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Ulfsdotter Gunnarsson K, Henriksson M, McCambridge J, Bendtsen M. Effects of a waiting list control design on alcohol consumption among online help-seekers: A randomised controlled trial. Drug Alcohol Depend 2024; 263:112409. [PMID: 39153442 DOI: 10.1016/j.drugalcdep.2024.112409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Indirect evidence suggests that using waiting list control designs in behavioural research may have unintended consequences. The aim of this study was to estimate the effects of a waiting list design on alcohol consumption among individuals who had looked online for help. METHODS A two-arm randomised controlled trial was employed. The intervention group was informed that they belonged to the intervention group and would receive immediate access to a digital alcohol intervention. The waiting list control group was informed that they belonged to the group that had to wait four weeks to be given access to the intervention and in the meantime, they would be given a summary of their drinking. However, both groups received immediate access to the same digital alcohol intervention; the experimental contrast was thus between being told to wait or not. RESULTS We randomised 3388 participants (intervention: 1692, waiting list: 1696). Data were available for 954 participants at 1-month follow-up. We found no strong evidence that alcohol consumption differed between groups, but the evidence pointed towards the intervention group reporting lowering weekly alcohol consumption compared to the waiting list control group (IRR = 0.95, 95 % CI = 0.83; 1.08, probability of effect = 78.8 %). CONCLUSION We found no strong evidence that being informed that access to an intervention would be delayed produced differential self-reported alcohol consumption compared to being informed that access would be immediate. We did find a difference in engagement with the intervention materials, indicating that the experimental manipulation was successful.
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Affiliation(s)
| | - Martin Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
| | - Jim McCambridge
- Department of Health Sciences, University of York, United Kingdom.
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
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2
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Abuatiq RA, Hoffman ME, LaForme Fiss A, Looper J, Feldner HA. Exploring the Efficacy of a Dynamic Harness System on Gross Motor Development and Motivation for Infants With Down Syndrome: A Pilot Study. Pediatr Phys Ther 2024:00001577-990000000-00099. [PMID: 39073058 DOI: 10.1097/pep.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
PURPOSE To explore the benefits of a Partial Body Weight Support (PBWS) harness system within a play enriched environment on gross motor development and mastery motivation of infants with Down Syndrome (DS). METHODS A randomized crossover study with 17 pre-walking infants with DS in two conditions-play with or without the harness engaged-each for 3×/week over 3 weeks with a 1-week washout. Assessments took place at baseline, crossover, and completion. RESULTS Statistically and clinically significant changes were evident on the Gross Motor Function Measure-88; however, there were no significant changes in parent-reported mastery motivation. CONCLUSION The combination of PBWS harness system support and high frequency-facilitated play within an enriched play environment positively affected gross motor development. The intervention did not impact mastery motivation skills, and the direct impact of the harness remains unclear.
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Affiliation(s)
- Reham A Abuatiq
- Department of Rehabilitation Medicine (Ms Abuatiq and Dr Feldner), University of Washington; Department of Mechanical Engineering (Ms Hoffman), University of Washington, Seattle, Washington State; School of Physical Therapy (Dr LaForme Fiss), Texas Woman's University, Dallas, Texas; Physical Therapy Department (Dr Looper), University of Puget Sound, Tacoma, Washington State
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Banks HC, Lemos T, Oliveira LAS, Ferreira AS. Short-term effects of Pilates-based exercise on upper limb strength and function in people with Parkinson's disease. J Bodyw Mov Ther 2024; 39:237-242. [PMID: 38876632 DOI: 10.1016/j.jbmt.2024.02.032] [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: 11/25/2022] [Revised: 11/27/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND People with Parkinson's disease (PD) have impaired upper limb motor coordination, limiting the execution of activities of daily living. This study investigated the feasibility and safety of a short-term Pilates-based exercise program in the treatment of upper limb motor coordination for people with PD. METHODS Fifteen patients - n (%) 4 women/11 men (27/73), median [interquartile range] age 66 [9] years - participated in this quasi-experimental (before-and-after) clinical trial. Patients underwent a 6-week (30 min/day, 3 days/week) Pilates exercise program using Reformer, Cadillac, Chair, and Barrel equipment. Feasibility was evaluated by adherence to the program and the ability to perform the exercises including progressions on difficulty. Safety was evaluated based on self-reported adverse events. Clinical and functional trends before and after the intervention were also computed regarding handgrip strength (HGS), fine motor coordination (9 Hole Peg Test; 9HPT), bradykinesia (Movement Disorder Society - Unified Parkinson's disease Rating Scale; MDS-UPDRS), and upper limb functionality (Test D'évaluation des Membres Supérieurs des Personnes Âgées, TEMPA). RESULTS Of the 18 Pilates sessions, exercise adherence was 100%. The only adverse event observed was mild muscle pain. Pre-post differences were observed only for body bradykinesia and hypokinesia (1.0 [0.0] vs. 0.0 [1.0] s, adjusted p = 0.048). CONCLUSIONS A short-term Pilates-based exercise program in the treatment of upper limb muscle strength, manual dexterity, bradykinesia, and functionality is feasible and safe for people with PD. Changes in upper limb bradykinesia encourage randomized clinical trials.
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Affiliation(s)
- Helen Cristian Banks
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil
| | - Thiago Lemos
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
| | - Laura Alice Santos Oliveira
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
| | - Arthur Sá Ferreira
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
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4
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Modarres Zadeh A, Mehri A, Murray LL, Nejati V, Khatoonabadi AR. The effects of adding attention training to naming treatment for individuals with aphasia. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-15. [PMID: 38359428 DOI: 10.1080/23279095.2024.2315555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
AIM Given the ever-increasing evidence for the co-occurrence of attention impairments and language disorders in chronic aphasia, this study aimed to compare the effects of two naming treatment programs, one with and one without attention training components, on the naming performance of participants with aphasia. MATERIALS AND METHODS This was a single-subject crossover study in which six people with chronic aphasia and different degrees of naming and attention impairments participated. Two treatment programs were implemented for each participant, with the sequence of the treatments with crossover design. Each program consisted of 12 treatment sessions plus pre- and post-treatment assessment sessions (15 weeks for each participant). The visual analysis and WEighted STatistics methods were employed for data analysis. RESULTS Based on visual analysis, both treatments improved in comparison to the baseline phase. Statistical analysis revealed that the number of participants with significant naming improvement following combined program (5 participants) was larger than the number of participants showing improvement following completion of the single, program. CONCLUSION Although integrating attention training into a conventional treatment for anomia can increase the effect of treatment on naming ability, more studies are required to clarify the role of attention in remediating naming impairments in aphasia.
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Affiliation(s)
- Amin Modarres Zadeh
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Azar Mehri
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, Ontario, Canada
| | - Vahid Nejati
- Faculty of Psychology and Educational Sciences, Shahid Beheshti University, Tehran, Iran
| | - Ahmad Reza Khatoonabadi
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
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5
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Esfandiari E, Miller WC, King S, Mortenson WB, Ashe MC. Development of a co-created online self-management program for people with lower limb loss: self-management for amputee rehabilitation using technology (SMART). Disabil Rehabil 2024; 46:763-772. [PMID: 36803503 DOI: 10.1080/09638288.2023.2178678] [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: 08/22/2021] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To develop an online self-management program for individuals with recent lower limb loss, called Self-Management for Amputee Rehabilitation using Technology (SMART). MATERIALS AND METHODS We used the Intervention Mapping Framework as a blueprint and involved stakeholders throughout the process. A six-step study was conducted including (1) needs assessment using interviews, (2) translating needs to content, (3) applying the content into a prototype using theory-based methods, (4) a usability assessment using think-aloud cognitive testing, (5) planning for future adoption and implementation, and (6) assessing feasibility using mixed-methods to generate a plan to assess the effectiveness on health-outcomes in a randomized controlled trial. RESULTS Following interviews with healthcare professionals (n = 31) and people with lower limb loss (n = 26), we determined the content of a prototype version. We then tested usability (n = 9) and feasibility (n = 12) by recruiting individuals with lower limb loss from different pools. We modified SMART to be assessed in a randomized controlled trial. SMART is a six-week online program with weekly contact of a peer mentor with lower limb loss who supported patients with goal-setting and action-planning. CONCLUSIONS Intervention mapping facilitated the systematic development of SMART. SMART may improve health outcomes, but this would need to be confirmed in future studies.Implications for rehabilitationLearning new coping strategies and habits are essential after lower limb loss.Given the limitations and inaccessibility of educational and rehabilitation programs, online self-management education can assist patients in their recovery.Self-Management for Amputee Rehabilitation using Technology (SMART) has the potential to augment the self-management behaviors in individuals with lower limb loss through an improvement in access to educational content, skill-based videos, and support of a peer.
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Affiliation(s)
- Elham Esfandiari
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, Canada
| | - William C Miller
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Sheena King
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - W Ben Mortenson
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
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6
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Hughes Z, Ball LJ, Richardson C, Judge J. A meta-analytical review of the impact of mindfulness on creativity: Framing current lines of research and defining moderator variables. Psychon Bull Rev 2023; 30:2155-2186. [PMID: 37442873 PMCID: PMC10728263 DOI: 10.3758/s13423-023-02327-w] [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] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
Findings relating to the impact of mindfulness interventions on creative performance remain inconsistent, perhaps because of discrepancies between study designs, including variability in the length of mindfulness interventions, the absence of control groups or the tendencies to explore creativity as one unitary construct. To derive a clearer understanding of the impact that mindfulness interventions may exert on creative performance, two meta-analytical reviews were conducted, drawing respectively on studies using a control group design (n = 20) and studies using a pretest-posttest design (n = 17). A positive effect was identified between mindfulness and creativity, both for control group designs (d = 0.42, 95% CIs [0.29, 0.54]) and pretest-posttest designs (d = 0.59, 95% CIs [0.38, 0.81]). Subgroup analysis revealed that intervention length, creativity task (i.e., divergent vs. convergent thinking tasks) and control group type, were significant moderators for control group studies, whereas only intervention length was a significant moderator for pretest-posttest studies. Overall, the findings support the use of mindfulness as a tool to enhance creative performance, with more advantageous outcomes for convergent as opposed to divergent thinking tasks. We discuss the implications of study design and intervention length as key factors of relevance to future research aimed at advancing theoretical accounts of the relationship between mindfulness and creativity.
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Affiliation(s)
- Zoe Hughes
- School of Psychology and Computer Science, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - Linden J Ball
- School of Psychology and Computer Science, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Cassandra Richardson
- Department of Psychology, The University of Winchester, Winchester, SO22 4NR, UK
| | - Jeannie Judge
- School of Psychology and Computer Science, University of Central Lancashire, Preston, PR1 2HE, UK
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Hohenschurz-Schmidt D, Vase L, Scott W, Annoni M, Ajayi OK, Barth J, Bennell K, Berna C, Bialosky J, Braithwaite F, Finnerup NB, Williams ACDC, Carlino E, Cerritelli F, Chaibi A, Cherkin D, Colloca L, Côté P, Darnall BD, Evans R, Fabre L, Faria V, French S, Gerger H, Häuser W, Hinman RS, Ho D, Janssens T, Jensen K, Johnston C, Juhl Lunde S, Keefe F, Kerns RD, Koechlin H, Kongsted A, Michener LA, Moerman DE, Musial F, Newell D, Nicholas M, Palermo TM, Palermo S, Peerdeman KJ, Pogatzki-Zahn EM, Puhl AA, Roberts L, Rossettini G, Tomczak Matthiesen S, Underwood M, Vaucher P, Vollert J, Wartolowska K, Weimer K, Werner CP, Rice ASC, Draper-Rodi J. Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies: the CoPPS Statement. BMJ 2023; 381:e072108. [PMID: 37230508 DOI: 10.1136/bmj-2022-072108] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Research Department, University College of Osteopathy, London, UK
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London; INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marco Annoni
- Italian National Research Council, Interdepartmental Centre for Research Ethics and Integrity, Rome, Italy
| | - Oluwafemi K Ajayi
- Department of Arts and Music, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Switzerland
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, VIC, Australia
| | - Chantal Berna
- Centrer for Integrative and Complementary Medicine, Pain Center, Division of Anesthesiology, Sense Institute, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida, Gainesville FL, USA; Brooks-PHHP Research Collaboration, Jacksonville, FL, USA
| | | | - Nanna B Finnerup
- Danish Pain Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Elisa Carlino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | | | - Aleksander Chaibi
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dan Cherkin
- Osher Center for Integrative Health, Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing; Department of Anesthesiology, School of Medicine; University of Maryland, Baltimore, MD, USA
| | - Pierre Côté
- Faculty of Health Sciences, Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
| | - Beth D Darnall
- Stanford Pain Relief Innovations Lab; Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA, USA
| | - Roni Evans
- Integrative Health & Wellbeing Research Program; Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
| | - Laurent Fabre
- Centre Européen d'Enseignement Supérieur de l'Ostéopathie, Paris, France
| | - Vanda Faria
- Department of Psychology, Uppsala University, Uppsala, Sweden; Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - Heike Gerger
- Erasmus MC, University Medical Centre Rotterdam, Department of General Practice, Rotterdam, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Rana S Hinman
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Dien Ho
- Center for Health Humanities, School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston MA, USA
| | - Thomas Janssens
- Health Psychology, KU Leuven; Ebpracticenet, Leuven, Belgium
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Chris Johnston
- BC Patient Safety & Quality Council's Patient Voices Network; Health Research BC's Partnership-Ready Network; Health Standards Organization's Emergency Management Technical Committee & Working Group
| | - Sigrid Juhl Lunde
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Francis Keefe
- Duke University, School of Medicine, Durham, NC, USA
| | - Robert D Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, USA
| | - Helen Koechlin
- Division of Psychosomatics and Psychiatry, University Children's Hospital Zurich; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles CA, USA
| | - Daniel E Moerman
- College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan, Dearborn, MI, USA
| | - Frauke Musial
- National Research Centre in Complementary and Alternative Medicine, Department of Community Medicine, Faculty of Health Science UiT, Arctic University of Norway, Tromsø, Norway
| | | | - Michael Nicholas
- Pain Management Research Institute, University of Sydney Medical School (Northern) and Kolling Institute of Medical Research at Royal North Shore Hospital, Sydney, Australia
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Sara Palermo
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - Kaya J Peerdeman
- Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | - Lisa Roberts
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy; School of Physiotherapy, University of Verona, Verona, Italy
| | - Susan Tomczak Matthiesen
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Martin Underwood
- Warwick Clinical Trials Unit; University of Warwick, Coventry, UK; University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Paul Vaucher
- School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Neurophysiology, Mannheim Centre of Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany
| | - Karolina Wartolowska
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Centre, Ulm, Germany
| | - Christoph Patrick Werner
- School of Psychology, Faculty of Science, University of Sydney, Australia; Department of Clinical Research, University Hospital Basel, Switzerland
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Jerry Draper-Rodi
- Research Department, University College of Osteopathy, London, UK
- National Council for Osteopathic Research, London, UK
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Powers KE, das Nair R, Phillips J, Farrin A, Radford KA. Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4694. [PMID: 36981601 PMCID: PMC10048688 DOI: 10.3390/ijerph20064694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.
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Affiliation(s)
- Katie E. Powers
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Roshan das Nair
- Health Division, SINTEF, 7465 Trondheim, Norway
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Julie Phillips
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - Kathryn A. Radford
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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9
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Hohenschurz-Schmidt D, Draper-Rodi J, Vase L, Scott W, McGregor A, Soliman N, MacMillan A, Olivier A, Cherian CA, Corcoran D, Abbey H, Freigang S, Chan J, Phalip J, Sørensen LN, Delafin M, Baptista M, Medforth NR, Ruffini N, Andresen SS, Ytier S, Ali D, Hobday H, Ngurah Agung Adhiyoga Santosa AA, Vollert J, Rice AS. Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article II): a meta-analysis relating methods to trial results. Pain 2023; 164:509-533. [PMID: 36271798 PMCID: PMC9916063 DOI: 10.1097/j.pain.0000000000002730] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/16/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sham interventions in randomized clinical trials (RCTs) of physical, psychological, and self-management (PPS) therapies for pain are highly variable in design and believed to contribute to poor internal validity. However, it has not been formally tested whether the extent to which sham controls resemble the treatment under investigation consistently affects trial outcomes, such as effect sizes, differential attrition, participant expectancy, and blinding effectiveness. Placebo- or sham-controlled RCTs of PPS interventions of clinical pain populations were searched in 12 databases. The similarity of control interventions to the experimental treatment was rated across 25 features. Meta-regression analyses assessed putative links between employed control interventions, observed effect sizes in pain-related outcomes, attrition, and blinding success. The sample included 198 unique control interventions, dominated by manual therapy and chronic musculoskeletal pain research. Meta-analyses indicated small-to-moderate benefits of active treatments over control interventions, across subgroups of manual therapies, exercise, and rehabilitation, and psychological intervention trials. Multiple meta-regression modelling demonstrated that similarity between sham control and tested interventions predicted variability in pain-related outcomes, attrition, and blinding effectiveness. Influential variables were differences relating to the extent of intervention exposure, participant experience, and treatment environments. The results support the supposed link between blinding methods and effect sizes, based on a large and systematically sourced overview of methods. However, challenges to effective blinding are complex and often difficult to discern from trial reports. Nonetheless, these insights have the potential to change trial design, conduct, and reporting and will inform guideline development.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, Section for Psychology and Neuroscience, Aarhus University, Aarhus, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Human Performance Group, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nadia Soliman
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Andrew MacMillan
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Axel Olivier
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cybill Ann Cherian
- Chemical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hilary Abbey
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Lea Nørgaard Sørensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maite Delafin
- The Penn Clinic, Hertfordshire, Hatfield, United Kingdom
| | - Margarida Baptista
- Wolfson Centre for Age Related Diseases, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Nuria Ruffini
- National Centre Germany, Foundation C.O.M.E. Collaboration, Berlin, Germany
| | | | | | - Dorota Ali
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Hobday
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Jan Vollert
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster,Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Andrew S.C. Rice
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
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Hohenschurz-Schmidt D, Draper-Rodi J, Vase L, Scott W, McGregor A, Soliman N, MacMillan A, Olivier A, Cherian CA, Corcoran D, Abbey H, Freigang S, Chan J, Phalip J, Nørgaard Sørensen L, Delafin M, Baptista M, Medforth NR, Ruffini N, Skøtt Andresen S, Ytier S, Ali D, Hobday H, Santosa AANAA, Vollert J, Rice AS. Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article I): a systematic review and description of methods. Pain 2023; 164:469-484. [PMID: 36265391 PMCID: PMC9916059 DOI: 10.1097/j.pain.0000000000002723] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/17/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Lene Vase
- Section for Psychology and Neuroscience, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nadia Soliman
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Andrew MacMillan
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Axel Olivier
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cybill Ann Cherian
- Chemical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hilary Abbey
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Lea Nørgaard Sørensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maite Delafin
- The Penn Clinic, Hertfordshire, Hatfield, United Kingdom
| | - Margarida Baptista
- Department of Psychology, Wolfson Centre for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Nuria Ruffini
- National Centre Germany, Foundation C.O.M.E. Collaboration, Berlin, Germany
| | | | | | - Dorota Ali
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Hobday
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
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Esfandiari E, Miller WC, King S, Payne M, Mortenson WB, Underwood H, MacKay C, Ashe MC. Protocol for a randomized controlled trial to assess the effect of Self-Management for Amputee Rehabilitation using Technology (SMART): An online self-management program for individuals with lower limb loss. PLoS One 2023; 18:e0278418. [PMID: 36952517 PMCID: PMC10035895 DOI: 10.1371/journal.pone.0278418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/14/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Lower limb loss (LLL) is a distressing experience with psychological, physical, and social challenges. Education is needed to enhance the coping skills and confidence of patients to improve LLL outcomes. However, access to rehabilitation services and education is limited outside of urban centers. To address this service gap, we co-created an eHealth platform, called Self-Management for Amputee Rehabilitation using Technology (SMART). OBJECTIVES First, we will test the effect of SMART and usual care compared with usual care only on walking capacity and confidence among individuals with LLL. Second, we will describe key implementation factors for program delivery and adoption at the person- and provider-level. METHODS This is a Type 1 Effectiveness-Implementation Hybrid Design, mixed-methods, multi-site (British Columbia and Ontario, Canada), parallel, assessor-blinded randomized controlled trial. Participants will include adults with unilateral LLL, during early prosthetic fitting (<2 years after casting for initial prosthesis). Participants in both groups will receive usual care. The experimental group will receive SMART with weekly support sessions from a trained peer mentor for goal setting and action planning for six weeks. Participants will be encouraged to continue using SMART for an additional four weeks. The control group will receive usual care, and weekly social contacts for six weeks. The primary outcome measure is walking capacity operationalized as the performance based Timed Up and Go test. The secondary outcome is walking confidence using the Ambulatory Self-Confidence Questionnaire. Outcome measures will be assessed at baseline, immediately post-intervention, and four weeks follow-up. We will describe key implementation factors (such as, participant experience, intervention adoption, fidelity) throughout the study using questionnaires, semi-structured interviews, and direct observation. RESULTS No participants have been enrolled. CONCLUSIONS SMART has the potential to provide knowledge and skill development to augment rehabilitation outcomes for adults with LLL. TRIAL REGISTRATION NCT04953364 in Clinical Trial Registry (https://clinicaltrials.gov/).
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Affiliation(s)
- Elham Esfandiari
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
| | - W C Miller
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Sheena King
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Michael Payne
- Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - W Ben Mortenson
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Heather Underwood
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
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12
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Peper KK, Zardykhan D, Egger M, Steinbock M, Muller F, Hildenbrand X, Koenig A, Jensen ER, Haddadin S. Testing robot-based assist-as-needed therapy for improving active participation of a patient during early neurorehabilitation: a case study. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176105 DOI: 10.1109/icorr55369.2022.9896495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this study, a patient in the Intensive Care-Unit received robot-based mobilization therapy with an assist-as-needed (AAN) function over the course of three weeks. Therapists were able to adapt the hip range of motion $\beta$, the bed verticalization angle $\alpha$ and the leg load force FLoad for each therapy, based on the current condition of the patient. To evaluate the patient active participation, surface electromyography (sEMG) of the M. rectus femoris (RF) and M. biceps femoris (BF) were measured and analyzed. It was observed that the patient active participation, measured through sEMG, increased along with increased hip range of motion $\beta$, bed verticalization angle $\alpha$ and leg load force FLoad set by the therapists. The patient muscle activation pattern followed the pattern of healthy controls, in part. To the authors' best knowledge, this study is the first of its kind to be performed with an ICU patient.
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13
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Treatment Trials in Disorders of Consciousness: Challenges and Future Directions. Brain Sci 2022; 12:brainsci12050569. [PMID: 35624956 PMCID: PMC9139017 DOI: 10.3390/brainsci12050569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
The evidence base supporting treatment interventions for patients with disorders of consciousness is limited, and rigorous treatment trials are needed to guide future management of this complex patient population. There are many potential study designs that can be employed to develop this evidence, but the process of selecting the optimal study design is challenging. This article reviews common obstacles that impede research progress in this population and a range of study designs that may be employed. In addition, we consider how the particular practical and scientific obstacles may drive selection of the optimal design and, in particular, how the optimal design changes as treatment research proceeds along the translational continuum from mechanistic discovery to real-world clinical impact.
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Giallini I, Nicastri M, Mariani L, Turchetta R, Ruoppolo G, de Vincentiis M, Vito CD, Sciurti A, Baccolini V, Mancini P. Benefits of Parent Training in the Rehabilitation of Deaf or Hard of Hearing Children of Hearing Parents: A Systematic Review. Audiol Res 2021; 11:653-672. [PMID: 34940018 PMCID: PMC8698273 DOI: 10.3390/audiolres11040060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/09/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.
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Affiliation(s)
- Ilaria Giallini
- Department of Sense Organs, University Sapienza of Rome, 00185 Rome, Italy; (I.G.); (M.N.); (L.M.); (R.T.); (G.R.); (M.d.V.)
| | - Maria Nicastri
- Department of Sense Organs, University Sapienza of Rome, 00185 Rome, Italy; (I.G.); (M.N.); (L.M.); (R.T.); (G.R.); (M.d.V.)
| | - Laura Mariani
- Department of Sense Organs, University Sapienza of Rome, 00185 Rome, Italy; (I.G.); (M.N.); (L.M.); (R.T.); (G.R.); (M.d.V.)
| | - Rosaria Turchetta
- Department of Sense Organs, University Sapienza of Rome, 00185 Rome, Italy; (I.G.); (M.N.); (L.M.); (R.T.); (G.R.); (M.d.V.)
| | - Giovanni Ruoppolo
- Department of Sense Organs, University Sapienza of Rome, 00185 Rome, Italy; (I.G.); (M.N.); (L.M.); (R.T.); (G.R.); (M.d.V.)
| | - Marco de Vincentiis
- Department of Sense Organs, University Sapienza of Rome, 00185 Rome, Italy; (I.G.); (M.N.); (L.M.); (R.T.); (G.R.); (M.d.V.)
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, University Sapienza of Rome, 00185 Rome, Italy; (C.D.V.); (A.S.); (V.B.)
| | - Antonio Sciurti
- Department of Public Health and Infectious Diseases, University Sapienza of Rome, 00185 Rome, Italy; (C.D.V.); (A.S.); (V.B.)
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, University Sapienza of Rome, 00185 Rome, Italy; (C.D.V.); (A.S.); (V.B.)
| | - Patrizia Mancini
- Department of Sense Organs, University Sapienza of Rome, 00185 Rome, Italy; (I.G.); (M.N.); (L.M.); (R.T.); (G.R.); (M.d.V.)
- Correspondence: ; Tel.: +39-3387880512
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Mangset M, Kitzmüller G, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne KJ, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation. Trials 2021; 22:850. [PMID: 34838094 PMCID: PMC8627040 DOI: 10.1186/s13063-021-05765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is "usual care." The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants' reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. METHODS Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur's interpretation theory guided the analysis. RESULTS The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants' feelings of control and their ability to cope. Other participants' statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. CONCLUSIONS RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02338869. Registered on October 4, 2014.
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Affiliation(s)
- Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Anne S. Evju
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Sanne Angel
- Department of Public Health – Research Unit for Nursing and Healthcare, Department of Science in Nursing, Aarhus University, 8000 Aarhus, Denmark
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
| | - Lena Aadal
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
- Hammel Neurorehabilitation Centre and University Research Clinic, 8450 Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, C, 8000 Aarhus, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
| | | | - Kari J. Kvigne
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
- The Faculty of Nursing and Health Sciences, Nord University, P.B. 1490, 8049 Bodø, Norway
| | - Line K. Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Ellen Gabrielsen Hjelle
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
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16
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Avellanet M, Boada-Pladellorens A, Pages E, Dorca A, Sabria B, Pfeifer M, Gea E. A Comparative Study of a Novel Postural Garment Versus Exercise for Women with Nonspecific Cervical Pain: A Randomized Cross-over Trial. Spine (Phila Pa 1976) 2021; 46:1517-1524. [PMID: 34292213 PMCID: PMC8553007 DOI: 10.1097/brs.0000000000004123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/24/2021] [Accepted: 03/08/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized cross-over study. OBJECTIVE The aim of this study was to compare exercise, the criterion standard, to the postural garment PosturePlusForce in the management of nonspecific cervical pain in women. We also analyzed both interventions with regards to baseline posture, use of pharmacological pain relievers, compliance, and comfort. SUMMARY OF BACKGROUND DATA The prevalence of neck pain has increased during the last decade, preferentially affecting women. Those suffering from this condition may manifest a decrease in quality of life and inability to work. Consistent recommendations highlight the importance of exercise and posture for neck pain improvement. METHODS A total of 32 female health care professionals with cervical pain (≥3 on the visual analogue scale) entered the trial. Participants were allocated to either performing exercises or wearing the postural garment. The cross-over between interventions was separated by a 3-month washout period. Primary outcomes included pain intensity and posture. Secondary outcomes comprised cervical pain-related disability, psychological factors, physical activity, global perceived effect of treatment, and garment comfort. Treatment compliance, medication use, and adverse events were also recorded. RESULTS Both interventions showed a significant improvement in pain in subjects with an adherence >60%. However, in participants with dorsal hyperkyphosis (>45°), the garment demonstrated a greater reduction in pain than exercise (P = 0.019). Additionally, those wearing the garment needed fewer pain relievers than those performing exercises (P = 0.007). Compliance was >50% for both interventions and comfort was contingent on season. CONCLUSION In our study, PosturePlusForce showed, at least, a similar effect on pain to exercise, although those with dorsal hyperkyphosis exhibited a greater reduction in pain and related variables with the garment. Pain relievers were less required by those wearing PosturePlusForce than by those performing the exercises.Level of Evidence: 1.
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Affiliation(s)
- Merce Avellanet
- Rehabilitation Department, Hospital Nostra Sra. de Meritxell, Andorra, Research Group on Health Sciences and Health Services, University of Andorra, Andorra
| | - Anna Boada-Pladellorens
- Rehabilitation Department, Hospital Nostra Sra. de Meritxell, Andorra, Research Group on Health Sciences and Health Services, University of Andorra, Andorra
| | - Esther Pages
- Rehabilitation Department, Hospital Nostra Sra. de Meritxell, Andorra, Research Group on Health Sciences and Health Services, University of Andorra, Andorra
| | | | | | | | - Elvira Gea
- Head of Pharmacy Department, Hospital Nostra Sra de Meritxell, Andorra
- Research Group on Health Sciences and Health Services, University of Andorra, Andorra
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Estival S, Laurier V, Mourre F, Postal V. Improvement of Planning Abilities in Adults with Prader-Willi Syndrome: A Randomized Controlled Trial. Dev Neurorehabil 2021; 24:478-493. [PMID: 34184596 DOI: 10.1080/17518423.2021.1915405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prader-Willi Syndrome (PWS) is a neurodevelopmental genetic disorder with executive deficits. Planning is one of the impaired executive functions implied in the regulation of behavior and everyday actions. We aimed to explore the feasibility and the effectiveness of a metacognitive strategy training designed to improve planning in adults with PWS using a double-blind between-group (training versus usual care) randomized controlled trial, with computerized tests and paper-pencil ecological outcome measures targeting planning, other executive functions, and achievement of personalized goal. Results showed better performances in several executive tasks and in achievement of personalized goals after both interventions, but better improvement for the experimental group (n = 27) compared to control (n = 26) only on the task assessing planning abilities. Interviews with occupational therapists demonstrated the feasibility of this training with this population. Despite a small number of sessions, the metacognitive strategy training showed encouraging results on planning abilities of patients.
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Affiliation(s)
- Séverine Estival
- Laboratoire de Psychologie LabPsy EA4139, Université de Bordeaux, Bordeaux, France
| | | | - Fabien Mourre
- Hôpital Marin AP-HP, Unité Prader-Willi, Hendaye, France
| | - Virginie Postal
- Laboratoire de Psychologie LabPsy EA4139, Université de Bordeaux, Bordeaux, France
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Bendtsen M, Ulfsdotter Gunnarsson K, McCambridge J. Effects of a waiting list control design on alcohol consumption among online help-seekers: protocol for a randomised controlled trial. BMJ Open 2021; 11:e049810. [PMID: 34446493 PMCID: PMC8395291 DOI: 10.1136/bmjopen-2021-049810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Sparse attention has been given to the design of control conditions in trials, despite their important role as contrasts for novel treatments, and thus as a key determinant of effect sizes. This undermines valid inferences on effect estimates in trials, which are fundamentally comparative in nature. Such challenges to understanding also makes generalisation of effect estimates complex, for example, it may not be clear to what degree real-world alternatives to the novel treatments in pragmatic trials are similar to the control conditions studied. The present study aims to estimate the effects of being allocated to a waiting list control condition. METHODS AND ANALYSIS Individuals searching online for help to reduce their drinking will be invited to take part in a study. Individuals aged 18 years or older, who in the past month consumed six or more drinks on one occasion, or consumed 10 or more drinks the past week, will be eligible to participate. Both groups will receive identical feedback and advice on behaviour change; however, one group will be informed that they have to wait 1 month for the intervention materials. One month postrandomisation, participants will receive an email with the follow-up questionnaire measuring the primary outcomes: (1) frequency of heavy episodic drinking (defined as at study entry) in the past month; and (2) overall past week alcohol consumption. Differences between groups will be analysed using negative binomial regression models estimated using Bayesian inference. Recruitment will begin in October 2021. A Bayesian group sequential design will be employed to determine when to end enrolment (expected to be between 500 and 1500 individuals). ETHICS AND DISSEMINATION The study was approved by the Swedish Ethical Review Authority on 2021-01-25 (Dnr 2020-06267). Findings will be disseminated in open access peer-reviewed journals no later than 2023. TRIAL REGISTRATION TRIAL ISRCTN14959594; Pre-results.
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Affiliation(s)
- Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Using an integrated knowledge translation approach to inform a pilot feasibility randomized controlled trial on peer support for individuals with traumatic brain injury: A qualitative descriptive study. PLoS One 2021; 16:e0256650. [PMID: 34428259 PMCID: PMC8384186 DOI: 10.1371/journal.pone.0256650] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is estimated to affect 10 million people annually, making it a leading cause of morbidity and mortality worldwide. One cost-effective intervention that has been shown to minimize some of the negative sequelae after TBI is peer support. However, the evidence supporting the benefits of peer support for individuals with TBI is sparse and of low quality. Integrated knowledge translation (iKT) may be one approach to optimizing the evaluation of peer support programs among individuals with TBI. Therefore, the objectives are: (1) To understand key informants’ perspectives of the barriers and facilitators of participating in peer support research and programs among individuals with TBI; (2) to understand key informants’ perspectives on the perceived impacts of peer support programs on individuals with TBI; and, (3) to demonstrate how an iKT approach can inform the development and implementation of a pilot feasibility randomized controlled trial (RCT). Methods A qualitative descriptive approach using one-on-one semi-structured interviews was used. Purposive sampling of 22 key informants included 8 peer support mentors, 4 individuals with TBI who received peer support, 3 caregivers of individuals with TBI, 4 peer support program staff, and 3 academics in peer support and/or TBI. Results There were five main themes related to the barriers and facilitators to participating in peer support research and programs: knowledge, awareness, and communication; logistics of participating; readiness and motivation to participate; need for clear expectations; and matching. There were three main themes related to the perceived impact of peer support: acceptance, community, social experiences; vicarious experience/learning through others: shared experiences, role-modelling, encouragement; and “I feel better.” Discussions with our Research Partner led to several significant adaptations to our trial protocol, including removing the twice/week intervention arm, shortening of the length of trial, and changing the measure for the community integration outcome. Discussion/Conclusion This is the first study to use an iKT approach to inform a trial protocol and the first to assess the barriers and facilitators to participating in peer support research.
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Vaughan-Graham J, Torriani-Pasin C, Benito-Garcia M, Kypriglis-Kypriotis K, Sliwka A. Correspondence: Re: Scrivener et al. J Physiother 2021; 67:230. [PMID: 34148814 DOI: 10.1016/j.jphys.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/21/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
| | | | - Miguel Benito-Garcia
- Faculty of Physiotherapy and Nursing, Salus Infirmorum, Pontificia de Salamanca University, Spain
| | | | - Agnieszka Sliwka
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Arienti C, Armijo-Olivo S, Minozzi S, Tjosvold L, Lazzarini SG, Patrini M, Negrini S. Methodological Issues in Rehabilitation Research: A Scoping Review. Arch Phys Med Rehabil 2021; 102:1614-1622.e14. [PMID: 33989598 DOI: 10.1016/j.apmr.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 03/22/2021] [Accepted: 04/22/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To identify, synthesize, and categorize the methodological issues faced by the rehabilitation field. DATA SOURCES A scoping review was conducted using studies identified in MEDLINE, the Cochrane Library, EMBASE, Web of Science, Scopus, Physiotherapy Evidence Database, and Google Scholar up to August 2018. STUDY SELECTION We included all type of publications describing methodological issues in rehabilitation research where rehabilitation is described as a multimodal process. The methodological issues have been categorized and classified. DATA EXTRACTION The synthesis included qualitative and quantitative analysis. To focus the attention on rehabilitation, we post hoc divided in "specific issues" (highly related to, even if not exclusive of, rehabilitation research) and "generic issues" (common in biomedical research). DATA SYNTHESIS Seventy-one publications were included: 68% were narrative reviews, 15% systematic reviews, 7% editorials, 4% meta-epidemiologic studies, and 5% others. Specific methodological issues include the following: problematic application of randomized controlled trials (32%), absent definition of core outcome sets (28%), poor interventions description (22%), weak methodological (conducting) and reporting quality (21%), scarce clinical practice applicability (14%), lack of blinding assessor (10%), inadequate randomization methods or inadequate allocation concealment (8%), and inadequate participants description and recruitment (8%). "Generic" issues included the following: data and statistical description (31%), authors' methodological training (7%), peer review process (6%, n=4), funding declaration (6%), ethical statement (3%), protocol registration (3%), and conflict of interest declaration (1%). CONCLUSIONS Methodological and reporting issues might influence the quality of the evidence produced in rehabilitation research. The next steps to move forward in the field of rehabilitation could be to evaluate the influence of all these issues on the validity of trial results through meta-epidemiologic studies and to develop specific checklists to provide guidance to authors to improve the reporting and conduct of trials in this field.
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Affiliation(s)
| | - Susan Armijo-Olivo
- University of Applied Sciences, Faculty of Business and Social Sciences, Osnabrück, Germany; Faculties of Rehabilitation Medicine and Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Lisa Tjosvold
- Institute of Health Economics, Edmonton, Alberta, Canada
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan "La Statale", Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Estes S, Zarkou A, Hope JM, Suri C, Field-Fote EC. Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy. J Clin Med 2021; 10:1167. [PMID: 33799508 PMCID: PMC7999894 DOI: 10.3390/jcm10061167] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/06/2021] [Accepted: 03/06/2021] [Indexed: 01/01/2023] Open
Abstract
Locomotor training (LT) is intended to improve walking function and can also reduce spasticity in motor-incomplete spinal cord injury (MISCI). Transcutaneous spinal stimulation (TSS) also influences these outcomes. We assessed feasibility and preliminary efficacy of combined LT + TSS during inpatient rehabilitation in a randomized, sham-controlled, pragmatic study. Eighteen individuals with subacute MISCI (2-6 months post-SCI) were enrolled and randomly assigned to the LT + TSS or the LT + TSSsham intervention group. Participants completed a 4-week program consisting of a 2-week wash-in period (LT only) then a 2-week intervention period (LT + TSS or LT + TSSsham). Before and after each 2-week period, walking (10 m walk test, 2-min walk test, step length asymmetry) and spasticity (pendulum test, clonus drop test, modified spinal cord injury-spasticity evaluation tool) were assessed. Sixteen participants completed the study. Both groups improved in walking speed and distance. While there were no significant between-groups differences, the LT + TSS group had significant improvements in walking outcomes following the intervention period; conversely, improvements in the LT + TSSsham group were not significant. Neither group had significant changes in spasticity, and the large amount of variability in spasticity may have obscured ability to observe change in these measures. TSS is a feasible adjunct to LT in the subacute stage of SCI and may have potential to augment training-related improvements in walking outcomes.
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Affiliation(s)
- Stephen Estes
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Anastasia Zarkou
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Jasmine M. Hope
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
- Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
| | - Cazmon Suri
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA
- Program in Biomedical Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Hohenschurz-Schmidt D, Vollert J, Vogel S, Rice ASC, Draper-Rodi J. Performing and interpreting randomized clinical trials. J Osteopath Med 2021; 121:443-445. [PMID: 33694340 DOI: 10.1515/jom-2020-0320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/29/2020] [Indexed: 01/10/2023]
Affiliation(s)
| | - Jan Vollert
- Dept. of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Steven Vogel
- Research Centre, University College of Osteopathy, London, UK
| | - Andrew S C Rice
- Dept. of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Sima AP, Stromberg KA, Kreutzer JS. An adaptive method for assigning clinical trials wait-times for controls. Contemp Clin Trials Commun 2021; 21:100727. [PMID: 33604487 PMCID: PMC7872975 DOI: 10.1016/j.conctc.2021.100727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/16/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Wait-list control clinical trials are popular among psychologists and rehabilitation specialists partly because all participants receive the intervention. In 2 arm wait-list control trials, individuals randomized to the treatment group receive immediate treatment whereas individuals randomized to the control group wait a fixed amount of time before intervention is initiated. For interventions that have varying durations, careful consideration must be given to the period that participants in the control group have a delay until treatment begins, as incongruent wait times compared to the intervention durations of the treatment group may introduce confounding into the evaluation of the treatment differences. To alleviate this issue, we propose to adaptively assign wait times to individuals randomized to the control group based on the intervention duration of those in the treatment group. Simulations demonstrate the that our method not only results in similar timing distributions between participants in the treatment and control groups, but also allows participants in the control group to initiate treatment earlier than the traditional design. The latter characteristic may reduce dropout and result in more efficient study enrollment.
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Affiliation(s)
- Adam P. Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jeffrey S. Kreutzer
- Departments of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Maguire CC, Sieben JM, Lutz N, van der Wijden G, Scheidhauer H, de Bie R. Replacing canes with an elasticated orthotic-garment in chronic stroke patients - The influence on gait and balance. A series of N-of-1 trials. J Bodyw Mov Ther 2020; 24:203-214. [PMID: 33218513 DOI: 10.1016/j.jbmt.2020.06.006] [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: 02/03/2019] [Revised: 03/02/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effect of replacing canes with an elasticated orthotic-garment on balance and gait-function in chronic stroke survivors. DESIGN Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in a home setting. PARTICIPANTS Four cane using chronic stroke survivors (P1-4). INTERVENTIONS Phase A (9-12 weeks) cane-walking "as usual" to establish baseline values; Phase B (9-16 weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction; Phase C (9-10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment or cane. OUTCOME MEASURES Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walking measured as Total-Angle-Area (TAA°2) in frontal and sagittal-planes, both measured weekly. RESULTS Visual and statistical analysis of results showed significant improvements in FGA from phase A to B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deteriorated in P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2 & P4. Trunk-sway reduced during walking, indicating increased stability, in two participants from phase A to B and in three participants from A to C but no TAA changes were statistically significant. In phase C participant-selected walking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3 usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4-5 days. CONCLUSIONS Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke. "Hands-free" assistive-devices may be more effective than canes in improving gait-function in some patients. CLINICALTRIALS. GOV ID NCT03642444.
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Affiliation(s)
- Clare C Maguire
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland; Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Physiotherapy, REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland; Department of Health, Bern University of Applied Science, Schwarztorstrasse 48, 3007, Bern, Switzerland.
| | - Judith M Sieben
- Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Anatomy and Embryology, Maastricht University, 6200, MD, Maastricht, the Netherlands
| | - Nathanael Lutz
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland
| | - Gisela van der Wijden
- Department of Physiotherapy, REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Heike Scheidhauer
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland
| | - RobertA de Bie
- Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, 6200, MD, Maastricht, the Netherlands
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Alvarez G, Núñez-Cortés R, Solà I, Sitjà-Rabert M, Fort-Vanmeerhaeghe A, Fernández C, Bonfill X, Urrútia G. Sample size, study length, and inadequate controls were the most common self-acknowledged limitations in manual therapy trials: A methodological review. J Clin Epidemiol 2020; 130:96-106. [PMID: 33144246 DOI: 10.1016/j.jclinepi.2020.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to quantify and analyze the presence and type of self-acknowledged limitations (SALs) in a sample of manual therapy (MT) randomized controlled trials. STUDY DESIGN AND SETTING We randomly selected 120 MT trials. We extracted data related to SALs from the original reports and classified them into 12 categories. After data extraction, specific limitations within each category were identified. A descriptive analysis was performed using frequencies and percentages for qualitative variables. RESULTS The number of SALs per trial article ranged from 0 to 8, and more than two-thirds of trials acknowledged at least two different limitations. Despite its small proportion, 9% of trials did not report SALs. The most common limitation declared, in almost half of our sample, related to sample size (47.5%) followed by limitations related to study length and follow-up (33.3%) and inadequate controls (32.5%). CONCLUSION Our results indicate that at least two different limitations are consistently acknowledged in MT trial reports, the most common being those related to sample size, study length, follow-up, and inadequate controls. Analysis of the reasons behind the SALs gives some insights about the main difficulties in conducting research in this field and may help develop strategies to improve future research.
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Affiliation(s)
- Gerard Alvarez
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain; Foundation Centre for Osteopathic Medicine Collaboration. Spain National Centre, Barcelona, Spain.
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ivan Solà
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mercè Sitjà-Rabert
- Blanquerna School of Health Science (FCS), Ramon Llull University, Barcelona, Spain; Global Research on Wellbeing (GRoW) Research Group, Ramon Llull University, Barcelona, Spain
| | - Azahara Fort-Vanmeerhaeghe
- Blanquerna School of Health Science (FCS), Ramon Llull University, Barcelona, Spain; Blanquerna Faculty of Psychology, Education Sciences and Sport (FPCEE), Ramon Llull University, Barcelona, Spain
| | - Carles Fernández
- Blanquerna School of Health Science (FCS), Ramon Llull University, Barcelona, Spain; Global Research on Wellbeing (GRoW) Research Group, Ramon Llull University, Barcelona, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Gerard Urrútia
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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A Bayesian analysis of non-significant rehabilitation findings: Evaluating the evidence in favour of truly absent treatment effects. Ann Phys Rehabil Med 2020; 64:101425. [PMID: 32805456 DOI: 10.1016/j.rehab.2020.07.008] [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: 03/28/2020] [Revised: 05/06/2020] [Accepted: 07/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Relying solely on null hypothesis significance testing (NHST) to investigate rehabilitation interventions may result in researchers erroneously concluding the absence of a treatment effect. OBJECTIVE We aimed to distinguish between truly null treatment effects and data that are insensitive to detecting treatment effects by calculating Bayes factors (BF01s) for non-significant findings in the rehabilitation literature. Additionally, to examine associations between BF01, sample size, and observed P-values. METHOD We searched the Cochrane Database of Systematic Reviews for meta-analyses with "rehabilitation" as a keyword that clearly evaluated a rehabilitation intervention. We extracted means, standard deviations, and sample sizes for treatment and comparison groups for individual findings within 175 meta-analyses. Two independent investigators classified the interventions into 4 categories using the Rehabilitation Treatment Specification System. We calculated t-statistics and associated P-values for each finding in order to extract non-significant results (P>0.05). We calculated BF01s for 5790 non-significant results and classified BF01s based on the strength of evidence in favour of the null hypothesis (i.e., anecdotal, moderate, and strong) across and within intervention types. We examined correlations between BF01, sample size, and P-values across and within intervention types. RESULTS Across all intervention types, most (71.9%) findings were deemed anecdotal, and this pattern remained within distinct intervention types (58.4-76.0%). Larger sample sizes tended to be associated with greater strength in favour of the null hypothesis, both across and within intervention types. Larger P-values were not associated with greater strength in favour of the null hypothesis; this finding was present both across and within intervention types. CONCLUSION Our findings indicate that most non-significant rehabilitation findings are unable to distinguish between the true absence of a treatment effect and data that are merely insensitive to detecting a treatment effect. Findings also suggest that rehabilitation researchers may improve the strength of their statistical conclusions by increasing sample size and that Bayes factors may offer unique benefits relative to P-values.
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Chua LK, Wulf G, Lewthwaite R. Choose your words wisely: Optimizing impacts on standardized performance testing. Gait Posture 2020; 79:210-216. [PMID: 32442896 DOI: 10.1016/j.gaitpost.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/19/2020] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The OPTIMAL theory of motor learning identifies motivational (enhanced expectancies, EE, and autonomy support, AS) and attentional (an external attentional focus, EF) factors that affect motor performance and learning [1]. One implication of this theory is that standardized clinical and laboratory assessments of physical capacity and motor performance that do not incorporate optimizing conditions may underestimate true maximal capabilities. The influence of "optimized" conditions on a clinical-applied test of balance control was examined with healthy participants. Given the motor performance benefits of optimized conditions predicted by the OPTIMAL theory, it was hypothesized that providing participants with information that induced EE, provided them with AS, and promoted their use of EF would reduce balance errors and postural sway. METHODS We used as an exemplar assessment, the Balance Error Scoring System (BESS), and center-of-pressure (COP) velocity measurements of postural sway. Participants performed under two different conditions, separated by two days: an optimized (EE, AS, and EF) condition and a control ("neutral") condition, with sample-wide order counterbalancing. In each condition, participants performed three stances (double-leg, single-leg, and tandem) on two support surfaces (firm and foam). Stance order was participant-determined in the optimized condition and, for the control condition, yoked to a participant in the optimized condition. RESULTS Participants committed fewer balance errors in the optimized condition than in the control condition (p < .001) and their resultant COP velocity in the optimized condition was lower than that in the control condition (p = .004). BESS scores were correlated with resultant COP velocity (r = .593, p < .001). SIGNIFICANCE Our results demonstrated the impact of implementing optimized, as opposed to "neutral" control, conditions for better insight into balance capabilities in normal and challenging situations. Practitioners' roles in mediating test situations and using subtle wording to promote optimized performance may have consequential impacts on motor assessment outcomes.
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Affiliation(s)
- Lee-Kuen Chua
- Neurorestoration Center, University of Southern California, Los Angeles, CA, USA; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Gabriele Wulf
- Department of Kinesiology and Nutrition Services, University of Nevada, Las Vegas, NV, USA
| | - Rebecca Lewthwaite
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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Kinney AR, Eakman AM, Graham JE. Novel Effect Size Interpretation Guidelines and an Evaluation of Statistical Power in Rehabilitation Research. Arch Phys Med Rehabil 2020; 101:2219-2226. [PMID: 32272106 DOI: 10.1016/j.apmr.2020.02.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE First, to establish empirically-based effect size interpretation guidelines for rehabilitation treatment effects. Second, to evaluate statistical power in rehabilitation research. DATA SOURCES The Cochrane Database of Systematic Reviews was searched through June 2019. STUDY SELECTION Meta-analyses included in the Cochrane Database of Systematic Reviews with "rehabilitation" as a keyword and clearly evaluated a rehabilitation intervention. DATA EXTRACTION We extracted Cohen's d effect sizes and associated sample sizes for treatment and comparison groups. Two independent investigators classified the interventions into 4 categories using the Rehabilitation Treatment Specification System. The 25th, 50th, and 75th percentile values within the effect size distribution were used to establish interpretation guidelines for small, medium, and large effects, respectively. A priori power analyses established sample sizes needed to detect the empirically-based values for small, medium, and large effects. Post-hoc power analyses using median sample sizes revealed whether the "typical" rehabilitation study was sufficiently powered to detect the empirically-based values. Post hoc power analyses established the statistical power of each test based on the sample size and reported effect size. DATA SYNTHESIS We analyzed 3381 effect sizes extracted from 99 meta-analyses. Interpretation guidelines for small effects ranged from 0.08 to 0.15; medium effects ranged from 0.19 to 0.36; and large effects ranged from 0.41 to 0.67. We present sample sizes needed to detect these values based on a priori power analyses. Post hoc power analyses revealed that a "typical" rehabilitation study lacks sufficient power to detect the empirically-based values. Post hoc power analyses using reported sample sizes and effects indicated the studies were underpowered, with median power ranging from 0.14 to 0.23. CONCLUSIONS This study presented novel and empirically-based interpretation guidelines for small, medium, and large rehabilitation treatment effects. The observed effect size distributions differed across intervention categories, indicating that researchers should use category-specific guidelines. Furthermore, many published rehabilitation studies are underpowered.
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Affiliation(s)
- Adam R Kinney
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Aaron M Eakman
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado
| | - James E Graham
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado
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Nuara A, Avanzini P, Rizzolatti G, Fabbri-Destro M. Efficacy of a home-based platform for child-to-child interaction on hand motor function in unilateral cerebral palsy. Dev Med Child Neurol 2019; 61:1314-1322. [PMID: 31115046 DOI: 10.1111/dmcn.14262] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 12/19/2022]
Abstract
AIM To evaluate the feasibility and effectiveness of an action observation treatment (AOT) home-based platform promoting child-to-child interaction to improve hand motor function in unilateral cerebral palsy (CP). METHOD Twenty children (14 males, six females; mean age 6y 7mo, standard deviation 1y 7mo; range 5y 1mo-10y 6mo) with unilateral CP underwent 20 sessions where they had to observe and then imitate a wizard performing dexterity-demanding magic tricks; a child-to-child live video-session to practise the same exercise then took place. We assessed hand-motor skills with the Besta Scale, neurological motor impairment with Fugl-Meyer Assessment for upper extremity, as well as spasticity, muscle strength, visual analogue scale, and global impression of change 1-month before (T-1), at baseline (T0), and at the end of treatment (T1). RESULTS We observed a T0 to T1 improvement in global hand-motor and bimanual skills, and a significant correlation between motor improvement and difference in hand motor skills relative to the peer (r=-0.519). INTERPRETATION AOT associated with child-to-child interaction effectively improves hand motor function in unilateral CP. This improvement is linked to differences in hand motor ability among peers, suggesting that children should observe others with superior motor skills to their own. This study extends traditional AOT toward novel socially-enriched scenarios, where children might simultaneously be recipients and leaders within a motor learning process. WHAT THIS PAPER ADDS Home-based action observation treatment (AOT) based on child-to-child interaction improves hand motor function in children with unilateral cerebral palsy. Interaction with a more capable peer increases the chances of positive outcome in child-to-child AOT.
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Affiliation(s)
- Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy.,Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
| | - Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
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Estival S, Krasny-Pacini A, Laurier V, Maugard C, Thuilleaux D, Postal V. Cognitive Training Targeting Planning Dysfunction in Adults with Prader-Willi Syndrome: Brief Report of a Study Protocol. Dev Neurorehabil 2019; 22:569-575. [PMID: 31355692 DOI: 10.1080/17518423.2019.1642414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Prader-Willi syndrome (PWS) is a neurodevelopmental genetic disorder involving executive deficits notably with planning. The main objective of the study is to assess the effectiveness of cognitive training on daily life planning difficulties in PWS patients. Methods/design: The study is a double-blind randomized controlled trial which will compare the effectiveness of a metacognitive strategy intervention designed to improve planning difficulties for PWS patients to usual occupational therapy. Sixty adults will be included over 20 months. The main outcome measure will be the performance on the Modified Six Elements Test from the BADS; secondary outcome measures will be computerized executive tasks and questionnaires. Daily life planning difficulties will be identified and transformed into measurable goals using Goal Attainment Scaling. Discussion: The project will provide knowledge on the difficulties experienced by PWS patients, in relation to their executive functioning in order to implement effective intervention for planning in daily life.
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Affiliation(s)
| | - Agata Krasny-Pacini
- Institut Universitaire de Réadaptation Clemenceau , Strasbourg , France.,Unité INSERM 1114 Neuropsychologie Cognitive et Physiopathologie de la Schizophrénie , Strasbourg , France.,Hôpitaux Universitaires Pitié-Salpêtière-Charles Foix, GRC n°18 , Paris , France
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Peach RK, Beck KM, Gorman M, Fisher C. Clinical Outcomes Following Language-Specific Attention Treatment Versus Direct Attention Training for Aphasia: A Comparative Effectiveness Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2785-2811. [PMID: 31348732 DOI: 10.1044/2019_jslhr-l-18-0504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose This study was conducted to examine the comparative effectiveness of 2 different approaches, 1 domain-specific and the other domain-general, to language and attention rehabilitation in participants with stroke-induced aphasia. The domain-specific treatment consisted of language-specific attention treatment (L-SAT), and the domain-general treatment consisted of direct attention training (DAT) using the computerized exercises included in Attention Process Training-3 (Sohlberg & Mateer, 2010). Method Four individuals with mild-moderate aphasia participated in this study. A randomized controlled cross-over single-subject design was used to assess the effectiveness of the 2 treatments administered in this study. Treatment outcomes were evaluated in terms of participants' task performance for each program, standardized language and attention measures, tests of functional abilities, and patient-reported outcomes. Results Visual comparisons demonstrated linear improvements following L-SAT and variable patterns following DAT. Omnibus effect sizes were statistically significant for 9 of the 13 L-SAT tasks. The weighted standardized effect sizes for posttreatment changes following L-SAT ranged from small to large, with the exception of 1 task. The average group gain following DAT was 5%. The Western Aphasia Battery-Revised Aphasia Quotients (Kertesz, 2007) demonstrated reliable improvements for 3 of the 4 participants following L-SAT, whereas only 1 of the participants improved reliably following DAT. The margins of improvements in functional language were substantially larger following L-SAT than DAT. Performance on the Test of Everyday Attention improved significantly for 2 participants following L-SAT and for 1 participant following DAT on selected Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994) subtests. Patient-reported outcomes for communication and attention following treatment favored L-SAT compared to DAT. Conclusions The results support the view that attention is allocated in ways that are particular to specific tasks rather than as a general resource that is allocated equivalently to all processing tasks. Domain-specific treatment for language deficits due to attentional impairment appears to be a suitable, if not preferable, approach for aphasia rehabilitation. Supplemental Material https://doi.org/10.23641/asha.8986427.
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Affiliation(s)
- Richard K Peach
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
| | - Katherine M Beck
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
| | - Michelle Gorman
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
| | - Christine Fisher
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
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Ribeiro DC, Abbott JH, Sharma S, Lamb SE. Process evaluation of complex interventions tested in randomised controlled trials in musculoskeletal disorders: a systematic review protocol. BMJ Open 2019; 9:e028160. [PMID: 31110107 PMCID: PMC6530329 DOI: 10.1136/bmjopen-2018-028160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/27/2019] [Accepted: 04/05/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The effectiveness of complex interventions for the management of musculoskeletal disorders has been estimated in many randomised clinical trials (RCTs). These trials inform which interventions are the most effective, however they do not always inform how an intervention achieved its clinical outcomes, nor how and what elements of an intervention were delivered to patients. Such information is useful for translating findings into clinical practice. A few process evaluation studies have been conducted alongside RCTs and a variety of methods have been used. To gain a better understanding of current practices of process evaluation in RCTs in musculoskeletal disorders, this systematic review is designed to answer the following research question: How are process evaluation of complex interventions tested in RCTs in musculoskeletal disorders being conducted? METHODS AND ANALYSIS We will systematically search seven electronic databases (MEDLINE, SCOPUS, CINAHL, PsycINFO, EMBASE, Web of Science and Cochrane database) from the date of inception to August 2018 for studies on process evaluation of RCTs on non-surgical and non-pharmacological management of musculoskeletal disorders. We will include qualitative and quantitative studies conducted alongside RCTs, reported with the RCTs or separate studies that assessed interventions for musculoskeletal disorders. Two reviewers will screen abstracts and apply prespecified inclusion criteria to identify relevant studies, extract the data and assess the risk of bias within included studies. We will follow recommendations from the 'Cochrane Qualitative and Implementation Methods Group Guidance Series' when assessing methodological strengths and limitations of included studies. We will use a narrative synthesis to describe findings. ETHICS AND DISSEMINATION Ethical approval is not required as this review will not collect original data. Findings from this systematic review will be presented at a scientific conference and published in a peer reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018109600.
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Affiliation(s)
- Daniel C Ribeiro
- School of Physiotherapy, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
- Orthopedic Surgery Section, Department of Surgical Sciences, University of Otago Dunedin School of Medicine, Dunedin, Otago, New Zealand
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Masterson-Algar P, Burton CR, Rycroft-Malone J. The generation of consensus guidelines for carrying out process evaluations in rehabilitation research. BMC Med Res Methodol 2018; 18:180. [PMID: 30594133 PMCID: PMC6311071 DOI: 10.1186/s12874-018-0647-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although in recent years there has been a strong increase in published research on theories (e.g. realist evaluation, normalization process theory) driving and guiding process evaluations of complex interventions, there is limited guidance to help rehabilitation researchers design and carry out process evaluations. This can lead to the risk of process evaluations being unsystematic. This paper reports on the development of new consensus guidelines that address the specific challenges of conducting process evaluations alongside clinical trials of rehabilitation interventions. METHODS A formal consensus process was carried out based on a modified nominal group technique, which comprised two phases. Phase I was informed by the findings of a systematic review, and included a nominal group meeting with an expert panel of participants to rate and discuss the proposed statements. Phase II was an in depth semi-structured telephone interviews with expert panel participants in order to further discuss the structure and contents of the revised guidelines. Frequency of rating responses to each statement was calculated and thematic analysis was carried out on all qualitative data. RESULTS The guidelines for carrying out process evaluations within complex intervention rehabilitation research were produced by combining findings from Phase I and Phase II. The consensus guidelines include recommendations that are grouped in seven sections. These sections are theoretical work, design and methods, context, recruitment and retention, intervention staff, delivery of the intervention and results. These sections represent different aspects or stages of the evaluation process. CONCLUSION The consensus guidelines here presented can play a role at assisting rehabilitation researchers at the time of designing and conducting process evaluations alongside trials of complex interventions. The guidelines break new ground in terms of concepts and theory and works towards a consensus in regards to how rehabilitation researchers should go about carrying out process evaluations and how this evaluation should be linked into the proposed trials. These guidelines may be used, adapted and tested by rehabilitation researchers depending on the research stage or study design (e.g. feasibility trial, pilot trial, etc.).
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Affiliation(s)
- P. Masterson-Algar
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - C. R. Burton
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - J. Rycroft-Malone
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
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Kamwesiga JT, Eriksson GM, Tham K, Fors U, Ndiwalana A, von Koch L, Guidetti S. A feasibility study of a mobile phone supported family-centred ADL intervention, F@ce™, after stroke in Uganda. Global Health 2018; 14:82. [PMID: 30111333 PMCID: PMC6094578 DOI: 10.1186/s12992-018-0400-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023] Open
Abstract
Background There is a lack of evidence-based health services to reduce the impact of stroke in low-income countries at a personal, family or community level. The aim was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention (F@ce™), and ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke; perceived participation in everyday life; and self-efficacy in everyday activities amongst persons with stroke and their families in Uganda. Methods The study comprised a pre-post design with an intervention group (IG) receiving the F@ce™ and a control group (CG). The inclusion criteria’s were: a) confirmed stroke diagnosis, b) access to and ability to use a mobile phone, c) ability to communicate in English and/or Luganda, d) > 18 years, e) residents in Kampala, and f) a Modified Rankin Scale level 2 to 4. The aim of the F@ceTM was to increase functioning in daily activities for persons living with the consequences of stroke, and participation in everyday life for persons with stroke and their families. The F@ce™ was an eight-week family-centred intervention, which entailed goal setting and problem-solving strategies, daily reminders and self-rated follow-ups of performance by short message service (SMS). Data were collected in the participants’ home environment at baseline and after eight weeks. Data on acceptability of the F@ce™ and study procedures were collected by log-books and the responses of the SMS follow ups on the server. The primary outcomes were performance and satisfaction of valued daily activities in everyday life using the Canadian Occupational Performance Measure (COPM), self-efficacy in performance of activities in daily life. Results The IG comprised n = 13 and the CG n = 15. There were differences between the IG and CG in changes between baseline and follow-up in the primary outcomes COPM (performance component) and self-efficacy in favour of F@ce™. Overall with minor modifications the intervention and the study design were feasible for all participants involved. Conclusion The results support the need for further research to rigorously evaluate the effects of F@ce™ since the intervention appears to be feasible for persons with stroke and their family members. Electronic supplementary material The online version of this article (10.1186/s12992-018-0400-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julius T Kamwesiga
- Division of Occupational therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Uganda Allied Health Examinations Board, Kampala, Uganda
| | - Gunilla M Eriksson
- Division of Occupational therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Rehabilitation medicine, Uppsala University, Uppsala, Sweden
| | - Kerstin Tham
- Division of Occupational therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Malmö University, Malmö, Sweden
| | - Uno Fors
- Department of Computer and Systems Sciences (DSV), Stockholm University, Stockholm, Sweden
| | | | - Lena von Koch
- Division of Occupational therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Guidetti
- Division of Occupational therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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A mapping review of randomized controlled trials in the spinal cord injury research literature. Spinal Cord 2018; 56:725-732. [DOI: 10.1038/s41393-018-0155-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022]
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Dunn W, Little LM, Pope E, Wallisch A. Establishing Fidelity of Occupational Performance Coaching. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 38:96-104. [PMID: 28821218 DOI: 10.1177/1539449217724755] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As the call for evidence-based practices has risen, discussions about the fidelity of those practices have received increased attention. Although research suggests that Occupational Performance Coaching (OPC) is effective, a systematic evaluation of the fidelity of OPC is needed. The purpose of this study was to test fidelity of OPC intervention through study design, training, monitoring, and intervention receipt, and to offer the structure from this study as a guide for other programs of research and practice. As part of a trial of OPC with n = 17 families of children with autism spectrum disorder, we measured specific elements of fidelity during the study intervention design, training, delivery, and receipt as outlined by Gearing et al. We established fidelity of OPC design and training from the study data. Transcription and analysis of 40% of intervention sessions showed that we maintained fidelity during intervention delivery and receipt. This study reports on the evidence of the fidelity of OPC and provides fidelity standards for OPC for occupational therapy practice and research applications.
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Affiliation(s)
- Winnie Dunn
- 1 University of Missouri, Columbia, MO, USA.,2 University of Kansas, Kansas City, KS, USA.,3 Dunn & Pope-Strengths-Based Coaching, Sante Fe, NM, USA
| | - Lauren M Little
- 2 University of Kansas, Kansas City, KS, USA.,4 Rush University, Chicago, IL, USA
| | - Ellen Pope
- 2 University of Kansas, Kansas City, KS, USA.,3 Dunn & Pope-Strengths-Based Coaching, Sante Fe, NM, USA
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Engel L, Chui A, Goverover Y, Dawson DR. Optimising activity and participation outcomes for people with self-awareness impairments related to acquired brain injury: an interventions systematic review. Neuropsychol Rehabil 2017; 29:163-198. [DOI: 10.1080/09602011.2017.1292923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Lisa Engel
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Adora Chui
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Yael Goverover
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Deirdre R. Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Richardson JD, Hudspeth Dalton SG, Shafer J, Patterson J. Assessment Fidelity in Aphasia Research. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:S788-S797. [PMID: 27997953 PMCID: PMC7212813 DOI: 10.1044/2016_ajslp-15-0146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/15/2016] [Accepted: 06/13/2016] [Indexed: 05/14/2023]
Abstract
Purpose In aphasia treatment literature, scarce attention is paid to factors that may reduce a study's validity, including adherence to assessment and treatment procedures (i.e., fidelity). Although guidelines have been established for evaluating and reporting treatment fidelity, none exist for assessment fidelity. Method We reviewed treatment fidelity guidelines and related literature to identify assessment fidelity components. We then examined 88 aphasia treatment studies published between 2010 and 2015 and report the frequency with which researchers provide information regarding the following assessment fidelity components: assessment instruments, assessor qualifications, assessor or rater training, assessment delivery, assessor or rater reliability, and assessor blinding. Results We found that 4.5% of studies reported information regarding assessment instruments, 35.2% reported information regarding assessor qualifications, 6.85% reported information regarding assessor or rater training, 37.5% reported information regarding assessor or rater reliability, 27.3% reported on assessor blinding, and no studies reported information regarding assessment delivery. Conclusions There is a paucity of assessment fidelity information reported in aphasia treatment research. The authors propose a set of guidelines to ensure readers will be able to evaluate assessment fidelity, and thus study validity.
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Effects on Balance and Walking with the CoDuSe Balance Exercise Program in People with Multiple Sclerosis: A Multicenter Randomized Controlled Trial. Mult Scler Int 2016; 2016:7076265. [PMID: 28042485 PMCID: PMC5155099 DOI: 10.1155/2016/7076265] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/30/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Balance and walking impairments are frequent in people with multiple sclerosis (MS). Objective. The aim was to investigate the effects of a group-based balance exercise program targeting core stability, dual tasking, and sensory strategies (CoDuSe) on balance, postural sway, walking, perceived walking limitations, and balance confidence. Design. A single-blinded randomized multicenter trial. No intervention was given to controls. Participants. People with MS able to walk 100 meters but unable to maintain tandem stance ≥30 seconds. Eighty-seven participants were randomized to intervention or control. Intervention. The 60-minute CoDuSe group program, twice weekly for seven weeks, supervised by physical therapists. Measurements. Primary outcome was dynamic balance (Berg Balance Scale (BBS)). Secondary outcomes were postural sway, walking (Timed-Up and Go test; Functional Gait Assessment (FGA)), MS Walking Scale, and Activities-specific Balance Confidence (ABC) Scale. Assessments were performed before and after (week 8) the intervention. Results. 73 participants fulfilled the study. There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures: postural sway with eyes open, FGA, MS Walking Scale, and ABC scale in favor of the intervention. Conclusions. The seven-week CoDuSe program improved dynamic balance more than no intervention.
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Masterson-Algar P, Burton CR, Rycroft-Malone J. Process evaluations in neurological rehabilitation: a mixed-evidence systematic review and recommendations for future research. BMJ Open 2016; 6:e013002. [PMID: 28186944 PMCID: PMC5129134 DOI: 10.1136/bmjopen-2016-013002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/23/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To systematically review how process evaluations are currently designed, what methodologies are used and how are they developed alongside or within neurological rehabilitation trials. METHODS This mixed-methods systematic review had two evidence streams: stream I, studies reporting process evaluations alongside neurorehabilitation trials research and stream II, methodological guidance on process evaluation design and methodology. A search strategy was designed for each evidence stream. Data regarding process evaluation core concepts and design issues were extracted using a bespoke template. Evidence from both streams was analysed separately and then synthesised in a final overarching synthesis proposing a number of recommendations for future research. RESULTS A total of 124 process evaluation studies, reporting on 106 interventions, were included in stream I evidence. 30 studies were included as stream II evidence. Synthesis 1 produced 9 themes, and synthesis 2 identified a total of 8 recommendations for process evaluation research. The overall synthesis resulted in 57 'synthesis recommendations' about process evaluation methodology grouped into 9 research areas, including the use of theory, the investigation of context, intervention staff characteristics and the delivery of the trial intervention. CONCLUSIONS There remains no consensus regarding process evaluation terminology within the neurological rehabilitation field. There is a need for process evaluations to address the nature and influence of context over time. Process evaluations should clearly describe what intervention staff bring to a trial, including skills and experience prior to joining the research. Process evaluations should monitor intervention staff's learning effects and the possible impact that these may have on trial outcomes.
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Jesus TS. Systematic Reviews and Clinical Trials in Rehabilitation: Comprehensive Analyses of Publication Trends. Arch Phys Med Rehabil 2016; 97:1853-1862.e2. [DOI: 10.1016/j.apmr.2016.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
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Valero-Cuevas FJ, Klamroth-Marganska V, Winstein CJ, Riener R. Robot-assisted and conventional therapies produce distinct rehabilitative trends in stroke survivors. J Neuroeng Rehabil 2016; 13:92. [PMID: 27724916 PMCID: PMC5057463 DOI: 10.1186/s12984-016-0199-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/01/2016] [Indexed: 02/02/2023] Open
Abstract
Background Comparing the efficacy of alternative therapeutic strategies for the rehabilitation of motor function in chronically impaired individuals is often inconclusive. For example, a recent randomized clinical trial (RCT) compared robot-assisted vs. conventional therapy in 77 patients who had had chronic motor impairment after a cerebrovascular accident. While patients assigned to robotic therapy had greater improvements in the primary outcome measure (change in score on the upper extremity section of the Fugl-Meyer assessment), the absolute difference between therapies was small, which left the clinical relevance in question. Methods Here we revisit that study to test whether the multidimensional rehabilitative response of these patients can better distinguish between treatment outcomes. We used principal components analysis to find the correlation of changes across seven outcome measures between the start and end of 8 weeks of therapy. Permutation tests verified the robustness of the principal components found. Results Each therapy in fact produces different rehabilitative trends of recovery across the clinical, functional, and quality of life domains. A rehabilitative trend is a principal component that quantifies the correlations among changes in outcomes with each therapy. Conclusions These findings challenge the traditional emphasis of RCTs on using a single primary outcome measure to compare rehabilitative responses that are naturally multidimensional. This alternative approach to, and interpretation of, the results of RCTs may will lead to more effective therapies targeted for the multidimensional mechanisms of recovery. Trial registration ClinicalTrials.gov number NCT00719433. Registered July 17, 2008. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0199-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francisco J Valero-Cuevas
- Department of Biomedical Engineering, University of Southern California, 3710 McClintock Ave, RTH 404, Los Angeles, CA, 90089-2905, USA. .,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | | | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Robert Riener
- ETH Zurich and University of Zurich, Zurich, Switzerland
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Vaughan-Graham J, Cott C. Defining a Bobath clinical framework – A modified e-Delphi study. Physiother Theory Pract 2016; 32:612-627. [DOI: 10.1080/09593985.2016.1228722] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Julie Vaughan-Graham
- Department of Physical Therapy, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
| | - Cheryl Cott
- Department of Physical Therapy, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
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Schneider JC, Ozsecen MY, Muraoka NK, Mancinelli C, Della Croce U, Ryan CM, Bonato P. Feasibility of an Exoskeleton-Based Interactive Video Game System for Upper Extremity Burn Contractures. PM R 2015; 8:445-52. [PMID: 26409198 DOI: 10.1016/j.pmrj.2015.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Burn contractures are common and difficult to treat. Measuring continuous joint motion would inform the assessment of contracture interventions; however, it is not standard clinical practice. This study examines use of an interactive gaming system to measure continuous joint motion data. OBJECTIVE To assess the usability of an exoskeleton-based interactive gaming system in the rehabilitation of upper extremity burn contractures. DESIGN Feasibility study. SETTING Eight subjects with a history of burn injury and upper extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility. METHODS Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play. MAIN OUTCOME MEASURES Visual analog scale for engagement, difficulty and comfort. Angular range of motion by subject, joint, and game. RESULTS The study population had an age of 43 ± 16 (mean ± standard deviation) years and total body surface area burned range of 10%-90%. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game. CONCLUSIONS This study demonstrates the feasibility of use of an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors.
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Affiliation(s)
- Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Boston, MA 02129(∗).
| | - Muzaffer Y Ozsecen
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(†)
| | - Nicholas K Muraoka
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(‡)
| | - Chiara Mancinelli
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(§)
| | - Ugo Della Croce
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA; and Università degli Studi di Sassari, Dipartimento di Scienze Politiche, Scienze della Comunicazione e Ingegneria, Sassari, Italy(¶)
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School; and Shriners Hospitals for Children, Boston, MA(#)
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(‖)
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Lawrence EL, Dayanidhi S, Fassola I, Requejo P, Leclercq C, Winstein CJ, Valero-Cuevas FJ. Outcome measures for hand function naturally reveal three latent domains in older adults: strength, coordinated upper extremity function, and sensorimotor processing. Front Aging Neurosci 2015; 7:108. [PMID: 26097455 PMCID: PMC4456581 DOI: 10.3389/fnagi.2015.00108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/21/2015] [Indexed: 01/10/2023] Open
Abstract
Understanding the mapping between individual outcome measures and the latent functional domains of interest is critical to a quantitative evaluation and rehabilitation of hand function. We examined whether and how the associations among six hand-specific outcome measures reveal latent functional domains in elderly individuals. We asked 66 healthy older adult participants (38F, 28M, 66.1 ± 11.6 years, range: 45–88 years) and 33 older adults (65.8 ± 9.7 years, 44–81 years, 51 hands) diagnosed with osteoarthritis (OA) of the carpometacarpal (CMC) joint, to complete six functional assessments: hand strength (Grip, Key and Precision Pinch), Box and Block, Nine Hole Pegboard, and Strength-Dexterity tests. The first three principal components suffice to explain 86% of variance among the six outcome measures in healthy older adults, and 84% of variance in older adults with CMC OA. The composition of these dominant associations revealed three distinct latent functional domains: strength, coordinated upper extremity function, and sensorimotor processing. Furthermore, in participants with thumb CMC OA we found a blurring of the associations between the latent functional domains of strength and coordinated upper extremity function. This motivates future work to understand how the physiological effects of thumb CMC OA lead upper extremity coordination to become strongly associated with strength, while dynamic sensorimotor ability remains an independent functional domain. Thus, when assessing the level of hand function in our growing older adult populations, it is particularly important to acknowledge its multidimensional nature—and explicitly consider how each outcome measure maps to these three latent and fundamental domains of function. Moreover, this ability to distinguish among latent functional domains may facilitate the design of treatment modalities to target the rehabilitation of each of them.
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Affiliation(s)
- Emily L Lawrence
- Brain-Body Dynamics Laboratory, Department of Biomedical Engineering, University of Southern California Los Angeles, CA, USA
| | - Sudarshan Dayanidhi
- Brain-Body Dynamics Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California Los Angeles, CA, USA
| | | | - Philip Requejo
- Rancho Los Amigos National Rehabilitation Center Downey, CA, USA
| | | | - Carolee J Winstein
- Brain-Body Dynamics Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California Los Angeles, CA, USA
| | - Francisco J Valero-Cuevas
- Brain-Body Dynamics Laboratory, Department of Biomedical Engineering, University of Southern California Los Angeles, CA, USA ; Brain-Body Dynamics Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California Los Angeles, CA, USA
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47
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Skidmore ER. Training to Optimize Learning after Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015; 3:99-105. [PMID: 26217546 PMCID: PMC4514532 DOI: 10.1007/s40141-015-0081-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
One of the major foci of rehabilitation after traumatic brain injury is the design and implementation of interventions to train individuals to learn new knowledge and skills or new ways to access and execute previously acquired knowledge and skills. To optimize these interventions, rehabilitation professionals require a clear understanding of how traumatic brain injury impacts learning, and how specific approaches may enhance learning after traumatic brain injury. This brief conceptual review provides an overview of learning, the impact of traumatic brain injury on explicit and implicit learning, and the current state of the science examining selected training approaches designed to advance learning after traumatic brain injury. Potential directions for future scientific inquiry are discussed throughout the review.
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Affiliation(s)
- Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, Telephone: (412) 383-6617, Telefax: (412) 383-6613
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48
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Jesus TS, Silva IL. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes. Clin Rehabil 2015; 30:315-28. [DOI: 10.1177/0269215515585133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/12/2015] [Indexed: 12/20/2022]
Abstract
Background: There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Methods: Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. Results: After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. Discussion: This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.
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Affiliation(s)
- Tiago Silva Jesus
- Health Psychology Department, Medical School, Universidad Miguel Hernández, Elche, Spain
- Universidade Fernando Pessoa, Oporto, Portugal
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49
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Winstein CJ, Kay DB. Translating the science into practice: shaping rehabilitation practice to enhance recovery after brain damage. PROGRESS IN BRAIN RESEARCH 2015; 218:331-60. [PMID: 25890145 DOI: 10.1016/bs.pbr.2015.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The revolution in neuroscience provided strong evidence for learning-dependent neuroplasticity and presaged the role of motor learning as essential for restorative therapies after stroke and other disabling neurological conditions. The scientific basis of motor learning has continued to evolve from a dominance of cognitive or information processing perspectives to a blend with neural science and contemporary social-cognitive-psychological science, which includes the neural and psychological underpinnings of motivation. This transformation and integration across traditionally separate domains is timely now that clinician scientists are developing novel, evidence-based therapies to maximize motor recovery in the place of suboptimal solutions. We will review recent evidence pertaining to therapeutic approaches that spring from an integrated framework of learning-dependent neuroplasticity along with the growing awareness of protocols that directly address the patient's fundamental psychological needs. Of importance, there is mounting evidence that when the individual's needs are considered in the context of instructions or expectations, the learning/rehabilitation process is accelerated.
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Affiliation(s)
- Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, Los Angeles, CA, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.
| | - Dorsa Beroukhim Kay
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, Los Angeles, CA, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.
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50
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Connolly B, Thompson A, Douiri A, Moxham J, Hart N. Exercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit-acquired weakness: A pilot feasibility trial. J Crit Care 2015; 30:589-98. [PMID: 25703957 PMCID: PMC4416081 DOI: 10.1016/j.jcrc.2015.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/05/2015] [Accepted: 02/04/2015] [Indexed: 02/07/2023]
Abstract
Purpose The aim of this study was to investigate feasibility of exercise-based rehabilitation delivered after hospital discharge in patients with intensive care unit–acquired weakness (ICU-AW). Materials and methods Twenty adult patients, mechanically ventilated for more than 48 hours, with ICU-AW diagnosis at ICU discharge were included in a pilot feasibility randomized controlled trial receiving a 16-session exercise-based rehabilitation program. Twenty-one patients without ICU-AW participated in a nested observational cohort study. Feasibility, clinical, and patient-centered outcomes were measured at hospital discharge and at 3 months. Results Intervention feasibility was demonstrated by high adherence and patient acceptability, and absence of adverse events, but this must be offset by the low proportion of enrolment for those screened. The study was underpowered to detect effectiveness of the intervention. The use of manual muscle testing for the diagnosis of ICU-AW lacked robustness as an eligibility criterion and lacked discrimination for identifying rehabilitation requirements. Process evaluation of the trial identified methodological factors, categorized by “population,” “intervention,” “control group,” and “outcome.” Conclusions Important data detailing the design, conduct, and implementation of a multicenter randomized controlled trial of exercise-based rehabilitation for survivors of critical illness after hospital discharge have been reported. Registration Clinical Trials Identifier NCT00976807
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Affiliation(s)
- Bronwen Connolly
- Department of Asthma, Allergy & Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK; Guy's & St Thomas' NHS Foundation Trust and King's College London, National Institutes of Health Research Biomedical Research Centre, London, UK; Lane Fox Clinical Respiratory Physiology Research Unit, St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK.
| | - April Thompson
- Lane Fox Clinical Respiratory Physiology Research Unit, St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Abdel Douiri
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - John Moxham
- Department of Asthma, Allergy & Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Nicholas Hart
- Department of Asthma, Allergy & Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK; Guy's & St Thomas' NHS Foundation Trust and King's College London, National Institutes of Health Research Biomedical Research Centre, London, UK; Lane Fox Clinical Respiratory Physiology Research Unit, St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
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