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Stiekema APM, Rauwenhoff JCC, Bierlaagh D, Donkervoort M, Jansen N, Jurrius KHM, Zadoks J, van Heugten CM. Case management for people with acquired brain injury: feasibility and effectiveness of a two-year pragmatic randomized controlled trial. Brain Inj 2024:1-12. [PMID: 39245982 DOI: 10.1080/02699052.2024.2399070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 05/22/2024] [Accepted: 08/21/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Case management (CM) aims to facilitate access to and integration of health care and social services. We investigated the feasibility and effectiveness of CM. METHODS Randomized controlled trial with 219 patients and 114 caregivers randomly allocated to CM (109/59) or care as usual (110/55). CM was based on early and continuous online monitoring of problems and needs. Outcomes were assessed every 6 months with the Hospital Anxiety and Depression Scale (HADS). Secondary outcome domains were participant restrictions, life satisfaction, self-efficacy, caregiver burden, and needs. Multilevel modeling was used. Feasibility aspects were protocol delivery, participants' and case managers' satisfaction, and factors affecting implementation. RESULTS There were no significant differences between groups. Participation restrictions and unmet needs decreased in both groups within 6 months. Monitoring was successful in 38, and 10 participants asked the CM for support. CM consisted mostly of providing information. DISCUSSION CM based on early and continuous online monitoring does not have benefit in identifying and addressing problems early after relatively mild injury. Unsuccessful monitoring may have hindered access to the case manager and prevented us from evaluating CM as a complex intervention. It remains a challenge to early identify those who could benefit from care coordination.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
| | - Johanne C C Rauwenhoff
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
| | | | - Mireille Donkervoort
- Health Care and Social Work Division, Windesheim University of Applied Sciences, Almere, The Netherlands
- Mevrouw Slimmer Werken Social Innovation in Health Care and Well-Being, Drogteropslagen, Netherlands
| | - Natska Jansen
- Brain Injury Team, Brain Injury Network, Overijssel, Netherlands
| | | | - Judith Zadoks
- In-Tussen Foundation, Utrecht, the Netherlands
- BreinDok Innovation in Care, Utrecht, the Netherlands
| | - Caroline M van Heugten
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Leitch S, Logan M, Beishon L, Quinn TJ. International research priority setting exercises in stroke: A systematic review. Int J Stroke 2023; 18:133-143. [PMID: 35422174 DOI: 10.1177/17474930221096935] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Agreeing on priority topics for stroke research can help make best use of limited funding, people, and time. Formal priority-setting exercises collate stakeholders' opinions to reach consensus on the most important research questions. Several stroke research priority setting exercises have been published. Exploring commonalities and differences between these exercises could bring a better understanding of priority research topics. AIM We collated and compared published stroke research priority setting exercises across international healthcare systems. SUMMARY OF REVIEW Multidisciplinary, electronic literature databases were searched from 2000 to 2021, using a validated search syntax. Inclusion criteria were: full article; stroke focus (any subtype); prioritization method described; and lists priorities for research. Priorities were extracted, coded, and assigned to categories using thematic analysis. The Nine Common Themes of Good Practice and the Reporting guideline for priority setting of health research checklists were used to assess methodological and reporting quality respectively. From 623 titles assessed, 14 studies were eligible for inclusion, including 2410 participants and describing 165 priorities. The majority of priority setting exercises were conducted in high-income countries (86%, n = 12 articles), published between 2011 and 2021 (64%, n = 9), and included views of healthcare professionals (57%, n = 8), and stroke survivors (50%, n = 7). Caregivers (n = 3, 21%) were under-represented. The James Lind Alliance priority setting method was most commonly used (50%, n = 7). Priorities were grouped into 10 thematic categories. Rehabilitation and follow-up was the most common priority theme (15%, n = 25 priorities), followed by psychological recovery (14%, n = 23), pathology (14%, n = 23), and caregivers and support (14%, n = 23). Priorities differed by year and case-mix (stakeholder group and demographics) of respondents. No article was judged high quality for all aspects of method or reporting. Common limitations were around inclusiveness and evaluation of the exercise. CONCLUSION Stroke research priorities are dynamic and context-specific. However, there was a common theme of prioritizing research that considered life after stroke. Future priority settings should consider the inclusion of nonindustrialized countries and stroke survivors with a range of impairments.
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Affiliation(s)
- Stephanie Leitch
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Monica Logan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Duncan Millar J, VAN Wijck F, Pollock A, Ali M. International consensus recommendations for outcome measurement in post-stroke arm rehabilitation trials. Eur J Phys Rehabil Med 2020; 57:61-68. [PMID: 33215905 DOI: 10.23736/s1973-9087.20.06575-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Existing randomized controlled trials (RCTs) of arm rehabilitation interventions after stroke use a wide range of outcome measures, limiting ability to pool data to determine efficacy. Published recommendations also lack stroke survivor, carer and clinician involvement specifically about perceived relevance and importance of outcomes and measures. AIM To generate international consensus recommendations for selection of outcome measures for use in future stroke RCTs in arm rehabilitation, considering outcomes important to stroke survivors, carers and clinicians. The recommendations are the Standardizing Measurement in Arm Rehabilitation Trials (SMART) Toolbox. DESIGN Two-round international e-Delphi Survey and consensus meeting. SETTING Online and University. POPULATION Fifty-five researchers and clinicians with expertise in stroke upper limb rehabilitation from 18 countries (e-Delphi); N.=13 researchers and clinicians, N.=2 stroke survivors, N.=1 carer (consensus meeting). METHODS Using systematically identified outcome measures from published RCTs, we conducted a two-round international e-Delphi Survey with researchers and clinicians to identify the most important measures for inclusion in the toolbox. Measures that achieved ≥60% consensus were categorized using the International Classification of Functioning, Disability and Health Framework (ICF); psychometric properties were ascertained from literature and research resources. At a final consensus meeting, expert stakeholders selected measures for inclusion in the toolbox. RESULTS e-Delphi participants recommended 28/170 measures for discussion at the final consensus meeting. Expert stakeholders (N.=16) selected the Visual Analogue Scale for pain/0-10 Numeric Pain Rating Scale, dynamometry, Action Research Arm Test, Wolf Motor Function Test, Barthel Index, Motricity Index and Fugl-Meyer Assessment (upper limb section of each), Box and Block Test, Motor Activity Log 14, Nine Hole Peg Test, Functional Independence Measure, EQ-5D, Canadian Occupational Performance Measure and Modified Rankin Scale for inclusion in the toolbox. CONCLUSIONS The SMART Toolbox provides a refined selection of measures that capture outcomes considered important by stakeholders for each ICF domain. CLINICAL REHABILITATION IMPACT The toolbox will facilitate data aggregation for efficacy analyses thereby strengthening evidence to inform clinical practice. Clinicians can also use the toolbox to guide selection of measures ensuring a patient-centered focus.
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Affiliation(s)
- Julie Duncan Millar
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK -
| | - Frederike VAN Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Myzoon Ali
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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4
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Stiekema APM, Resch C, Donkervoort M, Jansen N, Jurrius KHM, Zadoks JM, van Heugten CM. Case management after acquired brain injury compared to care as usual: study protocol for a 2-year pragmatic randomized controlled superiority trial with two parallel groups. Trials 2020; 21:928. [PMID: 33203462 PMCID: PMC7672813 DOI: 10.1186/s13063-020-04804-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
Background People with acquired brain injury may suffer from cognitive, emotional and behavioural changes in the long term. Continuity of care is often lacking, leading to a variety of unmet needs and hindering psychosocial functioning from the occurrence of brain injury up to years thereafter. Case management aims to prevent (escalation of) problems and to facilitate timely access to appropriate services. In other populations, case management has shown to improve psychosocial well-being. In this study, we aim to evaluate the feasibility of case management after acquired brain injury and its effectiveness and cost-effectiveness, compared to care as usual. Methods This is a pragmatic randomized controlled superiority trial with two parallel groups and repeated measures in adults with ABI and their family, taking place between November 2019 and December 2021 in three provinces in the Netherlands. Participants will be randomly allocated to either the case management group, receiving case management from hospital discharge up to 2 years thereafter, or the control group, receiving care as usual. Effectiveness will be evaluated every 6 months for 18–24 months by patient-reported psychosocial well-being (Hospital Anxiety and Depression Scale (HADS), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) restriction subscale and the Life Satisfaction Questionnaire (LiSat)), self-management (Patient Activation Measure (PAM)) and care needs (Longer-term Unmet Needs after Stroke (LUNS)). Family outcomes include self-efficacy (Carer Self-Efficacy Scale (CSES)), caregiver burden (Caregiver Strain Index (CSI)), psychosocial well-being (LiSat, HADS), family needs (Family Needs Questionnaire (FNQ)). Feasibility will be evaluated using qualitative methods, assessing fidelity, dose delivered, dose received, reach, recruitment and context. Cost-effectiveness will be determined by the EQ-5D-3L and service use. Discussion At the moment, there is no integrated health care service for people with acquired brain injury and their family members in the long term. If case management is shown to be feasible and (cost)-effective, it could bridge the gap between patients’ and families’ needs and the available services. Trial registration Netherlands Trial Register NL8104. Registered on 22 October 2019.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
| | - Christine Resch
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Mireille Donkervoort
- Health Care and Social Work Division, Windesheim University of Applied Sciences, Almere, The Netherlands
| | - Natska Jansen
- Mevrouw Slimmer Werken Social Innovation in Health Care and Well-Being, Drogteropslagen, Netherlands.,Brain Injury Team, Overijssel, Netherlands
| | - Kitty H M Jurrius
- Health Care and Social Work Division, Windesheim University of Applied Sciences, Almere, The Netherlands
| | - Judith M Zadoks
- In-Tussen Foundation, Utrecht, the Netherlands.,BreinDok Innovation in Care, Utrecht, the Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. .,Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands. .,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
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5
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Duncan Millar J, van Wijck F, Pollock A, Ali M. Outcome measures in post-stroke arm rehabilitation trials: do existing measures capture outcomes that are important to stroke survivors, carers, and clinicians? Clin Rehabil 2019; 33:737-749. [PMID: 30646750 PMCID: PMC6429625 DOI: 10.1177/0269215518823248] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: We sought to (1) identify the outcome measures currently used across stroke arm rehabilitation randomized trials, (2) identify and compare outcomes important to stroke survivors, carers and clinicians and (3) describe where existing research outcome measures capture outcomes that matter the most to stroke survivors, carers and clinicians and where there may be discrepancies. Methods: First, we systematically identified and extracted data on outcome measures used in trials within a Cochrane overview of arm rehabilitation interventions. Second, we conducted 16 focus groups with stroke survivors, carers and clinicians using nominal group technique, supplemented with eight semi-structured interviews, to identify these stakeholders’ most important outcomes following post-stroke arm impairment. Finally, we described the constructs of each outcome measure and indicated where stakeholders’ important outcomes were captured by each measure. Results: We extracted 144 outcome measures from 243 post-stroke arm rehabilitation trials. The Fugl-Meyer Assessment Upper Extremity section (used in 79/243 trials; 33%), Action Research Arm Test (56/243; 23%), and modified Ashworth Scale (53/243; 22%) were most frequently used. Stroke survivors (n = 43), carers (n = 10) and clinicians (n = 58) identified 66 unique, important outcomes related to arm impairment following stroke. Between one and three outcomes considered important by the stakeholders were captured by the three most commonly used assessments in research. Conclusion: Post-stroke arm rehabilitation research would benefit from a reduction in the number of outcome measures currently used, and better alignment between what is measured and what is important to stroke survivors, carers and clinicians.
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Affiliation(s)
- Julie Duncan Millar
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Frederike van Wijck
- 2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Myzoon Ali
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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6
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Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, Kutluk K, Mikulik R, Wardlaw J, Richard E, Nabavi D, Molina C, Bath PM, Stibrant Sunnerhagen K, Rudd A, Drummond A, Planas A, Caso V. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J 2018; 3:309-336. [PMID: 31236480 PMCID: PMC6571507 DOI: 10.1177/2396987318808719] [Citation(s) in RCA: 263] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21-23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.
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Affiliation(s)
- Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Skåne
University Hospital, Lund University, Lund, Sweden
| | | | - Antoni Davalos
- Department of Neurosciences, Hospital Universitari Germans Trias
i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital,
Ludwig-Maximilians University, Munich, and Munich Cluster of Systems Neurology
(SyNergy), Munich, Germany
| | | | - Alla Guekht
- Clinical Center for Neuropsychiatry, Russian National Research
Medical University, Moscow, Russia
| | - Kursad Kutluk
- Department of Neurology, Stroke Unit, University of Dokuz Eylul,
Izmir, Turkey
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department,
St Anne's University Hospital Brno and Masaryk University Brno, Czech
Republic
| | - Joanna Wardlaw
- Centre for Clinical Neurosciences, Edinburgh Imaging and UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edo Richard
- Department of Neurology, Radboud University Medical Centre,
Nijmegen, and Department of Neurology, Academic Medical Centre, Amsterdam, the
Netherlands
| | - Darius Nabavi
- Department of Neurology with Stroke Unit, Vivantes Hospital
Neukölln, Berlin, Germany
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Vall d´Hebron
Barcelona, Spain
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience,
University of Nottingham, Nottingham, UK
| | | | - Anthony Rudd
- Guy's and St Thomas' NHS Foundation Trust, Stroke NHS England
and Royal College of Physicians, London, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham,
Nottingham, UK
| | - Anna Planas
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB),
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
| | - Valeria Caso
- Stroke Unit, Department of Medicine and Cardiovascular
Medicine, University of Perugia, Perugia, Italy
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Abstract
This is the first paper in a series of five on how to do good quality clinical research. It sets the scene for the four papers that follow. The aims of the series are to: promote reliable clinical research to inform clinical practice; help people new to research to get started (at any stage of their career); create teaching resources for experienced researchers; and help clinicians working in resource-poor settings to conduct research. We set out in this paper the skills clinicians need to run research projects that are relevant to their clinical practice. We focus on how to get the right training in research methodology, choose and refine a good research question, and then how to ensure the methods and data analysis plan are correct for the question being asked.
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Affiliation(s)
- Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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8
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Berge E, Salman RAS, van der Worp HB, Stapf C, Sandercock P, Sprigg N, Macleod MR, Kelly PJ, Nederkoorn PJ, Ford GA, Arnold M, Berge E, Diez-Tejedor E, Jatuzis D, Kelly PJ, Krieger DW, Nederkoorn PJ, Sandercock P, Stapf C, Weimar C, Ford GA, Salman RAS. Increasing value and reducing waste in stroke research. Lancet Neurol 2017; 16:399-408. [DOI: 10.1016/s1474-4422(17)30078-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 12/21/2022]
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Rodrigues MRM, Slimovitch M, Chilingaryan G, Levin MF. Does the Finger-to-Nose Test measure upper limb coordination in chronic stroke? J Neuroeng Rehabil 2017; 14:6. [PMID: 28114996 PMCID: PMC5259887 DOI: 10.1186/s12984-016-0213-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We aimed to kinematically validate that the time to perform the Finger-to-Nose Test (FNT) assesses coordination by determining its construct, convergent and discriminant validity. METHODS Experimental, criterion standard study. Both clinical and experimental evaluations were done at a research facility in a rehabilitation hospital. Forty individuals (20 individuals with chronic stroke and 20 healthy, age- and gender-matched individuals) participated.. Both groups performed two blocks of 10 to-and-fro pointing movements (non-dominant/affected arm) between a sagittal target and the nose (ReachIn, ReachOut) at a self-paced speed. Time to perform the test was the main outcome. Kinematics (Optotrak, 100Hz) and clinical impairment/activity levels were evaluated. Spatiotemporal coordination was assessed with slope (IJC) and cross-correlation (LAG) between elbow and shoulder movements. RESULTS Compared to controls, individuals with stroke (Fugl-Meyer Assessment, FMA-UE: 51.9 ± 13.2; Box & Blocks, BBT: 72.1 ± 26.9%) made more curved endpoint trajectories using less shoulder horizontal-abduction. For construct validity, shoulder range (β = 0.127), LAG (β = 0.855) and IJC (β = -0.191) explained 82% of FNT-time variance for ReachIn and LAG (β = 0.971) explained 94% for ReachOut in patients with stroke. In contrast, only LAG explained 62% (β = 0.790) and 79% (β = 0.889) of variance for ReachIn and ReachOut respectively in controls. For convergent validity, FNT-time correlated with FMA-UE (r = -0.67, p < 0.01), FMA-Arm (r = -0.60, p = 0.005), biceps spasticity (r = 0.39, p < 0.05) and BBT (r = -0.56, p < 0.01). A cut-off time of 10.6 s discriminated between mild and moderate-to-severe impairment (discriminant validity). Each additional second represented 42% odds increase of greater impairment. CONCLUSIONS For this version of the FNT, the time to perform the test showed construct, convergent and discriminant validity to measure UL coordination in stroke.
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Affiliation(s)
- Marcos R. M. Rodrigues
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC H3G 1Y5 Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
| | | | - Gevorg Chilingaryan
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC H3G 1Y5 Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
| | - Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC H3G 1Y5 Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
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10
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Rowat A, Pollock A, St George B, Cowey E, Booth J, Lawrence M. Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda. J Adv Nurs 2016; 72:2831-2843. [DOI: 10.1111/jan.13048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Anne Rowat
- School of Nursing, Midwifery and Social Care; Edinburgh Napier University; UK
| | - Alex Pollock
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit; Glasgow Caledonian University; UK
| | - Bridget St George
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit; Glasgow Caledonian University; UK
| | - Eileen Cowey
- Nursing and Health Care School; University of Glasgow; UK
| | - Joanne Booth
- Institute of Applied Health Research; School of Health and Life Sciences; Glasgow Caledonian University; UK
| | - Maggie Lawrence
- Institute of Applied Health Research; School of Health and Life Sciences; Glasgow Caledonian University; UK
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Klijn CJ, Sandercock PA. The forecast for future clinical trials and clinical trialists-Storms or sunshine? Int J Stroke 2016; 11:738-40. [PMID: 27316456 DOI: 10.1177/1747493016655362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/13/2016] [Indexed: 11/17/2022]
Abstract
Randomized controlled trials are the most unbiased way to evaluate many types of healthcare interventions. Pharmaceutical and medical technology industries play an important role in developing and testing new interventions that have commercial potential. However, many interventions for the prevention, treatment and rehabilitation of stroke are either not drugs or devices or have no commercial potential. Like many other clinicians who are uncertain about the value of existing or new treatments, we are involved in investigator-led clinical trials to resolve treatment uncertainties. There is common agreement that investigator-led clinical trials are facing increasing difficulties and that as a result clinicians may be deterred from pursuing clinical trials as a research career. In this article, we express our concerns for the future of such trials, balanced with the hope that systems to foster and sustain this important type of research in the future can be developed.
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Affiliation(s)
- Catharina Jm Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Ranta A, Barber PA. Transient ischemic attack service provision. Neurology 2016; 86:947-53. [DOI: 10.1212/wnl.0000000000002339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/07/2015] [Indexed: 11/15/2022] Open
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