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Watter K, Murray A, McLennan V, Vogler J, Jeffery S, Ehlers S, Nielsen M, Kennedy A. A framework to support early team-based provision of vocational rehabilitation for adults with acquired brain injury. Disabil Rehabil 2024; 46:3176-3188. [PMID: 37525931 DOI: 10.1080/09638288.2023.2239162] [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: 03/24/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Specialised vocational rehabilitation (VR) following acquired brain injury (ABI) positively impacts return to work, however access to this is limited globally. Providing VR as a component of standard ABI rehabilitation may improve access to VR and influence vocational outcomes. This study aimed to develop an evidence-based framework for the delivery of ABI VR during early transitional community rehabilitation. MATERIALS AND METHODS The development of the ABI VR framework utilised an emergent multi-phase design and was informed by models of evidence-based practice, national rehabilitation standards, guidelines for complex intervention development, model of care and framework development, and the knowledge-to-action framework. Four study phases were undertaken to identify and generate the evidence base, with findings synthesised to develop the ABI VR framework in phase five. RESULTS The framework provides a structure for the systematic delivery of VR as a component of team-based ABI rehabilitation, through five phases of rehabilitation: assessment; goal setting and rehabilitation planning; intervention; monitoring and evaluation; and discharge. It details the activities to be undertaken across the phases using a hybrid model of ABI VR (involving program-based VR and case coordination) and contains service delivery features. CONCLUSION The framework has the potential to translate to other similar service contexts.
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Affiliation(s)
- Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Alena Murray
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
| | - Vanette McLennan
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Jessica Vogler
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Sarah Jeffery
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Shelley Ehlers
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
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Pryde SJ, Williams O, O'Hare MP, Murdock C, Pedlow K. Exploring access to community neurorehabilitation for people with progressive neurological conditions: a qualitative study. Disabil Rehabil 2024:1-14. [PMID: 38632940 DOI: 10.1080/09638288.2024.2338198] [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: 06/12/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers. METHODS Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method. RESULTS Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified. CONCLUSIONS This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.
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Affiliation(s)
- Shona J Pryde
- School of Health Sciences, Ulster University, Londonderry, UK
- Physiotherapy Department, Belfast Health and Social Care Trust, Belfast, UK
| | | | | | - Carolyn Murdock
- School of Health Sciences, Ulster University, Londonderry, UK
| | - Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, UK
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Bartolomeu Pires S, Kunkel D, Kipps C, Goodwin N, Portillo MC. Person-centred integrated care for people living with Parkinson's, Huntington's and Multiple Sclerosis: A systematic review. Health Expect 2024; 27:e13948. [PMID: 39102669 PMCID: PMC10768870 DOI: 10.1111/hex.13948] [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: 05/16/2023] [Revised: 10/18/2023] [Accepted: 12/12/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION People living with long-term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions. METHODS A systematic review of the literature was undertaken evaluating multisectoral integrated care interventions in people living with Parkinson's disease (PD), Multiple Sclerosis (MS) and Huntington's disease (HD). Strength of evidence was rated for the different outcomes. RESULTS A total of 15 articles were included, reporting on 2095 patients and caregivers, finding that integrated care can improve people's access to resources and reduce patients' depression. UK studies indicated improvements in patients' quality of life, although the international literature was inconclusive. Few programmes considered caregivers' outcomes, reporting no difference or even worsening in depression, burden and quality of life. Overall, the evidence showed a mismatch between people's needs and outcomes measured, with significant outcomes (e.g., self-management, continuity of care, care experience) lacking. Successful programmes were characterised by expert knowledge, multisectoral care coordination, care continuity and a person-centred approach. CONCLUSIONS The impact of integrated care programmes on people living with LTNCs is limited and inconclusive. For a more person-centred approach, future studies need to assess integrated care from a service-user perspective. PATIENT AND PUBLIC CONTRIBUTION Thirty people living with LTNCs were involved in this review, through defining research questions, validating the importance of the project, and increasing the researchers' understanding on what matters to service users. A patient and public involvement subgroup of representatives with lived experience on PD, MS and HD identified the need for more person-centred integrated care, with specific concerns over care fragmentation, care duplication and care continuity. This was key to data analysis and formulating the characteristics of successful and unsuccessful integrated care programmes from the perspective of service users. The discrepancy between service users' needs and the outcomes assessed in the literature point to user-driven research as the solution to address what matters to patients and caregivers.
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Affiliation(s)
- Sandra Bartolomeu Pires
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation CentreSouthamptonUK
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Dorit Kunkel
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation CentreSouthamptonUK
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Christopher Kipps
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation CentreSouthamptonUK
- Department of Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- Wessex Neurological CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Nick Goodwin
- Central Coast Research Institute for Integrated Care, College of Health Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Mari C. Portillo
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation CentreSouthamptonUK
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Jackson K, Newbury-Birch D. Patient reported experiences of community rehabilitation and/or support services for people with long term neurological conditions: a narrative review of quantitative studies. Disabil Rehabil 2023:1-18. [PMID: 37905706 DOI: 10.1080/09638288.2023.2266369] [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: 12/13/2022] [Accepted: 09/24/2023] [Indexed: 11/02/2023]
Abstract
Objectives: 1. To identify validated quantitative Patient Reported Experience Measures (PREM's) being used in Community Rehabilitation and/or Support services for people with long term neurological conditions (PwLTNC). 2. To explore how data from quantitative PREM's adds to research on patient experiences of Community Rehabilitation and Support for PwLTNC.Method: Eight data bases were searched for peer reviewed studies (2005-2021) which met inclusion criteria. Data extraction and quality assessment for sixteen studies was performed by two reviewers. Narrative synthesis was conducted.Results: Eleven validated PREM's were identified which captured data for 15,831 PwLTNC. PREM scores indicated positive and negative experiences for people with Multiple Sclerosis (n = 13,123), Parkinson's Disease (n = 2215) and Acquired Brain Injury (n = 493). Negative experiences related to Picker Institute Principles: 1 (accessibility); 3 (coordination/continuity); 4 (involvement/support for family and carers); 5 (information provision), 6 (Involvement in decision making) and 7 (empathy and emotional support).Conclusion: Quantitative PREM's provide evidence of process quality and person-centred care within community rehabilitation and support services across large data sets of heterogeneous neurological conditions and geographical locations. Quality improvement initiatives for people with MS, PD and ABI should target processes relating to Picker Institute Principles 1,3,4,5,6, and 7.Implications for RehabilitationQuantitative validated Patient Reported Experience Measures can be used to evaluate process quality and person- centred care within community rehabilitation and support services for people with long term neurological conditions.Experiences of people with Multiple Sclerosis, Parkinson's Disease and Acquired Brain Injury indicate the need for quality improvement in community rehabilitation.Training in communication skills and person-centred care may enhance information provision and support for self-management for people with long term neurological conditions.
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Affiliation(s)
- Katherine Jackson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Bohan JK, Nielsen M, Watter K, Kennedy A. "It gave her that soft landing": Consumer perspectives on a transitional rehabilitation service for adults with acquired brain injury. Neuropsychol Rehabil 2023; 33:1144-1173. [PMID: 35543026 DOI: 10.1080/09602011.2022.2070222] [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: 10/20/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
Transitional rehabilitation service models for people with acquired brain injury (ABI) may address sub-optimal support for individuals returning home after hospitalization for ABI. This study investigated perspectives of people with ABI and close others who received transitional rehabilitation. A qualitative study involving semi-structured interviews with 10 individuals with ABI and 12 associated close others was conducted as part of a mixed-method evaluation of an Australian transitional rehabilitation service (TRS) pilot project. Thematic analysis based on the Framework method was conducted independently by two researchers. Three broad themes illustrated participants' experience of the TRS: (1) structure after hospital discharge; (2) a "soft landing"; and (3) equipped for community living. Findings suggest that home-based, interdisciplinary transitional rehabilitation after hospital discharge was perceived as an important stage of rehabilitation by participants. Valued features relate to post-hospital rehabilitation structure: a single point of contact to facilitate organization and information exchange, a known discharge destination, and consistent communication; support and therapy within a familiar home environment; and being equipped with relevant knowledge and strategies to manage ongoing challenges. Further research exploring the experiences of individuals with ABI without close family or social support, and research capturing longitudinal outcomes from transitional rehabilitation is recommended.
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Affiliation(s)
- Jaycie K Bohan
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Health and Rehabilitation Services, The University of Queensland, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Laurie K, Foster M, Gustafsson L. Personal experiences of appropriate access to post-acute care services in acquired brain injury: a scoping review. BRAIN IMPAIR 2023; 24:1-26. [PMID: 38167584 DOI: 10.1017/brimp.2021.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
People with an acquired brain injury (ABI) experience substantial access inequalities and unmet health needs, with many experiencing insufficient access to appropriate rehabilitation in the community. To deepen our understanding of what appropriate access to post-acute care services is for this population, and to facilitate optimal recovery, there is a need to synthesise research from the service user perspective. A scoping review study was conducted to identify key characteristics of 'appropriate' access to post-acute care services, as defined by the personal experiences of adults with ABI. Electronic scientific databases Medline, PsycINFO, Proquest Central and CINAHL were searched for studies published between 2000 and 2020. The initial search identified 361 articles which, along with articles retrieved from reference list searches, resulted in 52 articles included in the final analysis. Results indicated that a majority of the studies sampled participants with an average of over 1 year post-injury, with some studies sampling participants ranging over 10 years in difference in time post-injury. A thematic synthesis was conducted and results indicated a number of dominant elements which relate to (1) the characteristics of services: provider expertise, interpersonal qualities, partnership and adaptability; (2) characteristics of the health system: navigable system, integrated care, adequacy, and opportunity. These findings provide some insight into what might be considered appropriate. However, rigorous research, focused on personalised access to post-acute care services, is recommended to verify and elaborate on these findings.
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Affiliation(s)
- Kirstyn Laurie
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
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Saumur TM, Gregor S, Xiong Y, Unger J. Quantifying the amount of physical rehabilitation received by individuals living with neurological conditions in the community: a scoping review. BMC Health Serv Res 2022; 22:349. [PMID: 35296315 PMCID: PMC8925183 DOI: 10.1186/s12913-022-07754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Physical rehabilitation is often prescribed immediately following a neurological event or a neurological diagnosis. However, many individuals require physical rehabilitation after hospital discharge. The purpose of this scoping review was to determine the amount of physical rehabilitation that individuals living in the community with neurological conditions receive to understand current global practices and assess gaps in research and service use. Methods This scoping review included observational studies that 1) involved adults living with a neurological condition, and 2) quantified the amount of rehabilitation being received in the community or outpatient hospital setting. Only literature published in English was considered. MEDLINE, EMBASE, AMED, CINAHL, Cochrane Library, and PEDro databases were searched from inception. Two independent reviewers screened titles and abstracts, followed by full texts, and data extraction. Mean annual hours of rehabilitation was estimated based on the amount of rehabilitation reported in the included studies. Results Overall, 18 studies were included after screen 14,698 articles. The estimated mean annual hours of rehabilitation varied greatly (4.9 to 155.1 h), with individuals with spinal cord injury and stroke receiving the greatest number of hours. Participants typically received more physical therapy than occupational therapy (difference range: 1 to 22 h/year). Lastly, only one study included individuals with progressive neurological conditions, highlighting a research gap. Discussion The amount of rehabilitation received by individuals with neurological conditions living in the community varies greatly. With such a wide range of time spent in rehabilitation, it is likely that the amount of rehabilitation being received by most individuals in the community is insufficient to improve function and quality of life. Future work should identify the barriers to accessing rehabilitation resources in the community and how much rehabilitation is needed to observe functional improvements. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07754-4.
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Affiliation(s)
- Tyler M Saumur
- Rehabilitation Sciences Institute, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Sarah Gregor
- Rehabilitation Sciences Institute, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Yijun Xiong
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada
| | - Janelle Unger
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada.
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Exploring the enablers and barriers to social prescribing for people living with long-term neurological conditions: a focus group investigation. BMC Health Serv Res 2021; 21:1230. [PMID: 34774034 PMCID: PMC8590354 DOI: 10.1186/s12913-021-07213-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022] Open
Abstract
Background People living with Long Term Neurological Conditions (LTNCs) value peer support and social activities. Psychological support and wellbeing enables them to manage their condition. Social prescribing is a formal process of referring patients to a link worker to co-design a plan to improve their health and wellbeing. Intervention involves supporting participation in activities based within the individual’s local community. This study aimed to explore the barriers and enablers to accessing social prescribing for people living with LTNCs (plwLTNCs). Methods A total of four focus groups were carried out with 17 participants, including different neurological conditions such as multiple sclerosis, Fragile X Syndrome, epilepsy, and traumatic brain injury. Two participants were family carers and supported people living with epilepsy and motor neurone disease. Findings were analysed using thematic analysis. Results Five themes were identified: (1) Lack of knowledge; (2) Service provision difficulties; (3) Benefits of social prescribing activities; (4) Physical barriers and (5) Psychological barriers. There was a lack of knowledge about social prescribing and what it actually was. Participants anticipated service provision difficulties relating to funding, link workers need for knowledge of LTNC’s and for activities to be varied and individualised. The potential benefits of social prescribing activities were recognised across the groups especially its potential to tackle loneliness and to offer plwLTNC’s purpose. Participants highlighted a number of physical barriers such as transport and accessibility; and psychological barriers such as anxiety and stigma. Conclusion Social prescribing aims to address the health inequalities of those living with long-term conditions, however currently it is likely to exclude plwLTNCs. Recommendations for practice and future research are made. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07213-6.
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Siriwardena AN, Akanuwe JNA, Botan V, Laparidou D, Curtis F, Jackson J, Asghar ZB, Hodgson TL. Patient-reported symptoms and experience following Guillain-Barré syndrome and related conditions: Questionnaire development and validation. Health Expect 2021; 25:223-231. [PMID: 34597442 PMCID: PMC8849366 DOI: 10.1111/hex.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Guillain‐Barré syndrome (GBS) is a rare inflammatory peripheral nerve disorder with variable recovery. Evidence is lacking on experiences of people with GBS and measurement of these experiences. Objective We aimed to develop and validate an instrument to measure experiences of people with GBS. Design We used a cross‐sectional design and online self‐administered questionnaire survey. Question domains, based on a previous systematic review and qualitative study, covered experiences of GBS, symptom severity at each stage, healthcare and factors supporting or hindering recovery. Descriptive, exploratory factor and reliability analyses and multivariable regression analysis were used to investigate the relationships between variables of interest, explore questionnaire reliability and validity and identify factors predicting recovery. Setting and Participants People with a previous diagnosis of GBS were recruited through a social media advert. Results A total of 291 responders, of different sexes, and marital statuses, were included, with most diagnosed between 2015 and 2019. Factor analysis showed four scales: symptoms, information provided, factors affecting recovery and care received. Positive social interactions, physical activity including physiotherapy and movement, changes made at home and immunoglobulin treatment were important for recovery. Multivariable models showed that immunoglobulin and/or plasma exchange were significant predictors of recovery. Employment and recovery factors (positive interactions, work support and changes at work or home, physical activity and therapy), though associated with recovery, did not reach statistical significance. Conclusion The questionnaire demonstrated good internal reliability of scales and subscales and construct validity for people following GBS. Patient Contribution Patients were involved in developing and piloting the questionnaire.
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Affiliation(s)
| | - Joseph N A Akanuwe
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Vanessa Botan
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Despina Laparidou
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Ffion Curtis
- Centre for Ethnic Health Research, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Jennifer Jackson
- Community Orgnisation Group, Lincoln International Business School, University of Lincoln, Lincoln, UK
| | - Zahid B Asghar
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Timothy L Hodgson
- Perception Action Cognition, School of Psychology, University of Lincoln, Lincoln, UK
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O'Keeffe S, Chowdhury I, Sinanaj A, Ewang I, Blain C, Teodoro T, Edwards M, Yogarajah M. A Service Evaluation of the Experiences of Patients With Functional Neurological Disorders Within the NHS. Front Neurol 2021; 12:656466. [PMID: 34135848 PMCID: PMC8200476 DOI: 10.3389/fneur.2021.656466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 11/29/2022] Open
Abstract
Previous research into Functional Neurological Disorder (FND) has shown that there are significant barriers in providing patient-centred care. However, there has been no specific research into whether patient experiences of care for FND meet the current standards of care. This study aimed to investigate the types of problems experienced by FND patients, and whether these differed to patients with multiple sclerosis (MS). FND (n = 40) and MS patients (n = 37) were recruited from NHS tertiary neurology clinics and completed questionnaires on their experiences of health care services. Significant differences in experiences of care between the two patient groups were found, with FND patients reporting significantly more problems in their diagnosis and treatment (p = 0.003), patient-centred care (p < 0.001), relationships with healthcare professionals (p < 0.001), and in accessing community care (p = 0.001). Limitations include a small sample size, specificity to a single centre, and cross-sectional design. The results suggest that current care for FND patients is not meeting expected standards for long-term neurological conditions, highlighting the need for structured care pathways and patient-centred care.
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Affiliation(s)
- Shauna O'Keeffe
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Ibrahim Chowdhury
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, Cranmer Terrace, London, United Kingdom
| | - Anila Sinanaj
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Iberedem Ewang
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Camilla Blain
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Tiago Teodoro
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Mark Edwards
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom.,Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, Cranmer Terrace, London, United Kingdom
| | - Mahinda Yogarajah
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom.,Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, Cranmer Terrace, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Experimental and Clinical Epilepsy, University College London Institute of Neurology, London, United Kingdom
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Rafferty MR, Nettnin E, Goldman JG, MacDonald J. Frameworks for Parkinson's Disease Rehabilitation Addressing When, What, and How. Curr Neurol Neurosci Rep 2021; 21:12. [PMID: 33615420 PMCID: PMC8215896 DOI: 10.1007/s11910-021-01096-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the evidence on rehabilitation for people with Parkinson's disease, including when to refer, what rehabilitation professionals should address, and how to deliver rehabilitation care. RECENT FINDINGS Clinical practice guidelines support physical therapy, occupational therapy, and speech-language pathology for Parkinson's disease. However, integrating guidelines into practice may be difficult. Implementation studies take into account patient and clinician perspectives. Synthesizing guidelines with implementation research can improve local delivery. There is moderate to strong evidence supporting physical therapy, occupational therapy, and speech-language pathology soon after diagnosis and in response to functional deficits. We propose a framework of three pathways for rehabilitation care: (1) consultative proactive rehabilitation soon after diagnosis for assessment, treatment of early deficits, and promotion meaningful activities; (2) restorative rehabilitation to promote functional improvements; and (3) skilled maintenance rehabilitation for long-term monitoring of exercise, meaningful activities, safety, contractures, skin integrity, positioning, swallowing, and communication.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA.
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Jennifer G Goldman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hassett L, van den Berg M, Weber H, Chagpar S, Wong S, Rabie A, McCluskey A, Lindley RI, Crotty M, Sherrington C. Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial - description of device use and physiotherapy support in the post-hospital phase. Disabil Rehabil 2020; 43:3454-3460. [PMID: 32663066 DOI: 10.1080/09638288.2020.1790679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe device use and physiotherapy support in the post-hospital phase of the AMOUNT rehabilitation trial. METHODS We performed an evaluation of the support required for device use by participants randomised to the intervention group who received digitally-enabled rehabilitation in the post-hospital phase (n = 144). Intervention, additional to standard rehabilitation, utilised eight digital devices (virtual reality videogames, activity monitors and handheld computer devices) to improve mobility and increase physical activity. Participants were taught to use devices during inpatient rehabilitation and were then discharged home to use the devices for the remainder of the 6-month trial. Physiotherapist-participant contact occurred every 1-2 weeks using a health coaching approach, including technology support when required. Intervention datasheets were audited, and descriptive statistics used to report device use and support required. RESULTS Participants (mean (SD) age 70 (18) years; 49% neurological health conditions) used an average of 2 (SD 1) devices (98% used an activity monitor). Eight percent of physiotherapy contact included technology support with 30% provided remotely. Support addressed 845 issues categorised under initial set-up and instruction (27%), education and training (31%), maintenance (23%) and trouble-shooting (19%). CONCLUSION Digital devices can be used for home-based rehabilitation, but ongoing technology support is essential. Clinical Trials Registry: ACTRN12614000936628IMPLICATIONS FOR REHABILITATIONDigital device use at home to support long-term management of health conditions is likely to become increasingly important as the need for rehabilitation increases and rehabilitation resources become more limited.Technology support for set-up and ongoing device use is a critical enabler of home-based digital interventions.Health professionals delivering home-based digital interventions require sufficient training and equipment and may need to vary the mode (e.g., home visit vs. telephone or video conference) depending on the technology support required.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.,Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Maayken van den Berg
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Heather Weber
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Ashley Rabie
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,StrokeEd Collaboration, Sydney, Australia
| | - Richard I Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
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13
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Kılınç S, Erdem H, Healey R, Cole J. Finding meaning and purpose: a framework for the self-management of neurological conditions. Disabil Rehabil 2020; 44:219-230. [DOI: 10.1080/09638288.2020.1764115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephanie Kılınç
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Hannah Erdem
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Rebecca Healey
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Joanne Cole
- Neuro Key (working title of the Tees Valley, Durham and North Yorkshire Neurological Alliance), Acklam Green Centre, Middlesbrough, UK
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14
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Kovács A, Mezőfi V, Gyarmathy VA, Rácz J. Rehabilitation From Addiction and Chronic Illnesses: A Comparative Analysis of the Narratives of Hungarian Patients. Res Theory Nurs Pract 2020; 34:65-80. [PMID: 31937637 DOI: 10.1891/1541-6577.34.1.65] [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: 11/25/2022]
Abstract
BACKGROUND In Hungary the psychological care provided during the rehabilitation of patients with chronic illnesses is insufficient. Patients with addiction, on the other hand, appear to make more use of psychological services. Narratives of patients recovering from addiction and patients with various chronic illnesses were examined in order to gain a better understanding of psychological phenomena during rehabilitation. METHODS Semi-structured interviews were carried out. Narrative and thematic analysis was used in order to determine the structure and characteristics of patients' narratives. RESULTS The narratives of patients recovering from addiction were found to be more structured and uniform; they identified with their illness and played an active role in their recovery. Patients with a chronic illness mainly recounted passive events and physical difficulties. Stigmatization was mentioned by both groups. IMPLICATIONS FOR PRACTICE The level of stigmatization experienced by patients with a chronic illness may be one of the reasons why they use healthcare services more frequently than patients with an addiction. The authors believe that teaching patients to provide good narratives about suffering from and recovering from chronic illnesses may aid them in the rehabilitation process. An adaptive mixture of different illnesses and addiction narratives might be beneficial in the recovery process of various patient groups.
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Affiliation(s)
- Asztrik Kovács
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Virág Mezőfi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - V Anna Gyarmathy
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - József Rácz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Hungary Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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15
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Pohl P, Carlsson G, Bunketorp Käll L, Nilsson M, Blomstrand C. A qualitative exploration of post-acute stroke participants' experiences of a multimodal intervention incorporating horseback riding. PLoS One 2018; 13:e0203933. [PMID: 30235246 PMCID: PMC6147507 DOI: 10.1371/journal.pone.0203933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/30/2018] [Indexed: 12/29/2022] Open
Abstract
Background Multimodal rehabilitation interventions delivered in late phase of stroke recovery involve physical (motor and sensory), social, and cognitively challenging activities. Horseback riding can be incorporated within such interventions, leading to meaningful long-term improvements when applied to individuals with moderate levels of disability. There is a lack of research illuminating stroke survivors’ experiences and perceptions of horseback riding in the context of multimodal interventions. Aim To explore stroke survivors’ experiences of participation in a multimodal group-based intervention that included horseback riding. Methods An explorative interview study was conducted with individual face-to-face interviews performed on a single occasion, utilising a semi-structured interview guide. Eighteen participants were purposively selected from a larger trial (mean age 62, 12 men, 6 women) within four weeks after treatment completion. The interview duration was between 17 and 50 minutes. The data was analysed using a qualitative content analysis method. Findings Four broad themes were identified from the analysis. These themes were: transformative experiences; human–horse interaction; togetherness and belonging; and the all-in-one solution. Interacting with the horse and peers had a profound emotional impact on the participants. The participants also reported having learned new skills, increased self-efficacy and self-esteem, and improvements in balance and gait, all of which could be transferred to everyday life. The horse itself played a central role, but other components, such as the other group members, the instructors, and the challenging tasks on the horseback, were also important. Conclusion A multimodal rehabilitation intervention that includes horseback riding may provide stroke survivors in a late phase of recovery with rich pleasurable experiences that may have life-changing and profound impacts on their emotional and physical state.
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Affiliation(s)
- Petra Pohl
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Activity and Health, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- * E-mail:
| | - Gunnel Carlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lina Bunketorp Käll
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Stroke Centre West, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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