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O'Malley N, Coote S, Clifford AM. Outcomes of importance to people with multiple sclerosis, Parkinson's disease and stroke following a falls prevention intervention: a qualitative study to inform a core outcome set. Disabil Rehabil 2024; 46:1580-1592. [PMID: 37092355 DOI: 10.1080/09638288.2023.2201513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
Purpose: Falls are a major issue for people with neurological conditions, and the evaluation of falls prevention interventions is of high priority. To date, the views of patient groups regarding outcomes of importance have been largely overlooked. The purpose of this study was to explore outcomes of interest among people with Multiple Sclerosis (MS), Parkinson's disease (PD) and stroke upon completion of falls prevention interventions to inform the development of a core outcome set (COS).Materials and methods: Five online focus groups and one semi-structured interview were conducted among people with PD (n = 10), MS (n = 7), and post-stroke (n = 3), one of whom also had PD. Transcripts were analysed using reflexive thematic analysis.Results: Four themes were developed; (1) Fall events are not homogeneous, (2) Exercise-based programmes are beneficial but falls services are not meeting user needs, (3) Programme success beyond the reduction in falls, and (4) Acquisition of skills to self-manage falls beyond the life of the programme.Conclusions: This study presents new perspectives across patient groups regarding important outcomes upon completion of falls prevention interventions. Taken together with the findings of a literature review, this data will inform the development of a COS.Implications for rehabilitationPeople with multiple sclerosis, Parkinson's disease and stroke consider the success of a falls prevention intervention to be dependent on improvements across a wide range of outcomes.The design and implementation of falls prevention interventions should align with patient preferences.Clinicians and researchers should consider the use of multidomain interventions to facilitate improvements in the desired outcomes of patients.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Tuvemo Johnson S, Flink M, Peterson E, Gottberg K, Elf M, Johansson S, Kierkegaard M, Ytterberg C. Self-management of falls in people with multiple sclerosis: A scoping review. Clin Rehabil 2023; 37:162-176. [PMID: 36177511 PMCID: PMC9772893 DOI: 10.1177/02692155221128723] [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: 02/15/2022] [Accepted: 09/02/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Falls are common in people with multiple sclerosis. There is rising interest in how the multifactorial and chronic nature of fall risk among people with multiple sclerosis can be addressed through self-management. Thus, the aims were to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used. DATA SOURCES A systematic literature search in Medline, Cochrane, Web of Science and PsycInfo was conducted to identify publications until July 2022. REVIEW METHODS Published methodological guidance was followed. Articles targeting: (1) people with multiple sclerosis, (2) falls, and (3) self-management were selected. Of 1656 records, 203 publications were assessed for eligibility, of which 173 did not meet the inclusion criteria, and 16 publications did not contain empirical data. The type of publication, study focus, and study design was extracted. If applicable, key findings, self-management tasks and skills, and the definition of self-management were extracted. RESULTS Fourteen original articles met all inclusion criteria. Ten articles represented six different fall prevention interventions. Three publications were randomized controlled trials. Self-management content was variable and not comprehensive in nature. None of the 14 publications included a self-management definition. CONCLUSION The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. To progress in the research area of self-management of falls, a more robust, consensus-based description of self-management frameworks and activities is needed.
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Affiliation(s)
- Susanna Tuvemo Johnson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Elizabeth Peterson
- Department of Occupational Therapy, University of Illinois, Chicago, IL, USA
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Marie Elf
- School of Education and Learning, Dalarna University, Falun, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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Rapson R, Latour JM, Marsden J, Hughes H, Carter B. Defining usual physiotherapy care in ambulant children with cerebral palsy in the United Kingdom: A mixed methods consensus study. Child Care Health Dev 2022; 48:708-723. [PMID: 35080029 PMCID: PMC9541552 DOI: 10.1111/cch.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Ambulant children with cerebral palsy (CP) undertake physiotherapy to improve balance and walking. However, there are no relevant clinical guidelines to standardize usual physiotherapy care in the United Kingdom. A consensus process can be used to define usual physiotherapy care for children with CP. The resulting usual care checklist can support the development of clinical guidelines and be used to measure fidelity to usual care in the control groups of trials for children with CP. METHODS Twelve expert physiotherapists were recruited. In Phase 1, statements on usual care were developed using a survey and two nominal groups. Phase 2 included a literature review to support usual physiotherapy interventions. Phase 3 used a confirmatory survey, which also captured changes to provision during the COVID-19 pandemic. Consensus was calculated by deriving the mean of the deviations from the median score (MDM). High consensus was deemed to be where MDM < 0.42. RESULTS Physiotherapists reached high consensus on five outcome measures (MDM range 0-0.375) and nine areas of assessment (MDM range 0-0.25). Physiotherapists reached moderate consensus on task-specific training (MDM = 0.75), delivered at weekly intensity for 4-6 weeks (MDM = 0.43). There was high consensus (MDM = 0) that children should participate in modified sport and fitness activities and that children with Gross Motor Function Classification System Level III should be monitored on long-term pathways (MDM = 0.29). CONCLUSIONS Physiotherapists reached consensus on two usual care interventions, and a checklist was developed to inform the control groups of future randomized controlled trials. Further consensus work is required to establish clinical guidelines to standardize usual physiotherapy care in the United Kingdom.
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Affiliation(s)
- Rachel Rapson
- PhysiotherapyTorbay and South Devon NHS Foundation TrustTorquayUK
| | - Jos M. Latour
- School of Nursing & Midwifery, Faculty of Health and Human SciencesUniversity of PlymouthPlymouthUK,Plymouth Hospitals NHS TrustsPlymouthUK,Musgrove Park HospitalTauntonUK
| | | | | | - Bernie Carter
- Faculty of Health and Social CareEdge Hill UniversityOrmskirkUK
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O'Malley N, Coote S, Clifford AM. Protocol for the development of a core outcome set for evaluating mixed-diagnosis falls prevention interventions for people with Multiple Sclerosis, Parkinson’s Disease and stroke. HRB Open Res 2022; 4:123. [PMID: 35633846 PMCID: PMC9123332 DOI: 10.12688/hrbopenres.13459.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Given the high incidence of falls and their associated negative effects, the development of effective falls prevention interventions for people with Multiple Sclerosis (MS), Parkinson's Disease (PD) and stroke is a priority. Currently the implementation of condition-specific falls prevention interventions is challenging in the community due to lack of participants and resources. Given the similarities in falls risk factors across stroke, PD and MS, the design of mixed-diagnosis interventions for groups comprising of people with these three neurological conditions may solve these implementation challenges. Having a core outcome set (COS) for evaluating these interventions would enable the comparison and combination of data, thereby facilitating progress in this research area. Therefore, the aim of this research study is to develop a COS for evaluating mixed-diagnosis falls prevention interventions for people with MS, PD and stroke. Methods: This will be a mixed-methods, international, multi-perspective Delphi consensus study with five stages. Stage one will involve the identification of potential outcomes through a systematic literature search, patient focus groups, and consultation with our stakeholder group. The second stage will be the development of the Delphi survey using the outcomes elicited from stage one. Stage three will be the prioritisation of outcomes using a two-round online Delphi survey involving patients, clinicians, researchers and policy-makers/service-planners. The fourth stage will be to identify and recommend outcome measures and definitions. The final stage will be a consensus meeting with representatives from each stakeholder group to agree upon the final COS. Discussion: Adoption of this COS in future trials investigating the effectiveness of mixed-diagnosis falls prevention interventions for people with MS, PD and stroke will facilitate the comparison and combination of research findings. This should translate into improved decision-making by service-planners/policy-makers and clinicians regarding the implementation of evidence-based falls prevention interventions into practice.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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5
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O'Malley N, Coote S, Clifford AM. Protocol for the development of a core outcome set for evaluating mixed-diagnosis falls prevention interventions for people with Multiple Sclerosis, Parkinson's Disease and stroke. HRB Open Res 2022; 4:123. [PMID: 35633846 PMCID: PMC9123332 DOI: 10.12688/hrbopenres.13459.1] [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] [Accepted: 05/04/2022] [Indexed: 11/15/2023] Open
Abstract
Background: Given the high incidence of falls and their associated negative effects, the development of effective falls prevention interventions for people with Multiple Sclerosis (MS), Parkinson's Disease (PD) and stroke is a priority. Currently the implementation of condition-specific falls prevention interventions is challenging in the community due to lack of participants and resources. Given the similarities in falls risk factors across stroke, PD and MS, the design of mixed-diagnosis interventions for groups comprising of people with these three neurological conditions may solve these implementation challenges. Having a core outcome set (COS) for evaluating these interventions would enable the comparison and combination of data, thereby facilitating progress in this research area. Therefore, the aim of this research study is to develop a COS for evaluating mixed-diagnosis falls prevention interventions for people with MS, PD and stroke. Methods: This will be a mixed-methods, international, multi-perspective Delphi consensus study with five stages. Stage one will involve the identification of potential outcomes through a systematic literature search, patient focus groups, and consultation with our stakeholder group. The second stage will be the development of the Delphi survey using the outcomes elicited from stage one. Stage three will be the prioritisation of outcomes using a two-round online Delphi survey involving patients, clinicians, researchers and policy-makers/service-planners. The fourth stage will be to identify and recommend outcome measures and definitions. The final stage will be a consensus meeting with representatives from each stakeholder group to agree upon the final COS. Discussion: Adoption of this COS in future trials investigating the effectiveness of mixed-diagnosis falls prevention interventions for people with MS, PD and stroke will facilitate the comparison and combination of research findings. This should translate into improved decision-making by service-planners/policy-makers and clinicians regarding the implementation of evidence-based falls prevention interventions into practice.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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O'Malley N, Clifford AM, Conneely M, Casey B, Coote S. Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson's disease and stroke: an umbrella review. BMC Neurol 2021; 21:378. [PMID: 34587933 PMCID: PMC8480085 DOI: 10.1186/s12883-021-02402-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/29/2021] [Indexed: 03/15/2023] Open
Abstract
Background The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups. Methods A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table. Results Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS. Conclusions The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02402-6.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. .,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Bláthín Casey
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland.,Multiple Sclerosis Society of Ireland, Limerick, Ireland
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Audulv Å, Hutchinson S, Warner G, Kephart G, Versnel J, Packer TL. Managing everyday life: Self-management strategies people use to live well with neurological conditions. PATIENT EDUCATION AND COUNSELING 2021; 104:413-421. [PMID: 32819756 DOI: 10.1016/j.pec.2020.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/30/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This paper uses the Taxonomy of Everyday Self-management Strategies (TEDSS) to provide insight and understanding into the complex and interdependent self-management strategies people with neurological conditions use to manage everyday life. METHODS As part of a national Canadian study, structured telephone interviews were conducted monthly for eleven months, with 117 people living with one or more neurological conditions. Answers to five open-ended questions were analyzed using qualitative content analysis. A total of 7236 statements were analyzed. RESULTS Findings are presented in two overarching patterns: 1) self-management pervades all aspects of life, and 2) self-management is a chain of decisions and behaviours. Participants emphasized management of daily activities and social relationships as important to maintaining meaning in their lives. CONCLUSION Managing everyday life with a neurological condition includes a wide range of diverse strategies that often interact and complement each other. Some people need to intentionally manage every aspect of everyday life. PRACTICE IMPLICATIONS For people living with neurological conditions, there is a need for health providers and systems to go beyond standard advice for self-management. Self-management support is best tailored to each individual, their life context and the realities of their illness trajectory.
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Affiliation(s)
- Åsa Audulv
- Department of Nursing, Umeå University, Sweden & Department of Nursing Science, Mid Sweden University, Sweden.
| | - Susan Hutchinson
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Joan Versnel
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Tanya L Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, Canada; Radboud University Medical Centre, Nijmegen, the Netherlands
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Rice LA, Yarnot R, Peterson EW, Backus D, Sosnoff J. Fall Prevention for People With Multiple Sclerosis Who Use Wheelchairs and Scooters. Arch Phys Med Rehabil 2021; 102:801-804. [PMID: 33461727 DOI: 10.1016/j.apmr.2020.10.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
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Gunn H, Stevens KN, Creanor S, Andrade J, Paul L, Miller L, Green C, Ewings P, Barton A, Berrow M, Vickery J, Marshall B, Zajicek J, Freeman JA. Balance Right in Multiple Sclerosis (BRiMS): a feasibility randomised controlled trial of a falls prevention programme. Pilot Feasibility Stud 2021; 7:2. [PMID: 33390184 PMCID: PMC7780657 DOI: 10.1186/s40814-020-00732-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Balance, mobility impairments and falls are problematic for people with multiple sclerosis (MS). The “Balance Right in MS (BRiMS)” intervention, a 13-week home and group-based exercise and education programme, aims to improve balance and minimise falls. This study aimed to evaluate the feasibility of undertaking a multi-centre randomised controlled trial and to collect the necessary data to design a definitive trial. Methods This randomised controlled feasibility study recruited from four United Kingdom NHS clinical neurology services. Patients ≥ 18 years with secondary progressive MS (Expanded Disability Status Scale 4 to 7) reporting more than two falls in the preceding 6 months were recruited. Participants were block-randomised to either a manualised 13-week education and exercise programme (BRiMS) plus usual care, or usual care alone. Feasibility assessment evaluated recruitment and retention rates, adherence to group assignment and data completeness. Proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls) and economic data were collected at baseline, 13 and 27 weeks, and participants completed daily paper falls diaries. Results Fifty-six participants (mean age 59.7 years, 66% female, median EDSS 6.0) were recruited in 5 months; 30 randomised to the intervention group. Ten (18%) participants withdrew, 7 from the intervention group. Two additional participants were lost to follow up at the final assessment point. Completion rates were > 98% for all outcomes apart from the falls diary (return rate 62%). After adjusting for baseline score, mean intervention—usual care between-group differences for the potential primary outcomes at week 27 were MS Walking Scale-12v2: − 7.7 (95% confidence interval [CI] − 17.2 to 1.8) and MS Impact Scale-29v2: physical 0.6 (CI − 7.8 to 9), psychological − 0.4 (CI − 9.9 to 9). In total, 715 falls were reported, rate ratio (intervention:usual care) for falls 0.81 (0.41 to 2.26) and injurious falls 0.44 (0.41 to 2.23). Conclusions Procedures were practical, and retention, programme engagement and outcome completion rates satisfied a priori progression criteria. Challenges were experienced in completion and return of daily falls diaries. Refinement of methods for reporting falls is therefore required, but we consider a full trial to be feasible. Trial registration ISRCTN13587999 Date of registration: 29 September 2016
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Affiliation(s)
- H Gunn
- Faculty of Health, School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, England.
| | - K N Stevens
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England.,Peninsula Clinical Trials Unit, University of Plymouth, Room N16, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - S Creanor
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England.,University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, England
| | - J Andrade
- Faculty of Health, School of Psychology, University of Plymouth, Portland Square Building, Drake Circus Campus, Plymouth, PL4 8AA, England
| | - L Paul
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland
| | - L Miller
- Douglas Grant Rehabilitation Unit, Ayrshire Central Hospital, Kilwinning Road, Irvine, KA12 8SS, Scotland
| | - C Green
- University of Exeter Medical School, Health Economics Group, University of Exeter, St. Luke's Campus, Exeter, EX1 2LU, England
| | - P Ewings
- NIHR Research Design Service (South West), Musgrove Park Hospital, Taunton, TA1 5DA, England
| | - A Barton
- Faculty of Medicine and Dentistry, NIHR Research Design Service South West, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - M Berrow
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - J Vickery
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - B Marshall
- Faculty of Health, School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, England
| | - J Zajicek
- School of Medicine, Medical and Biological Sciences, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF, Scotland
| | - J A Freeman
- Faculty of Health, School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, England
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O'Malley N, Clifford AM, Comber L, Coote S. Effectiveness of non-pharmacological falls prevention interventions for people with Multiple Sclerosis, Parkinson's Disease and stroke: protocol for an umbrella review. HRB Open Res 2020; 3:17. [PMID: 33392439 PMCID: PMC7745191 DOI: 10.12688/hrbopenres.13023.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Falls are common among people with neurological diseases and have many negative physical, psychosocial and economic consequences. Implementation of single-diagnosis falls prevention interventions is currently problematic due to lack of participants and resources. Given the similarities in falls risk factors across stroke, Parkinson's Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for mixed neurological populations seems plausible and may provide a pragmatic solution to current implementation challenges. This umbrella review aims to summarise the totality of evidence regarding the effectiveness of non-pharmacological falls prevention interventions for people with MS, PD and stroke and identify the commonalities and differences between effective interventions for each disease to inform the development of an evidence-based intervention that can be tailored for people with mixed diagnoses. Methods: This umbrella review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. 15 electronic databases and grey literature will be searched. Systematic reviews of randomised controlled trials and studies investigating the effects of non-pharmacological falls prevention interventions on falls outcomes among people with MS, PD and stroke will be included. Methodological quality of included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 tool. The Grading of Recommendations Assessments, Development and Evaluation framework will be used to rate the quality of evidence. A summary of evidence table and narrative synthesis will be utilised to clearly indicate the findings. Discussion: This umbrella review presents a novel and timely approach to synthesise existing falls literature to identify effective non-pharmacological interventions for people with MS, PD and stroke. Of importance, a robust methodology will be used to explore the differences and similarities in effective interventions for individuals with these neurological conditions to facilitate the development of an intervention for these mixed neurological groups.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Amanda M. Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Centre, University of Limerick, Limerick, Ireland
| | - Laura Comber
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
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Dennett R, Coulter E, Paul L, Freeman J. A qualitative exploration of the participants' experience of a web-based physiotherapy program for people with multiple sclerosis: Does it impact on the ability to increase and sustain engagement in physical activity? Disabil Rehabil 2020; 42:3007-3014. [PMID: 30907159 DOI: 10.1080/09638288.2019.1582717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Web-based exercise and physical activity interventions are being developed as a potential way to help people with multiple sclerosis achieve and maintain increased physical activity levels. Seeking feedback from people who have used such interventions will help guide the development process.Methods: In-depth interviews were used to explore the experiences of participants who used a web-based physiotherapy intervention as part of a feasibility randomized controlled trial. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analysis.Results: Eleven people (age 28-68) were interviewed. Most perceived that their physical activity had increased, primarily due to completing twice-weekly web-based physiotherapy sessions. Three key themes were identified. 'It's all in one place' encompasses the value of having a convenient and portable program. 'Keeping an eye' captures people's thoughts regarding the supervision offered by the physiotherapist, through the website, and 'Hopes and expectations' reflects the importance of having opportunity to discuss what may be gained from using such a program.Conclusions: This intervention offered a convenient, flexible and portable physiotherapy program which most people perceived helped them achieve and sustain increased levels of physical activity. Talking with people about expectations is important, particularly if a person's condition is deteriorating.IMPLICATIONS FOR REHABILITATIONWhen discussing the potential benefits of exercise programs with people with multiple sclerosis it is important to have honest and open conversations about the expectations of what may be achieved. This is particularly important for people with progressive disease.Web-based interventions may be most valuable to people who are technology literate, seek flexibility regarding where and when to exercise, prefer to exercise independently and have the confidence and skills to self-manage.Trial registration: ClinicalTrials.gov identifier: NCT02508961.
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Affiliation(s)
- Rachel Dennett
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Elaine Coulter
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Jennifer Freeman
- School of Health Professions, University of Plymouth, Plymouth, UK
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Gunn H, Andrade J, Paul L, Miller L, Creanor S, Stevens K, Green C, Ewings P, Barton A, Berrow M, Vickery J, Marshall B, Zajicek J, Freeman J. A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the BRiMS feasibility RCT. Health Technol Assess 2020; 23:1-166. [PMID: 31217069 DOI: 10.3310/hta23270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (BRiMS), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility. OBJECTIVE This feasibility trial aimed to obtain the necessary data and operational experience to finalise the planning of a future definitive multicentre randomised controlled trial. DESIGN Randomised controlled feasibility trial. Participants were block randomised 1 : 1. Researcher-blinded assessments were scheduled at baseline and at 15 and 27 weeks post randomisation. As is appropriate in a feasibility trial, statistical analyses were descriptive rather than involving formal/inferential comparisons. The qualitative elements utilised template analysis as the chosen analytical framework. SETTING Four sites across the UK. PARTICIPANTS Eligibility criteria included having a diagnosis of secondary progressive MS, an Expanded Disability Status Scale (EDSS) score of between ≥ 4.0 and ≤ 7.0 points and a self-report of two or more falls in the preceding 6 months. INTERVENTIONS Intervention - manualised 13-week education and exercise programme (BRiMS) plus usual care. Comparator - usual care alone. MAIN OUTCOME MEASURES Trial feasibility, proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls), feasibility of the BRiMS programme (via process evaluation) and economic data. RESULTS A total of 56 participants (mean age 59.7 years, standard deviation 9.7 years; 66% female; median EDSS score of 6.0 points, interquartile range 6.0-6.5 points) were recruited in 5 months; 30 were block randomised to the intervention group. The demographic and clinical data were broadly comparable at baseline; however, the intervention group scored worse on the majority of baseline outcome measures. Eleven participants (19.6%) withdrew or were lost to follow-up. Worsening of MS-related symptoms unrelated to the trial was the most common reason (n = 5) for withdrawal. Potential primary and secondary outcomes and economic data had completion rates of > 98% for all those assessed. However, the overall return rate for the patient-reported falls diary was 62%. After adjusting for baseline score, the differences between the groups (intervention compared with usual care) at week 27 for the potential primary outcomes were MS Walking Scale (12-item) version 2 -7.7 [95% confidence interval (CI) -17.2 to 1.8], MS Impact Scale (29-item) version 2 (MSIS-29vs2) physical 0.6 (95% CI -7.8 to 9) and MSIS-29vs2 psychological -0.4 (95% CI -9.9 to 9) (negative score indicates improvement). After the removal of one outlier, a total of 715 falls were self-reported over the 27-week trial period, with substantial variation between individuals (range 0-93 falls). Of these 715 falls, 101 (14%) were reported as injurious. Qualitative feedback indicated that trial processes and participant burden were acceptable, and participants highlighted physical and behavioural changes that they perceived to result from undertaking BRiMS. Engagement varied, influenced by a range of condition- and context-related factors. Suggestions to improve the utility and accessibility of BRiMS were highlighted. CONCLUSIONS The results suggest that the trial procedures are feasible and acceptable, and retention, programme engagement and outcome completion rates were sufficient to satisfy the a priori progression criteria. Challenges were experienced in some areas of data collection, such as completion of daily diaries. FUTURE WORK Further development of BRiMS is required to address logistical issues and enhance user-satisfaction and adherence. Following this, a definitive trial to assess the clinical effectiveness and cost-effectiveness of the BRiMS intervention is warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN13587999. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hilary Gunn
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Jackie Andrade
- School of Psychology, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Linda Miller
- Douglas Grant Rehabilitation Unit, Ayrshire Central Hospital, Irvine, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.,Medical Statistics Group, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Kara Stevens
- Medical Statistics Group, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Colin Green
- University of Exeter Medical School, Health Economics Group, University of Exeter, Exeter, UK
| | - Paul Ewings
- National Institute for Health Research (NIHR) Research Design Service (South West), Musgrove Park Hospital, Taunton, UK
| | - Andrew Barton
- National Institute for Health Research (NIHR) Research Design Service, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Margie Berrow
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | | | - John Zajicek
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Jennifer Freeman
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
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das Nair R, de Groot V, Freeman J. Beyond current research practice: Methodological considerations in MS rehabilitation research (is designing the perfect rehabilitation trial the Holy Grail or a Gordian knot?). Mult Scler 2020; 25:1337-1347. [PMID: 31469355 DOI: 10.1177/1352458519858271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rehabilitation is an essential aspect of symptomatic and supportive treatment for people with multiple sclerosis (MS). The number of randomised controlled trials (RCTs) for rehabilitation interventions in MS has increased over the last two decades. The design, conduct and reporting quality of some of these trials could be improved. There are, however, some specific challenges that researchers face in conducting RCTs of rehabilitation interventions, which are often 'complex interventions'. This paper explores some of the challenges of undertaking robust clinical trials in rehabilitation. We focus on issues related to (1) participant selection and sample size, (2) interventions - the 'dose', content, active ingredients, targeting, fidelity of delivery and treatment adherence, (3) control groups and (4) outcomes - choosing the right type, number, timing of outcomes, and the importance of defining a primary outcome and clinically important difference between groups. We believe that by following internationally accepted RCT guidelines, by developing a critical mass of MS rehabilitation 'trialists' through international collaboration and by continuing to critique, challenge, and develop RCT designs, we can exploit the potential of RCTs to answer important questions related to the effectiveness of rehabilitation interventions.
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Affiliation(s)
- Roshan das Nair
- Clinical Psychology and Neuropsychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - Vincent de Groot
- Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Freeman
- Physiotherapy and Rehabilitation, School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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O'Malley N, Clifford AM, Comber L, Coote S. Effectiveness of non-pharmacological falls prevention interventions for people with Multiple Sclerosis, Parkinson's Disease and stroke: protocol for an umbrella review. HRB Open Res 2020; 3:17. [PMID: 33392439 PMCID: PMC7745191 DOI: 10.12688/hrbopenres.13023.1] [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] [Accepted: 04/09/2020] [Indexed: 09/19/2023] Open
Abstract
Background: Falls are common among people with neurological diseases and are associated with many negative physical, psychosocial and economic consequences. Implementation of single diagnosis falls prevention interventions is currently problematic due to lack of participants and resources. Given the similarities in falls risk factors across stroke, Parkinson's Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for mixed neurological populations seems plausible and may provide a solution to current implementation challenges. This umbrella review aims to summarise the totality of evidence regarding the effectiveness of non-pharmacological falls prevention interventions for people with MS, PD and stroke and to identify the commonalities and differences between interventions that are effective for each disease to inform the development of an intervention for mixed diagnoses. Methods: This umbrella review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases and grey literature will be searched. Systematic reviews of randomised controlled trials (RCTS) and studies investigating the effects of non-pharmacological falls prevention interventions on falls outcomes among people with MS, PD and stroke will be included. Methodological quality of included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 tool. The Grading of Recommendations Assessments, Development and Evaluation framework will be used to rate the quality of evidence. A summary of evidence table and narrative synthesis will be utilised to clearly indicate the findings. Discussion: This umbrella review presents a novel and timely approach to synthesise existing falls literature to identify effective non-pharmacological interventions for people with MS, PD and stroke. Of importance, this umbrella review will use a robust methodology to explore the key differences and similarities in effective interventions for individuals with these neurological diseases to facilitate the development of an intervention for mixed neurological groups.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Amanda M. Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Centre, University of Limerick, Limerick, Ireland
| | - Laura Comber
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
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