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Abstract
The last decade has witnessed an increase in the number of moderate to large-scale nonpharmacologic stroke recovery trials. While a majority, having tested the superiority of a particular evidence-based intervention, returned negative findings, the rehabilitation research community has gained an important perspective for future efforts. We offer our interpretation first, on why most of the past decade’s trials failed in the sense of not supporting the primary superiority hypothesis, and, second, we provide our perspective on how to solve this problem and thereby inform the next generation of neurorehabilitation clinical trials. The first large-scale randomized controlled trial (RCT) ever conducted in neurorehabilitation was the Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) trial. The majority of stroke recovery trials that followed were based on a prevailing, but as yet immature science of brain-behavior mechanisms for recovery and limited practical know-how about how to select the most meaningful outcomes. The research community had been seduced by a set of preclinical studies, ignited by the 1990’s revolution in neuroscience and an oversimplified premise that high doses of task-oriented training was the most important ingredient to foster recovery. Here, we highlight recent qualitative and quantitative evidence, both mechanistic and theory-driven, that integrates crucial social and personal factors to inform a more mature science better suited for the next generation of recovery-supportive rehabilitation clinical trials.
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152
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Bindawas SM, Vennu V, Moftah E. Improved functions and reduced length of stay after inpatient rehabilitation programs in older adults with stroke: A systematic review and meta-analysis of randomized controlled trials. NeuroRehabilitation 2017; 40:369-390. [PMID: 28211819 DOI: 10.3233/nre-161425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND to examine the effects of inpatient rehabilitation programs on function and length of stay in older adults with strokeMETHODS: A total of five electronic databases were searched for relevant randomized controlled trials that examined the effects of inpatient rehabilitation programs on functional recovery, as measured by the functional independence measure and length of stay, which was measured in days. We included full-text articles written in English, and no time limit. The methodological quality and risk of bias were assessed using the Physiotherapy Evidence Database Scale and the Cochrane collaboration tools respectively. The effect sizes and confidence intervals were estimated using fixed-effect modelsRESULTS: Eight randomized controlled trials involving 1,910 patients with stroke were included in the meta-analysis showed that patients who participated in the inpatient rehabilitation programs had significantly (p less than 0.05) higher functional independence measure scores (effect size = 0.10; 95 percent confidence interval = 0.01, 0.22) and shorter length of stay (effect size = 0.14; 95 percent confidence interval = 0.03, 0.22). CONCLUSIONS This systematic review provided evidence that inpatient rehabilitation programs have beneficial effects, improving functionality and reducing length of stay for older adults with stroke.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Emad Moftah
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia.,Department of Rehabilitation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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153
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Rosbergen ICM, Brauer SG, Fitzhenry S, Grimley RS, Hayward KS. Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit. BMJ Open 2017; 7:e018226. [PMID: 29273658 PMCID: PMC5778299 DOI: 10.1136/bmjopen-2017-018226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE An enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an acute stroke unit. DESIGN A descriptive qualitative approach. SETTING An acute stroke unit in a regional Australian hospital. PARTICIPANTS We purposively recruited three allied health and seven nursing professionals involved in the delivery of the enriched environment. Face-to-face, semistructured interviews were conducted 8 weeks post-completion of the enriched environment study. One independent researcher completed all interviews. Voice-recorded interviews were transcribed verbatim and analysed by three researchers using a thematic approach to identify main themes. RESULTS Three themes were identified. First, staff perceived that 'the road to recovery had started' for patients. An enriched environment was described to shift the focus to recovery in the acute setting, which was experienced through increased patient activity, greater psychological well-being and empowering patients and families. Second, 'it takes a team' to successfully create an enriched environment. Integral to building the team were positive interdisciplinary team dynamics and education. The impact of the enriched environment on workload was diversely experienced by staff. Third, 'keeping it going' was perceived to be challenging. Staff reflected that changing work routines was difficult. Contextual factors such as a supportive physical environment and variety in individual enrichment opportunities were indicated to enhance implementation. Key to sustaining change was consistency in staff and use of change management strategies. CONCLUSION Investigating staff perceptions and experiences of an enrichment model in an acute stroke unit highlighted the need for effective teamwork. To facilitate staff in their new work practice, careful selection of change management strategies are critical to support clinical translation of an enriched environment. TRIAL REGISTRATION NUMBER ANZCTN12614000679684; Results.
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Affiliation(s)
- Ingrid C M Rosbergen
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Fitzhenry
- Community Integrated Services and Subacute Services, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
| | - Rohan S Grimley
- Sunshine Coast Clinical School, The University of Queensland, Birtinya, Queensland, Australia
| | - Kathryn S Hayward
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Stroke Rehabilitation and Brain Recovery, NHMRC Centre of Research Excellence, Melbourne, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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154
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Winstein C. The ATTEND trial: An alternative explanation with implications for future recovery and rehabilitation clinical trials. Int J Stroke 2017; 13:112-116. [DOI: 10.1177/1747493017743061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the past decade, ATTEND is one of only a handful of moderate to large-scale nonpharmacologic stroke recovery trials with a focus on rehabilitation. While unique in some respects, its test of superiority for the experimental intervention returned negative/neutral results, with no differences in outcome between the experimental intervention and an appropriate control group – a result not uncommon to the majority of moderate to large stroke rehabilitation intervention trials (i.e. six out of eight conducted in the past decade). The authors offer a number of potential explanations for the negative outcome, all of which have merit. We choose not to dwell on these possibilities, but rather offer a radically different explanation, one which has implications for future rehabilitation clinical trials. Our premise is that the process of neurorehabilitation is complex and multifaceted, but most importantly, for success, it requires a genuine collaboration between the patient and the clinician or caregiver to effect optimal recovery. This collaborative relationship must be defined by the unique perspective of each patient. By doing so, we acknowledge the importance of the individual patient’s values, goals, perspectives, and capacity. Rehabilitation scientists can design what arguably is a scientifically sound intervention that is evidence-based and even with preliminary data supporting its efficacy, but if the patient does not value the target outcome, does not fully engage in the therapy, or does not expect the intervention to succeed, the likelihood of success is poor. We offer this opinion, not to be critical, but to suggest a paradigm shift in the way in which we conduct stroke recovery and rehabilitation trials.
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Affiliation(s)
- Carolee Winstein
- Department of Biokinesiology and Physical Therapy and Department of Neurology, University of Southern California, Los Angeles, USA
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155
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A Community-Based, Bionic Leg Rehabilitation Program for Patients with Chronic Stroke: Clinical Trial Protocol. J Stroke Cerebrovasc Dis 2017; 27:372-380. [PMID: 29097056 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/16/2017] [Accepted: 09/07/2017] [Indexed: 11/20/2022] Open
Abstract
Stroke is a major global health problem whereby many survivors have unmet needs concerning mobility during recovery. As such, the use of robotic-assisted devices (i.e., a bionic leg) within a community setting may be an important adjunct to normal physiotherapy in chronic stroke survivors. This study will be a dual-center, randomized, parallel group clinical trial to investigate the impact of a community-based training program using a bionic leg on biomechanical, cardiovascular, and functional outcomes in stroke survivors. Following a baseline assessment that will assess gait, postural sway, vascular health (blood pressure, arterial stiffness), and functional outcomes (6-minute walk), participants will be randomized to a 10-week program group, incorporating (1) a physiotherapy plus community-based bionic leg training program; (2) physiotherapy only; or (3) usual care control. The training program will involve participants engaging in a minimum of 1 hour per day of bionic leg activities at home. Follow-up assessments, identical to baseline, will occur after 10 weeks, and 3 and 12 months postintervention. Given the practical implications of the study, the clinical significance of using the bionic leg will be assessed for each outcome variable. The potential improvements in gait, balance, vascular health, and functional status may have a meaningful impact on patients' quality of life. The integration of robotic devices within home-based rehabilitation programs may prove to be a cost-effective, practical, and beneficial resource for stroke survivors.
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156
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Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disabil Rehabil 2017; 41:396-404. [DOI: 10.1080/09638288.2017.1393698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mia Ingerslev Loft
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
- Clinic of Neurorehabilitation, TBI unit, Rigshospitalet, Hvidovre, Denmark
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157
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Thomas CM, Allison R, Latour JM. Using blogs to explore the lived-experience of life after stroke: "A journey of discovery I never wanted to take". J Adv Nurs 2017; 74:579-590. [PMID: 28910496 DOI: 10.1111/jan.13457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
AIMS To explore the lived-experiences of stroke survivors as expressed in blogs and to discover the role the blogs play in the writers' lives. BACKGROUND Stroke can be a devastating, life changing event. Previous qualitative studies tend to examine one aspect of life after stroke. As stroke often has multiple effects, it is necessary to look widely at its lived-experience. New resources which can enable researchers to explore the lived-experience of stroke are blogs. DESIGN Phenomenological exploration using an interpretive thematic analysis. METHODS The Internet was searched for stroke survivors' blogs (January-March 2016) using pre-set criteria, seeking blogs with entries over an extended time (>1 year). Suitable blogs were identified and codes of meaning were identified and developed into categories, subthemes and themes. FINDINGS Eight blogs were identified for analysis. Of the 40 categories, eight subthemes were assimilated; internal dialogue, emotions, transition, stroke effects, health care, "in the world", relationships, rehabilitation. Two main themes were identified related to perspectives of lived-experience; Internal relationship with "self" and External relationship with "the world". Participants expressed loss and initially strove to regain their "old" lives, their focus being recovery and independence. CONCLUSION Stroke survivors must transition from their previous life to a new and initially unwelcome way of being. Rehabilitation should respect this process and support stroke survivors as they undertake this individual journey.
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Affiliation(s)
- Caroline M Thomas
- Torbay and South Devon NHS Foundation Trust, Torquay, UK.,School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.,School of Nursing, Midwifery and Paramedicine, Faculty of Human Science, Curtin University, Perth, WA, Australia
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158
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Putrino D, Zanders H, Hamilton T, Rykman A, Lee P, Edwards DJ. Patient Engagement Is Related to Impairment Reduction During Digital Game-Based Therapy in Stroke. Games Health J 2017; 6:295-302. [PMID: 28910162 DOI: 10.1089/g4h.2016.0108] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Upper limb impairment in the chronic phase of stroke recovery is persistent, disabling, and difficult to treat. The objectives of this study were to determine whether therapeutic enjoyment is related to clinical improvement after upper limb rehabilitation and to assess the feasibility of a therapy gaming system. MATERIALS AND METHODS Ten chronic stroke survivors with persistent upper limb impairment were enrolled in the study. Upper limb impairment was evaluated by using the Fugl-Meyer Assessment of Upper Extremity Function (FMA-UE). The Physical Activity Enjoyment Scale (PACES) assessed the level of therapy enjoyment, and the System Usability Scale (SUS) measured the ease of operation of the game. Upper limb therapy involved 30 minutes of novel digital gaming therapy, three times per week, for 6 weeks. RESULTS The average improvement in the FMA-UE after the digital gaming therapy was 2.8 (±2.1) points. Participants scored the digital gaming system as having good usability (SUS: 72 ± 7.9), and the physical activity as enjoyable (PACES: 65.8 ± 10.6). There was a strong positive correlation between improvement in the FMA-UE score and the PACES (Spearman's Rho = 0.84; P < 0.002). CONCLUSION This pilot study demonstrates the feasibility and potential for improvements in upper limb motor function by using digital gaming in the chronic stroke patient population. The positive correlation found between therapy enjoyment and clinical gains highlights the importance of engagement in therapy to optimize outcomes in chronic stroke survivors.
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Affiliation(s)
- David Putrino
- 1 Telemedicine and Virtual Rehabilitation Laboratory, Burke Medical Research Institute , White Plains, New York.,2 Department of Rehabilitation Medicine, Weill Cornell Medicine , New York, New York.,6 Department of Rehabilitation Medicine, Icahn School of Medicine , at Mount Sinai, New York, New York
| | - Helma Zanders
- 3 Brain Stimulation and Robotics Laboratory, Burke Medical Research Institute , White Plains, New York
| | - Taya Hamilton
- 1 Telemedicine and Virtual Rehabilitation Laboratory, Burke Medical Research Institute , White Plains, New York
| | - Avrielle Rykman
- 3 Brain Stimulation and Robotics Laboratory, Burke Medical Research Institute , White Plains, New York
| | - Peter Lee
- 3 Brain Stimulation and Robotics Laboratory, Burke Medical Research Institute , White Plains, New York
| | - Dylan J Edwards
- 3 Brain Stimulation and Robotics Laboratory, Burke Medical Research Institute , White Plains, New York.,4 Neurology Department, Weill Cornell Medicine , New York, New York.,5 School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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159
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Luker J, Murray C, Lynch E, Bernhardsson S, Shannon M, Bernhardt J. Carers' Experiences, Needs, and Preferences During Inpatient Stroke Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2017; 98:1852-1862.e13. [DOI: 10.1016/j.apmr.2017.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/30/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
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160
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Walder K, Molineux M. Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience. Br J Occup Ther 2017. [DOI: 10.1177/0308022617722711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Annually, approximately five million people worldwide are left with a permanent disability following a stroke, often with ongoing occupational issues. A deeper understanding of the emerging picture of occupational disruption and identity reconstruction after stroke is needed to inform client-centred practice. Method In-depth interviews using constructivist grounded theory methodology were conducted with six Queensland (Australia) adult stroke survivors. Data analysis identified themes which were woven into an overarching theory about the process of reintegration back into the community and living a meaningful life. Findings The central process of adjustment for all participants was reconstruction of an occupational identity, facilitated through connections within and across three domains – self, others and reality. Connecting with self involved emotional management; motivation; confidence; occupational engagement; and seizing control. Connecting with others included being understood; belonging; receiving help; and interactions. Connecting with reality meant confronting the impact on daily life and one's unfolding life story according to three realities: past reality, the reality of the stroke and future reality. Conclusion Exploring how stroke survivors form and maintain connections across the domains of self, reality and others provides a framework to ground occupational therapy services in the reality of individual needs from an occupational perspective.
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Affiliation(s)
- Kim Walder
- Lecturer and Higher Degree Research Student, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Gold Coast campus, Australia
| | - Matthew Molineux
- Head, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Gold Coast campus, Australia
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161
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Consequences and coping strategies six years after a subarachnoid hemorrhage - A qualitative study. PLoS One 2017; 12:e0181006. [PMID: 28854198 PMCID: PMC5576756 DOI: 10.1371/journal.pone.0181006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/23/2017] [Indexed: 11/19/2022] Open
Abstract
Background After a subarachnoid haemorrhage (SAH), continuing impairment is common and may impact the person’s life. There is a lack of knowledge regarding long-term consequences experienced. Purpose To explore experiences of the care and rehabilitation as well as the consequences and strategies used to cope with everyday life six years post SAH. Methods An explorative interview study with a qualitative design. Individual interviews, with open ended questions, using an interview guide were performed with sixteen participants (mean age 63, 8 men, 8 women) six years post SAH. Data was analyzed according to a descriptive thematic analysis, and themes were discovered inductively. Results Two major themes from the analysis, both including four sub-themes, were identified; these themes were consequences of the SAH and coping strategies. Participants were grateful to have survived the SAH and most were satisfied with their acute medical care. If discharged directly from the neurosurgical unit participants can feel abandoned. In contrast, participants who were referred to a rehabilitation clinic felt supported and informed. Cognitive problems, such as impaired memory and mental fatigue, were reported as still present six years post SAH. Coping strategies were; receiving support from family, society, employers, or technical equipment. At work, talking to colleagues and to taking breaks were common. Participants described hiding their symptoms from employers and friends, as well as trying to continue doing tasks in the same manner as prior to the SAH. If this was not possible, some refrained from doing these tasks. They went through a mourning process, fear, and worries. Conclusions Participants reported several long-term consequences which impacted on their daily lives post SAH, and different coping strategies were used to cope with these problems. Participants reported lack of awareness regarding the consequences of SAH and stressed the importance of structured multidisciplinary follow-ups, which mostly is missing.
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162
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Baier J, Kuchinke LM, Neumann M, Bender B. Form and function - Exemplary analysis of the significance for the design of rehabilitation devices. IEEE Int Conf Rehabil Robot 2017; 2017:740-745. [PMID: 28813908 DOI: 10.1109/icorr.2017.8009336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stroke often leads to motor impairment that could be recovered by extensive training. Multiple devices exist to support the rehabilitation process. Most systems interact directly with the patient and therefore, depend strongly on the ergonomic design which is determined by its form and function. In this work the interdependence of form and function and their particular significance for the development of rehabilitation devices are outlined. As a case study the development of a hand rehabilitation device is presented, where two approaches answering different key questions to focus either on function or form were realized at the same time to generate different concepts. The function-oriented approach led to a concept based on linkages and the form-oriented approach to one using leaf springs. In the discussion, the differences between the approaches are analyzed in respect to the creation of a geometrical-material entireness. Furthermore, new findings are discussed and the integration of both concepts into a final prototype is shown.
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163
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Langan J, Subryan H, Nwogu I, Cavuoto L. Reported use of technology in stroke rehabilitation by physical and occupational therapists. Disabil Rehabil Assist Technol 2017; 13:641-647. [PMID: 28812386 DOI: 10.1080/17483107.2017.1362043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs. MATERIALS AND METHODS Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded. RESULTS Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists' report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently. CONCLUSIONS The use of technology is not pervasive in the continuum of stroke rehabilitation. Implications for Rehabilitation The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling. Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback. Physical and occupational therapists do not widely use technology in stroke rehabilitation. Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.
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Affiliation(s)
- Jeanne Langan
- a Department of Rehabilitation Sciences , University at Buffalo , Buffalo , NY , USA
| | - Heamchand Subryan
- b School of Architecture , University at Buffalo , Buffalo , NY , USA
| | - Ifeoma Nwogu
- c Computer Science and Engineering , University at Buffalo , Buffalo , NY , USA
| | - Lora Cavuoto
- d Department of Industrial and Systems Engineering , University at Buffalo , Buffalo , NY , USA
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164
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Kenah K, Bernhardt J, Cumming T, Spratt N, Luker J, Janssen H. Boredom in patients with acquired brain injuries during inpatient rehabilitation: a scoping review. Disabil Rehabil 2017; 40:2713-2722. [DOI: 10.1080/09638288.2017.1354232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katrina Kenah
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Bernhardt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Toby Cumming
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Neil Spratt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Luker
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
- International Centre for Allied Health Evidence, Sansom Institute, University of South Australia, Adelaide, SA, Australia
| | - Heidi Janssen
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
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165
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Blaschke S. The role of nature in cancer patients' lives: a systematic review and qualitative meta-synthesis. BMC Cancer 2017; 17:370. [PMID: 28545539 PMCID: PMC5445345 DOI: 10.1186/s12885-017-3366-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background A systematic review and meta-synthesis was conducted to identify, compare and synthesize the published qualitative literature contributing to our understanding of the role of nature in cancer patients’ lives. Method An electronic search of Medline, CINAHL, PsycINFO and Cochrane Databases was conducted to identify qualitative studies focused on cancer patients’ nature experiences published between January 1985 and May 2015. Records were assessed according to pre-defined inclusion criteria. Data were extracted on study characteristics and evaluated using the COREQ guidelines for comprehensive quality reporting. Qualitative data from ‘results’ and ‘findings’ sections were entered into data management software NVivo in order to identify recurring themes and facilitate interpretation across studies. Results From 11 eligible publications, seven inter-related core themes with descriptive themes were identified as follows: connecting with what is valued; being elsewhere, seeing and feeling differently; exploration, inner and outer excursions; home and safe; symbolism, understanding and communicating differently; benefitting from old and new physical activities; and, enriching aesthetic experiences. Conclusions Nature provides patients with unburdened physical and psychic space invested with personal significance. Findings propose nature’s role as a “secure base” offering patients a familiar and nurturing context from which new perspectives can emerge and caring connections can be made with themselves, others, the past, and the future. As such, nature supported patients to navigate the clinical and personal consequences of cancer. Comprehensive representation of cancer patients’ nature experiences identified patient values and care opportunities embedded in clinical and personal environments, which may be considered for future research and care service development. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3366-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Blaschke
- Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, Melbourne, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia.
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166
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Douiri A, Grace J, Sarker SJ, Tilling K, McKevitt C, Wolfe CDA, Rudd AG. Patient-specific prediction of functional recovery after stroke. Int J Stroke 2017; 12:539-548. [DOI: 10.1177/1747493017706241] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aims Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patient-specific prognostic model for monitoring recovery after stroke and assessed its clinical utility. Methods Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients’ functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis. Results Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6–97.4]) and 93% [90.8–95.3], respectively, with a potential clinical utility measured by likelihood ratios (LR+:17 [10.8–26.8] at three months and LR+:11 [6.5–17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes. Conclusions A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.
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Affiliation(s)
- Abdel Douiri
- Division of Health and Social Care, King’s College London, London, UK
| | - Justin Grace
- Division of Health and Social Care, King’s College London, London, UK
| | - Shah-Jalal Sarker
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Charles DA Wolfe
- Division of Health and Social Care, King’s College London, London, UK
| | - Anthony G Rudd
- Division of Health and Social Care, King’s College London, London, UK
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167
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Moloney J, Walshe M. “I had no idea what a complicated business eating is…”: a qualitative study of the impact of dysphagia during stroke recovery. Disabil Rehabil 2017; 40:1524-1531. [DOI: 10.1080/09638288.2017.1300948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Jennifer Moloney
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Republic of Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Republic of Ireland
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Törnbom K, Sunnerhagen KS, Danielsson A. Perceptions of physical activity and walking in an early stage after stroke or acquired brain injury. PLoS One 2017; 12:e0173463. [PMID: 28273158 PMCID: PMC5342245 DOI: 10.1371/journal.pone.0173463] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical activity has been established as being highly beneficial for health after stroke. There are considerable global efforts to find rehabilitation programs that encourage increased physical activity for persons with stroke. However, many persons with stroke or acquired brain injury do not reach recommended levels of physical activity and increased knowledge about why is needed. We aimed to explore views and experiences of physical activity and walking among persons with stroke or acquired brain injury. METHOD A qualitative study was conducted, among persons with stroke (n = 8) or acquired brain injury (n = 2) from a rehabilitation unit at Sahlgrenska University Hospital in Sweden. Semi-structured in-depth interviews were held about perceptions and experiences of walking and physical activity in general. Data were analyzed using qualitative content analysis, with categories that were determined inductively. RESULTS Physical activity in general and walking ability more specifically were considered very important by the participants. However, physical activity was, regardless of exercising habits pre-injury, associated with different kinds of negative feelings and experiences. Commonly reported internal barriers in the current study were; fatigue, fear of falling or getting hurt in traffic, lack of motivation and depression. Reported external barriers were mostly related to walking, for example; bad weather, uneven ground, lack of company or noisy or too busy surroundings. CONCLUSION Persons with stroke or acquired brain injury found it difficult to engage in and sustain an eligible level of physical activity. Understanding individual concerns about motivators and barriers surrounding physical activity may facilitate the work of forming tailor-made rehabilitation for these groups, so that the levels of physical activity and walking can increase.
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Affiliation(s)
- Karin Törnbom
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Anna Danielsson
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Unit of physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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169
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Swinnen E, Lefeber N, Willaert W, De Neef F, Bruyndonckx L, Spooren A, Michielsen M, Ramon T, Kerckhofs E. Motivation, expectations, and usability of a driven gait orthosis in stroke patients and their therapists. Top Stroke Rehabil 2016; 24:299-308. [PMID: 27996894 DOI: 10.1080/10749357.2016.1266750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the development of efficacious driven gait orthoses (DGO), it is an added value to consider patients' and therapists' perspectives concerning robot-assisted gait training (RAGT). A better understanding of these issues may improve the process of care and outcome. OBJECTIVES This study aimed to examine stroke patients' motivation and expectations of RAGT, and therapists' expectations and perspectives on the usability of RAGT. Additionally, the differences in expectations between stroke patients and their therapists were analyzed. METHODS A cross sectional, multi-center, three-group trial was conducted. Included were (1) stroke patients who have experience with RAGT (i.e. the stroke user group), (2) stroke patients who have no experience with RAGT (i.e. the stroke non-user group), and (3) therapists who have experience with RAGT (i.e. the therapist user group). The Intrinsic Motivation Inventory (IMI), Credibility/Expectancy Questionnaire (CEQ), and Usefulness, Satisfaction and Ease of Use Questionnaire (USE) were used. Descriptive statistics and non-parametric Kruskal-Wallis tests were conducted. RESULTS In total, 46 subjects were assessed (stroke user group: n = 23, stroke non-user group: n = 14, therapist user group: n = 9). IMI subscale scores ranged from 42 to 88%. Mean credibility and expectancy ranged from 80 to 85% and 57 to 72%, respectively, with no significant differences between groups. USE subscale scores ranged from 61 to 72%. CONCLUSIONS Stroke user group patients seem quite motivated to train with the DGO and both patients and therapists reasonably believe that this training could improve gait functioning. Therapists are moderately satisfied with the usability of the DGO, but there is room for improvement with respect to usefulness and ease of use.
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Affiliation(s)
- Eva Swinnen
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nina Lefeber
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ward Willaert
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Fallon De Neef
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lyn Bruyndonckx
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Annemie Spooren
- d Centre of Expertise - Care in Innovation , PXL University College , Hasselt , Belgium.,e Faculty of Medicine and Life Sciences, REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute , Hasselt University , Hasselt , Belgium
| | - Marc Michielsen
- f St. Ursula Rehabilitation Centre , Jessa Hospital , Herk-de-Stad , Belgium
| | - Tine Ramon
- g AZ Delta Hospital , Roeselare , Belgium
| | - Eric Kerckhofs
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
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170
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Davies RJ, Parker J, McCullagh P, Zheng H, Nugent C, Black ND, Mawson S. A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole. JMIR Rehabil Assist Technol 2016; 3:e11. [PMID: 28582260 PMCID: PMC5454559 DOI: 10.2196/rehab.5449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 06/27/2016] [Accepted: 08/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges. OBJECTIVE Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home. METHODS A realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a "smart insole" to facilitate measurement of walking activities in a free-living, nonrestrictive environment. RESULTS Initial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants' affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use. CONCLUSION Our findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants.
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Affiliation(s)
- Richard John Davies
- Computer Science Research Institute, Faculty of Computing and Engineering, Ulster University, Belfast, United Kingdom
| | - Jack Parker
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Paul McCullagh
- Computer Science Research Institute, Faculty of Computing and Engineering, Ulster University, Belfast, United Kingdom
| | - Huiru Zheng
- Computer Science Research Institute, Faculty of Computing and Engineering, Ulster University, Belfast, United Kingdom
| | - Chris Nugent
- Computer Science Research Institute, Faculty of Computing and Engineering, Ulster University, Belfast, United Kingdom
| | - Norman David Black
- Computer Science Research Institute, Faculty of Computing and Engineering, Ulster University, Belfast, United Kingdom
| | - Susan Mawson
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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171
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Powell L, Parker J, Martyn St-James M, Mawson S. The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review. J Med Internet Res 2016; 18:e259. [PMID: 27717920 PMCID: PMC5075044 DOI: 10.2196/jmir.5891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/02/2016] [Accepted: 08/21/2016] [Indexed: 12/26/2022] Open
Abstract
Background With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness. Objective This review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors. Methods Randomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs. Results In the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P ≤.001. Conclusions This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity.
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Affiliation(s)
- Lauren Powell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
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172
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Transitions in the Embodied Experience After Stroke: Grounded Theory Study. Phys Ther 2016; 96:1565-1575. [PMID: 27103225 DOI: 10.2522/ptj.20150419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 04/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The body is central to the practice of physical therapy, but clinical theory largely neglects the body as a concept. A better understanding of the embodied experience could enhance delivery of physical therapy. OBJECTIVES The purpose of this study was to gain an in-depth understanding of embodiment for people after stroke while transitioning from the hospital to the home. DESIGN AND METHODS Seven people with stroke, aged 66 to 89 years, were interviewed 1 month after discharge from a stroke rehabilitation unit. Interviews were analyzed using grounded theory methods, and a theoretical model was developed. RESULTS Two main themes in the embodied experience of stroke were: (1) "a divergent body-self," where participants referred to an objective physical body, separate from their sense of self, and (2) "a cohesive body-self," reflecting a sense that "it's all me." The theme "a divergent body-self" included subthemes of a body that was "strange," "unpredictable," and "effortful." In contrast, the theme "a cohesive body-self" comprised the subthemes "freedom," "control," and "self-identity," reflecting experiences of bodily movement, personal independence, and self-identity. Participants fluxed between these perspectives, within moments and over time, with these perspectives influenced by "anchors," including their environment, knowledge, and attitude. CONCLUSIONS The bodily experience of stroke is intimately connected with a person's sense of self. A person's social and physical environment, as well as his or her personal attributes, can serve to "anchor" that person more comfortably within his or her embodied experience of stroke. Theory that acknowledges the integral connection between body and self could enhance physical therapist practice. This study supports the need for physical therapists to be adequately informed to integrate the embodied experience in their practice when working with people after stroke.
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173
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Shiraishi N, Suzuki Y, Matsumoto D, Jeong S, Sugiyama M, Kondo K. Effects of a Self-Exercise Program on Activities of Daily Living in Patients After Acute Stroke: A Propensity Score Analysis Based on the Japan Association of Rehabilitation Database. Arch Phys Med Rehabil 2016; 98:434-441. [PMID: 27633938 DOI: 10.1016/j.apmr.2016.08.467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/02/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge. DESIGN Retrospective, observational, propensity score (PS)-matched case-control study. SETTING General hospitals. PARTICIPANTS Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no-self-exercise program groups. INTERVENTION Self-exercise program participation. MAIN OUTCOME MEASURES At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value - admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no-high efficiency), and mRS score. RESULTS Patients were classified into a self-exercise program (n=780) or a no-self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no-high efficiency) of 2.2 (95% confidence ratio, 1.75-2.70). CONCLUSIONS SEPs may contribute to improving ADL.
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Affiliation(s)
- Nariaki Shiraishi
- Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Handa-city, Aichi, Japan.
| | - Yusuke Suzuki
- Department of Comprehensive Community Care Systems, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Daisuke Matsumoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Koryo, Nara, Japan
| | - Seungwon Jeong
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Motoya Sugiyama
- Department of Rehabilitation, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Katsunori Kondo
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba-shi, Chiba, Japan
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Specker Sullivan L, Illes J. Beyond ‘communication and control’: towards ethically complete rationales for brain-computer interface research. BRAIN-COMPUTER INTERFACES 2016. [DOI: 10.1080/2326263x.2016.1213603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Laura Specker Sullivan
- National Core for Neuroethics, University of British Columbia, Vancouver, Canada
- Center for Sensorimotor Neural Engineering, University of Washington, Box 37, 1414 NE 42nd Street Suite 204, Seattle, WA 98105-6271, USA
- Department of Philosophy, University of Washington, USA
| | - Judy Illes
- National Core for Neuroethics, University of British Columbia, Vancouver, Canada
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175
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The Importance of Patient Involvement in Stroke Rehabilitation. PLoS One 2016; 11:e0157149. [PMID: 27285997 PMCID: PMC4902299 DOI: 10.1371/journal.pone.0157149] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. RESULTS The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. CONCLUSIONS The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.
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176
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Luker JA, Craig LE, Bennett L, Ellery F, Langhorne P, Wu O, Bernhardt J. Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT. BMC Med Res Methodol 2016; 16:52. [PMID: 27164839 PMCID: PMC4862225 DOI: 10.1186/s12874-016-0156-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of multidisciplinary stroke rehabilitation interventions is challenging, even when the intervention is evidence-based. Very little is known about the implementation of complex interventions in rehabilitation clinical trials. The aim of study was to better understand how the implementation of a rehabilitation intervention in a clinical trial within acute stroke units is experienced by the staff involved. This qualitative process evaluation was part of a large Phase III stroke rehabilitation trial (AVERT). METHODS A descriptive qualitative approach was used. We purposively sampled 53 allied health and nursing staff from 19 acute stroke units in Australia, New Zealand and Scotland. Semi-structured interviews were conducted by phone, voice-internet, or face to face. Digitally recorded interviews were transcribed and analysed by two researchers using rigorous thematic analysis. RESULTS Our analysis uncovered ten important themes that provide insight into the challenges of implementing complex new rehabilitation practices within complex care settings, plus factors and strategies that assisted implementation. Themes were grouped into three main categories: staff experience of implementing the trial intervention, barriers to implementation, and overcoming the barriers. Participation in the trial was challenging but had personal rewards and improved teamwork at some sites. Over the years that the trial ran some staff perceived a change in usual care. Barriers to trial implementation at some sites included poor teamwork, inadequate staffing, various organisational barriers, staff attitudes and beliefs, and patient-related barriers. Participants described successful implementation strategies that were built on interdisciplinary teamwork, education and strong leadership to 'get staff on board', and developing different ways of working. CONCLUSIONS The AVERT stroke rehabilitation trial required commitment to deliver an intervention that needed strong collaboration between nurses and physiotherapists and was different to current care models. This qualitative process evaluation contributes unique insights into factors that may be critical to successful trials teams, and as AVERT was a pragmatic trial, success factors to delivering complex intervention in clinical practice. TRIAL REGISTRATION AVERT registered with Australian New Zealand Clinical Trials Registry ACTRN12606000185561 .
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Affiliation(s)
- Julie A Luker
- Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia. .,International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| | - Louise E Craig
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Leanne Bennett
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Fiona Ellery
- Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Peter Langhorne
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Julie Bernhardt
- Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Latrobe University, Melbourne, Australia
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Åstrand A, Saxin C, Sjöholm A, Skarin M, Linden T, Stoker A, Roshandel S, Dedering Å, Halvorsen M, Bernhardt J, Cumming T. Poststroke Physical Activity Levels No Higher in Rehabilitation than in the Acute Hospital. J Stroke Cerebrovasc Dis 2016; 25:938-45. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/04/2015] [Accepted: 12/30/2015] [Indexed: 11/29/2022] Open
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178
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Şimşek TT, Çekok K. The effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study. Int J Neurosci 2015; 126:1061-70. [PMID: 26626539 DOI: 10.3109/00207454.2015.1115993] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. METHODS 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (∼8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45-60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. RESULTS There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). CONCLUSION These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.
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Affiliation(s)
- Tülay Tarsuslu Şimşek
- a School of Physical Therapy and Rehabilitation , Dokuz Eylül University , İzmir , Turkey
| | - Kübra Çekok
- b Department of Physical Therapy and Rehabilitation , Medicalpark Izmir Hospital , İzmir , Turkey
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179
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Luker JA, Bernhardsson S, Lynch E, Murray C, Hill OP, Bernhardt J. Carers' experiences, needs and preferences during inpatient stroke rehabilitation: a protocol for a systematic review of qualitative studies. Syst Rev 2015; 4:108. [PMID: 26260629 PMCID: PMC4532249 DOI: 10.1186/s13643-015-0097-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large numbers of people provide carer roles for survivors of stroke. Person-centred stroke rehabilitation must consider the perspectives of carers, as stroke affects not only the stroke survivor but also the quality of life and health of the carers. There is little collective knowledge about stroke carers' experiences, needs and preferences during the inpatient stroke rehabilitation process to then inform person-centred service improvements. Our objective is to report and synthesise experiences, needs and preferences of the carers of stroke survivors undergoing rehabilitation in inpatient settings. METHODS/DESIGN We will conduct a systematic review of qualitative studies using a thematic synthesis methodology. We will follow the Enhancing Transparency in Reporting the Synthesis of Qualitative Research Guidelines (ENTREQ) and search the following databases for relevant articles: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Embase, and Web of Science. No language or publication date constraints will be applied. Eligible studies will have to use qualitative methods of data collection and analysis and reported data from the carers of stroke survivors who underwent inpatient stroke rehabilitation. Studies will be eligible for inclusion if they report the experiences, needs and preferences of carers regarding inpatient rehabilitation environments, organisation, care systems, therapeutic interventions, information exchange, carer training, discharge and community service planning and other issues of relevance to their roles as carers. Study selection and assessment of quality will be performed independently by two reviewers. Any disagreement will be resolved by a third reviewer. Data will be extracted by one reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results, discussion and conclusion sections will be entered into the NVivo software for analysis. Extracted texts will be inductively coded independently by two reviewers and analysed in three phases using thematic synthesis. Descriptive and analytical themes will be developed. DISCUSSION This study is expected to provide new insights into the perspectives of stroke survivors' carers. Increased knowledge about carer perspectives and preferences will inform person-centred improvements in stroke rehabilitation. STUDY REGISTRATION PROSPERO registration number: CRD42015017315 .
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Affiliation(s)
- Julie A Luker
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia. .,Florey Institute of Neuroscience & Mental Health, University of Melbourne, Melbourne, Australia.
| | - Susanne Bernhardsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Strandvägen 35, 475 40, Hönö, Sweden.
| | - Elizabeth Lynch
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia.
| | - Carolyn Murray
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia.
| | - Olivia P Hill
- International Centre for Allied Health Evidence and the Sansom Institute, University of South Australia, Adelaide, Australia.
| | - Julie Bernhardt
- Florey Institute of Neuroscience & Mental Health, University of Melbourne, Melbourne, Australia.
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