowcaddens Road, Glasgow, UK, G4 0BA
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Pollock A, Brady MC, Farmer SE, Langhorne P, Mead GE, Mehrholz J, Wiffen PJ, van Wijck F. The purpose of rating quality of evidence differs in an overview, as compared to guidelines or recommendations. J Clin Epidemiol 2016; 74:238-40. [PMID: 26769255 DOI: 10.1016/j.jclinepi.2016.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Buchanan House, Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Buchanan House, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Sybil E Farmer
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Buchanan House, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 5NN, UK
| | - Jan Mehrholz
- Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, An der Wolfsschlucht 1-2, 01731 Kreischa, Germany
| | - Philip J Wiffen
- Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
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