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Thompson C, Moss SA, Hooper ME, Kurz E, Ladbrook E, Bushell M. The healthcare experience of young stroke survivors: an interpretative phenomenological study. Disabil Rehabil 2024:1-8. [PMID: 39370756 DOI: 10.1080/09638288.2024.2410989] [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: 12/19/2023] [Revised: 09/20/2024] [Accepted: 09/21/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE While stroke is becoming increasingly prevalent in young people (<65 years), diagnosis, treatment, rehabilitation, and management continue to reflect the needs of older people. This study aimed to characterise and appreciate the healthcare experiences of young stroke survivors, whose needs and trajectories differ from those of older people. MATERIALS AND METHODS Qualitative in-depth semi-structured interviews were conducted with 11 stroke survivors aged 18-49 using virtual conferencing software. The data were analysed using interpretative phenomenological analysis. RESULTS Four main themes were identified that reflect the experiences and needs of young stroke survivors and are (1) The health system overlooks the experiences and needs of young stroke survivors; (2) Support is fragmented rather than holistic; (3) Feelings of helplessness at a time agency is required; and (4) Positive attitudes despite challenges. CONCLUSIONS The experiences of young stroke survivors are distinct. Health services that consider the unique trajectories of young stroke survivors will better facilitate rehabilitation and support for this population.
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Affiliation(s)
- Claire Thompson
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Simon Andrew Moss
- Graduate Research School, University of Wollongong, Wollongong, Australia
| | | | - Ella Kurz
- Faculty of Health, University of Canberra, Canberra, Australia
- Australian National University, Canberra, Australia
| | - Elyse Ladbrook
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Mary Bushell
- Faculty of Health, University of Canberra, Canberra, Australia
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Power E, Morrow R. Digital, co-created implementation of communication partner training programs for stroke, brain injury, and dementia: Past, present, and future. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:317-333. [PMID: 38962904 DOI: 10.1080/17549507.2024.2362856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE Communication partner training is a recommended intervention for partners of people with acquired brain injury. In this paper we explore the past, present, and future of communication partner training (CPT) based on our 2023 Speech Pathology Australia national conference address. METHOD We focus on our research team's contributions, and highlight research knowledge across stroke, traumatic brain injury (TBI), and dementia. This work is anchored in the voice of people with communication disability. One partner in the CPT journey, Rosey Morrow, co-authors this paper. RESULT The CPT evidence base for acquired neurological conditions is growing, including in the areas of technology, co-design, and translation. However, knowledge and implementation gaps remain. CONCLUSION The future of CPT will require us to harness co-design and technology, whilst meeting the implementation challenges of complex systems to enable communication for all.
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Affiliation(s)
- Emma Power
- Speech Pathology, Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Anemaat L, Palmer VJ, Copland DA, Binge G, Druery K, Druery J, Mainstone K, Aisthorpe B, Mainstone P, Wallace SJ. Qualitative Exploration of Speech Pathologists' Experiences and Priorities for Aphasia Service Design: Initial Stage of an Experience-Based Co-Design Project to Improve Aphasia Services. Health Expect 2024; 27:e14105. [PMID: 38879788 PMCID: PMC11180296 DOI: 10.1111/hex.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/13/2024] [Accepted: 05/26/2024] [Indexed: 06/19/2024] Open
Abstract
INTRODUCTION AND AIMS Stroke survivors with aphasia (impaired language/communication) have poor outcomes and gaps in the clinical implementation of best practice contribute to this. Little is known, however, about speech pathologist perspectives on the touchpoints (key moments shaping experiences) in the clinical care pathway that have the greatest impact on service delivery nor how this varies by geographical location. We explored the experiences of speech pathologists who provide aphasia services to establish priorities for improvement and design. METHODS AND ANALYSIS This is the initial experience gathering and priority identification stage of an experience-based co-design (EBCD) project. Speech pathologists were recruited from 21 geographically diverse Hospital and Health Services in Queensland, Australia. Speech pathologists working in acute, rehabilitation and community services shared positive and negative experiences of delivering aphasia care in interviews and focus groups. Experiential data were analysed using qualitative thematic analysis to determine touchpoints. Priorities for service design were identified using an adapted nominal group technique. RESULTS Speech pathologists (n = 62) participated in 16 focus groups and nine interviews and shared 132 experiences of delivering aphasia care. Providing care in teams with poor awareness of the impacts of aphasia was identified as a key challenge, as poor patient-provider communication was perceived to increase risk of adverse outcomes for patients. Speech pathologists identified areas for improvement related to their own professional needs (e.g., greater access to clinical supervision); collaborative health care (e.g., better coordination and interdisciplinary care to increase therapy time); and the service context and environment (e.g., psychological services able to support diverse communication needs). CONCLUSIONS Speech pathologist delivery of aphasia services could be improved through increased access to clinical supervision, opportunities for peer debriefing and interdisciplinary care. Priorities for service design varied by geographical location and included: education to support care transitions (remote areas), improved referral pathways and service linkage (regional areas) and dedicated aphasia staffing (metropolitan areas). PATIENT OR PUBLIC CONTRIBUTION A consumer advisory committee comprising people with aphasia (n = 3, authors K.M., K.D. and B.A.), their significant others (n = 2, authors J.D. and P.M.), and a Cultural Capability Officer (author G.B.) guided this research. The team: (1) reviewed participant information; (2) co-designed surveys and workshop resources; (3) copresented research outcomes and contributed to publications. Research questions and study design (e.g., analysis methods and assessment measures) were developed by the research team (authors L.A., V.J.P., D.A.C. and S.J.W.).
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Affiliation(s)
- Lisa Anemaat
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research AllianceThe University of Queensland and Metro North HealthAustralia
| | - Victoria J. Palmer
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneMelbourneAustralia
| | - David A. Copland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research AllianceThe University of Queensland and Metro North HealthAustralia
| | - Geoffrey Binge
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Kent Druery
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Julia Druery
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Kathryn Mainstone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Bruce Aisthorpe
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Penelope Mainstone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Sarah J. Wallace
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
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Levine R, Zingelman S, McSween MP, Shrubsole K, Hill AJ, Copland DA. Allied Health Clinicians' Uptake of Evidence in Stroke Rehabilitation: A Systematic Review of Determinants Targeted in Implementation Studies. Arch Phys Med Rehabil 2024; 105:988-999. [PMID: 37666287 DOI: 10.1016/j.apmr.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE This study aimed to determine whether targeting specific implementation determinants is associated with allied health clinicians' uptake of evidence when implemented within stroke rehabilitation settings. DATA SOURCES 7 key databases were searched to identify articles published between 1990 and 2022 for inclusion. Reference lists of relevant articles were hand searched. STUDY SELECTION Studies were independently screened by 2 authors and included if the implementation intervention targeted allied health clinical practice in any stroke rehabilitation context and reported at least 1 quantitative measure of evidence uptake. Thirty studies met inclusion criteria. DATA EXTRACTION Data were independently extracted by the first and second author. Implementation outcomes for each study were categorized as either mostly successful, partially successful, or not successful based on the degree of evidence uptake achieved. Determinants targeted were categorized using the Consolidated Framework for Implementation Research (CFIR). DATA SYNTHESIS Patterns between the degree of evidence uptake and determinants targeted across studies were analyzed by the first and second authors in 1 of 3 groups: A (pre-post statistical analysis), B (pre-post descriptive analysis), or C (post-only descriptive analysis). Patterns between evidence uptake and determinants targeted were first identified within groups A and B, with group C consulted to support findings. All studies categorized as "mostly successful" targeted facilitation in combination with establishing face-to-face networks and communication strategies. Conversely, no studies rated "not successful" targeted either of these determinants. Studies rated "partially successful" targeted either 1, but seldom both, of these determinants. CONCLUSIONS This review has provided descriptive evidence of determinants which may be important to target for allied health clinicians' uptake of evidence within stroke rehabilitation settings.
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Affiliation(s)
- Rachel Levine
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia.
| | - Sally Zingelman
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Marie-Pier McSween
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia; Faculty of Health, Southern Cross University, Bilinga, Queensland Australia
| | - Annie Jane Hill
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
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Harvey S, Stone M, Zingelman S, Copland DA, Kilkenny MF, Godecke E, Cadilhac DA, Kim J, Olaiya MT, Rose ML, Breitenstein C, Shrubsole K, O'Halloran R, Hill AJ, Hersh D, Mainstone K, Mainstone P, Unsworth CA, Brogan E, Short KJ, Burns CL, Baker C, Wallace SJ. Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study. BMJ Open 2024; 14:e080532. [PMID: 38514146 PMCID: PMC10961567 DOI: 10.1136/bmjopen-2023-080532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.
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Affiliation(s)
- Sam Harvey
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Marissa Stone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Sally Zingelman
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Joosup Kim
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Miranda L Rose
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Robyn O'Halloran
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Annie J Hill
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Deborah Hersh
- Curtin School of Allied Health and EnAble Institute, Curtin University, Perth, Western Australia, Australia
- Australian Aphasia Association, Perth, Western Australia, Australia
| | - Kathryn Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Penelope Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carolyn A Unsworth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Emily Brogan
- Edith Cowan University, Joondalup, Western Australia, Australia
- Fiona Stanley Fremantle Hospitals Group, South Metropolitan Health Service, Palmyra, Western Australia, Australia
| | - Kylie J Short
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Clare L Burns
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Caroline Baker
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- Speech Pathology Department, Monash Health, Clayton, Victoria, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
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Zhang J, He C. Evidence-based rehabilitation medicine: definition, foundation, practice and development. MEDICAL REVIEW (2021) 2024; 4:42-54. [PMID: 38515780 PMCID: PMC10954297 DOI: 10.1515/mr-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/19/2023] [Indexed: 03/23/2024]
Abstract
To determine the definition, foundation, practice, and development of evidence-based rehabilitation medicine (EBRM) and point out the development direction for EBRM. Retrieve the database of PubMed, Cochrane Library, Embase, China national knowledge infrastructure (CNKI), Wanfang, and China science and technology journal database (CSTJ). The search was conducted from the establishment of the database to June 2023. The key words are "rehabilitation medicine and evidence based" in Chinese and English. After reading the abstract or full text of the literature, a summary analysis is conducted to determine the definition, foundation, practice, and development of EBRM. A total of 127 articles were included. The development of 14 sub majors in EBRM are not balanced, evidence-based musculoskeletal rehabilitation medicine (EBMRM) (31 articles, mainly focuses on osteoarthritis, osteoporosis and musculoskeletal pain), evidence-based neurorehabilitation medicine (EBNM) (34 articles, mainly concentrated in stroke, traumatic brain injury and spinal cord injury) and evidence-based education rehabilitation medicine (EBEDRM) (17 articles, mainly focuses on educational methodology), evidence-based nursing rehabilitation medicine (EBNRM) (2 articles), evidence-based engineering rehabilitation medicine (EBENRM) (7 articles), evidence-based traditional Chinese rehabilitation medicine (EBTCRM) (3 articles), evidence-based internal rehabilitation medicine (EBIRM) (11 articles), evidence-based intensive care rehabilitation medicine (EBICRM) (4 articles), evidence-based oncology rehabilitation medicine (EBORM) (6 articles), evidence-based physical therapy medicine (EBPTM) (3 articles), evidence-based cardiopulmonary rehabilitation medicine (EBCRM) (6 articles), evidence-based speech therapy medicine (EBSTM)/evidence-based occupation therapy medicine (EBOTM)/evidence-based geriatric rehabilitation medicine (EBGRM) (1 article). The EBMRM, EBNM and EBEDRM are relatively well developed. The development of EBNRM, EBENRM, EBTCRM, EBIRM, EBICRM, EBGRM, EBORM, EBCRM, EBPTM, EBSTM and EBOTM is relatively slow, indicating these eleven fields should be pay more attention in future.
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Affiliation(s)
- Jinlong Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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Dalvandi A, Khoshbakht-Pishkhani M, Ebadi A, Hosseini M. Developing post-stroke psychometric properties for an Adherence to rehabilitation regimen scale: A sequential exploratory mixed-method study. JOURNAL OF VASCULAR NURSING 2023; 41:219-225. [PMID: 38072576 DOI: 10.1016/j.jvn.2023.09.001] [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: 01/02/2022] [Revised: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Adherence to rehabilitation in patients post-stroke plays a significant role in the effectiveness of rehabilitation and patient recovery. This study aimed to design and determine the psychometric properties of a scale for measuring adherence to the rehabilitation regimen in patients post-stroke in the Iranian community. METHODS The present study used a sequential exploratory mixed method and was conducted in two phases (phase one qualitative and phase two quantitative). Participants in the first phase were patients post-stroke, caregivers, and rehabilitation team members (n=20). The second phase was conducted on patients post-stroke (n=198), and the psychometric steps, including face, content, and construct validity, as well as reliability, were assessed. RESULTS The Adherence to Rehabilitation Regimen Scale (ARRS)was designed with 26 items and four factors of participation: 1) physical exercises, 2) following prescribed regimens, 3) performing the activities of daily living, and 4) psychological follow-up. The internal consistency was 0.96 by calculating Cronbach's alpha coefficient. The Interclass Correlation Coefficient was 0.99 with a confidence interval of 0.96-0.99. CONCLUSION The scale measuring adherence to the rehabilitation regimen in patients post-stroke has optimal psychometric properties. Therefore, as the first specific scale to measure the degree of rehabilitation regimen adherence in patients post-stroke, this tool may be beneficial for other rehabilitation programs interested in managing and improving program adherence.
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Affiliation(s)
- Asghar Dalvandi
- Department of Nursing,School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; School of Nursing and Midwifery, Islamic Azad University of Tehran, Central branch, Tehran, Iran
| | - Maryam Khoshbakht-Pishkhani
- Department of Medical Surgical Nursing, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran; Department of Nursing,School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Departement, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Gutiérrez-Suárez A, Pérez-Rodríguez M, García-Hernández JJ, Rodríguez-Romero B. A Randomized Controlled Trial to Evaluate the Impact of an Exercise Therapy Program Based on Sports in People with Acquired Brain Injury: Discover Study Protocol. J Clin Med 2023; 12:7068. [PMID: 38002681 PMCID: PMC10671999 DOI: 10.3390/jcm12227068] [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: 09/18/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Acquired brain injury (ABI) constitutes a significant and growing global public health concern. People with ABI often face a range of physical and psychosocial challenges that span the domains of "body structure and function", "activity", and "participation", as defined by the International Classification of Functioning, Disability, and Health. Multidisciplinary approaches based on exercise therapy with social leisure activities are essential to improve physical recovery and health-related quality of life after injury. METHODS Adults with ABI, aged > 18 years, in the subacute or chronic stage (within more than one month after the injury) will be recruited through a rehabilitation center. Adults will be randomized to receive either a racket sports-based exercise therapy program combined with usual care (sET) or usual care alone (UC) using a random number sequence with a 1:1 allocation ratio. sET intervention consists of an 8-week exercise therapy program focusing on different racket sports skills, 1 h in duration, 2 days/week. It will be delivered by a physiotherapist in tailored, face-to-face, group-based sessions. Primary outcomes will be the health-related quality of life (SF-36) and upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity Scale). DISCUSSION The study proposes an intervention that combines sports-based exercise therapy with usual care. It aims to determine whether this intervention improves the health-related quality of life and upper limb motor function in adults with ABI compared with usual care alone. The results of this study may have clinical implications for the rehabilitation of this population.
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Affiliation(s)
- Andrea Gutiérrez-Suárez
- University of A Coruña, Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Oza, 15071 A Coruña, Spain
| | - Marta Pérez-Rodríguez
- AFIPE Research Group, Faculty of Physical Activity and Sports Sciences, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Segunda Parte Foundation, 28034 Madrid, Spain
| | - Juan José García-Hernández
- Segunda Parte Foundation, 28034 Madrid, Spain
- Faculty of Health Sciences, Exercise and Sport Sciences, University of Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
| | - Beatriz Rodríguez-Romero
- University of A Coruña, Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Oza, 15071 A Coruña, Spain
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Hombali A, Mahmood A, Gandhi DBC, Kamalakannan S, Chawla NS, D’souza J, Urimubenshi G, Sebastian IA, Solomon JM. Clinical Practice Guidelines (CPGs) for stroke rehabilitation from Low- and Middle-Income Countries (LMICs): Protocol for systematic review. PLoS One 2023; 18:e0293733. [PMID: 37943755 PMCID: PMC10635447 DOI: 10.1371/journal.pone.0293733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Stroke rehabilitation guidelines promoteclinical decision making, enhance quality of healthcare delivery, minimize healthcare costs, and identify gaps in current knowledge to guide future research. However, there are no published reviews that have exclusively evaluated the quality of existing Clinical Practice Guidelines (CPGs) for stroke rehabilitation from Low- and Middle-Income Countries (LMICs) or provided any insights into the cultural variation, adaptations, or gaps in implementation specific to LMICs. OBJECTIVES To identify CPGs developed by LMICs for stroke rehabilitation and evaluate their quality using AGREE-II and AGREE-REX tool. METHODS The review protocol is prepared in accordance with the PRISMA-P guidelines and the review was registered in PROSPERO (CRD42022382486). The search was run in Medline, EMBASE, CINHAL, PEDro for guidelines published between 2000 till July 2022. Additionally, SUMSearch, Google, and other guideline portals and gray literature were searched. The included studies were then subjected to data extraction for the following details: Study ID, title of the CPG, country of origin, characteristics of CPG (Scope-national/regional, level of care, multidisciplinary/uni-disciplinary), and information on stroke rehabilitation relevant recommendations. The quality of the included CPGs will be subsequently evaluated using AGREE-II and AGREE-REX tool. RESULTS & CONCLUSION This systematic review aims to explore the gaps in existing CPGs specific to LMICs and will aid in development/adaptation/contextualization of CPGs for implementation in LMICs.
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Affiliation(s)
- Aditi Hombali
- Visible Analytics and Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Amreen Mahmood
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Dorcas B. C. Gandhi
- Department of Neurology & College of Physiotherapy, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Sureshkumar Kamalakannan
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Nistara S. Chawla
- Department of Neurology & College of Physiotherapy, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Jennifer D’souza
- Department of Physiotherapy, St. John’s Medical College Hospital, Bangalore, Karnataka, India
| | - Gerard Urimubenshi
- Department of Physiotherapy, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ivy A. Sebastian
- Department of Neurology, St. Stephen’s Hospital, New Delhi, India
| | - John M. Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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11
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Brusco N, Morris ME, Foster S, Woods J, McCaskie D, Goodman S, Barnes C, Keren C, Frawley H. Improving stroke clinical guideline adherence in an Australian hospital using a clinician-led implementation process. Top Stroke Rehabil 2023; 30:738-750. [PMID: 36323526 DOI: 10.1080/10749357.2022.2141819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Private hospitals in Australia manage 11% of acute and 48% of rehabilitation stroke admissions, yet little is known about implementation of stroke clinical guidelines in this setting. Clinical guidelines recommend that acute stroke patients be co-located in a stroke unit in a geographically defined area, rather than dispersed across the hospital. OBJECTIVE To investigate post-intervention adherence to clinical guidelines for stroke management, and to explore staff barriers and facilitators to guideline implementation. METHODS Observational study before-and-after local implementation of Australian stroke clinical guidelines. The primary outcome was a change in the proportion of patients who were physically co-located in an acute stroke unit. Secondary outcomes included changes in adherence to additional acute and rehabilitation guideline criteria, and staff identification of barriers and facilitators to guide implementation. Data were collected from medical record audits, health service information and staff surveys. RESULTS Co-location in an acute stroke unit did not change significantly after guideline implementation (49% adherence pre-intervention and 54% post-intervention). Across acute and rehabilitation wards, 15% (11/72) of guideline criteria improved (p < .05). These related to assessments of swallowing and neglect, presence of a stroke care co-ordinator and occupational therapist, post-discharge care plan, provision of patient education and return to driving. Facilitators to guideline implementation included staff education, collaboration, and dissemination of user-friendly stroke policies. CONCLUSION Stroke clinical guideline implementation led to a favorable uptake of some criteria, yet not all. Implementation was assisted by staff education, user-friendly stroke policies and multidisciplinary team collaboration. TRIAL REGISTRATION ANZCTR: registration number ACTRN12616000646448 (http://www.ANZCTR.org.au/ACTRN12616000646448.aspx).
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Affiliation(s)
- Natasha Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Meg E Morris
- Healthscope ARCH, The Victorian Rehabilitation Centre, Glen Waverley, 3150, VIC, Australia
| | | | - Jeffrey Woods
- Healthscope ARCH, Melbourne, Victoria, Australia & College Science Health and Engineering, La Trobe University, Bundoora, 3086, VIC, Australia
| | - Doug McCaskie
- Associate Director of Allied Health, Alfred Health, Melbourne, VIC, Australia
| | | | | | | | - Helena Frawley
- School of Health Sciences, the University of Melbourne; Allied Health Research, Royal Women's Hospital, Melbourne and Mercy Hospital for Women, Melbourne, Victoria, Australia
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12
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Burton B, Isaacs M, Brogan E, Shrubsole K, Kilkenny MF, Power E, Godecke E, Cadilhac DA, Copland D, Wallace SJ. An updated systematic review of stroke clinical practice guidelines to inform aphasia management. Int J Stroke 2023; 18:1029-1039. [PMID: 36803248 PMCID: PMC10614176 DOI: 10.1177/17474930231161454] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote high-quality service delivery and optimize patient outcomes. However, there are currently no high-quality guidelines specific to post-stroke aphasia management. AIMS To identify and evaluate recommendations from high-quality stroke guidelines that can inform aphasia management. SUMMARY OF REVIEW We conducted an updated systematic review in accordance with PRISMA guidelines to identify high-quality clinical guidelines published between January 2015 and October 2022. Primary searches were performed using electronic databases: PubMed, EMBASE, CINAHL, and Web of Science. Gray literature searches were conducted using Google Scholar, guideline databases, and stroke websites. Clinical practice guidelines were evaluated using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. Recommendations were extracted from high-quality guidelines (scored > 66.7% on Domain 3: "Rigor of Development"), classified as aphasia-specific or aphasia-related, and categorized into clinical practice areas. Evidence ratings and source citations were assessed, and similar recommendations were grouped. Twenty-three stroke clinical practice guidelines were identified and 9 (39%) met our criteria for rigor of development. From these guidelines, 82 recommendations for aphasia management were extracted: 31 were aphasia-specific, 51 aphasia-related, 67 evidence-based, and 15 consensus-based. CONCLUSION More than half of stroke clinical practice guidelines identified did not meet our criteria for rigorous development. We identified 9 high-quality guidelines and 82 recommendations to inform aphasia management. Most recommendations were aphasia-related; aphasia-specific recommendation gaps were identified in three clinical practice areas: "accessing community supports," "return to work, leisure, driving," and "interprofessional practice."
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Affiliation(s)
- Bridget Burton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Megan Isaacs
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Emily Brogan
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Monique F Kilkenny
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Emma Power
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- University of Technology Sydney, Graduate School of Health, Speech Pathology, Sydney, NSW, Australia
| | - Erin Godecke
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Dominique A Cadilhac
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - David Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health,
Queensland, Australia
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Cormican A, Hirani SP, McKeown E. Healthcare professionals' perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review. Clin Rehabil 2023; 37:701-712. [PMID: 36475911 PMCID: PMC10041573 DOI: 10.1177/02692155221141036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify healthcare professionals' perceived barriers and facilitators to clinical practice guideline implementation within stroke rehabilitation. DATA SOURCES CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and Scopus. Additional papers were identified through hand searching. REVIEW METHODS The review followed the Preferred Reporting Item for Systematic Reviews and Meta-Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on healthcare professionals' perceived factors influencing clinical guideline implementation in stroke rehabilitation was included. One reviewer screened all titles and abstract reviews (n = 669). Another two reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews (n = 61). Study quality was assessed using the mixed-method appraisal tool. RESULTS Data from 10 qualitative, six quantitative and six mixed-method studies published between 2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints, resources) alongside healthcare professionals' lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators. CONCLUSION Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational-level barriers.
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Affiliation(s)
| | | | - Eamonn McKeown
- Health Services Research & Management Division, School of Health Sciences City, University of London, London, UK
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14
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Lim I, Cha B, Cho DR, Park E, Lee KS, Kim M. Safety and Potential Usability of Immersive Virtual Reality for Brain Rehabilitation: A Pilot Study. Games Health J 2023; 12:34-41. [PMID: 36206236 DOI: 10.1089/g4h.2022.0048] [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] [Indexed: 02/01/2023] Open
Abstract
Objective: This study was conducted to demonstrate the safety and usability of an immersive virtual reality (VR) game as a rehabilitative training by assessing adverse events (AEs), adherence, and satisfaction in patients with brain injury who had free optional opportunities. Materials and Methods: The results were analyzed retrospectively. Seventy-eight patients with brain injury, undergoing rehabilitation treatment for motor impairment, were recruited. Among them, 51 were available for postintervention survey. The immersive type of VR training was programmed to facilitate use of the paralyzed upper extremity through a fishing simulation game. The Oculus Rift was used as head-mounted display device. Patients were observed for any AEs as defined in the Common Terminology Criteria for AEs during and after each VR training session. A postintervention telephone survey was done to investigate adherence-related factors and safety. Results: The results were analyzed after dividing the patients into nonadherence (patients participated <3 times) and high-adherence (≥3 times) groups. No serious AEs were reported during and after the VR training, and several patients reported other AEs, predominantly dizziness, with one case requiring cessation of VR training. Overall, the satisfaction rate was 54%. Compared with the nonadherence group, the high-adherence group expressed higher satisfaction with VR training, regarded it as effective for recovery from upper limb paralysis, accepted VR as comprehensible, and considered the level of difficulty to be appropriate (P < 0.05). Conclusion: Immersive VR training appeared to be safe for patients with brain injury.
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Affiliation(s)
- IkHyun Lim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Byoungwoo Cha
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Dong Rae Cho
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - EunYoung Park
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ki Suk Lee
- VR/AR Content Research Laboratory, Electronics and Telecommunications Research Institute, Daejeon, Republic of Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
- Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea
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15
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Mahmood A, Nayak P, Deshmukh A, English C, N M, Solomon M J, B U. Measurement, determinants, barriers, and interventions for exercise adherence: A scoping review. J Bodyw Mov Ther 2023; 33:95-105. [PMID: 36775533 DOI: 10.1016/j.jbmt.2022.09.014] [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: 07/15/2021] [Revised: 05/21/2022] [Accepted: 09/18/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Adherence to exercise interventions is the cornerstone of a successful rehabilitation program. However, there is limited evidence on multifaceted components of exercise adherence. Therefore, we aimed to summarize the existing literature on measurement, determinants, barriers, theoretical frameworks, and evidence-based interventions that support exercise adherence. METHODS We conducted a scoping review based on the PRISMA extension for scoping reviews guidelines and searched the literature in PubMed, Cochrane Databases of Systematic Reviews, ScienceDirect, and Web of Science. Two reviewers independently screened articles. The included articles were subjected to data extraction and qualitative synthesis. RESULTS A total of 72 articles were included for this review. Data synthesis showed that there are no gold standard methods of measuring exercise adherence; however, questionnaires and daily logs are commonly used tools. The determinants of adherence are personal, disease-related, therapy-related, provider-related, and health system-related. The common barriers to adherence are the absence of a caregiver, low health literacy, poor communication by healthcare providers, cost, and lack of access to health facilities. Few evidence-based interventions used for supporting adherence are behavioral strategies, improving self-efficacy, motivational therapy, and mHealth or multimedia. CONCLUSION Non-adherence to exercises is a challenge for healthcare providers. There are no standard guidelines for the evaluation and management of non-adherence to exercises. Future studies should aim at developing objective measures of exercise adherence and investigate the long-term effects of adherence strategies in different disease populations. It is an under-researched area and requires multipronged strategies to improve adherence levels among patients.
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Affiliation(s)
- Amreen Mahmood
- Department of Health Professions, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, M15 6GX, Manchester, United Kingdom.
| | - Pradeepa Nayak
- Department of Health Professions, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, M15 6GX, Manchester, United Kingdom.
| | - Anagha Deshmukh
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Coralie English
- School of Health Sciences and Priority Research, Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia.
| | - Manikandan N
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - John Solomon M
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
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16
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Scheffler B, Schimböck F, Schöler A, Rösner K, Spallek J, Kopkow C. Current physical therapy practice and implementation factors regarding the evidence-based 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline in Germany: a cross-sectional online survey. BMC Neurol 2022; 22:284. [PMID: 35907809 PMCID: PMC9338587 DOI: 10.1186/s12883-022-02780-5] [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: 12/20/2021] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evaluation of the current physical therapy practice for German stroke rehabilitation with respect to the 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline recommendations and the associated implementation factors. METHODS A descriptive cross-sectional study employing an online survey was performed among German physical therapists in 2019. The survey consisted of three sections with open and closed questions: 1) self-reported use of ReMoS recommendations, 2) barriers of guideline use and 3) socio-demographic characteristics. The benchmark level for guideline adherent physical therapy was set at > 80%. RESULTS Data from 170 questionnaires were eligible for analysis. Participants' mean age was 41.6 years, 69.4% were female, while 60.1% had no academic degree. The ReMoS guideline was unknown to 52.9% of the responders. Out of all the 46 ReMoS guideline recommendations, only 'intensive walking training without a treadmill' was reported to be performed in a guideline adherent manner. Respondents usually denied any personal limitations, such as limited knowledge, or that the ReMoS guideline did not fit their routine practice. CONCLUSIONS Among German physical therapists, the ReMoS guideline is not well-known and many interventions are not performed as recommended, illustrating the discrepancies between the ReMoS guideline recommendations and current physical therapy practice. Interventions aimed at overcoming this gap should consider both knowledge of existing barriers and facilitators of guideline usage. TRIAL REGISTRATION The study was retrospectively registered to the German Clinical Trials Register ( DRKS00026681 ).
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Affiliation(s)
- Bettina Scheffler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany.
| | - Florian Schimböck
- Department of Nursing Sciences and Clinical Nursing, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Almut Schöler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
| | - Katrin Rösner
- Institute of Health Sciences, Department of Physiotherapy, University of Luebeck, Lübeck, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
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Howlett O, O’Brien C, Gardner M, Neilson C. The use of mentoring for knowledge translation by allied health: a scoping review. INT J EVID-BASED HEA 2022; 20:250-261. [DOI: 10.1097/xeb.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Fields SM, Unsworth CA, Harreveld B. Education leads to increased adherence to the 'Australian Competency Standards for Occupational Therapy Driver Assessors'. Scand J Occup Ther 2022:1-16. [PMID: 35704712 DOI: 10.1080/11038128.2022.2076735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists' adherence to their use. AIMS/OBJECTIVES To investigate if education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors. MATERIALS AND METHODS A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors' adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education. RESULTS Qualitative and quantitative analyses suggest that education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice. CONCLUSIONS AND SIGNIFICANCE Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists' adherence to these standards.
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Affiliation(s)
- Sally M Fields
- Occupational Therapy, Bond University, Robina, Australia.,Occupational Therapy, Federation University, Gippsland, Australia
| | - Carolyn A Unsworth
- Occupational Therapy, Federation University, Gippsland, Australia.,Monash University, Clayton, Australia.,Central Queensland University, Rockhampton, Australia
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19
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Wijeratne T, Sales C, Wijeratne C, Karimi L, Jakovljevic M. Systematic Review of Existing Stroke Guidelines: Case for a Change. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5514793. [PMID: 35722461 PMCID: PMC9199531 DOI: 10.1155/2022/5514793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Methods We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and October 2020. Any other evidence of system biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of system biology. Results The scoping review found 2,911 titles at the beginning of the search. Final review included with 15 guidelines. Stroke-related organizations wrote sixty-five percent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the system biology approach to one of the most complex diseases affecting the human brain, stroke. Conclusions This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current "living stroke guidelines," stroke guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach, and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII) and serial systemic immune inflammatory indices (SSIIi) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data (continuous pulse, blood pressure, sleep, oxygen saturation, progressive changes in NLR, SII, SSIIi, etc.). Working with an interdisciplinary team also provides a distinct advantage. Recent adoption of historic WHO-IGAP calls for immediate action. The 2022 World Brain Day campaign on Brain Health for All is the perfect opportunity to raise awareness and start the process.
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Affiliation(s)
- Tissa Wijeratne
- School of Applied Health, Department of Psychology, RMIT University, Melbourne, Australia
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura, Sri Lanka
- Department of Neurology, Western Health & University of Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans, 3021, Australia
| | - Carmela Sales
- School of Applied Health, Department of Psychology, RMIT University, Melbourne, Australia
- Department of Neurology, Western Health & University of Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans, 3021, Australia
| | | | - Leila Karimi
- School of Applied Health, Department of Psychology, RMIT University, Melbourne, Australia
- Department of Neurology, Western Health & University of Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans, 3021, Australia
- Faculty of Social and Political Sciences, Tbilisi State University, Georgia
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University Chiyoda, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Serbia
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Oliart E, Rojas E, Capurro D. Are we ready for conformance checking in healthcare? Measuring adherence to clinical guidelines: A scoping systematic literature review. J Biomed Inform 2022; 130:104076. [PMID: 35525401 DOI: 10.1016/j.jbi.2022.104076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
Clinical guidelines are recommendations of how to diagnose, treat, and manage a patient's medical condition. Health organizations must measure adherence to clinical guidelines to enhance the quality of service, but due to the complexity of the medical environment, there is no simple way of measuring adherence to clinical guidelines. This scoping review will systematically assess the criteria used to measure adherence to clinical guidelines in the past 20 years and explore the suitability of using process mining techniques. We will use a workflow protocol based on declarative and temporal constraints to translate the narrative text rules in the publications into a high-level process model. This approach will enable us to explore the main patterns and gaps identified when measuring adherence to clinical guidelines and how they affect the adoption of process mining techniques. The main contributions of this paper are a) a comprehensive analysis of the criteria used for measuring adherence, considering a diverse set of medical conditions b) a framework that will classify the level of complexity of the rules used to measure adherence based on declarative and temporal constraints c) list of key trends and gaps identified in the literature and how they relate to the use of process mining techniques in healthcare.
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Affiliation(s)
- Eimy Oliart
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Eric Rojas
- Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Daniel Capurro
- School of Computing and Information Systems, Centre for the Digital Transformation of Health, University of Melbourne, Melbourne, Australia.
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21
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Schindel D, Mandl L, Schilling R, Meisel A, Schenk L. Guideline adherence in speech and language therapy in stroke aftercare. A health insurance claims data analysis. PLoS One 2022; 17:e0263397. [PMID: 35113968 PMCID: PMC8812973 DOI: 10.1371/journal.pone.0263397] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background Impairments to comprehension and production of speech (aphasia, dysarthria) and swallowing disorders (dysphagia) are common sequelae of stroke, reducing patients’ quality of life and social participation. Treatment oriented on evidence-based guidelines seems likely to improve outcomes. Currently, little is known about guideline adherence in stroke aftercare for the above-mentioned sequelae. This study aims to analyse guideline adherence in the treatment of aphasia, dysarthria and dysphagia after stroke, based on suitable test parameters, and to determine factors that influence the implementation of recommended therapies. Methods Six test parameters were defined, based on systematic study of guidelines for the treatment of speech impairments and swallowing disorders (e.g. comprehensive diagnostics, early initiation and continuity). Guideline adherence in treatment was tested using claims data from four statutory health insurance companies. Multivariate logistic and linear regression analyses were performed in order to test the outcomes. Results 4,486 stroke patients who were diagnosed with specific disorders or received speech therapy were included in the study. The median age was 78 years; the proportion of women was 55.9%. Within the first year after the stroke, 90.3% of patients were diagnosed with speech impairments and swallowing disorders. Overall, 44.1% of patients received outpatient speech and language therapy aftercare. Women were less frequently diagnosed with specific disorders (OR 0.70 [95%CI:0.55/0.88], p = 0.003) and less frequently received longer therapy sessions (OR 0.64 [95%CI:0.43/0.94], p = 0.022). Older age and longer hospitalization duration increased the likelihood of guideline recommendations being implemented and of earlier initiation of stroke aftercare measures. Conclusions Our observations indicate deficits in the implementation of guideline recommendations in stroke aftercare. At the same time, they underscore the need for regular monitoring of implementation measures in stroke aftercare to address group-based disparities in care.
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Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- * E-mail:
| | - Lena Mandl
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ralph Schilling
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Meisel
- Center for Stroke Research Berlin, NeuroCure Clinical Research Center and Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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22
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A Scoping Review of Non-Pharmacological, Non-Surgical Secondary Prevention Strategies in Ischaemic Stroke and TIA in National Stroke Guidelines and Clinical Audit Documents. Healthcare (Basel) 2022; 10:healthcare10030481. [PMID: 35326959 PMCID: PMC8954875 DOI: 10.3390/healthcare10030481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 12/22/2022] Open
Abstract
The Stroke Action Plan for Europe (2018–2030) calls for national-level secondary prevention plans that address lifestyle, in addition to prevention medications and surgical interventions. This scoping review examines national stroke care guideline and audit documents across WHO regions to identify non-pharmacological, non-surgical stroke secondary prevention recommendations and associated performance indicators. Using a snowballing methodology, 27 guideline documents met the inclusion criteria. Sixteen (59%) detailed, non-pharmacological, non-surgical stroke secondary prevention-addressing known, modifiable population attributable risk factors, of physical inactivity (N = 11), smoking (N = 11), unsafe alcohol consumption (N = 10), diet (N = 8), weight (N = 5), stress (N = 4) and depression (N = 2). Strategies recommended to address these risk factors were: assessment of stroke risk/risk factors (N = 4); provision of advice and information on reducing lifestyle related risk (N = 16); education and counselling for lifestyle behaviour change (N = 8) and onward referral for specialist management of risk (N = 4). Of the nine stroke audits/registries identified, only three (33%) included non-pharmacological, non-surgical quality indicators of documented provision of advice or information on the following: general lifestyle (N = 2); smoking cessation for current smokers (N = 2); reduction in alcohol consumption, where relevant (N = 1), exercise participation (N = 1) and diet (N = 1). Preventive quality indicators addressing the management of weight, stress or depression were absent. This review highlights current gaps in optimal stroke secondary prevention recommendations and their implementation.
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Mahmood A, Deshmukh A, Natarajan M, Marsden D, Vyslysel G, Padickaparambil S, Ts S, Direito A, Kumaran S, N G, Sachdev H, Kumar Veluswamy S, Karthikbabu S, Unnikrishnan B, English C, Solomon JM. Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus. BMJ Open 2022; 12:e055946. [PMID: 34992120 PMCID: PMC8739434 DOI: 10.1136/bmjopen-2021-055946] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies. METHOD We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK. RESULTS In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains-(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4. CONCLUSION We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies.
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Affiliation(s)
- Amreen Mahmood
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Anagha Deshmukh
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Manikandan Natarajan
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Dianne Marsden
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton, New South Wales, Australia
- Priority Research Centre Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Glade Vyslysel
- Westlakes Community Rehabilitation Team, Hunter New England Local Health District, Toronto, NSW, Australia
| | - Sebastian Padickaparambil
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shwetha Ts
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Artur Direito
- Centre for Behaviour Change, University College London, London, UK
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Senthil Kumaran
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Girish N
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Harpreet Sachdev
- Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Suruliraj Karthikbabu
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bangalore, Karnataka, India
| | - B Unnikrishnan
- Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Coralie English
- Priority Research Centre Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - John M Solomon
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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Camicia M, Lutz B, Summers D, Klassman L, Vaughn S. Nursing's Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community. Stroke 2021; 52:e794-e805. [PMID: 34727736 DOI: 10.1161/strokeaha.121.033938] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Facilitating successful care transitions across settings is a key nursing competency. Although we have achieved improvements in acute stroke care, similar advances in stroke care transitions in the postacute and return to community phases have lagged far behind. In the current delivery system, care transitions are often ineffective and inefficient resulting in unmet needs and high rates of unnecessary complications and avoidable hospital readmissions. Nurses must use evidence-based approaches to prepare stroke survivors and their family caregivers for postdischarge self-management, rehabilitation, and recovery. The purpose of this article is to provide evidence on the important nursing roles in stroke care and transition management across the care continuum, discuss cross-setting issues in stroke care, and provide recommendations to leverage nursing's impact in optimizing outcomes for stroke survivors and their family unit across the continuum. To optimize nursing's influence in facilitating safe, effective, and efficient care transitions for stroke survivors and their family caregivers across the continuum we have the following recommendations (1) establish a system of coordinated and seamless comprehensive stroke care across the continuum and into the community; (2) implement a stroke nurse liaison role that provides consultant case management for the episode of care across all settings/services for improved consistency, communication and follow-up care; (3) implement a validated caregiver assessment tool to systematically assess gaps in caregiver preparedness and develop a tailored caregiver/family care plan that can be implemented to improve caregiver preparedness; (4) use evidence-based teaching and communication methods to optimize stroke survivor/caregiver learning; and (5) use technology to advance stroke nursing care. Nurses must leverage their substantial influence over the health care delivery system to achieve these improvements in stroke care delivery to improve the health and lives of stroke survivors and their families.
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Affiliation(s)
- Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente, Vallejo, CA (M.C.)
| | | | | | - Lynn Klassman
- Advocate Lutheran General Hospital, Park Ridge, IL (L.K.)
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25
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Pilbeam C, Malden D, Newell K, Dagens A, Kennon K, Michelen M, Gobat N, Sigfrid L. Accessibility, inclusivity, and implementation of COVID-19 clinical management guidelines early in the pandemic: a global survey. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16984.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: With a rapidly changing evidence base, high-quality clinical management guidelines (CMGs) are key tools for aiding clinical decision making and increasing access to best available evidence-based care. A rapid review of COVID-19 CMGs found most lacked methodological rigour, overlooked at-risk populations, and varied in treatment recommendations. Furthermore, social science literature highlights the complexity of implementing guidelines in local contexts where they were not developed and the resulting potential to compound health inequities. This study aimed to evaluate access to, inclusivity of, and implementation of COVID-19 CMGs in different settings. Methods: A cross-sectional survey of clinicians worldwide was conducted from 15th June to 20th July 2020, to explore access to and implementation of COVID-19 CMGs, and treatment and supportive care recommendations provided. Data on accessibility, inclusivity, and implementation of CMGs were analysed by geographic location. Results: 76 clinicians from 27 countries responded: 82% from high-income countries, 17% from lower middle-income countries (LMICs). Most respondents reported access to COVID-19 CMGs and confidence in their implementation. However, many respondents, particularly from LMICs, reported barriers to implementation, including limited access to treatment and equipment. Only 20% of respondents reported having access to CMGs covering care for children, 25% for pregnant women, and 50% for older adults (>65 years). Identified themes were for CMGs to include recommendations for at-risk populations and settings, include supportive care guidance, and be updated as evidence emerges, and for clinicians to have training and access to recommended treatments to support implementation. Conclusion: Our findings highlight important gaps in COVID-19 CMG development and implementation challenges during a pandemic, particularly affecting at-risk populations and lower resourced settings. This study identifies an urgent need for an improved CMG development framework that is inclusive and adaptable to emerging evidence and considers contextual implementation support, to improve access to evidence-based care globally.
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26
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Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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27
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Mahmood A, Nayak P, English C, Deshmukh A, U S, N M, Solomon JM. Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: A randomized controlled trial. Top Stroke Rehabil 2021; 29:438-448. [PMID: 34180370 DOI: 10.1080/10749357.2021.1940800] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking.Objectives: To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke.Methods: We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) , mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale.Results: The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p < .001) and 12 weeks (MD 51, 95% CI 39, 63, p < .001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p = .002). There was no difference in the quality of life scores between groups at six or 12 weeks.Conclusion: The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life.Trial registration: CTRI/2018/08/015212.
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Affiliation(s)
- Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Coralie English
- School of Health Sciences and Priority Research, Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Anagha Deshmukh
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shashikiran U
- Department of Medicine, Dr. TMA Pai Hospital, Udupi, MMMC, Manipal Academy of Higher Education, India
| | - Manikandan N
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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28
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Halls D, Murray C, Sellar B. Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies. Clin Rehabil 2021; 35:1611-1626. [PMID: 33906456 DOI: 10.1177/02692155211012324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To capture qualitative research about the perspectives and reasoning of allied health professionals about variability in the use of clinical guidelines in stroke rehabilitation. DATA SOURCES Ovid Medline, Psychinfo, Cochrane, Ovid Emcare, Scopus and Web of Science. METHOD The review protocol followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Qualitative or mixed methods research that provided qualitative data about use of clinical guidelines delivered by allied health professionals in stroke rehabilitation was included. Clinical guidelines included any evidence-based documents that guided allied health stroke rehabilitation practice. All studies were screened in duplicate at title and abstract and then at full text. Included studies were appraised using the McMaster Critical Appraisal Tool. RESULTS Data from 850 allied health professionals in 22 qualitative research studies from seven different countries were analysed and synthesised. Four themes were developed including: context necessitates strategy, all clients are different, systemic changes are needed and need a good reason to change something. The findings aligned with the four arms of evidence-base practice. Allied health professionals use clinical guidelines when they align with their reasoning and match the 'sweet spot' for client goals and circumstance. Clinical guideline use is attributed to sufficient resourcing, time and motivation and a strong research culture within health systems. CONCLUSIONS Variabilities in clinical guideline use by allied health professionals are due to their clinical reasoning, contextual factors, client characteristics and enabling health systems.
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Affiliation(s)
- Dayna Halls
- The Royal Society for the Blind, Adelaide, Australia
| | - Carolyn Murray
- University of South Australia, Allied Health and Human Performance, International Centre for Allied Health Evidence, Adelaide, SA, Australia
| | - Ben Sellar
- University of South Australia, Allied Health and Human Performance, International Centre for Allied Health Evidence, Adelaide, SA, Australia
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Age-Related Disparities in the Quality of Stroke Care and Outcomes in Rehabilitation Hospitals: The Australian National Audit. J Stroke Cerebrovasc Dis 2021; 30:105707. [PMID: 33735667 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Stroke affects all ages. Despite increased incidence in those <65 years, little is known about age-based differences in inpatient rehabilitation management and outcomes. OBJECTIVES To investigate management and outcomes, comparing younger (<65 years) and older (≥65 years) patients with stroke, who received inpatient rehabilitation. METHODS Multicentre, cross-sectional study using data from Australian hospitals who participated in the Stroke Foundation national stroke rehabilitation audit (2016-2018). Chi-square tests compared characteristics and care by age. Multivariable regression models were used to compare outcomes by age (e.g. length of stay). Models were adjusted for sex, stroke type and severity factors. RESULTS 7,165 audited cases from 127 hospitals; 23% <65 years (66% male; 72% ischaemic stroke). When compared to older patients, younger patients were more likely male (66% vs 52%); identify as Aboriginal or Torres Strait Islander (6% vs 1%); be less disabled on admission; receive psychology (46% vs 34%) input, and community reintegration support, including return to work (OR 1.47, 95% CI 1.03, 2.11), sexuality (OR 1.60, 95% CI 1.39, 1.84) and self-management (OR 1.39, 95% CI 1.23, 1.57) advice. Following adjustment, younger patients had longer lengths of stay (coeff 3.54, 95% CI 2.27, 4.81); were more likely to be independent on discharge (aOR 1.96, 95% CI 1.68, 2.28); be discharged to previous residences (aOR 1.64, 95% CI 1.41, 1.91) and receive community rehabilitation (aOR: 2.27, 95% CI 1.91, 2.70). CONCLUSIONS Age-related differences exist in characteristics, management and outcomes for inpatients with stroke accessing rehabilitation in Australia.
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Green TL, McNair ND, Hinkle JL, Middleton S, Miller ET, Perrin S, Power M, Southerland AM, Summers DV. Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e179-e197. [PMID: 33691469 DOI: 10.1161/str.0000000000000357] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 2009, the American Heart Association/American Stroke Association published a comprehensive scientific statement detailing the nursing care of the patient with an acute ischemic stroke through all phases of hospitalization. The purpose of this statement is to provide an update to the 2009 document by summarizing and incorporating current best practice evidence relevant to the provision of nursing and interprofessional care to patients with ischemic stroke and their families during the acute (posthyperacute phase) inpatient admission phase of recovery. Many of the nursing care elements are informed by nurse-led research to embed best practices in the provision and standard of care for patients with stroke. The writing group comprised members of the Stroke Nursing Committee of the Council on Cardiovascular and Stroke Nursing and the Stroke Council. A literature review was undertaken to examine the best practices in the care of the patient with acute ischemic stroke. The drafts were circulated and reviewed by all committee members. This statement provides a summary of best practices based on available evidence to guide nurses caring for adult patients with acute ischemic stroke in the hospital posthyperacute/intensive care unit. In many instances, however, knowledge gaps exist, demonstrating the need for continued nurse-led research on care of the patient with acute ischemic stroke.
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Training persons with early-stage Alzheimer’s disease how to use an electronic medication management device: development of an intervention protocol. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground/Objectives:Medication management is challenging for persons with Alzheimer’s disease (AD) and their caregivers. Electronic medication management devices (eMMDs) are specifically designed to support this task. However, theory-driven interventions for eMMD training with this population are rarely described. This study aimed to develop and assess the appropriateness of an intervention protocol to train persons with early-stage AD how to use an eMMD.Methods:Interviews with three categories of participants [persons with early-stage AD (n = 3), caregivers (n = 3), and clinicians (n = 3)] were conducted to understand medication management needs, perceived usefulness of an eMMD, and to explore training strategies. Subsequently, this knowledge was integrated in an intervention protocol which was validated with the three clinicians. A content analysis led to iterative modifications to maximize the acceptability and coherence of the intervention protocol in a homecare context.Results:The final intervention protocol specifies the expertise required to provide the training intervention and the target population, followed by an extensive presentation of eMMD features. Specific learning strategies tailored to the cognitive profile of persons with AD with step-by-step instructions for clinicians are included. Finally, it presents theoretical information on cognitive impairment in AD and how eMMDs can support them.Conclusions:This intervention protocol with its theoretical and pragmatic foundation is an important starting point to enable persons with early-stage AD to become active users of eMMDs. Next steps should evaluate the immediate and long-term impacts of its implementation on medication management in the daily lives of persons with AD and their caregivers.
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Klaic M, Galea MP. Using the Technology Acceptance Model to Identify Factors That Predict Likelihood to Adopt Tele-Neurorehabilitation. Front Neurol 2020; 11:580832. [PMID: 33343488 PMCID: PMC7738474 DOI: 10.3389/fneur.2020.580832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Tele-neurorehabilitation has the potential to reduce accessibility barriers and enhance patient outcomes through a more seamless continuum of care. A growing number of studies have found that tele-neurorehabilitation produces equivalent results to usual care for a variety of outcomes including activities of daily living and health related quality of life. Despite the potential of tele-neurorehabilitation, this model of care has failed to achieve mainstream adoption. Little is known about feasibility and acceptability of tele-neurorehabilitation and most published studies do not use a validated model to guide and evaluate implementation. The technology acceptance model (TAM) was developed 20 years ago and is one of the most widely used theoretical frameworks for predicting an individual's likelihood to adopt and use new technology. The TAM3 further built on the original model by incorporating additional elements from human decision making such as computer anxiety. In this perspective, we utilize the TAM3 to systematically map the findings from existing published studies, in order to explore the determinants of adoption of tele-neurorehabilitation by both stroke survivors and prescribing clinicians. We present evidence suggesting that computer self-efficacy and computer anxiety are significant predictors of an individual's likelihood to use tele-neurorehabilitation. Understanding what factors support or hinder uptake of tele-neurorehabilitation can assist in translatability and sustainable adoption of this technology. If we are to shift tele-neurorehabilitation from the research domain to become a mainstream health sector activity, key stakeholders must address the barriers that have consistently hindered adoption.
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Affiliation(s)
- Marlena Klaic
- Allied Health Department, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia
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Frenette AJ, Williamson D, Weiss MJ, Rochwerg B, Ball I, Brindamour D, Serri K, D'Aragon F, Meade MO, Charbonney E. Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines. Can J Anaesth 2020; 67:1839-1857. [PMID: 32949008 DOI: 10.1007/s12630-020-01815-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The objectives of this study were to systematically identify and describe guidelines for the care of neurologically deceased donors and to evaluate their methodological quality, with the aim of informing and supporting the new Canadian guidelines for the management of organ donors. METHODOLOGY Following a systematic search, we included any document endorsed by an organ donation organization, a professional society, or a government, that aims to direct the medical management of adult, neurologically deceased, multi-organ donors. We extracted recommendations pertaining to six domains: the autonomic storm, hemodynamic instability, hormone supplementation, ventilation, blood product transfusions, and general intensive care unit (ICU) care. Methodological quality of the guidelines was assessed by the validated AGREE-II tool. MAIN FINDINGS This review includes 27 clinical practice guidelines representing 26 countries published between 1993 and 2019. Using the AGREE-II validated tool for the evaluation of guidelines' quality, documents generally scored well on their scope and clarity of presentation. Nevertheless, quality was limited in terms of the scientific rigor of guideline development. Recommendations varied substantially across the domains of managing the autonomic storm, subsequent management of hemodynamic instability, hormone therapy, mechanical ventilation, blood product transfusion, and general ICU care. We found consistent recommendations for low tidal volume ventilation subsequent to the publication of a landmark clinical trial. CONCLUSION Highly inconsistent recommendations for deceased donor care summarized in this review likely reflect the relatively slow emergence of high-quality clinical research in this field, as well as a late uptake of recent validated guideline methodology. Even in this context of few randomized-controlled trials, our group supported the need for new Canadian guidelines for the management of organ donors that follow rigorous recognized methodology and grading of the evidence. TRIAL REGISTRATION PROSPERO (CRD42018084012); registered 25 February 2016.
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Affiliation(s)
- Anne Julie Frenette
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada.
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada.
| | - David Williamson
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Matthew-John Weiss
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec, Université Laval Research Center, Quebec, QC, Canada
- Pediatrics Department, Intensive Care Division, Faculté de Médecine, Université Laval, Quebec, QC, Canada
- Transplant Québec, Montreal, QC, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON, Canada
| | - Dave Brindamour
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Karim Serri
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | | | - Maureen O Meade
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmanuel Charbonney
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
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Baker C, Rose ML, Ryan B, Worrall L. Barriers and facilitators to implementing stepped psychological care for people with aphasia: Perspectives of stroke health professionals. Top Stroke Rehabil 2020; 28:581-593. [PMID: 33232219 DOI: 10.1080/10749357.2020.1849952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Concomitant aphasia and depression after stroke is highly prevalent, but there is a lack of psychological care in stroke rehabilitation for people with aphasia and family members. Evidence-based frameworks such as stepped psychological care may be viable, but the barriers and facilitators to translating this framework into aphasia rehabilitation practice are unknown.Aim The aim of this study was to identify, from the perspective of stroke health professionals, the barriers and facilitators to implementing stepped psychological care for depression after post-stroke aphasia.Method Five semi-structured focus groups of stroke health professionals were conducted (n = 39) across the stroke care continuum. Verbatim transcripts were analyzed using Interpretive Description.Results Barriers and facilitators were identified within three core themes: knowledge, skills, and attitudes have the most impact on implementing stepped psychological care; the physical environment impacts on managing depression and communication disability for people with aphasia; and the support and leadership of the health organization influence change in any implementation of a stepped psychological care approach. Barriers included: no experience with stepped psychological care; limited understanding of aphasia and communication support; lack of adequate physical space and resources; lack of psychologists. Facilitators included: specialist training; enhancement of physical spaces; communication tools; leadership; funding; specialized staff.Conclusion Addressing the identified barriers and facilitators to stepped psychological care will improve the viability of implementing this evidence-based framework after post-stroke aphasia. Change may be driven through specialist training for health professionals in communication support; mood assessment and treatments; modification of physical space; and accessible resources.
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Affiliation(s)
- Caroline Baker
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre for Research Excellence in Aphasia Rehabilitation and Recovery, Australia.,School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre for Research Excellence in Aphasia Rehabilitation and Recovery, Australia
| | - Brooke Ryan
- Centre for Research Excellence in Aphasia Rehabilitation and Recovery, Australia.,School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Linda Worrall
- Centre for Research Excellence in Aphasia Rehabilitation and Recovery, Australia.,School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia
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Bernhardt J, Urimubenshi G, Gandhi DBC, Eng JJ. Stroke rehabilitation in low-income and middle-income countries: a call to action. Lancet 2020; 396:1452-1462. [PMID: 33129396 DOI: 10.1016/s0140-6736(20)31313-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
The WHO Rehabilitation 2030 agenda recognises the importance of rehabilitation in the value chain of quality health care. Developing and delivering cost-effective, equitable-access rehabilitation services to the right people at the right time is a challenge for health services globally. These challenges are amplified in low-income and middle-income countries (LMICs), in which the unmet need for rehabilitation and recovery treatments is high. In this Series paper, we outline what is happening more broadly as part of the WHO Rehabilitation 2030 agenda, then focus on the specific challenges to development and implementation of effective stroke rehabilitation services in LMICs. We use stroke rehabilitation clinical practice guidelines from both high-income countries and LMICs to highlight opportunities for rapid uptake of evidence-based practice. Finally, we call on educators and the stroke rehabilitation clinical, research, and not-for-profit communities to work in partnership for greater effect and to accelerate progress.
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Affiliation(s)
- Julie Bernhardt
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia; National Health and Medical Research Council Centre, University of Melbourne, Melbourne, VIC, Australia.
| | - Gerard Urimubenshi
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Dorcas B C Gandhi
- College of Physiotherapy, Christian Medical College and Hospital, Ludhiana, India; DBT/Wellcome Trust India Alliance, Hyderabad, India
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Rehab Research Program, GF Strong Rehab Centre, Vancouver, BC, Canada
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36
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Frith J, James C, Hubbard I, Warren-Forward H. Australian health professionals' perceptions about the management of return to driving early after stroke: A mixed methods study. Top Stroke Rehabil 2020; 28:198-206. [PMID: 32787668 DOI: 10.1080/10749357.2020.1803570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stroke can affect a person's ability to drive a motor vehicle. In Australia, there is a 4-week restriction in driving after stroke and a 2-week restriction after transient ischemic attack. Concerns exist as to whether people discharged home from the acute setting receive education about these driving restrictions. OBJECTIVES This study sought to investigate health professionals' knowledge about, and responsibilities for patients return-to-driving (RTD) education after stroke and TIA. METHODS A cross-sectional online survey was designed and included questions about health professional demographic characteristics and knowledge and opinions of RTD guidelines. An open-ended question at the end of the survey enabled respondents to provide additional, free text information. Descriptive analyses were used to describe respondents' demography and characteristics. Chi-square analysis was used to compare responses across the different professional groups. Significance was tested using a p-value of 0.05. Data obtained from the free text question were analyzed through an inductive thematic approach. RESULTS A total of 455 health professionals responded to the survey, with 45% being occupational therapists. Only 22% of health professionals correctly selected the 4-week restriction period after stroke and 27% selected the 2-week restriction period for those with TIA. Occupational therapists were identified by 85% of respondents as the profession responsible for providing RTD education, followed by doctors (72%). Health professionals lack clarity in RTD guidelines and often defer the responsibility of managing RTD to others. CONCLUSIONS Education of health professionals in RTD guidelines is recommended to improve the processes of care after stroke.
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Affiliation(s)
- Janet Frith
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Carole James
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia.,University of South Australia
| | - Isobel Hubbard
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Helen Warren-Forward
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia
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Pishkhani MK, Dalvandi A, Ebadi A, Hosseini MA. Adherence to a Rehabilitation Regimen in Stroke Patients: A Concept Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:139-145. [PMID: 32195160 PMCID: PMC7055185 DOI: 10.4103/ijnmr.ijnmr_170_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/07/2019] [Accepted: 12/23/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adherence to rehabilitation regimens is a major issue in the treatment of stroke. Despite the agreement on the importance of adherence, there is still no clear definition of this concept in rehabilitation. The aim of this study was the concept analysis of the concept of adherence to rehabilitation regimens in stroke patients. MATERIALS AND METHODS This qualitative concept analysis was performed using Walker and Avant's method. English and Persian articles were searched using keywords such as "adherence", "compliance", "rehabilitation", "stroke", and other related keywords among articles published from 1997 to 2018 in PubMed, Scopus, Web of Science, Google Scholar, Iranmedex, Magiran, and Scientific Information Database (SID). Related textbooks were also searched and all articles containing definitions, attributes, antecedents, and consequences of the concept were included in the study. RESULTS The attributes of the concept included complex, multidimensional, and dynamic behavior in the treatment process, personal experience, and adaptive behavior in patients, changeable, situational, voluntary, and collaborative behavior, and active communication between the patient and the healthcare provider. Common antecedents of the concept of adherence to the rehabilitation regimen were classified into patient-related and environmental-related categories and the consequences were classified into the three categories of patient-related, healthcare professional-related, and healthcare system-related. CONCLUSIONS This concept analysis can be useful in eliminating any ambiguity of the concept of adherence to rehabilitation regimens. It helps clarify the vague concepts used in nursing rehabilitation instead of adherence. The results of this study can be helpful for researchers for further studies in this context.
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Affiliation(s)
- Maryam Khoshbakht Pishkhani
- Department of Nursing, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- School of Nursing and Midwifery, Islamic Azad University of Tehran, Central Branch, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Hosseini
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Bowen IM, Redpath A, Dugdale A, Burford JH, Lloyd D, Watson T, Hallowell GD. BEVA primary care clinical guidelines: Analgesia. Equine Vet J 2020; 52:13-27. [PMID: 31657050 DOI: 10.1111/evj.13198] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Abstract
Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.
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Affiliation(s)
- I M Bowen
- Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK
| | - A Redpath
- Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK
| | - A Dugdale
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - J H Burford
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - D Lloyd
- ChesterGates Veterinary Specialists, Chester, UK
| | - T Watson
- Waterlane Equine Vets, Stroud, UK
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Mahmood A, Solomon JM, English C, Bhaskaran U, Menon G, Manikandan N. Measurement of adherence to home-based exercises among community-dwelling stroke survivors in India. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1827. [PMID: 31880059 DOI: 10.1002/pri.1827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To develop an adherence questionnaire specific to stroke and measure the level of adherence to home-based exercises among community-dwelling stroke survivors. METHODS We developed and validated the "Stroke-Specific Measure of Adherence to Home-based Exercises" (SS-MAHE). We measured the exercise adherence among 92 community-dwelling stroke survivors in a cross-sectional study. RESULTS The SS-MAHE has two sections covering (a) the dosage of prescribed exercises and (b) dosage of actual exercises done by the participants. It was found to be reliable with ICC score of 0.81 (95% CI, 0.44, 0.94, p = .001.) Adherence was measured by comparing prescribed exercises to the actual exercises performed at home. We rated participants as "adherent" if they were following more than 70% of the prescribed exercise dosage. In our sample of 92 stroke survivors, only 28% of participants were adherent to prescribed home-based exercises. CONCLUSION SS-MAHE is a practical and reliable tool to measure adherence to home-based exercises after a stroke. Exercise adherence among stroke survivors is less than ideal. There is a need for strategies to specifically target exercise adherence in stroke survivors.
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Affiliation(s)
- Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - John Michael Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, India
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Unnikrishnan Bhaskaran
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Natarajan Manikandan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, India
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Nascimento LR, Fernandes MOP, Teixeira-Salmela LF, Scianni AA. Personal and organizational characteristics associated with evidence-based practice reported by Brazilian physical therapists providing service to people with stroke: a cross-sectional mail survey. Braz J Phys Ther 2019; 24:349-357. [PMID: 31160221 DOI: 10.1016/j.bjpt.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/09/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Although evidence-based practice has been widely used by physical therapists, data variation suggests that its implementation may be influenced by a number of factors. Population-specific information is required to help enhance the use of research in clinical practice. OBJECTIVE To identify the personal and organizational characteristics associated with the use of evidence-based practice by physical therapists providing services to people with stroke in Brazil. METHODS A cross-sectional mail survey was conducted. The Brazilian versions of the questionnaires "Practitioner and Organizational Barriers to Evidence-based Stroke Rehabilitation" and "Evidence-based practice self-efficacy scale" were mailed to physical therapists. Logistic regression analysis was used to explore associations between personal and organizational characteristics with education, attitudes, beliefs, interest, and perceived role, perceived support, and organizational resources for evidence-based practice. RESULTS The response rate was 36% (n=94). Ten characteristics explained 57% of the variance associated with attitudes and beliefs, and interest and perceived role for evidence-based practice. Nine characteristics explained 50% of the variance associated with perceived support and organizational resources for evidence-based practice. The most frequently cited barrier was lack of time (62%). CONCLUSIONS Although participants had positive attitudes regarding evidence-based practice, there is a need to develop a supportive organizational infrastructure, in addition to enhancing skills of the evidence-based practitioner, to increase research integration in physical therapy practice for assessing and treating people with stroke. Potential strategies should include use of evidence-based practice during undergraduate programs, partnership with professional practice-oriented organizations, and investments to enable research-related activities.
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Affiliation(s)
- Lucas Rodrigues Nascimento
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.
| | | | | | - Aline Alvim Scianni
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Bird ML, Miller T, Connell LA, Eng JJ. Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials. Clin Rehabil 2019; 33:1586-1595. [PMID: 31066289 DOI: 10.1177/0269215519847253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians. DATA SOURCES EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search. REVIEW METHODS Randomized controlled trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria. RESULTS A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination of interventions). Four used educational interventions alone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteria indicated that this body of literature was of low quality. This review found higher efficacy of trials which targeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877 patients) that trials which included both site facilitation and tailoring for local factors were effective in changing clinical practice. The effect size of these varied (odds ratio: 1.63-4.9). Education interventions alone were not effective. CONCLUSION A large range of interventions are used to facilitate clinical practice change. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.
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Affiliation(s)
| | - Tiev Miller
- Hong Kong Polytechnic University, Hong Kong, China
| | | | - Janice J Eng
- University of British Columbia, Vancouver, BC, Canada
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Douglas NF, Burshnic VL. Implementation Science: Tackling the Research to Practice Gap in Communication Sciences and Disorders. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2018_pers-st-2018-0000] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
The purpose of this article is to outline how implementation science can contribute to the advancement of communication sciences and disorders through its impact on both clinical research and clinical practice. Implementation science's pertinent definitions and history are discussed. Then, information is highlighted pertaining to the position of implementation science within the larger realm of clinical practice research. An exemplar study is reviewed to inform clinical researchers in communication sciences and disorders.
Conclusion
The importance of implementation science is emphasized by outlining ways that speech-language pathologists and audiologists can use implementation science to both inform their clinical practice and contribute to the evidence base of the disciplines.
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Affiliation(s)
- Natalie F. Douglas
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI
| | - Vanessa L. Burshnic
- Department of Communication Sciences & Disorders, University of South Florida, Tampa, FL
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Jordan JE, Norbash A. A Call to Improve the Visibility and Access of the American College of Radiology Practice Parameters in Neuroradiology: A Powerful Value Stream Enhancer for Both Neuroradiologists and Patients. AJNR Am J Neuroradiol 2019; 40:213-216. [PMID: 30591509 DOI: 10.3174/ajnr.a5923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/29/2018] [Indexed: 11/07/2022]
Abstract
Clinical practice guidelines and clinical practice parameters are among the tools that clinicians and radiologists use to inform decision making in the diagnosis and treatment of patients. Radiologists have been urged to objectively establish their value and measurable contributions to patient care. Radiology's contribution to the health care value stream can be established in the development of sound clinical practice guidelines. Neuroradiologists have been quite active in developing clinical guidelines, particularly in collaboration with the American College of Radiology, but there is a need to increase the visibility and accessibility of such documents. Increasing access and visibility can contribute to improved patient outcomes and an improved overall quality of care.
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Affiliation(s)
- J E Jordan
- From the Department of Radiology (J.E.J.), Providence Little Company of Mary Medical Center, Torrance, California
- Department of Radiology (J.E.J.), Stanford University School of Medicine, Stanford, California
| | - A Norbash
- Department of Radiology (A.N.), University of California, San Diego School of Medicine, La Jolla, California
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Meyer MJ, Teasell R, Thind A, Koval J, Speechley M. In-Home Rehabilitation Resources and Avoidable Admissions to Inpatient Rehabilitation after Stroke: An Ecological Study. Rehabil Process Outcome 2018. [DOI: 10.1177/1179572718820543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purpose: In Ontario (Canada’s most populous province), it has been suggested that mildly impaired stroke patients are being admitted to inpatient rehabilitation unnecessarily due to a lack of alternative options in the community. This ecological study aimed to formally test this hypothesis. Methods: Patients admitted to an inpatient rehabilitation bed in Ontario’s most highly functioning patient classification group (Rehabilitation Patient Group 1160) were retrospectively identified as potentially avoidable admissions, and the proportion of such patients was calculated for each Local Health Integration Network every year between 2006/2007 and 2010/2011. Five indicators of community-based rehabilitation availability were used to test the relationships between avoidable admissions and resource indicators. Results: Of the 25 correlations tested, 21 agreed with the hypothesized direction of effect and 4 reached statistical significance. Logistic-linear regressions on combined data from each of the 5 years demonstrated statistically significant associations between all 5 resource indicators and the proportion of potentially avoidable admissions. Conclusions: This study confirms the suggestion of variation in the proportion of mildly impaired patients admitted to inpatient rehabilitation across Ontario’s Local Health Integration Networks. It also adds evidence to support the concern that a lack of community-based rehabilitation is contributing to these potentially avoidable admissions.
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Affiliation(s)
- Matthew J Meyer
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Decision Sciences London Health Sciences Centre, London, ON, Canada
- Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Robert Teasell
- Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, St. Joseph’s Healthcare, London, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
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Shrubsole K, Worrall L, Power E, O'Connor DA. The Acute Aphasia IMplementation Study (AAIMS): a pilot cluster randomized controlled trial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:1021-1056. [PMID: 30079573 DOI: 10.1111/1460-6984.12419] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Effective implementation strategies to improve speech and language therapists' (SLTs) aphasia management practices are needed. Australian SLTs working in the acute setting have reported inconsistent implementation of post-stroke aphasia guideline recommendations. Therefore, implementation efforts to address these gaps are necessary. However, little is known about the effectiveness of behaviour-change strategies in SLTs providing acute aphasia management. AIMS This study designed and tested the feasibility, acceptability and potential effectiveness of a tailored implementation strategy to improve acute SLTs' uptake of evidence in two areas of practice: aphasia-friendly information provision; and collaborative goal setting. METHODS & PROCEDURES A pilot cluster randomized controlled trial design was used (retrospective trial registration number ACTRN12618000170224). Four acute SLT teams were randomly assigned to receive either Intervention A (targeted at improving information provision) or Intervention B (targeted at improving collaborative goal setting), and were blinded to their allocation. Interventions were tailored to address known barriers and included a face-to-face workshop incorporating behaviour-change techniques. Outcomes addressed the research questions of feasibility (e.g., treatment fidelity and retention of participants), acceptability (e.g., post-study focus groups) and potential effectiveness (e.g., medical record audits and behaviour construct surveys). The quantitative data were recorded at baseline and 3-6-month follow-up, allowing for change scores to be calculated. OUTCOMES & RESULTS All four clusters completed the study, with 37 SLTs participating. The majority of participants were female (36/37 = 97.3%), entry-level clinicians (15/37 = 40.5%), with a mean age of 30 years. Medical record data from 107 patients were included (post-intervention n = 61; information provision intervention n = 36, goal-setting intervention n = 25). Overall, there was a significant improvement in the target behaviour for Intervention A (mean improvement 52.78%, p = 0.001), but a small non-significant change in the target behaviour for Intervention B (8.46%, p = 0.406). There were potentially significant changes seen in several, but not all, of the domains targeted by the interventions (e.g., Knowledge (p = 0.014), Beliefs about Capabilities (p = 0.032), and Environmental Context and Resources (p = 0.000) for Intervention A). CONCLUSIONS & IMPLICATIONS This study showed that a tailored implementation intervention targeting acute SLTs' aphasia management practices was feasible to deliver and acceptable for most participants. In addition, the interventions were potentially effective, particularly for the information provision behaviour targeted by Intervention A. It was possible partially to explain the mechanisms of behaviour change that occurred during the study.
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Affiliation(s)
- Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Power
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Denise A O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Abery P, Kuys S, Lynch M, Low Choy N. Allied health clinicians using translational research in action to develop a reliable stroke audit tool. J Eval Clin Pract 2018; 24:718-725. [PMID: 29790631 DOI: 10.1111/jep.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To design and establish reliability of a local stroke audit tool by engaging allied health clinicians within a privately funded hospital. METHODS Design: Two-stage study involving a modified Delphi process to inform stroke audit tool development and inter-tester reliability. PARTICIPANTS Allied health clinicians. INTERVENTIONS A modified Delphi process to select stroke guideline recommendations for inclusion in the audit tool. Reliability study: 1 allied health representative from each discipline audited 10 clinical records with sequential admissions to acute and rehabilitation services. MAIN OUTCOME MEASURES Recommendations were admitted to the audit tool when 70% agreement was reached, with 50% set as the reserve agreement. Inter-tester reliability was determined using intra-class correlation coefficients (ICCs) across 10 clinical records. RESULTS Twenty-two participants (92% female, 50% physiotherapists, 17% occupational therapists) completed the modified Delphi process. Across 6 voting rounds, 8 recommendations reached 70% agreement and 2 reached 50% agreement. Two recommendations (nutrition/hydration; goal setting) were added to ensure representation for all disciplines. Substantial consistency across raters was established for the audit tool applied in acute stroke (ICC .71; range .48 to .90) and rehabilitation (ICC.78; range .60 to .93) services. CONCLUSIONS Allied health clinicians within a privately funded hospital generally agreed in an audit process to develop a reliable stroke audit tool. Allied health clinicians agreed on stroke guideline recommendations to inform a stroke audit tool. The stroke audit tool demonstrated substantial consistency supporting future use for service development. This process, which engages local clinicians, could be adopted by other facilities to design reliable audit tools to identify local service gaps to inform changes to clinical practice.
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Affiliation(s)
- Philip Abery
- Allied health Department, John Flynn Private Hospital, Australia
| | - Suzanne Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Australia
| | - Mary Lynch
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Australia
| | - Nancy Low Choy
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Australia
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Ramanathan S, Reeves P, Deeming S, Bernhardt J, Nilsson M, Cadilhac DA, Walker FR, Carey L, Middleton S, Lynch E, Searles A. Implementing a protocol for a research impact assessment of the Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery. Health Res Policy Syst 2018; 16:71. [PMID: 30068358 PMCID: PMC6090618 DOI: 10.1186/s12961-018-0349-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/13/2018] [Indexed: 01/22/2023] Open
Abstract
Background There is growing recognition that the wider benefits of research (economic, social and health impacts) should be assessed and valued alongside traditional research performance metrics such as peer-reviewed papers. Translation of findings into policy and practice needs to accelerate and pathways to impact need to be better understood. This research protocol outlines a mixed methods study to apply the Framework to Assess the Impact from Translational health research (FAIT) to the Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery (CRE-Stroke). FAIT is purpose-designed to encourage research translation and assess research impact but lacks validation. Methods/Design Phase 1 involves application of the FAIT-modified programme logic model to each CRE-Stroke research stream including identifying process, output and impact metrics, as well as end users of the research. A scoping review will inform potential impacts anticipated from CRE-Stroke. In Phase 2, audit and feedback on achievements against plans will track and encourage research translation. Logic models will be updated to account for changes in the research pathways over time. In Phase 3, three proven methods for measuring research impact – Payback, economic assessment and narratives – will be applied to each research stream and the data triangulated and reported in Phase 4. The feasibility of applying FAIT will also be assessed as part of Phase 3. Discussion Use of prospective, comprehensive research impact frameworks for large interdisciplinary programmes of research is rare. FAIT’s application to CRE-Stroke will provide opportunity for the impact of CRE-Stroke to be assessed and a range of impacts beyond standard academic achievements to be reliably reported. The feasibility of FAIT’s application will also be assessed and, if necessary, refined. The usefulness of FAIT for encouraging research translation will also be described and may prove useful for other programmes looking to implement a research impact framework.
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Affiliation(s)
- Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Insitute, Locked Bag 1, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - Penny Reeves
- Health Research Economics, Hunter Medical Research Insitute, Locked Bag 1, New Lambton Heights, NSW, 2305, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Simon Deeming
- Health Research Economics, Hunter Medical Research Insitute, Locked Bag 1, New Lambton Heights, NSW, 2305, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- Health Research Economics, Hunter Medical Research Insitute, Locked Bag 1, New Lambton Heights, NSW, 2305, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Dominique A Cadilhac
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia.,Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Frederick Rohan Walker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Leeanne Carey
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia.,School of Allied Health, College of Science, Health and Engineering, Department of Community and Clinical Allied Health, LaTrobe University, Bundoora, VIC, Australia
| | - Sandy Middleton
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia.,Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Darlinghurst, NSW, Australia
| | - Elizabeth Lynch
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, SA, Australia
| | - Andrew Searles
- Health Research Economics, Hunter Medical Research Insitute, Locked Bag 1, New Lambton Heights, NSW, 2305, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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Harewood-Marshall AS, Craig LS, Martelly TP, Corbin DOC, Maul L, McIntosh-Clarke D, Blackman T, George KS, Hennis AJM, Hambleton IR, Rose AMC. Managing acute ischaemic stroke in a small island developing state: meeting the guidelines in Barbados. BMC Public Health 2018; 18:648. [PMID: 29788951 PMCID: PMC5964927 DOI: 10.1186/s12889-018-5565-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 05/11/2018] [Indexed: 01/19/2023] Open
Abstract
Background We describe hospital-based management of acute ischaemic stroke patients in 2010–2013 in Barbados, by comparing documented treatment given in the single tertiary public hospital with international guideline recommendations. Methods Evidence-based stroke management guidelines were identified through a systematic literature search. Comparisons were made between these guidelines and documented diagnostic practice (all strokes) and prescribed medication (ischaemic stroke only), using a combination of key informant interviews and national stroke registry data for 2010–2013. Results Several published international guidelines for the acute management of ischaemic stroke recommended patient management in a dedicated stroke unit or nearest hospital specialised in stroke care. Further, patients should receive clinical diagnosis, CT brain scan, specialist evaluation by a multidisciplinary team and, if eligible, thrombolysis with alteplase within 3–3.5 h of symptom onset. Subsequent secondary prophylaxis, with a platelet aggregation inhibitor and a statin was advised. Barbados had no stroke unit or stroke team, and no official protocol for acute stroke management during the study period. Most of the 1735 stroke patients were managed by emergency physicians at presentation; if admitted, they were managed on general medical wards. Most had a CT scan (1646; 94.9%). Of 1406 registered ischaemic stroke patients, only 6 (0.4%) had been thrombolysed, 521 (37.1%) received aspirin within 24 h of admission and 670 (47.7%) were prescribed aspirin on discharge. Conclusions Acute ischaemic stroke diagnosis was consistent with international recommendations, although this was less evident for treatment. While acknowledging the difficulty in implementing international guidelines in a low-resource setting, there is scope for improvement in acute ischaemic stroke management and/or its documentation in Barbados. A stroke unit was established in August 2013 and written clinical protocols for acute stroke care were in development at the time of the study; future registry data will evaluate their impact. Our findings have implications for other low-resource settings with high stroke burden.
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Affiliation(s)
- Asanchia S Harewood-Marshall
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Leslie S Craig
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Tanya P Martelly
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - David O C Corbin
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Lauren Maul
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Damani McIntosh-Clarke
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Tracey Blackman
- Ministry of Health, Frank Walcott Building, Culloden Road, Bridgetown, Barbados
| | - Kenneth S George
- Ministry of Health, Frank Walcott Building, Culloden Road, Bridgetown, Barbados
| | - Anselm J M Hennis
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Ian R Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Angela M C Rose
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados.
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Unsworth CA, Timmer A, Wales K. Reliability of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). Aust Occup Ther J 2018; 65:376-386. [DOI: 10.1111/1440-1630.12476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Carolyn A. Unsworth
- School of Health, Medical and Applied Sciences; Central Queensland University; Melbourne Vic. Australia
| | - Amanda Timmer
- Donvale Rehabilitation Hospital-Ramsay Health Care; Donvale Vic. Australia
- School of Health, Medical and Applied Sciences; Central Queensland University; Rockhampton City Qld Australia
| | - Kylie Wales
- School of Health Sciences; University of Newcastle; Callaghan NSW Australia
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M. S. A, Kooven S, Al-Mudahka N. Adherence of physical therapy with clinical practice guidelines for the rehabilitation of stroke in an active inpatient setting. Disabil Rehabil 2018. [DOI: 10.1080/09638288.2018.1449257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ajimsha M. S.
- Department of Physical Therapy, Hamad Medical Corporation, Doha, Qatar
| | - Smithesh Kooven
- Department of Physical Therapy, Hamad Medical Corporation, Doha, Qatar
| | - Noora Al-Mudahka
- Department of Physical Therapy, Hamad Medical Corporation, Doha, Qatar
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