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Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev 2021; 6:CD012996. [PMID: 34184251 PMCID: PMC8238669 DOI: 10.1002/14651858.cd012996.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Mahmood A, Nayak P, English C, Deshmukh A, U S, N M, Solomon JM. Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: A randomized controlled trial. Top Stroke Rehabil 2021; 29:438-448. [PMID: 34180370 DOI: 10.1080/10749357.2021.1940800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking.Objectives: To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke.Methods: We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) , mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale.Results: The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p < .001) and 12 weeks (MD 51, 95% CI 39, 63, p < .001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p = .002). There was no difference in the quality of life scores between groups at six or 12 weeks.Conclusion: The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life.Trial registration: CTRI/2018/08/015212.
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Cadilhac DA, Cameron J, Kilkenny MF, Andrew NE, Harris D, Ellery F, Thrift AG, Purvis T, Kneebone I, Dewey H, Drummond A, Hackett M, Grimley R, Middleton S, Thijs V, Cloud G, Carey M, Butler E, Ma H, Churilov L, Hankey GJ, English C, Lannin NA. Protocol of a randomized controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS). Int J Stroke 2021; 17:236-241. [PMID: 34037468 DOI: 10.1177/17474930211022678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. HYPOTHESIS Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. METHODS AND DESIGN Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. OUTCOMES Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum sample capped at 1100. DISCUSSION We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
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English C, Attia JR, Bernhardt J, Bonevski B, Burke M, Galloway M, Hankey GJ, Janssen H, Kuys S, Lindley RI, Lynch E, Marsden DL, Nilsson M, Ramage ER, Said CM, Spratt NJ, Zacharia K, Macdonald-Wicks L, Patterson A. Secondary Prevention of Stroke: Study Protocol for a Telehealth-Delivered Physical Activity and Diet Pilot Randomized Trial (ENAbLE-Pilot). Cerebrovasc Dis 2021; 50:605-611. [PMID: 33895733 DOI: 10.1159/000515689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing physical activity (PA) and improving diet quality are opportunities to improve secondary stroke prevention, but access to appropriate services is limited. Interventions co-designed with stroke survivors and delivered by telehealth are a potential solution. AIM The aim of this study is to test the feasibility, safety, and potential efficacy of a 6-month, telehealth-delivered PA and/or dietary (DIET) intervention. METHODS Pilot randomized trial. 80 adults with previous stroke who are living at home with Internet access and able to exercise will be randomized in a 2 × 2 factorial (4-arm) pilot randomized, open-label, blinded outcome assessment trial to receive PA, DIET, PA + DIET, or control interventions via telehealth. The PA intervention aims to support participants to meet the minimum recommended levels of PA (150 min/week moderate exercise), and the DIET intervention aims to support participants to follow the AusMed (Mediterranean-style) diet. The control group receives usual care plus education about PA and healthy eating. The co-primary outcomes are feasibility (proportion and characteristics of eligible participants enrolled and proportion of scheduled intervention sessions attended) and safety (adverse events) at 6 months. The secondary outcomes include recurrent stroke risk factors (blood pressure, physical activity levels, and diet quality), fatigue, mood, and quality of life. Outcomes are measured at 3, 6, and 12 months. CONCLUSION This trial will produce evidence for the feasibility, safety, and potential effect of telehealth-delivered PA and DIET interventions for people with stroke. Results will inform development of an appropriately powered trial to test effectiveness to reduce major risk factors for recurrent stroke. TRIAL REGISTRATION ACTRN12620000189921.
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Ramage E, Fini N, Lynch E, Marsden DL, Patterson AJ, Said CM, English C. Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke-A Scoping Review. Phys Ther 2021; 101:6145897. [PMID: 33611602 PMCID: PMC7928700 DOI: 10.1093/ptj/pzab073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has seen a rapid shift to telehealth-delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy, and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke. METHODS Searches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weight-bearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another, and results synthesized narratively. RESULTS Seven studies (2 randomized trials, 1 mixed-methods, and 4 pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment, and 2 (29%) studies included only participants who walked independently. Adherence (reported in 3 studies) and satisfaction (reported in 4 studies) were good, and no serious adverse events (data from 4 studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance, and in-person exercise prescription. However, there is limited high-quality evidence of efficacy. CONCLUSIONS We identified strategies used in research to date that can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services. IMPACT The COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers and optimize safety and adherence for telehealth interventions involving activities in weight-bearing or standing positions.
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Simpson DB, Jose K, English C, Gall SL, Breslin M, Callisaya ML. "Factors influencing sedentary time and physical activity early after stroke: a qualitative study". Disabil Rehabil 2021; 44:3501-3509. [PMID: 33399023 DOI: 10.1080/09638288.2020.1867656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to understand from the perspective of stroke survivors and their carers (1) factors contributing to sedentary time and physical activity during inpatient rehabilitation and the transition home, and (2) actual and perceived opportunities to reduce sedentary time and increase physical activity. MATERIAL AND METHODS Qualitative study with 7 stroke survivor/carer dyads and 8 stroke survivors. Semi-structured interviews were conducted 2-4 weeks after hospital discharge, audio recorded and transcribed prior to thematic analysis. RESULTS Stroke survivors were mean age 69 [SD15] years (53% male). Carers were mean age 62 [SD15] years (86% were female). Five themes were identified: (1) Education and guidance about physical activity and sedentary behaviour after stroke is important to build understanding of recovery and secondary prevention, (2) Stroke survivors need clear communication about safety and risk, (3) Return to life participation supports motivation for and engagement in physical activity, 4) Social and professional influences and 5) Opportunities to be physically active. CONCLUSION Stroke survivors and their carers need a clearer understanding of the role of physical activity and risks of sedentary time during stroke recovery. Physical activity enablers included consistent communication, building confidence and skills to self-manage activity before discharge.Implications for RehabilitationInpatient rehabilitation and early after discharge may be an important time-point to support stroke survivors to establish long term physical activity behaviours before contact with healthcare professionals reduces.To reduce sedentary behaviour, people need to understand the health benefits of breaking up sedentary time and people who need physical support to stand up will need greater support from health professionals.Being able to imagine a future post-stroke self is important motivation to get up and move. Rehabilitation should help develop a person's vision of their post-stroke self.Managing potential risks in hospital without overly restricting physical activity is important and requires consistent communication from the multi-disciplinary team.Building a person's confidence and skills to self-manage physical activity in the community prior to discharge home may be another key enabler for activity.
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English C, Weerasekara I, Carlos A, Chastin S, Crowfoot G, Fitzsimons C, Forster A, Holliday E, Janssen H, Mackie P, Mead G, Dunstan D. Investigating the rigour of research findings in experimental studies assessing the effects of breaking up prolonged sitting - extended scoping review. Braz J Phys Ther 2021; 25:4-16. [PMID: 32439303 PMCID: PMC7817869 DOI: 10.1016/j.bjpt.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Sedentary behaviour research is a relatively new field, much of which has emerged since the widespread acceptance of clinical trial registration. The aim of this study was to investigate the trial registration and related issues in studies investigating the effect of frequent activity interruptions to prolonged sitting-time. METHODS Secondary analysis of a scoping review including systematic searches of databases and trial registries. We included experimental studies investigating the effects of frequent activity interruptions to prolonged sitting-time. RESULTS We identified 32 trials published in 45 papers. Only 16 (50%) trials were registered, with all 16 trials being completed and published. Of the unregistered trials, we identified three (19%) for which similarities in the sample size and participant demographics across papers was suggestive of duplicate publication. Identification of potential duplicate publications was difficult for the remaining 13 (81%). Results from 53 (76%) of the 70 registered outcomes were published, but 11 (69%) registered trials reported results from additional outcomes not prospectively registered. A total of 46 different outcomes (out of 53 reported outcome measures, similar measures were collated) were reported across all trials, 31 (67%) of which were collected in ≤2 trials. CONCLUSIONS We found direct evidence of trial registration issues in experimental trials of breaking up sitting-time. The lack of prospective registration of all trials, and the large number of outcomes measured per trial are key considerations for future research in this field. These issues are unlikely to be confined to the field of sedentary behaviour research.
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Lannin NA, Coulter M, Laver K, Hyett N, Ratcliffe J, Holland AE, Callaway L, English C, Bragge P, Hill S, Unsworth CA. Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens' Jury. Health Expect 2020; 24:352-362. [PMID: 33264470 PMCID: PMC8077088 DOI: 10.1111/hex.13176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked 'What considerations are important to include in a model of care of brain injury rehabilitation?' METHODS Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days. RESULTS Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made. CONCLUSION Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term. PATIENT AND PUBLIC CONTRIBUTION As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.
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Alme KN, Knapskog AB, Næss H, Naik M, Beyer M, Ellekjaer H, English C, Hansen HI, Kummeneje CS, Munthe-Kaas R, Saltvedt I, Seljeseth Y, Tan X, Thingstad P, Askim T. Is long-bout sedentary behaviour associated with long-term glucose levels 3 months after acute ischaemic stroke? A prospective observational cohort study. BMJ Open 2020; 10:e037475. [PMID: 33243789 PMCID: PMC7692836 DOI: 10.1136/bmjopen-2020-037475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Sedentary behaviour is a risk factor for vascular disease and stroke patients are more sedentary than their age-matched peers. The association with glucose levels, as a potential mediator, is unclear, and we have investigated the association between long-bout sedentary behaviour and long-term glucose levels in stroke survivors. METHODS This study uses data from the Norwegian Cognitive Impairment After Stroke study, a multicentre cohort study. The patients were recruited at hospital admission for acute stroke, and the follow-up was done at the outpatient clinic. Sedentary behaviour-being in a sitting or reclining position-was registered 3 months after stroke using position transition data from the body-worn sensor activPAL attached to the unaffected thigh. A MATLAB script was developed to extract activity data from 08:00 to 10:00 for 4 days and to categorise the data into four bout-length categories. The primary outcome was glycated haemoglobin (HbA1c), analysed at 3 months. Regression models were used to analyse the association between HbA1c and sedentary behaviour in the whole population and stratified based on a diagnosis of diabetes mellitus (DM). Age, body mass index and the use of antidiabetic drugs were added as covariates into the models. RESULTS From a total of 815 included patients, 379 patients fulfilled the inclusion criteria for this study. We found no association between time in sedentary behaviour and HbA1c in the whole stroke population. We found time in sedentary behaviour in bouts of ≥90 min to be associated with a higher HbA1c in patients with DM. CONCLUSION Long-bout sedentary time is associated with a higher HbA1c in patients with DM 3 months after ischaemic stroke. Future research should investigate the benefit of breaking up sedentary time as a secondary preventive measure. TRIAL REGISTRATION NUMBER NCT02650531, https://clinicaltrials.gov/ct2/show/NCT02650531.
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Hall J, Morton S, Hall J, Clarke DJ, Fitzsimons CF, English C, Forster A, Mead GE, Lawton R. A co-production approach guided by the behaviour change wheel to develop an intervention for reducing sedentary behaviour after stroke. Pilot Feasibility Stud 2020; 6:115. [PMID: 32821421 PMCID: PMC7429798 DOI: 10.1186/s40814-020-00667-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke. Methods A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two-stroke services (England and Scotland). Workshop format was informed by the behaviour change wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development. Findings Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.
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Heiland EG, Ekblom Ö, Tarassova O, Fernström M, English C, Ekblom MM. ABBaH: Activity Breaks for Brain Health. A Protocol for a Randomized Crossover Trial. Front Hum Neurosci 2020; 14:273. [PMID: 32760263 PMCID: PMC7372129 DOI: 10.3389/fnhum.2020.00273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/17/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction: Extended periods of sitting may have detrimental effects on brain health. However, the effects of breaking up prolonged sedentary periods with frequent, short physical activity bouts on mechanisms to improve brain health remain unclear. Therefore, this study aims to investigate the immediate effects of uninterrupted sitting and frequent, short bouts of physical activity on cerebral blood flow and cognitive function in the prefrontal cortex in middle-aged adults. Methods: This is a protocol article to describe a randomized crossover study. We will collect data from 13 healthy adults, aged between 40 and 60 years old, with a body mass index <35 kg/m2. Participants will be required to come into the laboratory on three occasions, sit for 3 h, and perform a different type of break for 3 min every 30 min at each visit in a random order, being either: (1) a social break; (2) brisk walk on a treadmill; or (3) simple resistance activities. Before and after each experimental condition, cerebral blood flow (primary outcome) will be measured using functional near-infrared spectroscopy (fNIRS), with short-separation channels, and working memory (1-, 2-, and 3-back on the computer) will be assessed. The following additional secondary outcomes will be collected: psychological factors (questionnaires); arterial stiffness; salivary cortisol levels; and blood glucose levels. Conclusion: The results from this randomized crossover study will determine the effects of uninterrupted sitting and frequent, short bouts of physical activity on cerebral blood flow and cognitive performance. Publication of this study protocol emphasizes the importance of registration and publication of protocols in the field of sedentary behavior research.
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, 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M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, 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Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Simpson DB, Breslin M, Cumming T, de Zoete SA, Gall SL, Schmidt M, English C, Callisaya ML. Sedentary time and activity behaviors after stroke rehabilitation: Changes in the first 3 months home. Top Stroke Rehabil 2020; 28:42-51. [PMID: 32578523 DOI: 10.1080/10749357.2020.1783917] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sedentary time is prevalent following stroke, limiting functional improvement, and increasing cardiovascular risk. At discharge we examined: 1) change in sedentary time and activity over the following 3 months' and 2) physical, psychological or cognitive factors predicting any change. A secondary aim examined cross-sectional associations between factors and activity at 3 months. METHODS People with stroke (n = 34) were recruited from two rehabilitation units. An activity monitor (ActivPAL3) was worn for 7 days during the first week home and 3 months later. Factors examined included physical, psychological, and cognitive function. Linear mixed models (adjusted for waking hours) were used to examine changes in sedentary time, walking, and step count over time. Interaction terms between time and each factor were added to the model to determine if they modified change over time. Linear regression was performed to determine factors cross-sectionally associated with 3-month activity. RESULTS ActivPAL data were available at both time points for 28 (82%) participants (mean age 69 [SD 12] years). At 3 months, participants spent 39 fewer minutes sedentary (95%CI -70,-8 p = .01), 21 minutes more walking (95%CI 2,22 p = .02) and completed 1112 additional steps/day (95%CI 268,1956 p = .01), compared to the first week home. No factors predicted change in activity. At 3 months, greater depression (β 22 mins (95%CI 8,36) p = .004) and slower gait speed (β - 43 mins 95%CI -59,-27 p ≤ 0.001) were associated with more sedentary time and less walking activity, respectively. CONCLUSIONS Sedentary time reduced and walking activity increased between discharge home and 3 months later. Interventions targeting mood and physical function may warrant testing to reduce sedentary behavior 3 months following discharge.
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Hall J, Morton S, Fitzsimons CF, Hall JF, Corepal R, English C, Forster A, Lawton R, Patel A, Mead G, Clarke DJ. Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers. BMC Public Health 2020; 20:967. [PMID: 32560713 PMCID: PMC7305625 DOI: 10.1186/s12889-020-09113-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. METHODS Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 h) were analysed thematically and interview data (n = 31 stroke survivors, n = 12 caregivers) were analysed using the Framework approach. RESULTS Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers' influence on, and role in influencing stroke survivors' sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers' inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. CONCLUSIONS Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.
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Sammut M, Fini N, Haracz K, Nilsson M, English C, Janssen H. Increasing time spent engaging in moderate-to-vigorous physical activity by community-dwelling adults following a transient ischemic attack or non-disabling stroke: a systematic review. Disabil Rehabil 2020; 44:337-352. [PMID: 32478574 DOI: 10.1080/09638288.2020.1768599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: The risk of recurrent stroke following a transient ischaemic attack (TIA) or non-disabling stroke is high. Clinical guidelines recommend this patient population accumulate at least 150 minutes of moderate-to-vigorous physical activity each week to reduce the risk of recurrent stroke. We aimed to identify interventions that increase time adults spend in moderate-to-vigorous physical activity following TIA or non-disabling stroke.Method: We searched thirteen databases for articles of secondary prevention interventions reporting outcomes for duration in moderate-to-vigorous physical activity or exercise capacity.Results: Eight trials were identified (n = 2653). Of these, three (n = 198) reported changes in time spent in moderate-to-vigorous physical activity. Only one trial (n = 70), reported significant change in time spent engaging in moderate-to-vigorous physical activity (between-group difference: 11.7 min/day [95% CI 4.07-19.33]) when comparing participation in a six-month exercise education intervention to usual care. No trial measured moderate-to-vigorous physical activity after intervention end.Conclusion: Despite recommendations to participate in regular physical activity at moderate-to-vigorous intensity for secondary stroke prevention, there is very little evidence for effective interventions for this patient population. There is need for clinically feasible interventions that result in long-term participation in physical activity in line with clinical guidelines. Trial registration: Protocol registration: PROSPERO CRD42018092840Implications for rehabilitationThere is limited evidence of the effectiveness of interventions that aim to increase time spent engaging in moderate-to-vigorous physical activity (MVPA) for people following a TIA or non-disabling stroke.A program comprising aerobic and resistance exercises ≥2 per week, supervised by a health professional (supplemented with a home program) over at least 24 weeks appears to be effective in assisting people adhere to recommended levels of moderate to vigorous physical activity after TIA or non-disabling stroke.Secondary prevention programs which include health professional supervised exercise sessions contribute to better adherence to physical activity guidelines; didactic sessions alone outlining frequency and intensity are unlikely to be sufficient.
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Milte R, Ratcliffe J, Ada L, English C, Crotty M, Lannin NA. Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity. BMC Health Serv Res 2020; 20:478. [PMID: 32460773 PMCID: PMC7254740 DOI: 10.1186/s12913-020-05333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background Assessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial. Methods Recruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods. Discussion The results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.
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Hendrickx W, Vlietstra L, Valkenet K, Wondergem R, Veenhof C, English C, Pisters MF. General lifestyle interventions on their own seem insufficient to improve the level of physical activity after stroke or TIA: a systematic review. BMC Neurol 2020; 20:168. [PMID: 32357844 PMCID: PMC7195782 DOI: 10.1186/s12883-020-01730-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background Insufficient amounts of physical activity is a risk factor for (recurrent) stroke. People with a stroke or transient ischemic attack (TIA) have a high risk of recurrent stroke and have lower levels of physical activity than their healthy peers. Though several reviews have looked at the effects of lifestyle interventions on a number of risk factors of recurrent stroke, the effectiveness of these interventions to increase the amounts of physical activity performed by people with stroke or TIA are still unclear. Therefore, the research question of this study was: what is the effect of lifestyle interventions on the level of physical activity performed by people with stroke or TIA? Method A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Pubmed, Embase and Cumulative Index for Nursing and Allied Health Literature (CINAHL), were searched up to August 2018. Randomised controlled trials that compared lifestyle interventions, aimed to increase the amount of physical activity completed by participants with a stroke or TIA, with controls were included. The Physiotherapy Evidence Database (PEDro) score was used to assess the quality of the articles, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method for the best evidence synthesis. Results Eleven trials (n = 2403) met the inclusion criteria. The quality of the trials was mostly high, with 8 (73%) of trials scoring ≥6 on the PEDro scale. The overall best evidence syntheses showed moderate quality evidence that lifestyle interventions do not lead to significant improvements in the physical activity level of people with stroke or TIA. There is low quality evidence that lifestyle interventions that specifically target physical activity are effective at improving the levels of physical activity of people with stroke or TIA. Conclusion Based on the results of this review, general lifestyle interventions on their own seem insufficient in improving physical activity levels after stroke or TIA. Lifestyle interventions that specifically encourage increasing physical activity may be more effective. Further properly powered trials using objective physical activity measures are needed to determine the effectiveness of such interventions. Trial registration PROSPERO, CRD42018094437.
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Gyawali P, Chow WZ, Hinwood M, Kluge M, English C, Ong LK, Nilsson M, Walker FR. Opposing Associations of Stress and Resilience With Functional Outcomes in Stroke Survivors in the Chronic Phase of Stroke: A Cross-Sectional Study. Front Neurol 2020; 11:230. [PMID: 32390923 PMCID: PMC7188983 DOI: 10.3389/fneur.2020.00230] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/10/2020] [Indexed: 12/21/2022] Open
Abstract
Stroke survivors report significant levels of psychological distress post stroke. To date, most studies conducted have focused on the relationship between psychological stress and functional outcomes in the acute phase of stroke. However, no studies had considered the role of stress over the chronic phase, where stress may continue to exert negative effects on cognitive and psychological processes. Further, the role of potentially modulatory variables, such as psychological resilience, on stroke outcomes has been understudied. The purpose of this study was to consider the relationships between stress and resilience with functional outcomes in long-term survivors of stroke. People (N = 70) who had experienced a stroke between 5 months and 28 years ago were included in the cross-sectional study, along with age-matched controls (N = 70). We measured stress using both the Perceived Stress Scale and biological markers, and resilience using both the Brief Resilience Scale and the Connor-Davidson Resilience Scale. Stroke outcomes were assessed using the Stroke Impact Scale. We found that, compared with age-matched controls, stroke survivors reported greater levels of perceived stress, and lower levels of resilience. In stroke survivors, both perceived stress and resilience were independently associated with stroke outcomes in linear regression models. In particular, these relationships were observed for cognitive outcomes including mood, memory, and communication. The association between stress and stroke outcome did not differ across time post stroke. Given that resilience is a modifiable psychological construct, future research may consider whether strategies directed at enhancing resilience may improve recovery from stroke. Australia and New Zealand Clinical Trials Registry: ACTRN12617000736347.
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Zacharia K, Patterson AJ, English C, MacDonald-Wicks L. Feasibility of the AusMed Diet Program: Translating the Mediterranean Diet for Older Australians. Nutrients 2020; 12:E1044. [PMID: 32290076 PMCID: PMC7230642 DOI: 10.3390/nu12041044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022] Open
Abstract
The Mediterranean diet pattern (MEDI) is associated with a lower risk of chronic conditions related to ageing. Adherence research mostly comes from Mediterranean countries with high cultural acceptability. This study examines the feasibility of a MEDI intervention designed specifically for older Australians (AusMed). Phase 1 involved a consumer research group (n = 17) presentation of program materials with surveys after each section. In-depth individual semi-structured interviews (n = 6) were then conducted. All participants reported increased knowledge and confidence in adherence to the MEDI, with the majority preferring a booklet format (70%) and group delivery (58%). Three themes emerged from interviews-1. barriers (complexity, perceived cost and food preferences), 2. additional support and 3. individualisation of materials. Program materials were modified accordingly. Phase 2 was a 2-week trial of the modified program (n = 15). Participants received a group counselling session, program manual and food hamper. Adherence to the MEDI was measured by the Mediterranean Diet Score (MDS). All participants increased their adherence after the 2-week trial, from a mean score of 5.4 ± 2.4 (low adherence) to a mean score of 9.6 ± 2.0 (moderate to high adherence). All found that text message support helped achieve their goals and were confident to continue the dietary change.
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Chapman SJ, Blanco-Colino R, Pérez-Ajates S, Bautista OA, Hodson J, Blanco-Colino R, Chapman SJ, Glasbey JC, Pata F, Pellino G, Soares ASA, van Elst T, Van Straten S, Nepogodiev D, Hodson J, Borakati A, Bath MF, Yasin IH, Mclean K, Arthur T, Kovacevic M, Delibegovic S, Karamanliev M, Swamad M, Žebrák R, Paramasivam R, Martensen A, Larsen HM, Rãdeker L, Frey PE, Kechagias A, Venara A, Duchalais E, Ioannidis A, Pata F, Pellino G, Pasquali S, Simioni ASA, Farina V, Podda M, Lorenzon L, ItSURG, Schaeff V, Otto A, Jakubauskas M, van Elst TR, Chu M, Fagan PVB, Wells CI, João AA, Soares A, Juloski J, Blanco-Colino R, Pérez-Ajates S, Bautista OA, El Kasmi YEK, Espin-Basany E, Clerc D, Ciubotaru C, Popescu S, Yanishev A, Lee S, Ozkan BB, Sen AY, Aktas MK, Baki BE, Yüksek B, Glasbey JC, Kamarajah S, Mclean K, Borakati A, Yasin IH, Khaw RA, Mills E, Goodson R, Thakral N, Ablett AD, Adra M, Kwek I, Khan SM, Quinn P, Manley LR, Badran A, Ramjeeawon A, Campbell A, Tan HL, Rye DS, Rajaraman N, Norman JG, Vutipongsatorn K, Solomou G, Akhbari M, Ali A, Brandao BD, Stainer B, Thavayogan R, Jones D, Onafowokan OO, Gharooni A, Dabab N, Carlton-Carew S, Kungwengwe G, Gabriel M, Sewart E, Shortland TC, Lawday S, Pockney P, Dawson A, Stewart P, Ng B, Luong JK, Delibegovic S, Ivanov V, Borisova A, Neykov V, Žebrák MFR, Harbjerg JL, Brandsborg S, Mark-Christensen A, Unbehaun KP, Dalsgaard P, Lycke KD, Kechagias A, LeNaoures P, Duchalais E, Brigand C, Dumange E, Gout M, Moehwald C, Prem M, Alhalabi O, Sliwinski S, Krupp J, Gablenz E, Schmitzer L, Kopp A, Steinle J, Gsenger J, Pohl LJ, Riccardi M, Christodoulou IM, Konstantinidis M, Machairas N, Zoikas A, Balalis D, Manatakis DK, Aguilera ML, Simioni ASA, Marano L, Fleres F, Lovisetto F, Sasia D, Segalini E, Pata G, Lucchi A, Sagnotta A, Campagnaro T, Petrelli F, Gallo G, Papandrea M, Testa V, Sinibaldi G, Di Candido F, Colombo F, Perrone G, Aresu S, Biancafarina A, Canonico G, Pagnanelli M, Curletti G, Bini R, de Manzoni Garberini A, Impellizzeri H, Cillara N, Tutino R, Picciariello A, Coletta D, Savino G, Ferrara F, Tamini N, Talamo G, Parini D, Giamundo P, Pagano G, Ripetti V, Pesce A, Menduni N, Pellino G, Giudicissi R, Podda M, Goldin E, Rega D, Belli A, Andriola V, Gordini L, Pata F, Foppa C, Piccolo G, Birindelli A, Ferrari C, Ballarini Z, Tirelli F, Milone M, De Rosa M, Federico NSP, Molteni B, Tilocca PL, Sancini G, Piozzi GN, Lauretta A, Mulas S, Schaeff V, Otto A, Jakubauskas M, Simcikas D, Portelli L, van Wijnbergen JWM, Dinger TL, ten Doesschate SFH, van Dalen ASHM, van den Bos DD, Hansmann M, Feliz JM, Kuiper SZ, Abdulrahman Z, Pruijssers SR, Geneta VP, Chu M, Wilton S, Kandelaki H, Peng SL, Campbell S, Lim YK, Yassaie SS, Murray M, Fagan PVB, Haran C, Tan J, Castro J, Laranjeira A, Catarino S, Neves-Marques C, Correia JG, Vieira BN, Quintela AC, Serra ML, Maciel J, Cunha M, Aparício DJ, Neves J, Azevedo J, Romano M, Eiró F, Romano J, Monteiro C, Claro M, Almeida, Peyroteo M, Machado ND, Capote H, Ferreira M, Sousa X, Devesa H, Cavadas D, Guerreiro I, Costa M, Rosete M, Salman M, English C, Mohammed N, Popescu S, Yanishev A, Litvin A, Ćuk VV, Mészárosová K, Van Straten S, Jaich R, De Lima H, Brooks S, Marx M, Salvation MN, Cardo JG, Mora-Guzmán I, Muriel JS, de Andres Olabarria U, Muriel P, Viñas CJ, Alconchel F, Sinovas OE, El Kasmi YEK, Oro CF, Pérez-Ajates S, Otero ML, Jiménez SF, Bellmunt OC, Caballero JM, Rubio-Pérez I, Aguilar-Martínez MM, Segura-Sampedro JJ, Moreno CO, Parra DN, Diz AME, Martín-Balbuena R, Recuenco CB, Bolaños REL, Fernández P, Padillo AD, Forero-Torres A, Román IAS, Rosés HS, Campos PV, Moreira CCL, Peralta PU, Navidad MS, Ripollés-Melchor J, Garcea A, Facundo HG, Bautista OA, Pereira PT, Guarinos CVP, Clerc D, Blaser B, Piazza G, Gagliardi B, Serin H, Sen AY, Yurdaor SS, Aktas MK, Arslan E, Kopac O, Uyanik A, Ozmen BB, Tiftik E, Aksoy B, Yalcinkaya A, Bilicen G, Cinar EN, Uslu Ö, Kaya Y, Wong J, Farhan-Alanie MMH, Suresh G, Asif A, Finch BJ, Bhahirathan Y, Herron J, Tew ZY, Obukofe R, Russell C, Suchett-Kay I, Netke T, Williams L, Kisiel A, Liu FY, Claireaux H, James P, Mondal A, Kalderon R, Nadama HH, Al-Saraff Z, Tam JPH, Powell-Chandler A, Wood F, Campbell A, Gorgievska R, Ragavoodoo A, Thakrar C, Rojoa D, Palmer C, Davidson K, Giacci L, Hale J, Gan FW, Makin-Taylor R, Hey CY, Toh C, Findlay JM, Griffiths N, Ganesananthan S, Jasionowska S, Poustie M, Wong C, Turner T, Pyc W, Sloper W, Warner C, Coey J, Mason D, Sait S, Kowal M, Shortland TC, Owen M, Saiyed A, Ashworth I, Akbari K, Curran M, Martin P, Parker D, Dawson A, Kwok K, Lye C, Pockney P, Ghaly M, Sammour T, Lewis D, Mundasad R, Wilkes A, Ctercteko G, Stewart P, Delibegovic S, Maslyankov S, Dimov R, Iliev S, Dimitrov D, Marek F, Örhalmi J, Skalický P, Skalický T, Chrz K, Christensen P, Worsøe J, Kristensen ES, Emmertsen KJ, Loeve US, Duchalais E, Mihaljevic AL, Herrle F, Konstantinidis KM, Manatakis DK, Korkolis D, Karanikas I, Aguilera ML, Vincenti L, Anania G, Borghi F, Agresta F, Maretto I, Parisi A, Bucci L, De Palma G, Guglielmi A, Cucinotta E, La Torre F, Cianchi F, Guerrieri M, Lauretta A, Trompetto M, Persiani R, Micheletto G, Delrio P, Belli A, Cantafio S, Lovisetto F, Ronconi M, Bisagni PAG, De Prizio M, Tamini N, Sinibaldi G, Franceschi A, Galleano R, Cavallini M, Brescia A, D'Ambra L, Benevento A, Niolu P, Calgaro M, Colangelo E, Grottola T, Altomare DF, Puleo S, Salamone G, Pietrabissa A, Poggioli G, Ripetti V, Erdas E, Ottonello R, Canonico G, Tonini V, Selvaggi F, Sammarco G, Ceccarelli G, De Nisco C, Surgo D, Taglietti L, Ozolins A, Sivinš A, Poskus T, Psaila J, Bemelman WA, Graat LJ, Langenhoff B, Wijnhoven BPL, van de Ven AHW, Poelman M, Stassen LPS, Slooter G, Acherman YIZ, Hoff C, Gerhards MF, Stommel MWJ, Hazebroek EJ, van Geloven AAW, Schasfoort RA, van Leeuwen BL, Tuynman JB, van Tilburg MWA, Boerma EG, Sharma P, Jenkins B, Bissett IP, Peng SL, Herd A, Gordon A, Vernon D, Omundsen M, Ly J, Reddy A, Bonnet G, Harmston C, Morales M, Francisco V, Costa S, Manso A, Amorim E, Pereira J, Cardoso J, Ourô S, Caratão M, Nascimento C, da Silva BR, Taranu V, Dias R, Devesa H, Mendes J, Allen M, Silva A, Carlos S, Barbosa E, Carneiro C, Ramos L, Maciel J, Lencastre L, Martins R, Silva-Vaz P, Cahill R, Hogan A, Larkin J, Negoi I, Abelevich A, Ćuk VM, Vician M, Ede C, Sardiwalla I, Mulira S, Montwedi D, Oyomno M, Sabia D, Porras VP, Vigorita V, Ortega GS, García J, Macías AE, Antona FB, Mompeán JAL, Ruiz SS, Villarejo-Campos P, Simó MR, Sánchez-Guillén L, Jiménez-Gómez LM, López AS, Golda T, Bergkvist DJ, Nevado C, Aguilar JFN, Felipe BR, Septiem J, Sánchez AR, Cañete-Gómez J, Montesinos IR, Ripollés-Melchor J, Millán-Scheiding M, Prieto-Nieto I, Segura-Sampedro JJ, Espin-Basany E, Frasson M, Román IAS, Olmo DG, Hübner M, Petermann D, Sauvain MO, Ozben V, Geçim IE, Disçi E, Rencuzogullari A, Kurt A, Bisgin T, Pehlivan M, Isik A, Onur E, Leventoglu S, Keskin M, Guner A, Sahin ST, Ozbalci GS, Pergel A, Albayrak D, Bruce D, Fearnhead N, Arthur J, Harron M, Beattie G, Titu L, Ali A, Saunders M, Phillips J, Dindyal S, Cresswell B, Gercek Y, Lee J, Linn T, Faulkner G, Lockwood S, Rees J, Charalabopoulos A, Campbell B, Kontovounisios C, Amarnath T, Johnson M, Epanomeritakis E, Vigs S, Nastro P, Gilliam A, Smolarek S, Wilson T, Orbell J, McIntyre R, Agarwal T, Hainsworth P, Patel P, Vijay J, Liu B, Rao PD, Roxburgh C, Vipond M, Youssef H, Thorn C, Schizas A, Denley S, Bowley D, Das K, Cuming T, Saha A, Chung L, Pitt J, Davis P, Jones O, Taylor M, Bhargava A, Haji A, Watson N, Bloom I, Singh B, Norwood M, Gurjar S, Stylianides N, Mirza S, Evans M, Williams G, Patil P, Hernon J, Finch G, Green S, Chapple K, Fafemi O, Warusavitarne J, Samee A, Carden C, Ong L, Verma K, Joseph A, Rawat N, Pinkney T, Oke O, Glen P, Maxwell-Armstrong C, Oliphant R, Garner J, Moug SJ, Middleton S, Lund JN, Smart NJ, Osborn G, Moore T, Raymond T, Knowles CH, Hany TS, Clarke R, Khera G, Brady R, Sellahewa C, Mason C, Torrance A, Lasithiotakis K, Knight J, Pullybank A, Ainsworth P, Reid F, Ramwell A, Maslekar S, George R, Skull A, Holtham S, Muhammad K, Lal R, Varcada M, Smith FM, Howlader M, Defriend D, Kirk S, Richards T, Evans C, Borg CM, Telford K, Sarfraz N, Busby K, Hollingshead J, Speake D, Pawa N, West D, Chadwick M, Komolafe O, Richardson S, Thornton M, Goede A, Osborne C, Bandyopadhyay D, Foong J, Lee YJ, Liebenberg P, Mijalkov D, Wells A, Bull N, Ajmera A, Warburton T, Morgan S, Mahmoud A, Schachtel M, Mikhail B, Fomin I, Mekaeil B, Taylor N, Stevenson C, Drane A, Pahalawatta U, Lai LT, Debiasio A, Chrimes A, Agarwal A, Zhao J, Williams S, Jayalath JMSN, Liebenberg P, Khor S, Muddasani T, Childs S, Ridgway S, Blefari NDA, Tam H, Puchalski N, Ngai C, Horne D, Borrow JL, Campbell C, Cousins G, Jackson L, Maheepala K, Zhao S, Holden E, Tutt L, Thompson B, Collins H, Louie F, Buckland B, Smith D, Chong C, Chua TH, Nayak C, Redmond J, Tan RR, Gramlick M, Teh JS, Ng SY, Britten-Jones P, Rosli RM, Pham HDV, 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Brandsma AM, Davids J, Rottier SJ, de Roy van Zuidewijn D, Hawkins R, Ong HI, Li Y, Desmond B, Winstanley J, Martins M, Rosete M, Americano M, Santos M, Frade S, Senhorinho R, Peixoto R, João AA, Alves-Vale C, Lamas M, O'Connor DB, Hoo M, Gopaul A, Scanlon K, O'Dwyer N, Negoi I, Jovanović M, Panyko A, De Lima H, Van Vuuren S, Centeno A, Bernado IR, Señorans MPG, Amor LG, Ramírez AC, Abrisqueta J, Gomez ME, Arroyo A, Cerdán C, Romeu NG, Forero-Torres A, Enriquez-Navascues JM, Collado-Roura F, Curchod P, Gaspar S, Imadalou L, Mutlu D, Akyol C, Uygur FA, Eray IC, Biyiklioglu O, Çetin MF, Isik AE, Karip B, Dogan H, Sarıgül L, Tunc E, Aydin T, Bodur S, Karabulut K, Francis AA, Al-hadithi A, Lau ISF, Smith E, Mahapatra S, McAuliffe O, Francis AA, Imam L, Akram B, Hossaini S, Davies R, Ko M, Collins J, Pandya A, Reilly S, Archer J, Livie J, Chaudhry FA, Ntakomyti E, Diallo R, Bylinski T, Wright J, Lawday S, Masiha E, Tung J, Shirazi B, Neilson A, Epton S, Patel N, Trussell S, Couldrey A, Donnelly C, Eftychiou S. Safety of hospital discharge before return of bowel function after elective colorectal surgery. Br J Surg 2020; 107:552-559. [PMID: 31976560 DOI: 10.1002/bjs.11422] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. METHODS A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. RESULTS A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). CONCLUSION Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.
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S, Eames S, Lewis F, Kirupananthan P, Boh ZY, Dass S, Soma A, Newton A, Hill M, Shafiq Y, Brkljac M, Boyce L, Jasionowska S, English WJ, Lam S, Chipeta C, Yilmaz D, Jain C, Garofalidou T, Novotny SA, Locke S, Bowman C, Begaj A, Murphy C, Radcliffe K, Chong JT, Poustie M, Jeffrey E, Chaudhury N, Rajendran K, Akbar Z, Walters B, Kulendrarajah B, Tran N, Shrestha S, Parmar S, Gallagher C, Hennessy L, Pentti E, Badhrinarayanan S, Fung A, Mansoor M, Kenny R, Kan P, Lee DE, Khosla S, Samake M, Shaban F, Aftab R, Gough M, Woodburn B, Vayalapra S, McMurrugh K, Wong C, Jimulia D, Deol S, Pike S, Embury-Young Y, Turner T, Patel M, Kilgallon E, Keating R, Walsh A, Khan H, Logue G, Orekoya M, Alasmar M, Charalambides M, Clavé Llavall A, Williamson E, Bharwada Y, Zearmal S, Evans H, Panikkar M, Cruz G, Caplan J, Ruparelia A, Tanvir T, Soare C, Pang YL, Trotter J, Zaidi A, Thakrar V, Pulickal P, Ahmed H, Parnell J, Khan H, Lennock S, Ford V, Pyc W, Brignall R, O'Neill D, Hanna R, Kane R, Nicola M, Rajput K, Xiao Y, Warner C, Michael S, Wright E, Juniper S, Thompson E, Hoskyns L, Kanitkar A, Ross C, Unsworth A, Rshaidat H, Demarre K, Chiang A, Bareh A, Dellen J, Faqihinejad C, Gadhvi A, Grant R, Lewsey J, Morris A, Martin H, McClarty C, Sanyal S, Alsaif A, Palkhi A, Bhopal S, Vishnu K S, Papanikolaou A, Mitra A, Nur A, Ali F, Burford C, Huq T, Sloper W, Irwin E, Matthews L, Ngu WS, Hosfield T, Muneeb F, Page O, Zeb E, Coey J, Al-Azzawi A, McIntosh J, Vucicevic A, Hughes M, Brooks L, Fanibi B, Dixon M, Njoku P, Morris D, Jobson J, Chowdhury H, Alawode DOT, Wynell-Mayow W, Udayachandran V, Alsoof D, Ekert J, Joseph N, Zulkefley N, Hunt G, Christodoulou T, Wright O, Soman S, Jamal M, Beqiri S, Borgas P, Christie S, Pereira F, Browne S, Yiu J, Dworkin A, Brayley J, Palmer A, Charalambos M, Jones CJ, Toner S, Cowden R, Lee L, Nicol P, Holman O, Imtiaz M, Albert V, Leung SP, Erotocritou M, Wong J, Stroud R, Mason D, Wilkin R, Thomson W, Mackee L, G N, Bei Y, Sait S, Mckenna Favier S, Ibrahim A, Kler A, Reynolds L, Mohamed SH, Majeed Y, Fakim B, Jones A, Kowal M, Liversedge G, Carrington Z, Windebank J, Izzarina A, Akbani U, Craven J, Aldarragi A, Harding S, Millward A, Shortland TC, Bedford M, Stroud R, Obukofe R, Mackenzie E, Gopalan V, Midgen A, Khadka P, Cheng O, Taneja S, Manobharath N, Kok JY, Lim DWE, Buick T, Boland M, Piya S, Devlin R, Fairfield CJ, George RJ, Rahi M, Zaman S, Hajiev S, Ross T, Owen M, Crisp E, Thompson C, Charalambous A, Hollywood JL, Saiyed A, Hammond RFL, Matthews J, Mendonca V, Spinty J, Khan K, Cheng J, Glynn N, Muhammad U, Khan M, Anderson L, Mccormack K, Mak J, Patrawala S, Milinkovic N, Schofield R, Chauhan M, Hartley L, Hind J, Ashworth I, Nelson L, Ratnasingham D, Akbari K, Whitehead T, Dimitriadis S, Marshall K, Flint EJ, Curran M, Horner C, Heybourne A, Morgan H, Wickstone C, Panagiotou D, O'Connell E, Dean K, Iqbal R, Walsh L, Yu N, Rana N, Massie E, Ng J, Jung M, Lee YD, Harris M, White S, Delibegovic S, Boev B, Tonchev P, Prochazka V, Örhalmi J, Riško J, Skalický A, Chrz K, Ravn S, Ojakäär A, Duchalais E, Dörr-Harim C, Herrle F, Koutserimpas C, Giraudo G, Armellini A, Ruzzenente A, Mazzeo C, De Padua C, Realis Luc A, Maroli A, Giani I, Cufari ME, Vitali M, Ceccarelli G, Gusai GP, Quattromani R, Virgilio E, Berti S, Mulas S, Di Mola FF, Papagni V, Tuminello F, Magnoli M, Vittori L, Longheu A, Loche GA, Braccio B, De Luca E, Resta G, Ancans G, Tamosiunas A, Petrulionis M, Andrejevic P, Stellingwerf ME, Abdulrahman N, Pas KGH, Thomas G, Brandsma AM, Davids J, Rottier SJ, Roy van Zuidewijn D, Hawkins R, Ong HI, Li Y, Desmond B, Winstanley J, Martins M, Rosete M, Americano M, Santos M, Frade S, Senhorinho R, Peixoto R, Alagoa João A, Alves-Vale C, Lamas M, O'Connor DB, Hoo M, Gopaul A, Scanlon K, O'Dwyer N, Negoi I, Jovanović M, Panyko A, De Lima H, Van Vuuren S, Curchod P, Gaspar S, Imadalou L, Mutlu D, Akyol C, Uygur FA, Eray IC, Biyiklioglu O, Çetin MF, Isik AE, Karip B, Dogan H, Sarıgül L, Tunc E, Aydin T, Bodur S, Karabulut K, Francis AA, Al-hadithi A, To N, Lau ISF, Smith E, Mahapatra S, McAuliffe O, Francis AA, Imam L, Akram B, Hossaini S, Davies R, Ko M, Collins J, Pandya A, Reilly S, Archer J, Auty C, Roche CD, Livie J, Chaudhry FA, Ntakomyti E, Diallo R, Bylinski T, Wright J, Lawday S, Masiha E, Tung J, Shirazi B, Neilson A, Epton S, Patel N, Trussell S, Couldrey A, Donnelly C, Eftychiou S. Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery. Br J Surg 2020; 107:e161-e169. [PMID: 31595986 DOI: 10.1002/bjs.11326] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 07/04/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. METHODS A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. RESULTS A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). CONCLUSION NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
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Mahmood A, Solomon JM, English C, Bhaskaran U, Menon G, Manikandan N. Measurement of adherence to home-based exercises among community-dwelling stroke survivors in India. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1827. [PMID: 31880059 DOI: 10.1002/pri.1827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To develop an adherence questionnaire specific to stroke and measure the level of adherence to home-based exercises among community-dwelling stroke survivors. METHODS We developed and validated the "Stroke-Specific Measure of Adherence to Home-based Exercises" (SS-MAHE). We measured the exercise adherence among 92 community-dwelling stroke survivors in a cross-sectional study. RESULTS The SS-MAHE has two sections covering (a) the dosage of prescribed exercises and (b) dosage of actual exercises done by the participants. It was found to be reliable with ICC score of 0.81 (95% CI, 0.44, 0.94, p = .001.) Adherence was measured by comparing prescribed exercises to the actual exercises performed at home. We rated participants as "adherent" if they were following more than 70% of the prescribed exercise dosage. In our sample of 92 stroke survivors, only 28% of participants were adherent to prescribed home-based exercises. CONCLUSION SS-MAHE is a practical and reliable tool to measure adherence to home-based exercises after a stroke. Exercise adherence among stroke survivors is less than ideal. There is a need for strategies to specifically target exercise adherence in stroke survivors.
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Galloway M, Marsden DL, Callister R, Nilsson M, Erickson KI, English C. The Feasibility of a Telehealth Exercise Program Aimed at Increasing Cardiorespiratory Fitness for People After Stroke. Int J Telerehabil 2019; 11:9-28. [PMID: 35949926 PMCID: PMC9325643 DOI: 10.5195/ijt.2019.6290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Accessing suitable fitness programs post-stroke is difficult for many. The feasibility of telehealth delivery has not been previously reported. Objectives: To assess the feasibility of, and level of satisfaction with home-based telehealth-supervised aerobic exercise training post-stroke. Methods: Twenty-one ambulant participants (≥ 3 months post-stroke) participated in a home-based telehealth-supervised aerobic exercise program (3 d/week, moderate-vigorous intensity, 8-weeks) and provided feedback via questionnaire post-intervention. Session details, technical issues, and adverse events were also recorded. Results: Feasibility was high (83% of volunteers met telehealth eligibility criteria, 85% of sessions were conducted by telehealth, and 95% of participants rated usability favourably). Ninety-five percent enjoyed telehealth exercise sessions and would recommend them to others. The preferred telehealth exercise program parameters were: frequency 3 d/week, duration 20-30 min/session, program length 6-12 weeks. Conclusion: The telehealth delivery of exercise sessions to people after stroke appears feasible and may be considered as a viable alternative delivery means for providing supervised exercise post-stroke.
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Lannin NA, Ada L, English C, Ratcliffe J, Faux SG, Palit M, Gonzalez S, Olver J, Cameron I, Crotty M. Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial. Stroke 2019; 51:556-562. [PMID: 31813359 PMCID: PMC7004444 DOI: 10.1161/strokeaha.119.027602] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. The aim of this trial was to determine the effect of additional upper limb rehabilitation following botulinum toxin-A for upper limb activity in chronic stroke.
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Simpson DB, Bird ML, English C, Gall SL, Breslin M, Smith S, Schmidt M, Callisaya ML. "Connecting patients and therapists remotely using technology is feasible and facilitates exercise adherence after stroke". Top Stroke Rehabil 2019; 27:93-102. [PMID: 31762412 DOI: 10.1080/10749357.2019.1690779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Repetitive task practice after stroke is important to improve function, yet adherence to exercise is low. The aim of this study was to determine whether using the internet, a tablet application, and a chair sensor that connected to a therapist was feasible in monitoring adherence and progressing a functional exercise at home.Methods: Ten participants with stroke completed a 4-week sit-to-stand exercise using the technology at home (ACTRN12616000051448). A therapist remotely monitored exercise adherence, progressed goals, and provided feedback via the app. Measures of feasibility (design, recruitment/withdrawals, adherence, safety, participant satisfaction and estimates of effect on function) were collected.Results: Participants' mean age was 73.6 years [SD 9.9 years]. The system was feasible to deliver and monitor exercise remotely. All participants completed the study performing a mean 125% of prescribed sessions and 104% of prescribed repetitions. Participants rated the system usability (78%), enjoyment (70%) and system benefit (80%) as high. No adverse events were reported. The mean pre- and post-intervention difference in the total short performance physical battery score was 1.4 (95% CI 0.79, 2.00).Conclusions: It was feasible and safe to prescribe and monitor exercises using an app and sensor-based system. A definitive trial will determine whether such technology could facilitate greater exercise participation after stroke.
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