1
|
Kamioka Y, Miura Y, Matsuda T, Miyata S, Hosota T, Isaji T. One-year changes in activities of daily living and social life in elderly patients undergoing home-based rehabilitation within 1 year of stroke onset. J Phys Ther Sci 2023; 35:689-695. [PMID: 37791002 PMCID: PMC10542423 DOI: 10.1589/jpts.35.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/06/2023] [Indexed: 10/05/2023] Open
Abstract
[Purpose] In this study, we investigated changes in activities of daily living and social participation over 1 year in elderly patients with stroke, who underwent home-based rehabilitation. [Participants and Methods] This 1 year, multicenter cohort study included patients aged ≥65 years with diagnosis of the first onset of stroke within 1 year. Variables recorded included the functional independence measure and performance qualifiers for "d6 domestic life" and "d9 community, social, and civic life" (social life) based on the International Classification of Functioning, Disability and Health framework. [Results] Of the 44 partients recruited at baseline, 19 completed the study over 1 year. We observed significant improvements in the functional independence measure-motor, functional independence measure-cognitive, and functional independence measure-total and in the performance qualifiers ("domestic life" and "social life") of the International Classification of Functioning, Disability and Health tool. We also observed that the functional independence measure-total scores improved over 3 months and "domestic life" and "social life" scores gradually improved over 1 year. [Conclusion] Our results showed that activities of daily living improved earlier than other variables, including social participation, which gradually improved over 1 year and that home-based rehabilitation may effectively improve activities of daily living and social participation.
Collapse
Affiliation(s)
- Yumiko Kamioka
- Department of Physical Therapy, School of Health Sciences,
Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun,
Ibaraki 300-0394, Japan
| | - Yuji Miura
- Narushima Clinic Home-based Rehabilitation Itoguruma,
Japan
| | - Tomoyuki Matsuda
- Department of Physical Therapy, School of Health Sciences,
Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun,
Ibaraki 300-0394, Japan
| | - Shoji Miyata
- Kanagawa Rehabili Home-visit Nursing Station Aoba, Tokyo
Rehabilitation Service, Japan
| | | | - Takashi Isaji
- Department of Rehabilitation, Tsukuba Memorial Hospital,
Japan
| |
Collapse
|
2
|
Sarzyńska-Długosz I. An optimal model of long-term post-stroke care. Front Neurol 2023; 14:1129516. [PMID: 37034084 PMCID: PMC10076665 DOI: 10.3389/fneur.2023.1129516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Stroke is a major healthcare challenge that is increasing worldwide. The burden of stroke is significant for the affected individuals as well as for the general population; high-quality care is needed to reduce its negative impacts. This article synthesized information from systematic reviews, guidelines, and primary literature on stroke care and post-stroke rehabilitation and proposes an optimal strategy for long-term post-stroke care. It also highlights the unmet needs of patients who experienced a stroke in terms of early diagnosis of complications and adequate, comprehensive therapy.
Collapse
|
3
|
Swanson VA, Johnson C, Zondervan DK, Bayus N, McCoy P, Ng YFJ, Schindele, BS J, Reinkensmeyer DJ, Shaw S. Optimized Home Rehabilitation Technology Reduces Upper Extremity Impairment Compared to a Conventional Home Exercise Program: A Randomized, Controlled, Single-Blind Trial in Subacute Stroke. Neurorehabil Neural Repair 2023; 37:53-65. [PMID: 36636751 PMCID: PMC9896541 DOI: 10.1177/15459683221146995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Upper extremity (UE) stroke rehabilitation requires patients to perform exercises at home, yet patients show limited benefit from paper-based home exercise programs. OBJECTIVE To compare the effectiveness of 2 home exercise programs for reducing UE impairment: a paper-based approach and a sensorized exercise system that incorporates recommended design features for home rehabilitation technology. METHODS In this single-blind, randomized controlled trial, 27 participants in the subacute phase of stroke were assigned to the sensorized exercise (n = 14) or conventional therapy group (n = 13), though 2 participants in the conventional therapy group were lost to follow-up. Participants were instructed to perform self-guided movement training at home for at least 3 hours/week for 3 consecutive weeks. The sensorized exercise group used FitMi, a computer game with 2 puck-like sensors that encourages movement intensity and auto-progresses users through 40 exercises. The conventional group used a paper book of exercises. The primary outcome measure was the change in Upper Extremity Fugl-Meyer (UEFM) score from baseline to follow-up. Secondary measures included the Modified Ashworth Scale for spasticity (MAS) and the Visual Analog Pain (VAP) scale. RESULTS Participants who used FitMi improved by an average of 8.0 ± 4.6 points on the UEFM scale compared to 3.0 ± 6.1 points for the conventional participants, a significant difference (t-test, P = .029). FitMi participants exhibited no significant changes in UE MAS or VAP scores. CONCLUSIONS A sensor-based exercise system incorporating a suite of recommended design features significantly and safely reduced UE impairment compared to a paper-based, home exercise program. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03503617.
Collapse
Affiliation(s)
- Veronica A. Swanson
- Department of Mechanical and Aerospace
Engineering, Henry Samueli School of Engineering, University of California, Irvine,
Irvine, CA, USA,Veronica A. Swanson, University of
California, Irvine, 3225 Engineering Gateway, Irvine, CA 92697-3975, USA.
| | - Christopher Johnson
- Department of Biomedical Engineering,
Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA,
USA
| | | | - Nicole Bayus
- Rancho Research Institute, Rancho Los
Amigos National Rehabilitation Hospital, Downey, USA
| | - Phylicia McCoy
- Arthur J. Bond Department of Mechanical
Engineering, Alabama A&M University, Huntsville, AL, USA
| | - Yat Fung Joshua Ng
- School of Social Sciences, University
of California, Irvine, Irvine, CA, USA
| | - Jenna Schindele, BS
- Mathematics and Statistics, University
of California, Los Angeles, Los Angeles, CA, USA
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace
Engineering, Henry Samueli School of Engineering, University of California, Irvine,
Irvine, CA, USA,Department of Anatomy and Neurobiology,
UC Irvine School of Medicine, University of California, Irvine, Irvine, CA,
USA
| | - Susan Shaw
- Department of Neurology, Rancho Los
Amigos National Rehabilitation Center, Downey, CA, USA
| |
Collapse
|
4
|
Gil-Pagés M, Solana J, Sánchez-Carrión R, Tormos JM, Enseñat-Cantallops A, García-Molina A. Functional improvement in chronic stroke patients when following a supervised home-based computerized cognitive training. Brain Inj 2022; 36:1349-1356. [PMID: 36331895 DOI: 10.1080/02699052.2022.2140832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Computerized Cognitive Training (CCT) is an effective treatment for cognitive impairment in the post-acute stage of stroke. However, it is still not clear if it is suitable for chronic stage. OBJECTIVES To explore if patients with cognitive deficit following stroke may benefit from CCT. METHODS Thirty patients post-stroke between 24 and 62 years old were randomized into two groups (A and B) to receive two different types of CCT. All patients were tested with a neuropsychological battery and functional questionnaires, before and after each CCT and also 6 months after the end of the study. In phase I, Group A received a customized CCT and Group B received a non-customized CCT, over 6 weeks. Three months after, each group received the other intervention (phase II). RESULTS After phase I, between-group analyses revealed that Group A showed a relative decrease in subjective complaints. In contrast, Group B showed improvement in performance-based measures. After phase II, the decrease in subjective complaints continued in Group A, and both groups showed improvement in performance-based measures. CONCLUSIONS Patients with chronic stroke improved cognitive functioning after performing supervised home-based multi-domain computerized cognitive training.
Collapse
Affiliation(s)
- Macarena Gil-Pagés
- Institut Guttmann, Institut Universitari de Neurorehabilitació, adscrit a la Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.,Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Javier Solana
- Institut Guttmann, Institut Universitari de Neurorehabilitació, adscrit a la Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Rocío Sánchez-Carrión
- Institut Guttmann, Institut Universitari de Neurorehabilitació, adscrit a la Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jose M Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació, adscrit a la Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antonia Enseñat-Cantallops
- Institut Guttmann, Institut Universitari de Neurorehabilitació, adscrit a la Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alberto García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació, adscrit a la Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| |
Collapse
|
5
|
Toh SFM, Chia PF, Fong KNK. Effectiveness of home-based upper limb rehabilitation in stroke survivors: A systematic review and meta-analysis. Front Neurol 2022; 13:964196. [PMID: 36188398 PMCID: PMC9521568 DOI: 10.3389/fneur.2022.964196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Home-based training is an alternative option to provide intensive rehabilitation without costly supervised therapy. Though several studies support the effectiveness of home-based rehabilitation in improving hemiparetic upper limb function in stroke survivors, a collective evaluation of the evidence remains scarce. Objectives This study aims to determine the effects of home-based upper limb rehabilitation for hemiparetic upper limb recovery in stroke survivors. Methods The databases of the Cochrane Library, MEDLINE, CINAHL, and Web of Science were systematically searched from January 2000 to September 2020. Only randomized, controlled, and cross-over trials that evaluated the effects of home-based upper limb interventions were selected. The Pedro scale was used to assess the methodological quality of the studies. A meta-analysis of the upper limb function outcomes was performed by calculating the mean difference/standardized mean difference using a fixed/random effect model. Results An initial search yielded 1,049 articles. Twenty-six articles were included in the review. The pooled evidence of the meta-analysis showed that home-based upper limb intervention was more effective in improving upper limb function [SMD: 0.28, 95% CI (0.12, 0.44), I2 = 0%, p < 0.001, fixed effect model] than conventional therapy. When comparing two types of home-based interventions, subgroup analysis revealed that home-based technology treatment—electrical stimulation—provided more significant improvement in upper limb function than treatment without the use of technology (SMD: 0.64, 95% CI (0.21, 1.07), I2 = 0%, p = 0.003, random effect model). Conclusion The beneficial effects of home-based upper limb interventions were superior to conventional therapy in improving function and perceived use of the hemiparetic upper limb in daily activities. Among the home-based interventions, home-based electrical stimulation seemed to provide the most optimal benefits.
Collapse
Affiliation(s)
- Sharon Fong Mei Toh
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Rehabilitation, Yishun Community Hospital, Singapore, Singapore
| | - Pei Fen Chia
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Kenneth N. K. Fong
| |
Collapse
|
6
|
Jarbandhan A, Toelsie J, Veeger D, Bipat R, Vanhees L, Buys R. Feasibility of a home-based physiotherapy intervention to promote post-stroke mobility: A randomized controlled pilot study. PLoS One 2022; 17:e0256455. [PMID: 35255091 PMCID: PMC8901054 DOI: 10.1371/journal.pone.0256455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Home-based physiotherapy interventions to improve post-stroke mobility are successful in high-income countries. These programs require less resources compared to center-based programs. However, feasibility of such an intervention in a low and middle-income setting remains unknown. Therefore, the SunRISe (Stroke Rehabilitation In Suriname) study aimed to assess feasibility and preliminary effectiveness of a home-based semi-supervised physiotherapy intervention to promote post-stroke mobility in a low resource setting. Design Prospective randomized controlled trial. Methods Chronic stroke patients were recruited and randomized into either an intervention group (IG (N = 20)) or a control group (CG (N = 10)). The IG received a 3-days-a-week home-based physiotherapy program that was supervised in the first 4 weeks and tele-supervised during the second 4 weeks. The physiotherapy program consisted of walking as well as functional and mobilization exercises. The CG received usual care. Feasibility outcome measures included adherence, patient satisfaction and safety. Efficacy measures included functional exercise tolerance (six-minute walking test (6MWT), functional balance (Berg Balance Score (BBS), upper extremity (UE) function (Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire), and UE strength ((non-)paretic handgrip (HG) strength). Two-way analysis of variance was used for data analysis. Results Thirty participants (61.8 ± 9.2 years old, 13 men) were enrolled in the study. The intervention was completed by 14 participants (70%). Adherence was affected by rainy season associated infrastructural problems (n = 2), the medical status of participants (n = 3) and insufficient motivation to continue the program without direct supervision (n = 1). No adverse events were noted and participants were satisfied with the program. Functional exercise tolerance (57.2 ± 67.3m, p = 0.02) and UE function (-9.8 ± 15.2, p = 0.04) improved in the IG compared to no change in the CG. HG strength was unaltered and a ceiling effect occurred for BBS. Conclusion Our home-based semi-supervised physiotherapy intervention seems safe, associated with moderate to high levels of engagement and patient satisfaction and results in functional improvements.
Collapse
Affiliation(s)
| | - Jerry Toelsie
- Dept. of Physiology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - DirkJan Veeger
- Dept. of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Robbert Bipat
- Dept. of Physiology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Luc Vanhees
- Dept. of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Roselien Buys
- Dept. of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- * E-mail:
| |
Collapse
|
7
|
Kojima K, Kamai D, Yamamoto A, Tsuchitani Y, Kataoka H. The Effect of Toe-grasping Exercises on Balance Ability in Home-based Rehabilitation: A Randomized Controlled Trial by Block Randomization. Phys Ther Res 2022; 24:272-279. [PMID: 35036262 DOI: 10.1298/ptr.e10105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of the study was to clarify the causal effect of toe-grasping exercises on the improvement of static or dynamic balance ability in home-based rehabilitation users. METHOD Our study included 34 subjects who met the criteria and were evaluable out of 98 rehabilitation service users at home nursing stations. This study was a randomized controlled trial. The intervention group performed towel gathering exercises in addition to the regular home-based rehabilitation program. The primary outcome was one-leg standing time, and the secondary outcomes were two-step test and toe grip strength. RESULTS Seventeen subjects were assigned to the intervention group and seventeen to the control group by block randomization. Data from 15 and 12 subjects in the intervention group and control group, respectively, who were able to complete the initial evaluation and the evaluation after 3 months, were analyzed. We compared the amount of change after 3 months of evaluation in the intervention group with the change in the control group. The results showed that the left/right mean value of oneleg standing time in the intervention group was significantly greater than that in the control group. In terms of the amount of change in the intervention period (T2-T1) within each assessment, there were significant improvements in both the toe-grip strength and the two-step values in the intervention group. CONCLUSION We found that toe-grasping exercises could improve the balance ability of home-based rehabilitation users. This suggests the clinical significance of toe function in rehabilitation programs.
Collapse
Affiliation(s)
| | | | | | | | - Hiroaki Kataoka
- Department of Physical Therapy, Faculty of Health Sciences, Okayama Healthcare Professional University, Japan
| |
Collapse
|
8
|
Vluggen TPMM, van Haastregt JCM, Tan FE, Verbunt JA, van Heugten CM, Schols JMGA. Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial. BMC Geriatr 2021; 21:134. [PMID: 33622269 PMCID: PMC7903755 DOI: 10.1186/s12877-021-02082-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care. Methods A multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes. Results In total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (− 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed. Conclusion The integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects. Trial registration Current Controlled Trials ISRCTN62286281. Registered 19-3-2010. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02082-4.
Collapse
Affiliation(s)
- Tom P M M Vluggen
- Department of Health Services Research, Maastricht University, Box 616, 6200, Maastricht, MD, The Netherlands. .,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Maastricht University, Box 616, 6200, Maastricht, MD, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Frans E Tan
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of methodology and statistics, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Box 616, 6200, Maastricht, MD, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
9
|
Gonzalez-Santos J, Soto-Camara R, Rodriguez-Fernández P, Jimenez-Barrios M, Gonzalez-Bernal J, Collazo-Riobo C, Jahouh M, Bravo-Anguiano Y, Trejo-Gabriel-Galan JM. Effects of home-based mirror therapy and cognitive therapeutic exercise on the improvement of the upper extremity functions in patients with severe hemiparesis after a stroke: a protocol for a pilot randomised clinical trial. BMJ Open 2020; 10:e035768. [PMID: 32978182 PMCID: PMC7520843 DOI: 10.1136/bmjopen-2019-035768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Neuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke. METHODS AND ANALYSIS This is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months). ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04163666).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Maha Jahouh
- Health Sciences, University of Burgos, Burgos, Spain
| | | | | |
Collapse
|
10
|
Kamioka Y, Miura Y, Matsuda T, Iijima Y, Suzuki A, Nakazato K, Saito H, Arita M. Changes in social participation and life-space mobility in newly enrolled home-based rehabilitation users over 6 months. J Phys Ther Sci 2020; 32:375-384. [PMID: 32581429 PMCID: PMC7276774 DOI: 10.1589/jpts.32.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/01/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine whether we were able to measure changes in social
participation and life-space mobility of newly enrolled home-based rehabilitation (HR)
users by using the activities and participation components of the International
Classification of Functioning, Disability and Health (ICF) and Life-Space Assessment (LSA)
over a 6-months period. [Participants and Methods] We enrolled 47 HR users who had
suffered from a stroke or other condition within the previous year. A 6-month prospective
cohort study was conducted. The performance qualifiers “d6 domestic life” and “d9
community, social and civic life” in the activities and participation components of the
ICF and LSA were used. [Results] We observed significant improvements in the performance
qualifier “d9 community, social and civic life” of the ICF over 3 months, and the LSA over
a 6-months period. We also identified significant improvements in “d910 community life”
and “d920 recreation and leisure” of the ICF. The LSA results showed that HR users had
more frequent mobility within the neighborhood. [Conclusion] This study showed that newly
enrolled HR users improved their social activities in the community, recreational
activities, and life-space mobility over a 6-months period. These were measured using
performance qualifiers from the ICF and LSA.
Collapse
Affiliation(s)
- Yumiko Kamioka
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki 300-0394 Japan
| | - Yuji Miura
- Narushima Clinic Home-based Rehabilitation, Japan
| | - Tomoyuki Matsuda
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki 300-0394 Japan
| | - Yayoi Iijima
- Ibaraki Rehabilitation Profession Association, Japan
| | - Ai Suzuki
- Special Elderly Nursing Home Shichifukujin, Japan
| | | | | | - Motohide Arita
- Arita Internal Medicine Orthopedics Rehabilitation Clinic, Japan
| |
Collapse
|
11
|
Shaw L, Bhattarai N, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Howel D, Laverty AM, McKevitt C, McMeekin P, Price C, Stamp E, Stevens E, Vale L, Rodgers H. An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT. Health Technol Assess 2020; 24:1-202. [PMID: 32468989 DOI: 10.3310/hta24240] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is limited evidence about the effectiveness of rehabilitation in meeting the longer-term needs of stroke patients and their carers. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of an extended stroke rehabilitation service (EXTRAS). DESIGN A pragmatic, observer-blind, parallel-group, multicentre randomised controlled trial with embedded health economic and process evaluations. Participants were randomised (1 : 1) to receive EXTRAS or usual care. SETTING Nineteen NHS study centres. PARTICIPANTS Patients with a new stroke who received early supported discharge and their informal carers. INTERVENTIONS Five EXTRAS reviews provided by an early supported discharge team member between 1 and 18 months post early supported discharge, usually over the telephone. Reviewers assessed rehabilitation needs, with goal-setting and action-planning. Control treatment was usual care post early supported discharge. MAIN OUTCOME MEASURES The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post randomisation. Secondary outcomes at 12 and 24 months included patient mood (Hospital Anxiety and Depression Scale), health status (Oxford Handicap Scale), experience of services and adverse events. For carers, secondary outcomes included carers' strain (Caregiver Strain Index) and experience of services. Cost-effectiveness was estimated using resource utilisation costs (adaptation of the Client Service Receipt Inventory) and quality-adjusted life-years. RESULTS A total of 573 patients (EXTRAS, n = 285; usual care, n = 288) with 194 carers (EXTRAS, n = 103; usual care, n = 91) were randomised. Mean 24-month Nottingham Extended Activities of Daily Living Scale scores were 40.0 (standard deviation 18.1) for EXTRAS (n = 219) and 37.2 (standard deviation 18.5) for usual care (n = 231), giving an adjusted mean difference of 1.8 (95% confidence interval -0.7 to 4.2). The mean intervention group Hospital Anxiety and Depression Scale scores were not significantly different at 12 and 24 months. The intervention did not improve patient health status or carer strain. EXTRAS patients and carers reported greater satisfaction with some aspects of care. The mean cost of resource utilisation was lower in the intervention group: -£311 (95% confidence interval -£3292 to £2787), with a 68% chance of EXTRAS being cost-saving. EXTRAS was associated with 0.07 (95% confidence interval 0.01 to 0.12) additional quality-adjusted life-years. At current conventional thresholds of willingness to pay for a quality-adjusted life-year, there is a 90% chance that EXTRAS is cost-effective. CONCLUSIONS EXTRAS did not improve stroke survivors' performance in extended activities of daily living but did improve their overall satisfaction with services. Given the impact on costs and quality-adjusted life-years, there is a high chance that EXTRAS could be considered cost-effective. FUTURE WORK Further research is required to identify whether or not community-based interventions can improve performance of extended activities of daily living, and to understand the improvements in health-related quality of life and costs seen by provision of intermittent longer-term specialist review. TRIAL REGISTRATION Current Controlled Trials ISRCTN45203373. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 24. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Lisa Shaw
- Stroke Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nawaraj Bhattarai
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robin Cant
- Service user, c/o Stroke Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Avril Drummond
- School of Health Sciences, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Gary A Ford
- Stroke Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Medical Sciences Division, University of Oxford and John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Francis
- Stroke Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Hills
- Stroke Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Anne Marie Laverty
- Stroke Service, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Peter McMeekin
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Christopher Price
- Stroke Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Stroke Service, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Elaine Stamp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eleanor Stevens
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Rodgers
- Stroke Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Stroke Service, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK.,Royal Victoria Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
12
|
Vluggen TPMM, van Haastregt JCM, Verbunt JA, van Heugten CM, Schols JMGA. Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation. BMC Neurol 2020; 20:219. [PMID: 32471443 PMCID: PMC7260779 DOI: 10.1186/s12883-020-01791-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme. Methods In this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme. Results A part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme. Conclusion This study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients.
Collapse
Affiliation(s)
- Tom P M M Vluggen
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. .,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
13
|
Fu V, Weatherall M, McPherson K, Taylor W, McRae A, Thomson T, Gommans J, Green G, Harwood M, Ranta A, Hanger C, Riley J, McNaughton H. Taking Charge after Stroke: A randomized controlled trial of a person-centered, self-directed rehabilitation intervention. Int J Stroke 2020; 15:954-964. [PMID: 32293236 PMCID: PMC7739137 DOI: 10.1177/1747493020915144] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background and purpose “Take Charge” is a novel, community-based self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. In a previous randomized controlled trial, a single Take Charge session improved independence and health-related quality of life 12 months following stroke in Māori and Pacific New Zealanders. We tested the same intervention in three doses (zero, one, or two sessions) in a larger study and in a broader non-Māori and non-Pacific population with stroke. We aimed to confirm whether the Take Charge intervention improved quality of life at 12 months after stroke in a different population and whether two sessions were more effective than one. Methods We randomized 400 people within 16 weeks of acute stroke who had been discharged to institution-free community living at seven centers in New Zealand to a single Take Charge session (TC1, n = 132), two Take Charge sessions six weeks apart (TC2, n = 138), or a control intervention (n = 130). Take Charge is a “talking therapy” that encourages a sense of purpose, autonomy, mastery, and connectedness with others. The primary outcome was the Physical Component Summary score of the Short Form 36 at 12 months following stroke comparing any Take Charge intervention to control. Results Of the 400 people randomized (mean age 72.2 years, 58.5% male), 10 died and two withdrew from the study. The remaining 388 (97%) people were followed up at 12 months after stroke. Twelve months following stroke, participants in either of the TC groups (i.e. TC1 + TC2) scored 2.9 (95% confidence intervals (CI) 0.95 to 4.9, p = 0.004) points higher (better) than control on the Short Form 36 Physical Component Summary. This difference remained significant when adjusted for pre-specified baseline variables. There was a dose effect with Short Form 36 Physical Component Summary scores increasing by 1.9 points (95% CI 0.8 to 3.1, p < 0.001) for each extra Take Charge session received. Exposure to the Take Charge intervention was associated with reduced odds of being dependent (modified Rankin Scale 3 to 5) at 12 months (TC1 + TC2 12% versus control 19.5%, odds ratio 0.55, 95% CI 0.31 to 0.99, p = 0.045). Conclusions Confirming the previous randomized controlled trial outcome, Take Charge—a low-cost, person-centered, self-directed rehabilitation intervention after stroke—improved health-related quality of life and independence. Clinical trial registration-URL http://www.anzctr.org.au. Unique identifier: ACTRN12615001163594
Collapse
Affiliation(s)
- Vivian Fu
- 194581Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - William Taylor
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Anna McRae
- 1387Auckland District Health Board, Auckland, New Zealand
| | - Tom Thomson
- 5178Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - John Gommans
- Hawkes Bay District Health Board, Hastings, New Zealand
| | - Geoff Green
- Counties-Manukau District Health Board, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Carl Hanger
- 63588Canterbury District Health Board, Christchurch, New Zealand
| | - Judith Riley
- 194581Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Harry McNaughton
- 194581Medical Research Institute of New Zealand, Wellington, New Zealand
| |
Collapse
|
14
|
Rodgers H, Howel D, Bhattarai N, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Laverty AM, McKevitt C, McMeekin P, Price CIM, Stamp E, Stevens E, Vale L, Shaw L. Evaluation of an Extended Stroke Rehabilitation Service (EXTRAS): A Randomized Controlled Trial and Economic Analysis. Stroke 2019; 50:3561-3568. [PMID: 31637972 PMCID: PMC7597995 DOI: 10.1161/strokeaha.119.024876] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Supplemental Digital Content is available in the text. There is limited evidence to guide rehabilitation to meet the longer term needs of stroke survivors. The clinical effectiveness and cost-effectiveness of an extended stroke rehabilitation service (EXTRAS) provided following early supported discharge were determined.
Collapse
Affiliation(s)
- Helen Rodgers
- From the Stroke Research Group, Institute of Neuroscience (H.R., G.A.F., R.F., K.H., C.I.M.P., L.S.), Newcastle University, Newcastle upon Tyne, United Kingdom.,Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, United Kingdom (H.R., A.-M.L., C.I.M.P.).,Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (H.R.)
| | - Denise Howel
- Institute of Health and Society Newcastle University, Newcastle upon Tyne, UK (D.H., N.B., E. Stamp, L.V.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nawaraj Bhattarai
- Institute of Health and Society Newcastle University, Newcastle upon Tyne, UK (D.H., N.B., E. Stamp, L.V.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robin Cant
- Lay Investigator, Stroke Research Group, Institute of Neuroscience, Newcastle (R.C.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Avril Drummond
- School of Health Sciences, Nottingham University, United Kingdom (A.D.)
| | - Gary A Ford
- From the Stroke Research Group, Institute of Neuroscience (H.R., G.A.F., R.F., K.H., C.I.M.P., L.S.), Newcastle University, Newcastle upon Tyne, United Kingdom.,Medical Sciences Division, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, United Kingdom (G.A.F.)
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, United Kingdom (A.F.)
| | - Richard Francis
- From the Stroke Research Group, Institute of Neuroscience (H.R., G.A.F., R.F., K.H., C.I.M.P., L.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Katie Hills
- From the Stroke Research Group, Institute of Neuroscience (H.R., G.A.F., R.F., K.H., C.I.M.P., L.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anne-Marie Laverty
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, United Kingdom (H.R., A.-M.L., C.I.M.P.)
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, King's College London, United Kingdom (C.M., E. Stevens)
| | - Peter McMeekin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (P.M.)
| | - Christopher I M Price
- From the Stroke Research Group, Institute of Neuroscience (H.R., G.A.F., R.F., K.H., C.I.M.P., L.S.), Newcastle University, Newcastle upon Tyne, United Kingdom.,Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, United Kingdom (H.R., A.-M.L., C.I.M.P.)
| | - Elaine Stamp
- Institute of Health and Society Newcastle University, Newcastle upon Tyne, UK (D.H., N.B., E. Stamp, L.V.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Eleanor Stevens
- School of Population Health and Environmental Sciences, King's College London, United Kingdom (C.M., E. Stevens)
| | - Luke Vale
- Institute of Health and Society Newcastle University, Newcastle upon Tyne, UK (D.H., N.B., E. Stamp, L.V.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lisa Shaw
- From the Stroke Research Group, Institute of Neuroscience (H.R., G.A.F., R.F., K.H., C.I.M.P., L.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
15
|
Aadal L, Pallesen H, Arntzen C, Moe S. Municipal Cross-Disciplinary Rehabilitation following Stroke in Denmark and Norway: A Qualitative Study. Rehabil Res Pract 2018; 2018:1972190. [PMID: 30498601 PMCID: PMC6222227 DOI: 10.1155/2018/1972190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/04/2018] [Accepted: 09/23/2018] [Indexed: 12/26/2022] Open
Abstract
AIM To explore and compare the content of rehabilitation practices in, respectively, a Danish and a Norwegian region, focusing on how the citizens' rehabilitation needs are met during rehabilitation in the municipalities. METHOD Six Danish and five Norwegian cases were followed 12 months after the onset of stroke. Field work and focus group interviews with multidisciplinary teams in the municipalities were conducted. The conceptual frame of the International Classification of Functioning was used to outline general patterns and local variation in the rehabilitation services. FINDINGS Each of the settings faces different challenges and opportunities in the provision of everyday life-supportive rehabilitation services. Rehabilitation after stroke in both settings basically follows the same guidelines, but the organization of rehabilitation programmes is more specialized in Denmark than in Norway. Team organization, multidisciplinarity, and collaboration to assess and target the patients' needs characterized the Danish rehabilitation services. Decentralized coordination and monodisciplinary contributions with scarce or unsystematic collaboration were common in the Norwegian cases. Seamless holistic rehabilitation was challenged in both countries, but more notably in Norway. The municipal services emphasized physical functioning, which could conflict with the patients' needs. Cognitive disturbances to and aspects of activity or participation were systematically addressed by the interdisciplinary teams in Denmark, while practitioners in Norway found that these disturbances were scarcely addressed. DISCUSSION The study showed major differences in municipal stroke rehabilitation services in the Northern Norway and Central Denmark Regions-in their ability to conduct everyday life-supportive rehabilitation services. Despite the fact that biopsychosocial conceptions of disease and illness, as recommended in the ICF, have been generally accepted, they seemed scarcely implemented in the political and health managerial arenas, especially in Norway. These national diversities can partly be explained by the size of the municipalities and the available health profiles in delivering patient and family-centred rehabilitation services.
Collapse
Affiliation(s)
- Lena Aadal
- Head of Clinical Nursing Research, Cand. Cur, Ph.D., Associate Professor, Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Voldbyvej 15, DK-8450 Hammel, Denmark
| | - Hanne Pallesen
- Head of Clinical Physiotherapy Research, Cand. Scient. san., Ph.D., Associate Professor, Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Voldbyvej 15, DK-8450, Denmark
| | - Cathrine Arntzen
- Associate Professor, Ph.D., Leader Centre for Care Research, North, Department of Health and Care Sciences, The Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Siri Moe
- Associate Professor, Ph.D., Department of Health and Care Sciences, The Faculty of Health Sciences, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| |
Collapse
|
16
|
Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Māori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017; 7:e016512. [PMID: 28576903 PMCID: PMC5726100 DOI: 10.1136/bmjopen-2017-016512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Stroke is one of the leading causes of disability worldwide. Recent data support the possibility that person-centred, self-management interventions can reduce dependence after stroke. However, there is limited information on the generalisability and optimum dose of these interventions. METHODS The Taking Charge After Stroke (TaCAS) study is a multicentre, investigator-blinded, randomised controlled trial recruiting 400 participants following acute stroke from seven hospitals in New Zealand. All patients discharged to community living who have ongoing symptoms at time of discharge (modified Rankin scale>0) will be eligible. Participants will be randomly assigned to one Take Charge session, two Take Charge sessions 6 weeks apart or control. OUTCOMES The primary outcome will be the Physical Component Summary score of the Short-Form 36 at 12 months post stroke. Secondary outcomes will include dependence (modified Rankin scale), performance in activities of daily living (Barthel Index) and carer strain (Caregiver Strain Index), at 6 and 12 months post stroke. All analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION The TaCAS study is funded by a Health Research Council of New Zealand grant. It has been approved by the Central Health and Disability Ethics Committee (15/CEN/115). Results will be published and presented at relevant stroke meetings within New Zealand and internationally, informing the use of a self-management intervention after stroke. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12615001163594. Date registered 02-11-2015. Medical Research Institute of New Zealand Registry TCS01. Universal trial number U1111-1171-4127.
Collapse
Affiliation(s)
| | | | - Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
| |
Collapse
|
17
|
Oscari F, Oboe R, Daud Albasini OA, Masiero S, Rosati G. Design and Construction of a Bilateral Haptic System for the Remote Assessment of the Stiffness and Range of Motion of the Hand. SENSORS 2016; 16:s16101633. [PMID: 27706085 PMCID: PMC5087421 DOI: 10.3390/s16101633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022]
Abstract
The use of haptic devices in the rehabilitation of impaired limbs has become rather popular, given the proven effectiveness in promoting recovery. In a standard framework, such devices are used in rehabilitation centers, where patients interact with virtual tasks, presented on a screen. To track their sessions, kinematic/dynamic parameters or performance scores are recorded. However, as Internet access is now available at almost every home and in order to reduce the hospitalization time of the patient, the idea of doing rehabilitation at home is gaining wide consent. Medical care programs can be synchronized with the home rehabilitation device; patient data can be sent to the central server that could redirect to the therapist laptop (tele-healthcare). The controversial issue is that the recorded data do not actually represent the clinical conditions of the patients according to the medical assessment scales, forcing them to frequently undergo clinical tests at the hospital. To respond to this demand, we propose the use of a bilateral master/slave haptic system that could allow the clinician, who interacts with the master, to assess remotely and in real time the clinical conditions of the patient that uses the home rehabilitation device as the slave. In this paper, we describe a proof of concept to highlight the main issues of such an application, limited to one degree of freedom, and to the measure of the stiffness and range of motion of the hand.
Collapse
Affiliation(s)
- Fabio Oscari
- Department of Management and Engineering, University of Padova, Stradella S. Nicola 3, 36100 Vicenza, Italy.
| | - Roberto Oboe
- Department of Management and Engineering, University of Padova, Stradella S. Nicola 3, 36100 Vicenza, Italy.
| | - Omar Andres Daud Albasini
- Center for the Development of Nanoscience and Nanotechnology, Universidad de Santiago de Chile, Av. Lib. Bernardo O'higgins, 3363 Santiago, Chile.
| | - Stefano Masiero
- Department of Neuroscience, Universiy-General Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - Giulio Rosati
- Department of Management and Engineering, University of Padova, Stradella S. Nicola 3, 36100 Vicenza, Italy.
| |
Collapse
|
18
|
Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation. J Stroke Cerebrovasc Dis 2016; 25:1158-1164. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/04/2016] [Indexed: 11/17/2022] Open
|
19
|
Yan LL, Li C, Chen J, Miranda JJ, Luo R, Bettger J, Zhu Y, Feigin V, O'Donnell M, Zhao D, Wu Y. Prevention, management, and rehabilitation of stroke in low- and middle-income countries. eNeurologicalSci 2016; 2:21-30. [PMID: 29473058 PMCID: PMC5818135 DOI: 10.1016/j.ensci.2016.02.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 12/28/2022] Open
Abstract
Although stroke incidence in high-income countries (HICs) decreased over the past four decades, it increased dramatically in low- and middle-income countries (LMICs). In this review, we describe the current status of primary prevention, treatment, and management of acute stroke and secondary prevention of and rehabilitation after stroke in LMICs. Although surveillance, screening, and accurate diagnosis are important for stroke prevention, LMICs face challenges in these areas due to lack of resources, awareness, and technical capacity. Maintaining a healthy lifestyle, such as no tobacco use, healthful diet, and physical activity are important strategies for both primary and secondary prevention of stroke. Controlling high blood pressure is also critically important in the general population and in the acute stage of hemorrhagic stroke. Additional primary prevention strategies include community-based education programs, polypill, prevention and management of atrial fibrillation, and digital health technology. For treatment of stroke during the acute stage, specific surgical procedures and medications are recommended, and inpatient stroke care units have been proven to provide high quality care. Patients with a chronic condition like stroke may require lifelong pharmaceutical treatment, lifestyle maintenance and self-management skills, and caregiver and family support, in order to achieve optimal health outcomes. Rehabilitation improves physical, speech, and cognitive functioning of disabled stroke patients. It is expected that home- or community-based services and tele-rehabilitation may hold special promise for stroke patients in LMICs.
Collapse
Affiliation(s)
- Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, USA
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Chaoyun Li
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Jie Chen
- Institute for Medical Humanities, Peking University Health Science Center, Beijing, China
| | - J. Jaime Miranda
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Janet Bettger
- Duke School of Nursing, Duke University, Durham, USA
- Duke Clinical Research Institute, Duke University, Durham, USA
| | - Yishan Zhu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | | | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University School of Public Health and Clinical Research Institute, Beijing, China
| |
Collapse
|
20
|
Cobbing S, Hanass-Hancock J, Myezwa H. A home-based rehabilitation intervention for people living with HIV and disability in a resource-poor community, KwaZulu-Natal: study protocol for a randomised controlled trial. Trials 2015; 16:491. [PMID: 26525296 PMCID: PMC4630848 DOI: 10.1186/s13063-015-1025-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background In the era of highly active antiretroviral therapy HIV is now viewed as a chronic disease. Although people living with HIV are living longer lives, they are prone to a number of disabilities. Home-based rehabilitation has been shown to be an effective means of improving quality of life and function for people with a wide range of chronic diseases. There is a dearth of evidence, however, related to home-based rehabilitation interventions for people living with HIV, particularly in sub-Saharan Africa — the region with the highest global prevalence of HIV. Methods A randomised controlled trial design will be employed. Adults living with HIV who have been on antiretroviral therapy for at least six months and with defined limited mobility will be randomly allocated to either an intervention group or the control group. Pre and post-intervention testing will be conducted at a public hospital in KwaZulu-Natal, South Africa in order to assess the participants’ quality of life, perceived level of disability, functional ability and endurance. Individuals randomly allocated to the intervention group will participate in a four-month home-based rehabilitation programme, conducted once a week in their homes. This programme will be implemented by community workers who will be trained and supervised by a qualified physiotherapist. The participants in the control group will continue with the standard clinic management offered to them. On completion of the intervention, all participants will be re-assessed using the same outcome measures. Analysis of results will be carried out on intention-to-treat basis in order to identify any changes between intervention and control groups. Discussion The researchers aim to employ a novel task shifting approach to implement a needs-based home-based rehabilitation programme for people living with HIV in order to improve their quality of life and functional ability. It is hoped that this study will provide rehabilitation professionals and researchers with evidence that can be utilised to improve existing rehabilitation interventions for people living with HIV. Trial registration South African National Clinical Trials Register: NHREC#4094 (Date of registration: 21 July 2015).
Collapse
Affiliation(s)
- Saul Cobbing
- Department of Physiotherapy, University of KwaZulu-Natal, Private Bag X 54001, Durban, 4000, South Africa.
| | - Jill Hanass-Hancock
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
21
|
Parke HL, Epiphaniou E, Pearce G, Taylor SJC, Sheikh A, Griffiths CJ, Greenhalgh T, Pinnock H. Self-Management Support Interventions for Stroke Survivors: A Systematic Meta-Review. PLoS One 2015. [PMID: 26204266 PMCID: PMC4512724 DOI: 10.1371/journal.pone.0131448] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is considerable policy interest in promoting self-management in patients with long-term conditions, but it remains uncertain whether these interventions are effective in stroke patients. DESIGN Systematic meta-review of the evidence for self-management support interventions with stroke survivors to inform provision of healthcare services. METHODS We searched MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, BNI, Database of Abstracts of Reviews for Effectiveness, and Cochrane Database of Systematic Reviews for systematic reviews of self-management support interventions for stroke survivors. Quality was assessed using the R-AMSTAR tool, and data extracted using a customised data extraction form. We undertook a narrative synthesis of the reviews' findings. RESULTS From 12,400 titles we selected 13 systematic reviews (published 2003-2012) representing 101 individual trials. Although the term 'self-management' was rarely used, key elements of self-management support such as goal setting, action planning, and problem solving were core components of therapy rehabilitation interventions. We found high quality evidence that supported self-management in the context of therapy rehabilitation delivered soon after the stroke event resulted in short-term (< 1 year) improvements in basic and extended activities of daily living, and a reduction in poor outcomes (dependence/death). There is some evidence that rehabilitation and problem solving interventions facilitated reintegration into the community. CONCLUSIONS Self-management terminology is rarely used in the context of stroke. However, therapy rehabilitation currently successfully delivers elements of self-management support to stroke survivors and their caregivers with improved outcomes. Future research should focus on managing the emotional, medical and social tasks of long-term survivorship.
Collapse
Affiliation(s)
- Hannah L. Parke
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Eleni Epiphaniou
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Gemma Pearce
- Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, United Kingdom
| | - Stephanie J. C. Taylor
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Aziz Sheikh
- Usher Institute of Medical Informatics and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Chris J. Griffiths
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, Medical Sciences division, University of Oxford, Oxford, United Kingdom
| | - Hilary Pinnock
- Usher Institute of Medical Informatics and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| |
Collapse
|
22
|
Rodgers H, Shaw L, Cant R, Drummond A, Ford GA, Forster A, Hills K, Howel D, Laverty AM, McKevitt C, McMeekin P, Price C. Evaluating an extended rehabilitation service for stroke patients (EXTRAS): study protocol for a randomised controlled trial. Trials 2015; 16:205. [PMID: 25939584 PMCID: PMC4445280 DOI: 10.1186/s13063-015-0704-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/02/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Development of longer term stroke rehabilitation services is limited by lack of evidence of effectiveness for specific interventions and service models. We describe the protocol for a multicentre randomised controlled trial which is evaluating an extended stroke rehabilitation service. The extended service commences when routine 'organised stroke care' (stroke unit and early supported discharge (ESD)) ends. METHODS/DESIGN This study is a multicentre randomised controlled trial with health economic and process evaluations. It is set within NHS stroke services which provide ESD. Participants are adults who have experienced a new stroke (and carer if appropriate), discharged from hospital under the care of an ESD team. The intervention group receives an extended stroke rehabilitation service provided for 18 months following completion of ESD. The extended rehabilitation service involves regular contact with a senior ESD team member who leads and coordinates further rehabilitation. Contact is usually by telephone. The control group receives usual stroke care post-ESD. Usual care may involve referral of patients to a range of rehabilitation services upon completion of ESD in accordance with local clinical practice. Randomisation is via a central independent web-based service. The primary outcome is extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post-randomisation. Secondary outcomes (at 12 and 24 months post-randomisation) are health status, quality of life, mood and experience of services for patients, and quality of life, experience of services and carer stress for carers. Resource use and adverse events are also collected. Outcomes are undertaken by a blinded assessor. Implementation and delivery of the extended stroke rehabilitation service will also be described. Semi-structured interviews will be conducted with a subsample of participants and staff to gain insight into perceptions and experiences of rehabilitation services delivered or received. Allowing for 25% attrition, 510 participants are needed to provide 90% power to detect a difference in mean Nottingham Extended Activities of Daily Living Scale score of 6 with a 5% significance level. DISCUSSION The provision of longer term support for stroke survivors is currently limited. The results from this trial will inform future stroke service planning and configuration. TRIAL REGISTRATION This trial was registered with ISRCTN (identifier: ISRCTN45203373 ) on 9 August 2012.
Collapse
Affiliation(s)
- Helen Rodgers
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK. .,Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, England, UK.
| | - Lisa Shaw
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK.
| | - Robin Cant
- Lay investigator. Contact via: Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK.
| | - Avril Drummond
- Division of Rehabilitation and Ageing, University of Nottingham, B Floor, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK.
| | - Gary A Ford
- Oxford Academic Health Science Network, John Eccles House, Robert Robinson Avenue, Oxford Science Business Park, Oxford, OX4 4GP, England, UK.
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, England, UK.
| | - Katie Hills
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK.
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, England, UK.
| | - Anne-Marie Laverty
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, England, UK.
| | - Christopher McKevitt
- Department of Public Health Sciences, King's College London, Capital House, 7th Floor, 41 Western Street, London, SE1 3QD, England, UK.
| | - Peter McMeekin
- Faculty of Health and Life Sciences, Coach Lane Campus, Northumbria University, Newcastle upon Tyne, NE7 7XA, England, UK.
| | - Christopher Price
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK. .,Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, England, UK.
| |
Collapse
|
23
|
Checkley W, Ghannem H, Irazola V, Kimaiyo S, Levitt NS, Miranda JJ, Niessen L, Prabhakaran D, Rabadán-Diehl C, Ramirez-Zea M, Rubinstein A, Sigamani A, Smith R, Tandon N, Wu Y, Xavier D, Yan LL. Management of NCD in low- and middle-income countries. Glob Heart 2014; 9:431-43. [PMID: 25592798 PMCID: PMC4299752 DOI: 10.1016/j.gheart.2014.11.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/31/2014] [Accepted: 11/14/2014] [Indexed: 12/23/2022] Open
Abstract
Noncommunicable disease (NCD), comprising cardiovascular disease, stroke, diabetes, and chronic obstructive pulmonary disease, are increasing in incidence rapidly in low- and middle-income countries (LMICs). Some patients have access to the same treatments available in high-income countries, but most do not, and different strategies are needed. Most research on noncommunicable diseases has been conducted in high-income countries, but the need for research in LMICs has been recognized. LMICs can learn from high-income countries, but they need to devise their own systems that emphasize primary care, the use of community health workers, and sometimes the use of mobile technology. The World Health Organization has identified "best buys" it advocates as interventions in LMICs. Non-laboratory-based risk scores can be used to identify those at high risk. Targeting interventions to those at high risk for developing diabetes has been shown to work in LMICs. Indoor cooking with biomass fuels is an important cause of chronic obstructive pulmonary disease in LMICs, and improved cookstoves with chimneys may be effective in the prevention of chronic diseases.
Collapse
Affiliation(s)
- William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hassen Ghannem
- Department of Epidemiology, Chronic Disease Prevention Research Centre, University Hospital Farhat Hached, Sousse, Tunisia
| | - Vilma Irazola
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Sylvester Kimaiyo
- AMPATH, Moi University School of Medicine, Eldoret, Kenya; Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa (CDIA), Cape Town, South Africa; Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - J Jaime Miranda
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Louis Niessen
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Centre of Excellence in Cardio-Metabolic Risk Reduction in South Asia, Public Health Foundation of India, New Delhi, India
| | - Cristina Rabadán-Diehl
- Office of Global Health, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Office of Global Affairs, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Adolfo Rubinstein
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Alben Sigamani
- St. John's Medical College and Research Institute, Bangalore, India
| | - Richard Smith
- Chronic Disease Initiative, UnitedHealth Group, London, United Kingdom.
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Peking University School of Public Health and Clinical Research Institute, Beijing, China
| | - Denis Xavier
- St. John's Medical College and Research Institute, Bangalore, India
| | - Lijing L Yan
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Duke Global Health Institute and Global Heath Research Center, Duke Kunshan University, Kunshan, China
| |
Collapse
|
24
|
Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 2014:CD010820. [PMID: 25387001 PMCID: PMC6469541 DOI: 10.1002/14651858.cd010820.pub2] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. OBJECTIVES To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. METHODS SEARCH METHODS We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. SELECTION CRITERIA We included Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up-to-date and comprehensive review and excluded reviews that overlapped with this. DATA COLLECTION AND ANALYSIS Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up-to-date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. MAIN RESULTS Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons.Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions.Moderate-quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential.Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high-quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high-quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands-on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up-to-date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach-to-grasp exercise, repetitive task training, strength training and stretching and positioning. AUTHORS' CONCLUSIONS Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.
Collapse
Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Sybil E Farmer
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Frederike van Wijck
- Glasgow Caledonian UniversityInstitute for Applied Health Research and the School of Health and Life SciencesGlasgowUK
| | | |
Collapse
|
25
|
Slijper A, Svensson KE, Backlund P, Engström H, Sunnerhagen KS. Computer game-based upper extremity training in the home environment in stroke persons: a single subject design. J Neuroeng Rehabil 2014; 11:35. [PMID: 24625289 PMCID: PMC3995595 DOI: 10.1186/1743-0003-11-35] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function. METHODS Twelve subjects with prior stroke were recruited; 11 completed the study. DESIGN The study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16-18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon's signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant. RESULTS Six females and five males, participated in the study with an average age of 58 years (range 26-66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study. CONCLUSION The results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.
Collapse
Affiliation(s)
| | | | | | | | - Katharina Stibrant Sunnerhagen
- Rehabilitation Medicine, The Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Per Dubbsgatan 14 3rd floor, SU/Sahlgrenska, Göteborg SE-413 45, Sweden.
| |
Collapse
|
26
|
Abstract
Stroke is a major cause of death and disability. International and national guidelines are available to help clinicians provide evidence-based care for stroke prevention, acute treatment, and rehabilitation. Stroke is a medical emergency and rapid assessment is needed to establish the diagnosis, identify the underlying cause, provide acute treatment, and prevent complications. Although stroke is a clinical diagnosis based upon a history of sudden onset of neurological symptoms, which include unilateral weakness or sensory loss, dysphasia, hemianopia, inattention, and reduced coordination, brain imaging with CT or MRI scan is needed to distinguish cerebral infarction from primary intracerebral haemorrhage. Stroke units are the cornerstones of stroke care and should be available to all stroke patients throughout their inpatient stay. Multidisciplinary stroke care should address the physical, psychological, and social consequences of stroke and consider the needs of both patients and carers. Good communication with patients and carers and between members of the multidisciplinary team is fundamental to quality care. Ongoing assessment and treatment may be needed for: dysphagia; nutrition and hydration; continence and skin care; mobility and upper limb function; comprehension and communication; concentration and memory; spatial awareness and inattention; mood; pain and spasticity. Patients and carers should be fully informed about the diagnosis, prognosis, treatment and available care. Discharge requires careful planning and consultation. Early supported discharge can improve outcome for carefully selected patients. It is important to recognize and address the long-term needs in order to maximize choice, independence, and wellbeing. Targeted rehabilitation to address issues such as mobility and leisure may be effective.
Collapse
Affiliation(s)
- Helen Rodgers
- Institute of Ageing and Health, Medical School, Newcastle upon Tyne, UK.
| |
Collapse
|
27
|
Unrath M, Kalic M, Berger K. Who receives rehabilitation after stroke?: Data from the quality assurance project "Stroke Register Northwest Germany". DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:101-7. [PMID: 23468819 DOI: 10.3238/arztebl.2013.0101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/15/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neurological rehabilitation after stroke lowers rates of death, dependency, and institutionalization. Little research has yet addressed the factors affecting the selection of ischemic stroke patients for rehabilitative treatment. METHOD The database for this study consisted of all cases of ischemic stroke (ICD-10 code I63) that occurred in 2010 and 2011 in the neurological inpatient care facilities participating in the "Stroke Register Northwest Germany" quality assurance project. A primary target group for rehabilitation was defined a priori (Barthel Index at discharge ≤ 65, no premorbid nursing dependency, no transfer to another acute-care hospital after initial treatment of stroke). Among these patients, factors potentially affecting the provision of rehabilitative treatment were studied with binary logistic regression and multilevel logistic regression. RESULTS There were 96 955 cases of ischemic stroke in the 127 participating hospitals. 40.8% and 11.4% of these patients underwent neurological and geriatric rehabilitation, respectively. The primary target group for rehabilitation contained 14 486 patients, 14.9% of whom underwent no rehabilitation after their acute treatment. The chances of undergoing subsequent rehabilitation were higher for patients with paresis and dysarthria on admission. Female sex, older age, impaired consciousness at admission, prior history of stroke, and lack of counseling by the hospital social services were all associated with a lower probability of undergoing rehabilitation. CONCLUSION In this study, 54.4% of all ischemic stroke patients and 85.1% of all patients in a primary target group for rehabilitation that was defined a priori underwent rehabilitation after acute care for stroke. Older patients and those who had had a previous stroke were less likely to undergo rehabilitation. Counseling by hospital social services increased the probability of rehabilitation. The potential exclusion of stroke patients from rehabilitation because of old age should be critically examined in every relevant case.
Collapse
Affiliation(s)
- Michael Unrath
- Institute of Epidemiology and Social Medicine, University of Münster, Germany.
| | | | | |
Collapse
|
28
|
Vluggen TPMM, van Haastregt JCM, Verbunt JA, Keijsers EJM, Schols JMGA. Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial. BMC Neurol 2012; 12:164. [PMID: 23273217 PMCID: PMC3547810 DOI: 10.1186/1471-2377-12-164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 11/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is one of the major causes of loss of independence, decreased quality of life and mortality among elderly people. About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke, which can lead to difficulties in picking up and managing their social life. The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients. Methods A two group multicentre randomised controlled trial is used to evaluate the effects of the rehabilitation programme. The programme consists of three care modules: 1) neurorehabilitation treatment for elderly stroke patients; 2) empowerment training for patient and informal caregiver; and 3) stroke education for patient and informal caregiver. The total programme has a duration of between two and six months, depending on the individual problems of the patient and informal caregiver. The control group receives usual care in the nursing home and after discharge. Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge. Data are gathered by face-to-face interviews, self-administered questionnaires, focus groups and registration forms. Primary outcomes for patients are activity level after stroke, functional dependence, perceived quality of life and social participation. Outcomes for informal caregivers are perceived care burden, objective care burden, quality of life and perceived health. Outcome measures of the process evaluation are implementation fidelity, programme deliverance and the opinion of the stroke professionals, patients and informal caregivers about the programme. Outcome measures of the economic evaluation are the healthcare utilisation and associated costs. Data are collected at baseline, and after six and 12 months. The first results of the study will be expected in 2014. Trial registration International Standard Randomised Controlled Trial Register Number ISRCTN62286281, The Dutch Trial Register NTR2412
Collapse
Affiliation(s)
- Tom P M M Vluggen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
29
|
Saywell N, Vandal AC, Brown P, Hanger HC, Hale L, Mudge S, Milosavljevic S, Feigin V, Taylor D. Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial. Trials 2012; 13:233. [PMID: 23216861 PMCID: PMC3543302 DOI: 10.1186/1745-6215-13-233] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/14/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent. METHODS/DESIGN This study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study. DISCUSSION The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home. TRIAL REGISTRATION ACTRN12612000464864.
Collapse
Affiliation(s)
- Nicola Saywell
- Health and Rehabilitation Research Institute, AUT University, Private Bag 92006, Auckland, 1142, New Zealand.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Lawrence M, Kinn S. Defining and measuring patient-centred care: an example from a mixed-methods systematic review of the stroke literature. Health Expect 2012; 15:295-326. [PMID: 21624025 PMCID: PMC5060626 DOI: 10.1111/j.1369-7625.2011.00683.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Involving patients in the determination of their care is increasingly important, and health-care professionals worldwide have recognized a need for clinical outcome measures and interventions that facilitate patient-centred care delivery in a range of settings. AIM A mixed-methods review was conducted, which aimed to identify stroke-specific patient-centred outcome measures and patient-centred interventions. SEARCH STRATEGY Databases searched included MEDLINE and PsycINFO; search strings were based on MeSH terms and keywords associated with the terms 'stroke' and 'patient-centred'. DATA EXTRACTION AND ANALYSIS Descriptive statistics were used to report quantitative data; thematic analysis was also performed in the included studies. MAIN RESULTS Three patient-centred outcome measures (Subjective Index of Physical and Social Outcomes, Stroke Impact Scale, Communication Outcome after Stroke scale) and four interventions were identified. Key elements of intervention design included delivery in people's own homes, involvement of families and tailoring to individual needs and priorities. Thematic analysis enabled description of three broad themes: meaningfulness and relevance, quality, and communication, which informed the development of a definition of patient-centred care specific to the specialty of stroke. CONCLUSIONS It is important for health-care professionals to ensure that their practice is relevant to patients and families. The review identified three stroke-specific patient-centred outcome measures, key elements of patient-centred interventions, and informed the development of a definition of patient-centred care. These review-derived outputs represent a useful starting point for health-care professionals, whatever their specialty, who are working to reconcile tensions between priorities of health-care professionals and those of patients and their families, to ensure delivery of patient-centred care.
Collapse
Affiliation(s)
- Maggie Lawrence
- Research Fellow, Institute for Applied Health Research/School of Health, Glasgow Caledonian University, Glasgow
| | - Sue Kinn
- Team Leader and Research Manager, Research and Evidence Division, Department for International Development, East Kilbride, UK
| |
Collapse
|
31
|
Coupar F, Pollock A, Legg LA, Sackley C, van Vliet P. Home-based therapy programmes for upper limb functional recovery following stroke. Cochrane Database Syst Rev 2012; 2012:CD006755. [PMID: 22592715 PMCID: PMC6464926 DOI: 10.1002/14651858.cd006755.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. OBJECTIVES To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. SEARCH METHODS We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. SELECTION CRITERIA Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. PRIMARY OUTCOMES were performance in activities of daily living (ADL) and functional movement of the upper limb. SECONDARY OUTCOMES were performance in extended ADL and motor impairment of the arm. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. MAIN RESULTS We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. PRIMARY OUTCOMES we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). SECONDARY OUTCOMES no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). AUTHORS' CONCLUSIONS There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care.
Collapse
Affiliation(s)
- Fiona Coupar
- Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK.
| | | | | | | | | |
Collapse
|
32
|
Hickey A, Horgan F, O'Neill D, McGee H. Community-based post-stroke service provision and challenges: a national survey of managers and inter-disciplinary healthcare staff in Ireland. BMC Health Serv Res 2012; 12:111. [PMID: 22559243 PMCID: PMC3506460 DOI: 10.1186/1472-6963-12-111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 02/23/2012] [Indexed: 11/10/2022] Open
Abstract
Background The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement. Methods The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7) and disciplinary allied health professional and public health nurse managers (N = 25) were interviewed (94% response rate). Results Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients. Conclusions This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for strategic planning; increased funding of healthcare staff; increased team resources and teamwork; and removal of service provision barriers based on age. There were notably many challenges beyond funding. Similar evaluations in other healthcare systems would serve to provide comparative lessons to serve to tackle this underserved aspect of care for patients with stroke and their families.
Collapse
Affiliation(s)
- Anne Hickey
- Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St, Stephen's Green, Dublin 2, Ireland.
| | | | | | | | | |
Collapse
|
33
|
Lemmens RJM, Timmermans AAA, Janssen-Potten YJM, Smeets RJEM, Seelen HAM. Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: a systematic review. BMC Neurol 2012; 12:21. [PMID: 22498041 PMCID: PMC3352056 DOI: 10.1186/1471-2377-12-21] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 04/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loss of arm-hand performance due to a hemiparesis as a result of stroke or cerebral palsy (CP), leads to large problems in daily life of these patients. Assessment of arm-hand performance is important in both clinical practice and research. To gain more insight in e.g. effectiveness of common therapies for different patient populations with similar clinical characteristics, consensus regarding the choice and use of outcome measures is paramount. To guide this choice, an overview of available instruments is necessary. The aim of this systematic review is to identify, evaluate and categorize instruments, reported to be valid and reliable, assessing arm-hand performance at the ICF activity level in patients with stroke or cerebral palsy. METHODS A systematic literature search was performed to identify articles containing instruments assessing arm-hand skilled performance in patients with stroke or cerebral palsy. Instruments were identified and divided into the categories capacity, perceived performance and actual performance. A second search was performed to obtain information on their content and psychometrics. RESULTS Regarding capacity, perceived performance and actual performance, 18, 9 and 3 instruments were included respectively. Only 3 of all included instruments were used and tested in both patient populations. The content of the instruments differed widely regarding the ICF levels measured, assessment of the amount of use versus the quality of use, the inclusion of unimanual and/or bimanual tasks and the inclusion of basic and/or extended tasks. CONCLUSIONS Although many instruments assess capacity and perceived performance, a dearth exists of instruments assessing actual performance. In addition, instruments appropriate for more than one patient population are sparse. For actual performance, new instruments have to be developed, with specific focus on the usability in different patient populations and the assessment of quality of use as well as amount of use. Also, consensus about the choice and use of instruments within and across populations is needed.
Collapse
Affiliation(s)
- Ryanne JM Lemmens
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Annick AA Timmermans
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Yvonne JM Janssen-Potten
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Rob JEM Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Henk AM Seelen
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| |
Collapse
|
34
|
Kirkevold M, Bronken BA, Martinsen R, Kvigne K. Promoting psychosocial well-being following a stroke: developing a theoretically and empirically sound complex intervention. Int J Nurs Stud 2011; 49:386-97. [PMID: 22051438 DOI: 10.1016/j.ijnurstu.2011.10.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 09/05/2011] [Accepted: 10/02/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND The psychosocial consequences of stroke are complex and comprehensive and include substantial and longlasting impacts on mood, identity, social relationships, return to work and quality of life. Many studies have explored possible interventions to prevent or treat psychosocial problems, but the results have generally been disappointing. Very few studies have provided adequate theoretical accounts of the mechanisms assumed to contribute to positive outcomes. OBJECTIVES To describe the development of a psychosocial nursing intervention aimed at promoting psychosocial health and well-being and to stimulate dialogue about how to develop and report theoretically and empirically sound complex interventions in nursing. DESIGN A systematic, stepwise approach was used, consistent with the framework recommended for developing and evaluating complex interventions by the UK Medical Research Council. DATA SOURCES Systematic reviews of empirical studies regarding the psychosocial consequences and needs of patients following stroke; qualitative, experiential studies of stroke and stroke recovery; theories of psychosocial well-being, coping, life skills, narrative approaches to rehabilitation and guided self-determination. REVIEW METHODS Each systematic review was examined to determine the major psychosocial challenges and needs experienced by stroke survivors, focusing on how these challenges and needs developed over the illness trajectory, how previous interventions had sought to address them and the effective mechanisms assumed to affect the level of success of interventions. Qualitative studies were examined to reveal the subjective experiences of stroke and stroke recovery, paying particular attention to the development of needs across time and context. A qualitative synthesis of the major characteristics of the trajectory of stroke rehabilitation and recovery during the first year was developed. Theories were examined to illuminate possible effective mechanisms and actions aimed at promoting psychosocial well-being during the stroke recovery process. RESULTS A dialogue-based intervention comprising eight encounters between stroke survivors and trained health care workers was designed, based on narrative theories, empowerment philosophy and guided self determination. Worksheets and a guiding topical outline were developed to support the dialogue. CONCLUSIONS The UK Medical Research Council framework facilitated the systematic development of an empirically and theoretically informed complex nursing intervention aimed at promoting post-stroke psychosocial well-being.
Collapse
Affiliation(s)
- Marit Kirkevold
- Institute of Health and Society, Department of Nursing Science, University of Oslo, P.O. Box 1153, Blindern, N-0318 Oslo, Norway.
| | | | | | | |
Collapse
|
35
|
Steib S, Schupp W. [Therapeutic strategies in stroke aftercare. Contents and effects]. DER NERVENARZT 2011; 83:467-75. [PMID: 22038388 DOI: 10.1007/s00115-011-3396-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
No generally accepted guidelines for stroke aftercare exist in Germany. This literature review summarizes the current evidence regarding the content and the effectiveness of aftercare strategies (exercise therapy, physiotherapy, occupational therapy) and their specific dose (intensity, duration, frequency). Exercise therapy (inter alia physiotherapy, resistance, endurance and gait training) has been shown to be effective for improving physical performance (strength, cardiopulmonary fitness, motor function) resulting in beneficial effects on gait, mobility and activities of daily living (ADL). As for the restoration of ADL and the resumption of social and leisure activities occupational therapy proved to be particularly effective. More research is needed to identify the specific effects of different aftercare strategies and their dose-response relationship to provide physicians a better foundation for therapy prescriptions.
Collapse
Affiliation(s)
- S Steib
- Institut für Sportwissenschaft und Sport, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | | |
Collapse
|
36
|
Graven C, Brock K, Hill K, Ames D, Cotton S, Joubert L. From rehabilitation to recovery: protocol for a randomised controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post-stroke. BMC Neurol 2011; 11:73. [PMID: 21682910 PMCID: PMC3135526 DOI: 10.1186/1471-2377-11-73] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/18/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined. METHODS/DESIGN Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy. DISCUSSION The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers, with emphasis on goal-directed practice to enhance home and community participation status. Facilitation of participation in valued activities may be effective in reducing the incidence or severity of post-stroke depression, as well as enhancing the individual's perception of their health-related quality of life. The engagement of carers in the rehabilitation process will enable review of the influence of the broader social context on recovery. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000042347.
Collapse
Affiliation(s)
- Christine Graven
- School of Health Sciences, The University of Melbourne, Parkville, Victoria 3052, Australia
- Physiotherapy Department, St.Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - Kim Brock
- Physiotherapy Department, St.Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - Keith Hill
- Faculty of Health Sciences, La Trobe University and Northern Health, Bundoora, Victoria 3086, Australia
- National Ageing Research Institute, PO Box 2127, Royal Melbourne Hospital, Victoria 3050, Australia
| | - David Ames
- National Ageing Research Institute, PO Box 2127, Royal Melbourne Hospital, Victoria 3050, Australia
| | - Susan Cotton
- Orygen Youth Health Research Centre, Locked Bag 10, Parkville, Victoria 3052, Australia
| | - Lynette Joubert
- School of Health Sciences, The University of Melbourne, Parkville, Victoria 3052, Australia
| |
Collapse
|
37
|
de Weerd L, Rutgers WAF, Groenier KH, van der Meer K. Perceived wellbeing of patients one year post stroke in general practice--recommendations for quality aftercare. BMC Neurol 2011; 11:42. [PMID: 21453512 PMCID: PMC3080803 DOI: 10.1186/1471-2377-11-42] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/31/2011] [Indexed: 01/22/2023] Open
Abstract
Background Annually, 41,000 people in the Netherlands have strokes. This has multiple physical and psychosocial consequences. Most patients return home after discharge from hospital. Quality aftercare by general practitioners is important to support patients at home. The purpose of this study is to examine the wellbeing of patients who returned home immediately after discharge from hospital, one year post stroke, in comparison with the general Dutch population of the same age and to determine factors that could influence wellbeing. Methods All the stroke patients from the Department of Neurology, Martini Hospital Groningen in the period November 2006 to October 2007 were included. People aged under 65 years or with haemorrhaging were excluded. All the patients (N = 57) were interviewed at home using the following questionnaires: Barthel Index, SF-36, HADS, CSI and a questionnaire about their way of life. Results 31% of the patients in this study experienced a decrease in functional status after one year. Nevertheless, there was no significant difference between the median Barthel Index value at discharge from hospital and one year post stroke. ADL independence correlated with a better quality of life. The health-related quality of life was high. Stroke patients have almost the same quality of life as the 'average' Dutch elderly population. Where patients can no longer fully participate in society, their perceived quality of life is also lower. In this study there is an indication of a high prevalence of depression and anxiety disorders in stroke patients. This negatively affects the quality of life a year after stroke. Although caregiver strain was low for the partners of stroke patients, a reduced quality of life is correlated to greater burden. Conclusions This study provides valuable insight into the wellbeing of patients living at home one year post stroke. Physical functioning and quality of life are comparable to the general population of the same age, but improvements in mental functioning can be envisaged. In addition, more attention should be paid to maintaining the patients' activities. The wellbeing of these stroke patients could be increased further if greater attention is paid to these aspects of life. This seems to be applicable to general practice.
Collapse
Affiliation(s)
- Leonie de Weerd
- Department of General Practice, University Medical Center Groningen, and Department of Neurology, Martini Hospital Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
| | | | | | | |
Collapse
|
38
|
Parker J, Mountain G, Hammerton J. A review of the evidence underpinning the use of visual and auditory feedback for computer technology in post-stroke upper-limb rehabilitation. Disabil Rehabil Assist Technol 2011; 6:465-72. [PMID: 21314295 DOI: 10.3109/17483107.2011.556209] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify and review the evidence to determine the current scientific basis underpinning the use of visual and/or auditory feedback for computer technology in home-based upper-limb stroke rehabilitation. METHOD A systematic search was conducted using the following databases: CINAHL (EBSCO), MEDLINE (Ovid and CSA), PubMed, Science Direct (Elsevier) and Cochrane Library. Journals, book chapters and conference proceedings were also used in the systematic search. Relevant papers were critically appraised using the Critical Appraisal Skills Programme tool for randomised controlled trials/quantitative designs. RESULTS Four controlled trials were identified as being relevant. Although the evidence is scarce, existing findings suggest that extrinsic visual and auditory feedback may improve motor and functional performance. In addition, concurrent feedback, knowledge of performance, knowledge of results and explicit feedback may be key components in the promotion of improved performance. CONCLUSIONS There is a paucity of evidence to inform the development and the use of technological systems for home-based stroke rehabilitation and specifically how such systems might be developed to provide best forms of feedback in the absence of a therapist. Further work is required to first investigate the efficacy of visual and auditory feedback using technology systems and second to explore their utilisation with the end user.
Collapse
Affiliation(s)
- Jack Parker
- The Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, S10 2BP, UK.
| | | | | |
Collapse
|
39
|
Standen PJ, Brown DJ, Battersby S, Walker M, Connell L, Richardson A, Platts F, Threapleton K, Burton A. A study to evaluate a low cost virtual reality system for home based rehabilitation of the upper limb following stroke. ACTA ACUST UNITED AC 2011. [DOI: 10.1515/ijdhd.2011.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
40
|
Roberts K, Stiller K, Harling R. Length of stay in an Australian stroke rehabilitation unit: a pilot study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.10.78812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims Length of stay (LOS) is an important consideration in rehabilitation, and it can be adversely affected by delayed discharge. The purpose of this prospective study was to document LOS, frequency of discharge delay, reasons for discharge delay and its impact on LOS. Methods Ninety-eight inpatients in a stroke rehabilitation unit were included in the study. Findings Sixty (61%) patients had a LOS that exceeded the Australasian Rehabilitation Outcomes Centre (AROC) benchmark LOS according to the Australian National Sub-acute and Non-acute Patient classification system. Twenty-five (26%) patients had delayed discharge resulting in a total delay of 886 days, with most of these related to delays in the provision of community services. When patients with discharge delay were factored out of analyses, LOS was still longer than AROC benchmark figures for 39 (57%) of the 69 patients without discharge delay. Conclusions The LOSs of the majority of patients included in this study were longer than the AROC benchmark figures, even when patients with discharge delay were factored out. Initiatives to address this problem include the implementation of a proactive computerized tool that will provide target LOSs and enable reasons for excessive LOS to be more closely examined.
Collapse
Affiliation(s)
| | | | - Rachel Harling
- Stroke Rehabilitation Unit, Hampstead Rehabilitation Centre, Northfield, Adelaide, South Australia
| |
Collapse
|
41
|
Morgenstern LB, Hemphill JC, Anderson C, Becker K, Broderick JP, Connolly ES, Greenberg SM, Huang JN, MacDonald RL, Messé SR, Mitchell PH, Selim M, Tamargo RJ. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41:2108-29. [PMID: 20651276 DOI: 10.1161/str.0b013e3181ec611b] [Citation(s) in RCA: 993] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage. METHODS A formal literature search of MEDLINE was performed. Data were synthesized with the use of evidence tables. Writing committee members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statements Oversight Committee and Stroke Council Leadership Committee. It is intended that this guideline be fully updated in 3 years' time. RESULTS Evidence-based guidelines are presented for the care of patients presenting with intracerebral hemorrhage. The focus was subdivided into diagnosis, hemostasis, blood pressure management, inpatient and nursing management, preventing medical comorbidities, surgical treatment, outcome prediction, rehabilitation, prevention of recurrence, and future considerations. CONCLUSIONS Intracerebral hemorrhage is a serious medical condition for which outcome can be impacted by early, aggressive care. The guidelines offer a framework for goal-directed treatment of the patient with intracerebral hemorrhage.
Collapse
|
42
|
Ellis G, Mant J, Langhorne P, Dennis M, Winner S. Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis. Cochrane Database Syst Rev 2010; 2010:CD005066. [PMID: 20464736 PMCID: PMC6464840 DOI: 10.1002/14651858.cd005066.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing. OBJECTIVES To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators. SELECTION CRITERIA Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care. DATA COLLECTION AND ANALYSIS We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain. MAIN RESULTS We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P = 0.002). This risk difference equates to 11 fewer dead or dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. AUTHORS' CONCLUSIONS There is no evidence for the effectiveness of this multifaceted intervention in improving outcomes for all groups of patients or carers. Patients with mild to moderate disability benefit from a reduction in death and disability. Patients and carers do report improved satisfaction with some aspects of service provision.
Collapse
Affiliation(s)
- Graham Ellis
- Monklands HospitalMedicine for the ElderlyMonkscourt AvenueAirdrieUKML6 0JS
| | - Jonathan Mant
- University of CambridgeGeneral Practice & Primary Care Research Unit, Department of Public Health & Primary CareForvie SiteAddenbrookes HospitalCambridgeUKCB2 0SR
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric Medicine3rd Floor, Centre BlockRoyal InfirmaryGlasgowUKG4 0SF
| | - Martin Dennis
- University of EdinburghDivision of Clinical NeurosciencesWestern General HospitalCrewe RoadEdinburghUKEH4 2XU
| | - Simon Winner
- Radcliffe InfirmaryDepartment of Clinical GeratologyOxfordUKOX2 6HE
| |
Collapse
|
43
|
States RA, Pappas E, Salem Y. Overground physical therapy gait training for chronic stroke patients with mobility deficits. Cochrane Database Syst Rev 2009; 2009:CD006075. [PMID: 19588381 PMCID: PMC6464905 DOI: 10.1002/14651858.cd006075.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Overground gait training forms a major part of physical therapy services for chronic stroke patients in almost every setting. Overground gait training refers to physical therapists' observation and cueing of the patient's walking pattern along with related exercises, but does not include high-technology aids such as functional electrical stimulation or body weight support. OBJECTIVES To assess the effects of overground physical therapy gait training on walking ability for chronic stroke patients with mobility deficits. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched March 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2008), MEDLINE (1966 to May 2008), EMBASE (1980 to May 2008), CINAHL (1982 to May 2008), AMED (1985 to March 2008), Science Citation Index Expanded (1981 to May 2008), ISI Proceedings (Web of Science, 1982 to May 2006), Physiotherapy Evidence Database (http://www.pedro.org.au/) (May 2008), REHABDATA (http://www.naric.com/research/rehab/) (1956 to May 2008), http://www.clinicaltrials.gov (May 2008), http://www.controlled-trials.com/ (May 2008), and http://www.strokecenter.org/ (May 2008). We also searched reference lists of relevant articles, and contacted authors and trial investigators. SELECTION CRITERIA Randomised controlled trials comparing overground physical therapy gait training with a placebo intervention or no treatment for chronic stroke patients with mobility deficits. DATA COLLECTION AND ANALYSIS Pairs of authors independently selected trials. Three authors independently extracted data and assessed quality. We contacted study authors for additional information. MAIN RESULTS We included nine studies involving 499 participants. We found no evidence for a benefit on the primary variable, post-test gait function, based on three studies with 269 participants. Uni-dimensional performance variables did show significant effects post-test. Gait speed increased by 0.07 metres per second (95% confidence interval (CI) 0.05 to 0.10) based on seven studies with 396 participants, timed up-and-go (TUG) test improved by 1.81 seconds (95% CI -2.29 to -1.33), and six-minute-walk test (6MWT) increased by 26.06 metres (95% CI 7.14 to 44.97) based on four studies with 181 participants. We found no significant differences in deaths/disabilities or in adverse effects, based on published reports or personal communication from all of the included studies. AUTHORS' CONCLUSIONS We found insufficient evidence to determine if overground physical therapy gait training benefits gait function in patients with chronic stroke, though limited evidence suggests small benefits for uni-dimensional variables such as gait speed or 6MWT. These findings must be replicated by large, high quality studies using varied outcome measures.
Collapse
Affiliation(s)
- Rebecca A States
- Long Island UniversityDivision of Physical Therapy1 University Plaza, HS 213BrooklynNYUSA11201
| | - Evangelos Pappas
- Long Island UniversityDivision of Physical Therapy1 University Plaza, HS 213BrooklynNYUSA11201
| | - Yasser Salem
- Long Island UniversityDivision of Physical Therapy1 University Plaza, HS 213BrooklynNYUSA11201
| | | |
Collapse
|
44
|
Aziz NA, Leonardi-Bee J, Phillips M, Gladman JRF, Legg L, Walker MF. Therapy-based rehabilitation services for patients living at home more than one year after stroke. Cochrane Database Syst Rev 2008; 2008:CD005952. [PMID: 18425928 PMCID: PMC6464721 DOI: 10.1002/14651858.cd005952.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Current practice of rehabilitation intervention mainly concentrates on the first six months of stroke. At present, there is no agreed consensus about the benefits of such a service more than one year after stroke. OBJECTIVES To ascertain whether therapy-based rehabilitation services can influence outcome one year or more after stroke. SEARCH STRATEGY We searched the trials registers of the following Cochrane Review Groups: Stroke Group (last searched September 2007), Effective Practice and Organisation of Care Group (last searched October 2006) and Dementia and Cognitive Improvement Group (last searched October 2006). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), CINAHL (1982 to October 2006), AMED (1985 to October 2006), PEDro (1952 to October 2006), British Nursing Index (1993 to October 2006), DARE (1994 to October 2006), HMIC (1979 to October 2006) and NHS EED (1991 to October 2006). We also searched dissertation databases and ongoing trials and research registers, scanned reference lists and contacted researchers and experts in the field. SELECTION CRITERIA All randomised controlled trials of community-based stroke patients, in which at least 75% were recruited one year after stroke and received a therapy-based rehabilitation intervention that was compared with conventional care. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials and extracted data on a number of pre-specified outcomes. The primary outcomes were the proportion of participants who had deteriorated or were dependent in personal activities of daily living at the end of scheduled follow up. MAIN RESULTS We identified five trials of 487 participants that were eligible for the review. Overall, there was inconclusive evidence as to whether therapy-based rehabilitation intervention one year after stroke was able to influence any relevant patient or carer outcome. Trials varied in design, type of interventions provided, quality, and outcomes assessed. AUTHORS' CONCLUSIONS This review highlights the dearth of evidence investigating long-term therapy-based rehabilitation interventions for patients with stroke.
Collapse
Affiliation(s)
- N A Aziz
- Universiti Kebangsaan Malaysia, Department of Family Medicine, Medical Faculty, Cheras, Kuala Lumpur, Malaysia, 53000.
| | | | | | | | | | | |
Collapse
|
45
|
Bader T. Home-based rehabilitation for people with stroke: An evaluation of efficacy. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.2.28191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tara Bader
- School of Medicine, University of Leeds UK
| |
Collapse
|
46
|
Prvu Bettger JA, Stineman MG. Effectiveness of multidisciplinary rehabilitation services in postacute care: state-of-the-science. A review. Arch Phys Med Rehabil 2007; 88:1526-34. [PMID: 17964900 PMCID: PMC4309994 DOI: 10.1016/j.apmr.2007.06.768] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 06/14/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To summarize the efficacy of postacute rehabilitation and to outline future research strategies for increasing knowledge of its effectiveness. DATA SOURCES English-language systematic reviews that examined multidisciplinary therapy-based rehabilitation services for adults, published in the last 25 years and available through Cochrane, Medline, or CINAHL databases. We excluded multidisciplinary biopsychosocial rehabilitation programs and mental health services. STUDY SELECTION Using the search term rehabilitation, 167 records were identified in the Cochrane database, 1163 meta-analyses and reviews were identified in Medline, and 226 in CINAHL. The Medline and CINAHL search was further refined with 3 additional search terms: therapy, multidisciplinary, and interdisciplinary. In summary, we used 12 reviews to summarize the efficacy of multidisciplinary, therapy-based postacute rehabilitation; the 12 covered only 5 populations. DATA EXTRACTION Two reviewers extracted information about study populations, sample sizes, study designs, the settings and timing of rehabilitation, interventions, and findings. DATA SYNTHESIS Based on systematic reviews, the evidence for efficacy of postacute rehabilitation services across the continuum was strongest for stroke. There was also strong evidence supporting multidisciplinary inpatient rehabilitation for patients with rheumatoid arthritis, moderate to severe acquired brain injury, including traumatic etiologies, and for older adults. Heterogeneity limited our ability to conclude a benefit or a lack of a benefit for rehabilitation in other postacute settings for the other conditions in which systematic reviews had been completed. The efficacy of multidisciplinary rehabilitation services has not been systematically reviewed for many of the diagnostic conditions treated in rehabilitation. We did not complete a summary of findings from individual studies. CONCLUSIONS Given the limitations and paucity of systematic reviews, information from carefully designed nonrandomized studies could be used to complement randomized controlled trials in the study of the effectiveness of postacute rehabilitation. Consequently, a stronger evidence base would become available with which to inform policy decisions, guide the use of services, and improve patient access and outcomes.
Collapse
Affiliation(s)
- Janet A Prvu Bettger
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA
| | | |
Collapse
|
47
|
|
48
|
Mistiaen P, Francke AL, Poot E. Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review. BMC Health Serv Res 2007; 7:47. [PMID: 17408472 PMCID: PMC1853085 DOI: 10.1186/1472-6963-7-47] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 04/04/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients encounter a variety of problems after discharge from hospital and many discharge (planning and support) interventions have been developed and studied. These primary studies have already been synthesized in several literature reviews with conflicting conclusions. We therefore set out a systematic review of the reviews examining discharge interventions. The objective was to synthesize the evidence presented in literature on the effectiveness of interventions aimed to reduce post-discharge problems in adults discharged home from an acute general care hospital. METHODS A comprehensive search of seventeen literature databases and twenty-five websites was performed for the period 1994-2004 to find relevant reviews. A three-stage inclusion process consisting of initial sifting, checking full-text papers on inclusion criteria, and methodological assessment, was performed independently by two reviewers. Data on effects were synthesized by use of narrative and tabular methods. RESULTS Fifteen systematic reviews met our inclusion criteria. All reviews had to deal with considerable heterogeneity in interventions, populations and outcomes, making synthesizing and pooling difficult. Although a statistical significant effect was occasionally found, most review authors reached no firm conclusions that the discharge interventions they studied were effective. We found limited evidence that some interventions may improve knowledge of patients, may help in keeping patients at home or may reduce readmissions to hospital. Interventions that combine discharge planning and discharge support tend to lead to the greatest effects. There is little evidence that discharge interventions have an impact on length of stay, discharge destination or dependency at discharge. We found no evidence that discharge interventions have a positive impact on the physical status of patients after discharge, on health care use after discharge, or on costs. CONCLUSION Based on fifteen high quality systematic reviews, there is some evidence that some interventions may have a positive impact, particularly those with educational components and those that combine pre-discharge and post-discharge interventions. However, on the whole there is only limited summarized evidence that discharge planning and discharge support interventions have a positive impact on patient status at hospital discharge, on patient functioning after discharge, on health care use after discharge, or on costs.
Collapse
Affiliation(s)
- Patriek Mistiaen
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Else Poot
- The Netherlands Centre of Excellence in Nursing (LEVV), P.O. Box 3135, 3502 GC Utrecht, the Netherlands
| |
Collapse
|
49
|
Affiliation(s)
- John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD5 0NA.
| | | |
Collapse
|
50
|
|