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Okita Y, Kawaguchi Y, Inoue Y, Ohno K, Sawada T, Levack W, Tomori K. Characteristics of goal-setting tools in adult rehabilitation: A scoping review. Clin Rehabil 2024; 38:234-250. [PMID: 37644842 PMCID: PMC10725121 DOI: 10.1177/02692155231197383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.
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Affiliation(s)
- Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Yuko Kawaguchi
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Aichi, Japan
| | - Yuki Inoue
- Central Rehabilitation Department, Yokohama Rousai Hospital, Kanagawa, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsunori Sawada
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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Stefanac S, Oppenauer C, Zauner M, Durechova M, Dioso D, Aletaha D, Hobusch G, Windhager R, Stamm T. From individualised treatment goals to personalised rehabilitation in osteoarthritis: a longitudinal prospective mapping study using the WHO international classification for functioning, disability and health. Ann Med 2022; 54:2816-2827. [PMID: 36259346 PMCID: PMC9586611 DOI: 10.1080/07853890.2022.2131326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/OBJECTIVE(S)/INTRODUCTION In clinical practice, treatment goals are often set up without exploring what patients really want. We, therefore, collected individualised treatment goals of patients with osteoarthritis (OA), categorised and mapped them to the World Health Organisation International Classification for Functioning, Disability and Health (ICF). PATIENTS/MATERIALS AND METHODS A longitudinal prospective cohort study was conducted (2019-2021). We used descriptive statistics and Chi2/Fisher's Exact Tests, where appropriate, as well as Kruskal-Wallis-Tests for the mean score ranks of the patients' goals. RESULTS In total, 305 goals reported by 132 participants were analysed (267 women vs. 38 men). The top 3 ICF categories were sensation of pain (ICF:b280), mobility of joint (ICF:b710) and muscle power functions (ICF:b730). Overall, 51% of all individually reported functional goals were achieved after 3 months. Men were more likely to achieve their goals than women (p = 0.009). The majority of the "very important" goals (51%) and "very difficult" goals (57%) was not improved. Goals' mean score ranks significantly differed between baseline and follow-up. CONCLUSION(S) As the human lifespan as well as the number of people affected by OA worldwide increase, there is a growing need to identify and evaluate rehabilitation outcomes that are relevant to people with OA.Key MessagesTreat-to-target agreements between patients and health care providers present a step towards more personalised precision medicine, which will eventually lead to better reported functional and health outcomes.In patients with osteoarthritis, the Goal Attainment Scale instrument can be used to measure health outcomes at different time points and its content may be linked to ICF providing a unified language and conceptual scientific basis.
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Affiliation(s)
- Sinisa Stefanac
- Institute for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Claudia Oppenauer
- Karl Landsteiner Private University for Health Sciences, Krems, Lower Austria
| | - Michael Zauner
- Clinical Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Martina Durechova
- Clinical Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daffodil Dioso
- Clinical Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Clinical Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hobusch
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Tanja Stamm
- Institute for Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
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Linking Prioritized Occupational Performance in Patients Undergoing Spasticity-Correcting Upper Limb Surgery to the International Classification of Functioning, Disability, and Health. Occup Ther Int 2022; 2022:8741660. [PMID: 36312840 PMCID: PMC9586799 DOI: 10.1155/2022/8741660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Spasticity is generally caused by damage to the spinal cord or the areas of the brain that controls movements, which poses significant limitations in occupational tasks. Objectives The aims of the study were to (I) describe prioritized occupational performance problems (POPP) among patients who underwent upper limb spasticity-correcting surgery and map them to the International Classification of Function, Disability, and Health (ICF); (II) assess outcomes postsurgery; (III) assess whether the results are influenced by the diagnosis, gender, and residual muscle function; and (IV) assess correlation between changes in COPM and gains in grasp ability and grip strength. Methods In this retrospective study, assessments occurred pre- and postsurgery, including the Canadian Occupational Performance Measure (COPM), grip strength, and grasp ability. POPP were transformed to prioritized occupational performance goals (POPG) during subsequent rehabilitation. Results 60 patients with a history of spinal cord injury (SCI) (n = 42; 59%), stroke (n = 25; 34%), traumatic brain injury (TBI) (n = 4; 6%), and reason unknown (n = 1; 1%) were included, with a mean age of 57 (±13) years. Of those, 11 had bilateral surgery, generating 71 COPM forms and 320 POPG. The POPG were mapped to the ICF activity and participation chapter, most often to self-care (n = 131; 41%), domestic life (n = 68; 21%), and mobility (n = 58; 18%). COPM scores were significantly increased postsurgery, irrespective of diagnosis, gender, and muscle function. No clear correlation between COPM improvement and hand function gains was shown. Conclusion Patients who underwent spasticity-correcting upper limb surgery identified difficulties with a wide range of occupational tasks that they considered as important to regain. Treatment-induced gains in occupational performance were significant but had no clear correlation with gains in grasp ability and hand strength. Independent of diagnosis, gender, and residual muscle function, it seems important to address the activity- and participation-specific aspects in the assessment and rehabilitation of patients.
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Yurkewich A, Ortega S, Sanchez J, Wang RH, Burdet E. Integrating hand exoskeletons into goal-oriented clinic and home stroke and spinal cord injury rehabilitation. J Rehabil Assist Technol Eng 2022; 9:20556683221130970. [PMID: 36212185 PMCID: PMC9535266 DOI: 10.1177/20556683221130970] [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: 01/12/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Robotic exoskeletons are emerging as rehabilitation and assistive
technologies that simultaneously restore function and enable independence
for people with disabilities. Aim We investigated the feasibility and orthotic and restorative effects of an
exoskeleton-supported goal-directed rehabilitation program for people with
hand impairments after stroke or Spinal Cord Injury (SCI). Method A single-arm case-series feasibility study was conducted using a wearable
untethered hand exoskeleton during goal-directed therapy programs with
in-clinic and at-home components. Therapists trained stroke and SCI patients
to use a hand exoskeleton during rehabilitation exercises, activities of
daily living and patient-selected goals. Each patient received a 1-hour
in-clinic training session on five consecutive days, then took the
exoskeleton home for two consecutive days to perform therapist-recommended
tasks. Goal Attainment Scaling (GAS) and the Box and Block Test (BBT) were
administered at baseline, after in-clinic
therapy and after home use, with and again without wearing
the exoskeleton. The System Usability Scale (SUS), Motor Activity Log, and
Fugl-Meyer Assessment were also administered to assess the intervention’s
acceptability, adherence, usability and effectiveness. Results Four stroke patients (Chedoke McMaster Stage of Hand 2–4) and one SCI patient
(ASIA C8 Motor Stage 1) 23 ± 19 months post-injury wore the hand exoskeleton
to perform 280 ± 23 exercise repetitions in the clinic and additional
goal-oriented tasks at home. The patients performed their own goals and the
dexterity task with higher performance following the 7-days therapy program
in comparison to baseline for both exoskeleton-assisted (ΔGAS: 18 ± 10,
ΔBBT: 1 ± 5) and unassisted (ΔGAS: 14 ± 14, ΔBBT: 3 ± 4) assessments.
Therapists and patients provided ‘good’ SUS ratings of 78 ± 6 and no harmful
events were reported. Conclusions The exoskeleton-supported stroke and SCI therapy program with in-clinic and
at-home training components was feasible.
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Affiliation(s)
- Aaron Yurkewich
- Bioengineering Department, Imperial College of Science
Technology and Medicine, London UK,Aaron Yurkewich, MESc, Institute of
Biomaterials and Biomedical Engineering, University of Toronto, Room 407,
Rosebrugh Bldg, 164 College St, Toronto, ON M5S 3G9, Canada.
| | - Sara Ortega
- Occupational Therapy, Centro Europeo de
Neurociencias, Madrid, Spain
| | - José Sanchez
- Occupational Therapy, Centro Europeo de
Neurociencias, Madrid, Spain
| | - Rosalie H Wang
- Occupational Science and
Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Etienne Burdet
- Bioengineering Department, Imperial College of Science
Technology and Medicine, London UK
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5
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Gould KR, Feeney TJ, Hicks AJ, Ponsford JL. Individualized goal attainment scaling during a trial of positive behaviour support in adults with acquired brain injury. Neuropsychol Rehabil 2022; 32:2392-2410. [PMID: 34253157 DOI: 10.1080/09602011.2021.1947325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Challenging behaviours after acquired brain injury (ABI) cause distress and reduce community participation. Evidence-based and effective interventions are needed. Positive Behaviour Support (PBS) interventions, such as PBS + PLUS, are person-driven and context-sensitive approaches which aim to improve quality of life and enhance behavioural self-regulation. This study aimed to expand the empirical outcomes of a recent waitlist-controlled trial of PBS + PLUS by examining individualized goal attainment. METHOD Participants were 44 adults with severe ABI sustained on average nine years previously (Range = 0.6-26) from the combined trial cohort who completed the intervention. Using Goal Attainment Scaling, trial therapists developed and reviewed goals collaboratively with the person with ABI and their natural supports. RESULTS The 182 goals in the sample focussed on psychological wellbeing, interpersonal relationships, routines and self-care. By the end of 12-month intervention, 84.6% of goals were achieved and 53.3% exceeded their expected outcome. CONCLUSIONS These findings indicate high levels of personally meaningful outcomes in a broad range of life-domains can be obtained for participants with severe ABI using PBS + PLUS. Whilst these results should be considered in combination with the findings of the waitlist-controlled trial, they contribute to the growing literature regarding benefits of PBS in enhancing quality of life post-ABI. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry identifier: ACTRN12616001704482.
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Affiliation(s)
- Kate Rachel Gould
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
| | - Tim J Feeney
- Belvedere Health Services and the Mill School, Winooski, USA
| | - Amelia J Hicks
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
| | - Jennie Louise Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
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Samitier Pastor CB, Climent Barbera JM, Cutillas Ruiz R, Formigo Couceiro J, Vázquez Doce A. [Clinical practice guideline for the treatment of spasticity: Consensus and algorithms]. Rehabilitacion (Madr) 2022; 56:204-214. [PMID: 35428487 DOI: 10.1016/j.rh.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/23/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
Spasticity is a complex phenomenon of extremely variable clinical expression, a dynamic and evolutionary process that can condition the activity and treatment of the patient. The current recommendation for early treatment aims to avoid progression and complications, and involves an individualized approach based on a wide range of pharmacological and non-pharmacological measures. This guide results from a forum of expert specialists who faced some frequent uncertainties in the assessment process and therapeutic approach of the spastic patient such as the suitability of initiating treatment, considerations for initiating, continuing and ceasing treatment with botulinum toxin, adjuvant treatments, pain or follow-up. The result is one algorithm of decision for the therapeutic approach of spasticity. Both scientific progress and the exchange of clinical experience on which this guide is based, can support decision-making on some areas of gloom that we find in daily practice.
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Affiliation(s)
- C B Samitier Pastor
- Servicio de Rehabilitación, Hospital Asepeyo, Sant Cugat, Sant Cugat del Vallés, Barcelona, España.
| | - J M Climent Barbera
- Servicio de Rehabilitación, Hospital General Universitario de Alicante, Alicante, España
| | - R Cutillas Ruiz
- Servicio de Rehabilitación, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - J Formigo Couceiro
- Servicio de Rehabilitación, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - A Vázquez Doce
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario de La Princesa, Madrid, España
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7
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Barnham I, Alahmadi S, Spillane B, Pick A, Lamyman M. Surgical interventions in adult upper limb spasticity management: a systematic review. HAND SURGERY & REHABILITATION 2022; 41:426-434. [DOI: 10.1016/j.hansur.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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Wissel J, Ri S. Assessment, goal setting, and botulinum neurotoxin a therapy in the management of post-stroke spastic movement disorder: updated perspectives on best practice. Expert Rev Neurother 2021; 22:27-42. [PMID: 34933648 DOI: 10.1080/14737175.2021.2021072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Post-stroke spastic movement disorder (PS-SMD) appears up to 20% in the first week following stroke and 40% in the chronic phase. It may create major hurdles to overcome in early stroke rehabilitation and as one relevant factor that reduces quality of life to a major degree in the chronic phase. AREAS COVERED In this review, we discuss predictors,early identification, clinical assessments, goal setting, and management in multiprofessional team, including Botulinum neurotoxin A (BoNT-A) injection for early and chronic management of PS-SMD. EXPERT OPINION The earlier PS-SMD is recognized and managed, the better the outcome will be. The comprehensive management in the subacute or chronic phase of PS-SMD with BoNT-A injections requires detailed assessment, patient-centered goal setting, technical-guided injection, effective dosing of BoNT-A per site, muscle, and session and timed adjunctive treatment, delivered in a multi-professional team approach in conjunction with physical treatment. Evidence-based data showed BoNT-A injections are safe and effective in managing focal, multifocal, segmental PS-SMD and its complications. If indicated, BoNT-A therapy should be accompanied with adjunctive treatment in adequate time slots. BoNT-A could be added to oral, intrathecal, and surgical treatment in severe multisegmental or generalized PS-SMD to reach patient/caregiver's goals, especially in chronic PS-SMD.
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Affiliation(s)
- Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Vivantes Klinikum Spandau, Neue Bergstrasse 6, 13585 Berlin, Germany.,Neurology and Psychosomatics at Wittenbergplatz, Out-Patient-Clinic, Ansbacher straße 17-19, 10787 Berlin, Germany
| | - Songjin Ri
- Neurology and Psychosomatics at Wittenbergplatz, Out-Patient-Clinic, Ansbacher straße 17-19, 10787 Berlin, Germany.,Department of Neurology, Charité University Hospital (CBS), Hindenburgdamm 30, Berlin 12203, Germany
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9
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Preede L, Soberg HL, Dalen H, Nyquist A, Jahnsen R, Saebu M, Bautz-Holter E, Røe C. Rehabilitation Goals and Effects of Goal Achievement on Outcome Following an Adapted Physical Activity-Based Rehabilitation Intervention. Patient Prefer Adherence 2021; 15:1545-1555. [PMID: 34276210 PMCID: PMC8277449 DOI: 10.2147/ppa.s311966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To explore the goal-setting process carried out at a rehabilitation facility providing adapted physical activity, by 1) identifying goals set by individuals with chronic disabilities, 2) comparing these goals to the negotiated goals set in collaboration with the rehabilitation team and 3) assessing goal achievement and its association with self-reported functioning after 12 months. METHODS A prospective observational study where adults (18-67 years) admitted to Beitostølen Healthsports Centre (n=151) reported mental and physical functioning measured by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) administered at baseline (eight weeks before rehabilitation), admission, discharge and follow-up 12 months after rehabilitation. The participants provided their individual goals for rehabilitation in the admission questionnaire. Individual goals were compared to negotiated goals set by the participants and the rehabilitation team together as part of the goal-setting process at the facility. The goals were linked to The International Classification of Functioning, Disability and Health (ICF) for comparison. Goal achievement was assessed on a 10-point numeric rating scale (NRS) in the discharge questionnaire. The association between SF-12 physical and mental functioning at long-term follow-up and goal achievement was explored. RESULTS The 293 individual goals and the 407 negotiated goals were most frequently linked to the ICF-component Body Functions. When comparing negotiated to individual goals, negotiated goals were more frequently linked to activities and participation. Goals to wide to be linked to the ICF were less frequent. For 76% of the participants, content of individual goals was captured in negotiated goals. Goal achievement with NRS scores ≥9 points was reported by 66% of the included participants. Goal achievement was a significant predictor for long-term mental functioning (p=0.04). CONCLUSION Collaboration between participants and health professionals resulted in more specific goals directed towards the activities and participation component. Goal achievement predicted long-term mental functioning following rehabilitation.
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Affiliation(s)
- Line Preede
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Beitostølen Healthsports Centre, Beitostølen, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helene L Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Håkon Dalen
- Beitostølen Healthsports Centre, Beitostølen, Norway
| | | | - Reidun Jahnsen
- Beitostølen Healthsports Centre, Beitostølen, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Martin Saebu
- Beitostølen Healthsports Centre, Beitostølen, Norway
| | - Erik Bautz-Holter
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Pike S, Lannin NA, Cameron L, Palit M, Cusick A. Chronic stroke survivors with upper limb spasticity: linking experience to the ICF. Disabil Rehabil 2021; 44:3925-3937. [PMID: 33725459 DOI: 10.1080/09638288.2021.1894490] [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: 10/21/2022]
Abstract
PURPOSE To identify the impact of upper limb spasticity on stroke survivors by linking their shared experience to the International Classification of Functioning, Disability, and Health (ICF). METHODS Ten community dwelling adults with a chronic stroke and spasticity, who had completed an upper limb rehabilitation trial participated in semi-structured interviews. Data were analysed using content analysis and linked to the ICF Comprehensive Core Set for stroke using standard linking rules. RESULTS Four hundred and thirty-nine meaningful concepts eligible for linking were identified. The majority (n = 178) linked to Body Function, n = 137 to Activities and Participation, n = 115 to Environmental Factors, and n = 9 to Body Structures. Sixty-two of the 130 Comprehensive Core Set categories were used; an additional eight were required to fully represent experience. Stroke survivors with upper limb spasticity use words and discuss topics concentrated around mental functions, functions of the joints and bones, muscles and movements, carrying, moving and handling objects, support and relationships with immediate family and health professionals, products and technology, and health services. CONCLUSIONS Half of the Comprehensive Core Set categories for stroke were relevant, but to adequately capture experience an additional eight were needed. The ICF category profile may be unique to our participants or may suggest further research is needed to determine if additions to core set categories are required.Implications for rehabilitationOur ICF mapping demonstrated that the Brief Core Set for stroke was not sufficient to capture the range of experience for stroke survivors with upper limb spasticity, instead the Comprehensive Core Set for stroke supplemented with eight clinical-cohort specific second-level-categories should be used.Our findings suggest that rehabilitation may better reflect lived experience if it focuses on Body Function (Chapters 1, 2, 4, 7), Activity and Participation (Chapters 1-9), and Environment (Chapters 1, 2, 3, 5) because Body Structure was rarely mentioned in this or previous post-stroke ICF mapping research.
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Affiliation(s)
- Shannon Pike
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Australia.,Wagga Wagga Ambulatory Rehabilitation Service, Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - Natasha A Lannin
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Australia.,Department of Neurosciences, Monash University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | | | | | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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11
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Maulet T, Pouplin S, Bensmail D, Zory R, Roche N, Bonnyaud C. Self-rehabilitation combined with botulinum toxin to improve arm function in people with chronic stroke. A randomized controlled trial. Ann Phys Rehabil Med 2020; 64:101450. [PMID: 33152520 DOI: 10.1016/j.rehab.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Botulinum toxin injection (BTI) reduces muscle hyperactivity, but its effect on active upper-limb function is limited. Intensive rehabilitation could optimize the effects; however, outpatient post-stroke rehabilitation is usually not intensive. One solution could be self-rehabilitation. OBJECTIVES The aim of this randomized controlled trial was to determine the effect of a self-rehabilitation program combined with BTI on upper-limb function in individuals with chronic hemiparesis. METHODS In total, 33 outpatients were randomly allocated to receive BTI+self-rehabilitation (R group: n=17) or BTI alone (C group: n=16). Outcomes evaluated just before the BTI and 4 weeks later included the Wolf Motor Function Test (WMFT time: primary outcome), Action Research Arm Test, fatigue and quality of life. RESULTS Change in WMFT did not differ between groups at 4 weeks (WMFT time: -14% for R group, -4% for C group. WFMT score: +12% for R group, 0% in C group). WFMT time and score improved significantly in the R group only (-14%, P=0.01, and +12%, P=0.02). In addition, the proportion of patients with improved WMFT time and score was higher in the R than C group (R group: 71% improved score, 77% improved time; C group: 43% improved score, 50% improved time). Also, passive range of shoulder flexion (P=0.03) and wrist extension (P=0.01) improved only in the R group. No other variables changed significantly. Compliance was excellent; average daily training time was greater than that prescribed. CONCLUSIONS The addition of a self-rehabilitation program to BTI did not significantly improve functional outcomes more than BTI alone; however, movement quality and speed improved only in the self-rehabilitation group. Participants in the self-rehabilitation group trained more than they were asked to, which suggests that they found the program worthwhile. These clinically relevant findings justify larger-scale studies of the effects of self-rehabilitation to enhance the effects of BTI. CLINICAL TRIAL NCT02699762.
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Affiliation(s)
- Théo Maulet
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP-HP, Garches, France; End: icap laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France; Paris-Saclay University, UVSQ, Research Unit ERPHAN, 78000 Versailles, France.
| | - Samuel Pouplin
- Paris-Saclay University, UVSQ, Research Unit ERPHAN, 78000 Versailles, France; New Technologies Platform, Raymond-Poincaré Hospital, APHP, Garches, France
| | - Djamel Bensmail
- End: icap laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France; Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, AP-HP, Garches, France
| | | | - Nicolas Roche
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP-HP, Garches, France; End: icap laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France; Côte d'Azur University, LAMHESS, Nice, France
| | - Celine Bonnyaud
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP-HP, Garches, France; Paris-Saclay University, UVSQ, Research Unit ERPHAN, 78000 Versailles, France
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12
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Santamato A, Facciorusso S, Spina S, Cinone N, Avvantaggiato C, Santoro L, Ciritella C, Smania N, Picelli A, Gasperini G, Molteni F, Baricich A, Fiore P. Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity. Eur J Phys Rehabil Med 2020; 57:424-433. [PMID: 33263248 DOI: 10.23736/s1973-9087.20.06478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic has affected health-care systems worldwide, including the outpatient spasticity care with botulinum neurotoxin toxin type A (BoNT-A). AIM The aim of this study was to investigate the impact of discontinuation of BoNT-A treatment on patients living with spasticity during the COVID-19 quarantine. DESIGN A multicentric cross-sectional study. SETTING Outpatients setting. POPULATION Patients with spasticity after stroke and traumatic brain injury treated with BoNT-A. METHODS A phone-based survey was conducted from March to May, 2020. Based on the International Classification of Functioning, Disability and Health (ICF), an ad hoc questionnaire CORTOX (CORonavirus TOXin survey) was developed to investigate patients' experiences following the discontinuation of their usual treatment for spasticity due to the lockdown and its implication on their health perception. It assessed patients' condition and explored different ICF domains related to spasticity: unpleasant sensations, mobility, self-care, facilitators and psychosocial factors. The sum of those represented the CORTOX score (Max 142). The questionnaire also collected data about the impact of COVID-19 on patients' wellbeing (mood, sleep, relationships, community life, motivation). RESULTS A total of 151 participants completed the survey. Most participants (72.2%) experienced a worsening in perceived spasticity, 53% got worse in independence and 70.9% had a negative impact on quality of life. The mean CORTOX score was 52.85±27.25, reflecting a perceived worsening in all ICF domains investigated. Moderate to strong correlations were found between different sub-scores of the questionnaire and severity of spasticity (P<0.001). COVID-19 psychosocial related factors were associated with loss of independence (P<0.05) but only mood was associated with worsening of spasticity (P<0.001). The lack of rehabilitation therapy was significantly associated with the worsening of independence but not with the worsening of spasticity. Finally, respondents reported that BoNT-A was useful to their condition and should not be discontinued. CONCLUSIONS The discontinuation of BoNT-A treatment was associated with worsening of activities and participation and perceived spasticity. COVID-19 related problems and rehabilitation showed an association with loss of independence. CLINICAL REHABILITATION IMPACT This study will provide useful information in the field of spasticity management using a patient's centred approach, with consistent quantitative and qualitative information.
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Affiliation(s)
- Andrea Santamato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy - .,"Fondazione Turati", Rehabilitation Center, Vieste, Foggia, Italy -
| | - Salvatore Facciorusso
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Stefania Spina
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicoletta Cinone
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Christian Avvantaggiato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Luigi Santoro
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Chiara Ciritella
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicola Smania
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation Unit, Maggiore della Carità University Hospital, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, Bari, Italy
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13
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Occupational Therapy Goal Achievement for People with Stroke: A Retrospective Study. Occup Ther Int 2020; 2020:8587908. [PMID: 32410926 PMCID: PMC7206877 DOI: 10.1155/2020/8587908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/06/2019] [Accepted: 04/02/2020] [Indexed: 11/17/2022] Open
Abstract
Methods A cross-sectional retrospective study design was used. People with stroke receiving rehabilitation services at King Abdulaziz Medical City (KAMC) were the target of this study. Data about the extent of achieving occupational therapy goals were collected using the Goal Attainment Scaling (GAS). Results Of the 100 medical records of people with stroke included in this study, only 30% of the goals were functional. Only 54% of the goals were achieved. No association was found between the number of achieved goals and variables such as age, gender, type of stroke, and stroke hemisphere/side. Conclusion People with stroke included in this study have not shown significant progress toward achieving their therapy goals. As for clinical practice, this study could guide therapists in the future to improve the process of achieving their patients' goals.
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14
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Lannin NA, Ada L, English C, Ratcliffe J, Faux SG, Palit M, Gonzalez S, Olver J, Cameron I, Crotty M. Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial. Stroke 2019; 51:556-562. [PMID: 31813359 PMCID: PMC7004444 DOI: 10.1161/strokeaha.119.027602] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. The aim of this trial was to determine the effect of additional upper limb rehabilitation following botulinum toxin-A for upper limb activity in chronic stroke.
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Affiliation(s)
- Natasha A Lannin
- From the Department of Neurosciences, Central Clinical School (N.A.L.), Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia (N.A.L., M.P.)
| | - Louise Ada
- Faculty of Health Sciences (Physiotherapy) (L.A.), The University of Sydney, New South Wales, Australia
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, New South Wales, Australia (C.E.)
| | - Julie Ratcliffe
- College of Nursing and Health Sciences (J.R.), Flinders University, Adelaide, South Australia, Australia
| | - Steven G Faux
- Sacred Heart Rehabilitation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia (S.G.F.).,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia (S.G.F.)
| | - Mithu Palit
- Alfred Health, Melbourne, Victoria, Australia (N.A.L., M.P.)
| | | | - John Olver
- Epworth Monash Rehabilitation Medicine Research Unit (J.O.), Monash University, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research (I.C.), The University of Sydney, New South Wales, Australia
| | - Maria Crotty
- Rehabilitation and Aged Care, College of Medicine and Public Health (M.C.), Flinders University, Adelaide, South Australia, Australia
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15
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Eftekhar P. Clinician's Commentary on Choi et al. 1. Physiother Can 2019; 69:120-121. [PMID: 28548139 PMCID: PMC5435399 DOI: 10.3138/ptc.2016-25-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Parvin Eftekhar
- Stroke-Toronto Rehabilitation Institute, University Health Network, Toronto;
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16
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Mizuno K, Abe T, Ushiba J, Kawakami M, Ohwa T, Hagimura K, Ogura M, Okuyama K, Fujiwara T, Liu M. Evaluating the Effectiveness and Safety of the Electroencephalogram-Based Brain-Machine Interface Rehabilitation System for Patients With Severe Hemiparetic Stroke: Protocol for a Randomized Controlled Trial (BEST-BRAIN Trial). JMIR Res Protoc 2018; 7:e12339. [PMID: 30522993 PMCID: PMC6302229 DOI: 10.2196/12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/07/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We developed a brain-machine interface (BMI) system for poststroke patients with severe hemiplegia to detect event-related desynchronization (ERD) on scalp electroencephalogram (EEG) and to operate a motor-driven hand orthosis combined with neuromuscular electrical stimulation. ERD arises when the excitability of the ipsi-lesional sensorimotor cortex increases. OBJECTIVE The aim of this study was to evaluate our hypothesis that motor training using this BMI system could improve severe hemiparesis that is resistant to improvement by conventional rehabilitation. We, therefore, planned and implemented a randomized controlled clinical trial (RCT) to evaluate the effectiveness and safety of intensive rehabilitation using the BMI system. METHODS We conducted a single blind, multicenter RCT and recruited chronic poststroke patients with severe hemiparesis more than 90 days after onset (N=40). Participants were randomly allocated to the BMI group (n=20) or the control group (n=20). Patients in the BMI group repeated 10-second motor attempts to operate EEG-BMI 40 min every day followed by 40 min of conventional occupational therapy. The interventions were repeated 10 times in 2 weeks. Control participants performed a simple motor imagery without servo-action of the orthosis, and electrostimulation was given for 10 seconds for 40 min, similar to the BMI intervention. Overall, 40 min of conventional occupational therapy was also given every day after the control intervention, which was also repeated 10 times in 2 weeks. Motor functions and electrophysiological phenotypes of the paretic hands were characterized before (baseline), immediately after (post), and 4 weeks after (follow-up) the intervention. Improvement in the upper extremity score of the Fugl-Meyer assessment between baseline and follow-up was the main outcome of this study. RESULTS Recruitment started in March 2017 and ended in July 2018. This trial is currently in the data correcting phase. This RCT is expected to be completed by October 31, 2018. CONCLUSIONS No widely accepted intervention has been established to improve finger function of chronic poststroke patients with severe hemiparesis. The results of this study will provide clinical data for regulatory approval and novel, important understanding of the role of sensory-motor feedback based on BMI to induce neural plasticity and motor recovery. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000026372; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000030299 (Archived by WebCite at http://www.webcitation.org/743zBJj3D). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12339.
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Affiliation(s)
- Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- School of Data Science, Yokohama City University, Yokohama, Japan.,Keio University School of Medicine, Tokyo, Japan
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Yokohama, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomomi Ohwa
- Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Kazuto Hagimura
- Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Miho Ogura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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17
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Fheodoroff K, Dressler D, Woldag H, Koßmehl P, Koch M, Maisonobe P, Reichel G. [Treatment goals in patients with post-stroke upper limb spasticity following injection of botulinum toxin A : Results of the German-Austrian subgroup of the ULIS-II study]. DER NERVENARZT 2018; 90:361-370. [PMID: 30324541 DOI: 10.1007/s00115-018-0630-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ULIS-II was an international cohort study (NCT01020500) evaluating current treatment of upper limb spasticity in post-stroke adult patients with botulinum toxin A (BoNT-A) in real-life practice. OBJECTIVE Post hoc analysis to compare current management of post-stroke adult patients regarding goal setting and attainment with BoNT-A in Germany (D) and Austria (A) with the full cohort of ULIS-II. MATERIAL AND METHODS The ULIS-II was a global, open-label, prospective, multicenter observational study with 2 visits conducted in 84 centers worldwide. A total of 468 patients aged ≥18 years with post-stroke upper limb spasticity were included. The primary outcome measure was the responder rate defined as achievement of a goal attainment scale (GAS) score of 0, 1 or 2 after 1 cycle of BoNT-A. RESULTS A total of 57 patients from D/A were included in the efficacy analysis. The number of patients in D/A and the full cohort achieving the primary (78.9% vs. 79.6%) and secondary treatment goal (76.8% vs. 75.6%), respectively, was comparable. Deviating from the full cohort, the most common primary treatment goal in D/A was related to impairment (33.3%). Compared to baseline there was a marked reduction in concomitant therapies at the follow-up visit after 3-5 months in the D/A group: patients receiving oral anti-spastic medication 61.4% vs. 40.4%, positioning 50.9% vs. 36.8% and splinting 43.9% vs. 31.6%. Injection control techniques were less frequently used in the D/A group compared to the global study cohort (electrical stimulation: 26.3% vs. 45.8% and electromyography: 12.3% vs. 29.2%). No adverse events were documented in the D/A cohort. CONCLUSION A single injection of BoNT-A in adult patients with post-stroke spasticity of the arm led to a high response rate of approximately 80% in both cohorts. The BoNT-A injections in post-stroke adult patients contributed to an improvement in the daily life of patients and their carers beyond simple reduction of muscle tone or spasticity.
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Affiliation(s)
- K Fheodoroff
- Gailtal-Klinik, Radnigerstraße 12, 9620, Hermagor, Österreich.
| | - D Dressler
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Woldag
- Praxis Dr. Schäker, Leipzig, Deutschland
| | - P Koßmehl
- Kliniken Beelitz GmbH, Beelitz-Heilstätten, Beelitz, Deutschland
| | - M Koch
- Ipsen Pharma, Ettlingen, Deutschland
| | | | - G Reichel
- Paracelcus-Klinik Zwickau, Zwickau, Deutschland
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