Falls among stroke survivors: an online survey on perceptions and approaches among physiotherapists in Flanders

Identifying priorities for balance interventions through a participatory co-design approach with end-users

BACKGROUND

Most individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance.

METHODS

Two individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants' experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers.

RESULTS

Four themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one's balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual's unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously.

CONCLUSIONS

End-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.

Physiotherapists' awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study

BACKGROUND

Recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results.

AIM

This study aimed to explore physiotherapists' awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions of current falls prevention strategies in the care of PLWH in selected regions of sub-Saharan Africa.

METHOD

An exploratory descriptive qualitative research method was employed to explore physiotherapists' perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis.

RESULTS

The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention, as perceived by the physiotherapists, were sub-optimal.

CONCLUSION

Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH.

Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial

BACKGROUND

Patients affected by mild stroke benefit more from physiological overground walking training than walking-like training performed in place using specific devices. The aim of the study was to evaluate the effects of overground robotic walking training performed with the servo-assistive robotic rollator (i-Walker) on walking, balance, gait stability and falls in a community setting in patients with mild subacute stroke.

METHODS

Forty-four patients were randomly assigned to two different groups that received the same therapy in two daily 40-min sessions 5 days a week for 4 weeks. Twenty sessions of standard therapy were performed by both groups. In the other 20 sessions the subjects enrolled in the i-Walker-Group (iWG) performed with the i-Walker and the Control-Group patients (CG) performed the same amount of conventional walking oriented therapy. Clinical and instrumented gait assessments were made pre- and post-treatment. The follow-up observation consisted of recording the number of fallers in the community setting after 6 months.

RESULTS

Treatment effectiveness was higher in the iWG group in terms of balance improvement (Tinetti: 68.4 ± 27.6 % vs. 48.1 ± 33.9 %, p = 0.033) and 10-m and 6-min timed walking tests (significant interaction between group and time: F(1,40) = 14.252, p = 0.001; and F(1,40) = 7.883, p = 0.008, respectively). When measured, latero-lateral upper body accelerations were reduced in iWG (F = 4.727, p = 0.036), suggesting increased gait stability, which was supported by a reduced number of falls at home.

CONCLUSIONS

A robotic servo-assisted i-Walker improved walking performance and balance in patients affected by mild/moderate stroke, leading to increased gait stability and reduced falls in the community.

TRIAL REGISTRATION

This study was registered on anzctr.org.au (July 1, 2015; ACTRN12615000681550 ).

Impaired reactive stepping among patients ready for discharge from inpatient stroke rehabilitation

BACKGROUND

Individuals with stroke are at increased risk for falls soon after hospital discharge. The ability to react to a balance perturbation, specifically with a rapid step, is critical to maintain balance and prevent falls.

OBJECTIVE

The purpose of the study was to determine the prevalence of impaired reactive stepping responses in an ambulatory group of patients with stroke who were preparing for discharge from inpatient rehabilitation and the relationship to patient performance on commonly used clinical measures of balance, mobility, and lower limb impairment.

DESIGN

This study was a retrospective analysis of patient admissions over a 3-year period.

METHODS

Charts were reviewed for patients who, at time of discharge, had completed a perturbation-evoked reactive stepping assessment.

RESULTS

Ninety-nine (71%) of 139 patients had impaired stepping reactions characterized by the need for assistance, an inability to step with either lower limb, or the need for multiple-step responses. There was a statistically significant difference in clinical scores between those with and without impaired stepping, but groups were characterized by considerable variation in clinical profiles. For example, Berg Balance Scale scores ranged from 25 to 55 versus 20 to 56 and gait speeds ranged from 0.17 to 1.43 versus 0.26 to 1.55 m/s for patients who demonstrated a failed step versus a successful step, respectively.

LIMITATIONS

Not all patients who attended stroke rehabilitation received a reactive stepping assessment at discharge.

CONCLUSIONS

Impaired reactive stepping is a prevalent problem for ambulatory patients with stroke preparing for discharge, possibly increasing their risk of falling when faced with the challenges of community ambulation. Specific tests that target the capacity to perform perturbation-evoked stepping reactions may be important to identify those at risk for falls and to direct appropriate intervention strategies.

Use of creative activities in occupational therapy practice in Sweden

The aim of this study was to describe the prevalence of creative activities in occupational therapy in Sweden and how often Swedish occupational therapists use creative activities as a means of intervention. A web-mail survey was sent to 2975 Swedish occupational therapists working in health care at regional, county council or primary health care level, and those working in vocational rehabilitation. A total of 1867 (63%) answered the questionnaire and showed that 44% did use creative activities as a means of intervention and most often by practitioners working in psychiatric health care. The most commonly used form of creative activity was arts and crafts followed by gardening. This web-mail survey was based on a limited amount of items regarding creative activities. Further research should focus on in-depth inquiries about how occupational therapists and their patients perceive the use of creative activities as a means of treatment in occupational therapy.