1
|
Sivertsen M, De Jaegher H, Alstadhaug KB, Arntzen EC, Normann B. The precarity of patient participation - a qualitative interview study of experiences from the acute stroke and rehabilitation journey. Physiother Theory Pract 2024; 40:1265-1280. [PMID: 36345567 DOI: 10.1080/09593985.2022.2140319] [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: 04/28/2021] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Active patient participation is an important factor in optimizing post-stroke recovery, yet it is often low, regardless of stroke severity. The reasons behind this trend are unclear. PURPOSE To explore how people who have suffered a stroke, perceive the transition from independence to dependence and whether their role in post-stroke rehabilitation influences active participation. METHODS In-depth interviews with 17 people who have had a stroke. Data were analyzed using systematic text condensation informed by the concept of autonomy from enactive theory. RESULTS Two categories emerged. The first captures how the stroke and the resultant hospital admission produces a shift from being an autonomous subject to "an object on an assembly line." Protocol-based investigations, inactivity, and a lack of patient involvement predominantly determine the hospital context. The second category illuminates how people who have survived a stroke passively adapt to the hospital system, a behavior that stands in contrast to the participatory enablement facilitated by community. Patients feel more prepared for the transition home after in-patient rehabilitation rather than following direct discharge from hospital. CONCLUSION Bodily changes, the traditional patient role, and the hospital context collectively exacerbate a reduction of individual autonomy. Thus, an interactive partnership between people who survived a stroke and multidisciplinary professionals may strengthen autonomy and promote participation after a stroke.
Collapse
Affiliation(s)
- Marianne Sivertsen
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromsoe, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
| | - Hanne De Jaegher
- Department of Philosophy, University of the Basque Country, Avenida de Tolosa, San Sebastián, Spain
- University of Sussex School of Psychology, Brighton, UK
| | - Karl Bjørnar Alstadhaug
- Department of Clinical Medicine, UiT the Arctic University of Norway, Langnes, Tromsoe, Norway
- Department of Neurology, Nordland Hospital Trust, Bodoe, Norway
| | - Ellen Christin Arntzen
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
| | - Britt Normann
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
| |
Collapse
|
2
|
Rendell R, Pinheiro M, Wang B, McKay F, Ewen A, Carnegie C, Tikomaidelana E, Fattah Z, Hassett L. Digital Apps to Improve Mobility in Adults with Neurological Conditions: A Health App-Focused Systematic Review. Healthcare (Basel) 2024; 12:929. [PMID: 38727486 PMCID: PMC11083333 DOI: 10.3390/healthcare12090929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps are suitable for prescribing mobility exercises for adults with neurological health conditions, (2) how well these apps incorporate telehealth strategies, and (3) how well these apps rate in terms of quality and capacity for behaviour change. The Australian Apple iTunes Store was systematically searched, by using a search code and manually, for apps suitable for training mobility in neurological rehabilitation. Additional searches were conducted in known app repositories and for web-based apps. Trained reviewers extracted data from the included apps, including population-specific characteristics; quality, by using the Mobile App Rating Scale (MARS); and behaviour change potential, by using the App Behaviour Change Scale (ABACUS). The included apps (n = 18) provided <50 to >10,000 exercises, many incurred a subscription fee (n = 13), and half included telehealth features. App quality was moderate (mean MARS score of 3.2/5 and SD of 0.5), and potential for behaviour change was poor (mean ABACUS score of 5.7/21 and SD of 2.1). A limited number of high-quality apps are available for the prescription of mobility exercises in people with neurological conditions.
Collapse
Affiliation(s)
- Reem Rendell
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW 2000, Australia
- Ingham Institute for Applied Medical Research/South Western Sydney Local Health District, Sydney, NSW 2000, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
| | - Belinda Wang
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
| | - Fiona McKay
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, VIC 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC 3000, Australia
| | | | - Catherine Carnegie
- Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
| | | | - Zino Fattah
- South Western Sydney Local Health District, Sydney, NSW 2000, Australia
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- Ingham Institute for Applied Medical Research/South Western Sydney Local Health District, Sydney, NSW 2000, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
| |
Collapse
|
3
|
Anåker A, Kevdzija M, Elf M. Enriched Environments in Stroke Units: Defining Characteristics and Limitations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:344-359. [PMID: 38494920 PMCID: PMC11080395 DOI: 10.1177/19375867231224972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units. OBJECTIVE The aim of this systematic review was to compile the concept of an EE in stroke units. METHODS The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included. RESULTS This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements. CONCLUSIONS To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.
Collapse
Affiliation(s)
- Anna Anåker
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Maja Kevdzija
- TU Wien, Department of Building Theory by Design, Faculty of Architecture and Planning, Institute of Architecture and Design, Vienna, Austria
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| |
Collapse
|
4
|
Debeuf R, De Vlieger D, Defour A, Feyen K, Guida S, Cuypers L, Firouzi M, Tassenoy A, Swinnen E, Beckwée D, Leemans L. Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis. Disabil Rehabil 2024:1-17. [PMID: 38557249 DOI: 10.1080/09638288.2024.2334444] [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: 10/31/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy. METHODS A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed. RESULTS In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I2 = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I2 = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I2 = 0%, p = 0.50). CONCLUSION Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.
Collapse
Affiliation(s)
- Ruben Debeuf
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Daan De Vlieger
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Arne Defour
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Karen Feyen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefania Guida
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lotte Cuypers
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mahyar Firouzi
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Brain, Body and Cognition, Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - An Tassenoy
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Lynn Leemans
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
5
|
Erfanian Abdoust M, Knecht S, Husain M, Le Heron C, Jocham G, Studer B. Effort-based decision making and motivational deficits in stroke patients. Brain Cogn 2024; 175:106123. [PMID: 38183905 DOI: 10.1016/j.bandc.2023.106123] [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: 10/05/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024]
Abstract
Motivational deficits in patients recovering from stroke are common and can reduce active participation in rehabilitation and thereby impede functional recovery. We investigated whether stroke patients with clinically reduced drive, initiation, and endurance during functional rehabilitative training (n = 30) display systematic alterations in effort-based decision making compared to age, sex, and severity-matched stroke patients (n = 30) whose drive appeared unaffected. Notably, the two groups did not differ in self-reported ratings of apathy and depression. However, on an effort-based decision-making task, stroke patients with clinically apparent drive impairment showed intact willingness to accept effort for reward, but were more likely to fail to execute the required effort compared to patients without apparent drive impairments. In other words, the decision behavioural assessment revealed that stroke patients that displayed reduced drive, initiation, and endurance during inpatient neurorehabilitation failed to persist in goal-directed effort production, even over very short periods. These findings indicate that reduced drive during rehabilitative therapy in post-stroke patients is not due to a diminished motivation to invest physical effort, but instead is related to a reduced persistence with effortful behaviour.
Collapse
Affiliation(s)
- Mani Erfanian Abdoust
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany.
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK; Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Campbell Le Heron
- Department of Medicine, University of Otago (Christchurch), New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Gerhard Jocham
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany
| |
Collapse
|
6
|
Stewart C, Power E, McCluskey A, Kuys S, Lovarini M. Implementing ward-based practice books to increase the amount of practice completed during inpatient stroke rehabilitation: a mixed-methods process evaluation. Disabil Rehabil 2024:1-11. [PMID: 38386409 DOI: 10.1080/09638288.2024.2315502] [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: 04/23/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Stroke survivors must complete large amounts of practice to achieve functional improvements but spend many hours inactive during their rehabilitation. We conducted a mixed methods process evaluation exploring factors affecting the success of a 6-month behaviour change intervention to increase use of ward-based practice books. METHODS Audits of the presence, quality and use of ward based-practice books were conducted, alongside focus groups with staff (n = 19), and interviews with stroke survivors (n = 3) and family members (n = 4). Quantitative data were analysed descriptively. Focus group and interview transcripts were analysed using qualitative analysis. RESULTS Personal (patient-related) factors (including severe weakness, cognitive and communication deficits of stroke survivors), staff coaching skills, understanding and beliefs about their role, affected practice book use. Staff turnover, nursing shift work and a lack of action planning reduced success of the behaviour change intervention. CONCLUSIONS Staff with the necessary skills and understanding of their role in implementing ward practice overcame personal (patient-related) factors and assisted stroke survivors to successfully practice on the ward. To improve success of the intervention, repeated training of new staff is required. In addition to audit and feedback, team action planning is needed around the presence, quality, and use of ward practice books.
Collapse
Affiliation(s)
- Claire Stewart
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Emma Power
- The University of Technology Sydney, Graduate School of Health, Sydney, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- The StrokeEd Collaboration, Sydney, Australia
| | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Meryl Lovarini
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| |
Collapse
|
7
|
Ogasawara T, Mukaino M, Matsunaga K, Wada Y, Suzuki T, Aoshima Y, Furuzawa S, Kono Y, Saitoh E, Yamaguchi M, Otaka Y, Tsukada S. Prediction of stroke patients' bedroom-stay duration: machine-learning approach using wearable sensor data. Front Bioeng Biotechnol 2024; 11:1285945. [PMID: 38234303 PMCID: PMC10791943 DOI: 10.3389/fbioe.2023.1285945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024] Open
Abstract
Background: The importance of being physically active and avoiding staying in bed has been recognized in stroke rehabilitation. However, studies have pointed out that stroke patients admitted to rehabilitation units often spend most of their day immobile and inactive, with limited opportunities for activity outside their bedrooms. To address this issue, it is necessary to record the duration of stroke patients staying in their bedrooms, but it is impractical for medical providers to do this manually during their daily work of providing care. Although an automated approach using wearable devices and access points is more practical, implementing these access points into medical facilities is costly. However, when combined with machine learning, predicting the duration of stroke patients staying in their bedrooms is possible with reduced cost. We assessed using machine learning to estimate bedroom-stay duration using activity data recorded with wearable devices. Method: We recruited 99 stroke hemiparesis inpatients and conducted 343 measurements. Data on electrocardiograms and chest acceleration were measured using a wearable device, and the location name of the access point that detected the signal of the device was recorded. We first investigated the correlation between bedroom-stay duration measured from the access point as the objective variable and activity data measured with a wearable device and demographic information as explanatory variables. To evaluate the duration predictability, we then compared machine-learning models commonly used in medical studies. Results: We conducted 228 measurements that surpassed a 90% data-acquisition rate using Bluetooth Low Energy. Among the explanatory variables, the period spent reclining and sitting/standing were correlated with bedroom-stay duration (Spearman's rank correlation coefficient (R) of 0.56 and -0.52, p < 0.001). Interestingly, the sum of the motor and cognitive categories of the functional independence measure, clinical indicators of the abilities of stroke patients, lacked correlation. The correlation between the actual bedroom-stay duration and predicted one using machine-learning models resulted in an R of 0.72 and p < 0.001, suggesting the possibility of predicting bedroom-stay duration from activity data and demographics. Conclusion: Wearable devices, coupled with machine learning, can predict the duration of patients staying in their bedrooms. Once trained, the machine-learning model can predict without continuously tracking the actual location, enabling more cost-effective and privacy-centric future measurements.
Collapse
Affiliation(s)
- Takayuki Ogasawara
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Yoshitaka Wada
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takuya Suzuki
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Yasushi Aoshima
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Shotaro Furuzawa
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Yuji Kono
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masumi Yamaguchi
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shingo Tsukada
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| |
Collapse
|
8
|
Ribbe Kelso L, Stockton K, Mahendran N, Brauer SG, Rosbergen I. The influence of communal spaces on patient activity in rehabilitation: a mixed methods study. Disabil Rehabil 2024; 46:309-321. [PMID: 36587814 DOI: 10.1080/09638288.2022.2160834] [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: 03/18/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aimed to determine whether patients are more active in communal spaces compared to their bedrooms and explore patient perspectives on communal spaces for activity, rest, and wellbeing. MATERIALS AND METHODS A prospective study observed participants via behavioural mapping in a mixed inpatient rehabilitation unit for up to three days. Physical, social, and cognitive activity levels in communal spaces were compared with activity in bedrooms using independent t-tests. Three focus groups explored participants' perspectives on communal spaces for activity, rest and wellbeing using thematic analysis. RESULTS Thirty-three participants (age 71.6 ± 13years, 39%male) were observed, and a subset (n = 12) (age 67.3 ± 16.9, 50%male) participated in focus groups. Participants spent a greater proportion of time being physically active (mean difference 22.7%, 95%CI 8.7-36.6, p = 0.002) and socially active (mean difference 23.6%, 95%CI 9.1-38.1, p = 0.002) in communal spaces than bedrooms. No difference in cognitive activity was found. Participants perceived communal spaces to positively influence mood and activity. Reduced independence was a barrier, while visitors, activities, and an inviting design attracted people to communal areas. CONCLUSION Communal spaces may positively influence patient activity and mood during inpatient rehabilitation. Future studies should seek strategies to optimise engagement in communal environments.IMPLICATIONS FOR REHABILITATIONOptimising patient activity throughout the day in inpatient rehabilitation is important to support recovery.Communal spaces in inpatient rehabilitation hospitals can positively influence patient activity and mood.Strategies to promote use of communal spaces in the inpatient rehabilitation hospital are needed.
Collapse
Affiliation(s)
- Lucy Ribbe Kelso
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kellie Stockton
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Niruthikha Mahendran
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ingrid Rosbergen
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Department of Physiotherapy, Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| |
Collapse
|
9
|
Rozevink SG, Beerepoot CM, van der Sluis CK, Hijmans JM. Standardized circuit class group training versus individualized goal-directed group training to improve upper limb function in stroke survivors during in-patient rehabilitation: a pragmatic trial. Disabil Rehabil 2023:1-13. [PMID: 37728092 DOI: 10.1080/09638288.2023.2255135] [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: 11/02/2022] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the usability and effectiveness of standardized circuit class group training (CCT) compared to individualized goal-directed group training (GDT) in subacute stroke survivors. MATERIALS AND METHODS This study consists of three parts. Part 1 involved a pragmatic, non-randomized controlled trial with subacute participants and their therapists, who participated in four weeks either CCT or GDT. Superiority of the intervention was defined as significantly larger improvement on the Motor Activity Log for patients and lower workload for therapists. In Part 2, six additional workstations were developed for CCT. Part 3 replicated the study of Part 1 with the expanded CCT. RESULTS Part 1 showed no difference in effectiveness between training methods. CCT did not match the rehabilitation goals of the patient sufficiently, however mental workload seemed lower for therapists. An expansion of CCT could improve the match between the patient's goals and the training (Part 2). Results of Part 3 showed again no difference in effectiveness between methods. CCT was however perceived as less engaging compared to GDT, but mental load for therapists remained lower. CONCLUSIONS A standardized training could reduce the mental workload for therapists, but patients seemed less engaged. A combination of both might be most beneficial.Trial registration: Dutch Trial Register: NL8844 and NL9471IMPLICATIONS FOR REHABILITATIONProviding a standardized training program after stroke reduces therapists' mental workload.Individualized goal-directed group training results in the best achievement of rehabilitation goals.A combination of standardized and individual training would use best of both intervention modalities.Patients should be involved in the co-creation developing process of training programs.
Collapse
Affiliation(s)
- S G Rozevink
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C M Beerepoot
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
10
|
Aravind N, Treacy D, Chagpar S, Harvey LA, Glinsky JV, Sherrington C, Hassett LM. Implementing digital devices to increase mobility training for people receiving inpatient rehabilitation: protocol for a feasibility hybrid type II randomized controlled trial. Pilot Feasibility Stud 2023; 9:69. [PMID: 37098616 PMCID: PMC10126551 DOI: 10.1186/s40814-023-01298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/10/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND People with mobility limitations can benefit from rehabilitation programs incorporating intensive, repetitive, and task-specific exercises using digital devices such as virtual reality gaming systems, tablet and smartphone applications, and wearable devices. The Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial (n = 300) showed improvements in mobility in people using these types of digital devices in addition to their usual rehabilitation care when the intervention was provided by an additional study-funded physiotherapist. However, it is not clear if this intervention can be implemented by hospital physiotherapists with a usual clinical load. The AMOUNT Implementation trial aims to explore the feasibility of conducting a large-scale implementation trial. METHODS A pragmatic, assessor blinded, feasibility hybrid type II randomized controlled trial will be undertaken at a public hospital in Australia. There will be two phases. Phase I (Implementation phase) will involve implementing the digital devices into physiotherapy practice. Physiotherapists from the rehabilitation ward will receive a multifaceted implementation strategy guided by the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model. The implementation strategy includes identifying and training a clinical champion; providing digital devices and education and training; facilitating use of the devices through clinical reasoning sessions and journal clubs; and audit and feedback of exercise dosage documentation. Phase II (Trial phase) will involve randomising 30 eligible inpatients from the same ward into either usual care or usual care plus an additional 30 min or more of exercises using digital devices. This intervention will be provided by the physiotherapists who took part in the implementation phase. We will collect data on feasibility, implementation, and patient-level clinical outcomes. The three primary outcome measures are the extent to which physiotherapists document the dosage of exercises provided to participants (feasibility criteria: exercise practice sheets complete for ≥85% of all participants); ability to recruit participants; and fidelity to the protocol of using digital devices to prescribe exercises (feasibility criteria: average of ≥ 30mins per day for > 50% intervention participants). DISCUSSION This feasibility study will provide important information to guide the planning and conduct of a future large-scale implementation trial. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry; ACTRN12621000938808; registered 19/07/2021. Trial sponsor: Prince of Wales Hospital. 320-346 Barker Street, Randwick, NSW, 2031, Australia. PROTOCOL VERSION 6.2 7th April 2021.
Collapse
Affiliation(s)
- Nisha Aravind
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia.
| | - Daniel Treacy
- Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, Australia
- Department of Health Sciences, Macquarie University, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Leanne M Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
| |
Collapse
|
11
|
Moore SA, Boyne P, Fulk G, Verheyden G, Fini NA. Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice. Stroke 2022; 53:3494-3505. [PMID: 36069185 PMCID: PMC9613533 DOI: 10.1161/strokeaha.122.038956] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life and future health. This narrative review explores the state of the science in walking recovery after stroke and potential for development. The importance of targeting walking capacity and performance is explored in relation to individual stroke survivor gait recovery, applying a common language, measurement, classification, prediction, current and future intervention development, and health care delivery. Findings are summarized in a model of current and future stroke walking recovery research and a mission statement is set for researchers and clinicians to drive the field forward to improve the lives of stroke survivors and their carers.
Collapse
Affiliation(s)
- Sarah A Moore
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK, and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (S.A.M.)
| | - Pierce Boyne
- Department of Rehabilitation Exercise and Nutritional Science, University of Cincinnati, OH (P.B.)
| | - George Fulk
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA (G.F.)
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Belgium (G.V.)
| | - Natalie A Fini
- Medicine Dentistry and Health Sciences, The University of Melbourne, Australia (N.A.F.)
| |
Collapse
|
12
|
Fulton S, Janssen H, Salih S, James A, Elphinston RA. Feasibility and acceptability of a mobile model of environmental enrichment for patients with mixed medical conditions receiving inpatient rehabilitation: a mixed methods study. BMJ Open 2022; 12:e061212. [PMID: 36115676 PMCID: PMC9486324 DOI: 10.1136/bmjopen-2022-061212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient rehabilitation. DESIGN A mixed methods study design was used. An online qualitative survey assessed staff perspectives of acceptability of the mobile EE model including perceived barriers and enablers pre-implementation and post implementation. An A-B quasi-experimental case study of patient activity levels over a 2-week observational period provided feasibility data. This included recruitment and retention rates, completion of scheduled patient activity observations and validated baseline questionnaires, and number of adverse events. SETTING A 30-bed mixed medical ward in a public hospital that services Brisbane's southern bayside suburbs. The rehabilitation programme operates with patients co-located throughout the medical/surgical wards. PARTICIPANTS Nursing and allied health professionals working across the rehabilitation programme completed pre-implementation (n=19) and post implementation (n=16) qualitative questions. Patients admitted to the ward and who received the inpatient rehabilitation programme from June to November 2016 were also recruited. INTERVENTIONS The mobile EE intervention included activities to primarily promote social and cognitive stimulation (eg, puzzles, board games) delivered by hospital volunteers and was designed to be moved throughout the wards. RESULTS Four themes emerged from staff reports, suggesting that the role of patient, staff and intervention characteristics, and the ward environment were important barriers and enablers to implementation. Of the 12 eligible patients, six consented to the study, and five completed the intervention. All patients completed the baseline measures. No adverse events were reported. CONCLUSIONS As interest grows in human EE models, it will be important to tailor EE interventions to the unique demands of hospital rehabilitation services. A mobile EE model delivered in a small, mixed rehabilitation ward appears feasible and acceptable to study in a larger controlled feasibility trial.
Collapse
Affiliation(s)
- Sarah Fulton
- Speech Pathology Department, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Heidi Janssen
- Hunter Stroke Service and Community and Aged Care Services, Community Stroke Team, Hunter New England Local Health District and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Salih Salih
- Rehabilitation Unit, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alecia James
- Speech Pathology Department, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence - Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
13
|
Kevdzija M, Bozovic-Stamenovic R, Marquardt G. Stroke Patients' Free-Time Activities and Spatial Preferences During Inpatient Recovery in Rehabilitation Centers. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:96-113. [PMID: 35850529 PMCID: PMC9523820 DOI: 10.1177/19375867221113054] [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] [Indexed: 11/21/2022]
Abstract
Objectives: To investigate which spaces stroke patients visit in their free time while undergoing inpatient recovery in rehabilitation centers, what activities they engage in, and what kind of spaces they want. Background: Research studies consistently show that stroke patients are highly inactive during rehabilitation. Much remains unknown about what patients do in their free time and how the built environment might affect their behavior and activities. Methods: Patients’ free-time activities were recorded via patient shadowing (n = 70, 840 hr), and their spatial preferences were collected using a survey (n = 60) in seven rehabilitation centers. Each participant was observed over one typical day (12 consecutive hours). Their activities, durations, and locations were recorded using floor plans and time log sheets. Results: Six main themes emerged from the analysis of shadowing data and patient surveys: (1) spending most free time in their room, (2) corridor as the overlooked activity hub, (3) food and beverage stations as triggers of activity, (4) wanting to socialize, (5) variety of common spaces for different activities is desired, and (6) common room’s atmosphere, comfort, style, and view are important. Even though socializing with other patients was mentioned as a primary reason for visiting common spaces in the survey, patients spent most of their free time alone. Conclusions: Corridor emerged as a space with great potential to motivate and support various activities of patients. Patients’ free-time activities could contribute to their recovery, and the built environment may play a role in facilitating and supporting these activities.
Collapse
Affiliation(s)
- Maja Kevdzija
- Chair for Social and Health Care Buildings and Design, Faculty of Architecture, Technische Universität Dresden, Germany.,Department of Building Theory by Design, Institute of Architecture and Design, Faculty of Architecture and Planning, TU Wien, Vienna, Austria
| | - Ruzica Bozovic-Stamenovic
- Department of Architecture, College of Design and Engineering, National University of Singapore, Singapore
| | - Gesine Marquardt
- Chair for Social and Health Care Buildings and Design, Faculty of Architecture, Technische Universität Dresden, Germany
| |
Collapse
|
14
|
Christiansen A, Scythes M, Ritsma BR, Scott SH, DePaul V. Art skill-based rehabilitation training for upper limb sensorimotor recovery post-stroke: A feasibility study. Clin Rehabil 2022; 36:1476-1488. [PMID: 35642286 PMCID: PMC9515518 DOI: 10.1177/02692155221105586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The objective of this study was to assess the feasibility of delivering Art
skill-based Rehabilitation Training (ART), a novel upper limb motor training
program, to patients with stroke as an adjunct to standard care in an
inpatient setting. Design Feasibility study. Setting Inpatient stroke rehabilitation unit at a university hospital. Participants Thirty-eight patients admitted to a stroke rehabilitation unit with upper
limb motor impairment were enrolled in the ART program facilitated by
trained non-healthcare professionals between December 2017 and June
2021. Intervention The ART program included nine, one-hour sessions of supervised tracing and
freehand drawing tasks completed with both hands. This program was intended
to be delivered at a frequency of three times per week over a duration of 3
weeks or for the length of inpatient stay. Main outcome measures Feasibility outcomes included ART program adherence, acceptability, and
safety. Results Thirty-two (84%) participants with subacute stroke completed the ART program
and 30 (79%) were included in the study analysis. Participants completed
93–100% of the ART tasks in a median [IQR] of 8 [6–10] ART sessions over a
median [IQR] duration of 15 [7–19] days. ART program facilitators
effectively provided upper limb assistance to patients with more severe
upper limb impairments. Adherence and acceptability were high and no
study-related adverse events occurred. Conclusion The ART program was feasible to deliver and highly acceptable to patients
with stroke. Further research is warranted to explore the impact of ART on
upper limb sensorimotor function and use.
Collapse
Affiliation(s)
- April Christiansen
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Marta Scythes
- Haliburton School of Art and Design, 125171Fleming College, Haliburton, ON, Canada
| | - Benjamin R Ritsma
- Department of Physical Medicine and Rehabilitation, 4257Queen's University, Kingston, ON, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, 4257Queen's University, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Vincent DePaul
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| |
Collapse
|
15
|
Adey-Wakeling Z, Jolliffe L, O'Shannessy E, Hunter P, Morarty J, Cameron ID, Liu E, Lannin NA. Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation. Ann Rehabil Med 2022; 45:413-421. [PMID: 35000366 PMCID: PMC8743846 DOI: 10.5535/arm.21034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect. Methods This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury; all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect. Results The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3; 95% confidence interval, 5.02–21.16). Conclusion Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.
Collapse
Affiliation(s)
- Zoe Adey-Wakeling
- Department of Rehabilitation, Flinders University of South Australia, Bedford Park, SA, Australia.,Department of Rehabilitation, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, Australia
| | - Laura Jolliffe
- Alfred Health, Melbourne, Australia.,Department of Neurosciences, Monash University, Melbourne, Australia
| | | | | | | | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
| | - Enwu Liu
- Department of Rehabilitation, Flinders University of South Australia, Bedford Park, SA, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Natasha A Lannin
- Alfred Health, Melbourne, Australia.,Department of Neurosciences, Monash University, Melbourne, Australia.,College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| |
Collapse
|
16
|
English K, Daley B, Cahill L, Liu E, Lannin NA, Baker A. Characteristics and Outcomes of a Community Upper Limb Rehabilitation Group for Adult Stroke Survivors in Australia: A Pre-Post Cohort Study. Occup Ther Health Care 2021; 36:440-458. [PMID: 34878364 DOI: 10.1080/07380577.2021.2012734] [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: 10/19/2022]
Abstract
This study investigated outcomes of a community-based upper limb rehabilitation group for adult stroke survivors in metropolitan Australia. Pre-post data were extracted from medical records. Participants (n = 27) were predominantly men (n = 22, 81%); mean age 61 years (SD 17) and median time 109 days post stroke. Participants improved on upper limb outcomes, with statistically significant changes on several of the items on the Motor Assessment Scale (item seven mean improvement 0.93 (95% CI 0.48-2.19), p = .016; item eight mean improvement 1.4 (95% CI 0.38-2.42), p = .016) and grip strength (mean improvement 4.5 kg/9 pounds, 14.73 ounces (95% CI 1.5-7.6), p = .006). These results guide occupational therapists implementing community-based upper limb rehabilitation groups.
Collapse
Affiliation(s)
- Kylie English
- Australian Catholic University, School of Allied Health, Melbourne, Australia; Eastern Health, Department of Occupational Therapy, Melbourne, Australia
| | - Bella Daley
- Alfred Health, Melbourne, Australia; St. Vincent's Hospital, Melbourne, Australia
| | - Liana Cahill
- Australian Catholic University, School of Allied Health, Melbourne, Australia
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia.,Allied Health (Occupational Therapy), Alfred Health, Melbourne, Australia
| | - Anne Baker
- Federation University, School of Health, Gippsland, Australia
| |
Collapse
|
17
|
Qin H, Reid I, Gorelik A, Ng L. Environmental enrichment for stroke and other non-progressive brain injury. Cochrane Database Syst Rev 2021; 11:CD011879. [PMID: 34811724 PMCID: PMC8609277 DOI: 10.1002/14651858.cd011879.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Rehabilitation is effective for recovery after stroke and other non-progressive brain injuries but it is unclear if the rehabilitation environment itself, outside of limited therapy hours, is maximally conducive to recovery. Environmental enrichment is a relatively new concept within rehabilitation for humans. In this review, this is defined as an intervention designed to facilitate physical (motor and sensory), cognitive and social activity by the provision of equipment and organisation of a structured, stimulating environment. The environment should be designed to encourage (but not force) activities without additional specialised rehabilitation input. OBJECTIVES To assess the effects of environmental enrichment on well-being, functional recovery, activity levels and quality of life in people who have stroke or non-progressive brain injury. SEARCH METHODS We conducted the search on 26 October 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) that compared environmental enrichment with standard services. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligible studies, extracted data, and assessed study quality. Any disagreements were resolved through discussion with a third review author. We determined the risk of bias for the included study and performed a 'best evidence' synthesis using the GRADE approach. MAIN RESULTS We identified one RCT, involving 53 participants with stroke, comparing environmental enrichment (which included physical, cognitive and social activities such as reading material, board and card games, gaming technology, music, artwork, and computer with Internet) with standard services in an inpatient rehabilitation setting. We excluded five studies, found two studies awaiting classification and one ongoing study which described environmental enrichment in their interventions. Of the excluded studies, three were non-RCTs and two described co-interventions with a significant component of rehabilitation. Based on the single small included RCT at high risk of bias, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the provision of environmental enrichment. AUTHORS' CONCLUSIONS The gap in current research should not, however, be interpreted as proof that environmental enrichment is ineffective. Further research is needed with robust study designs, such as cluster RCTs, and consistent outcome measurement evaluating the effectiveness of environmental enrichment in different settings (inpatient versus outpatient), the relative effectiveness of various components of environmental enrichment, cost-effectiveness, and safety of the intervention in people following stroke or other non-progressive brain injuries. It should be noted, however, that it is challenging to randomise or double-blind trials of environmental enrichment given the nature of the intervention.
Collapse
Affiliation(s)
- Helen Qin
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Isabella Reid
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Alexandra Gorelik
- Melbourne EpiCentre Melbourne Health, Royal Melbourne Hospital, Melbourne, Australia
| | - Louisa Ng
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Rehabilitation Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| |
Collapse
|
18
|
D'Souza S, Hersh D, Godecke E, Ciccone N, Janssen H, Armstrong E. Patients' experiences of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward following stroke: a qualitative description approach. Disabil Rehabil 2021; 44:6304-6313. [PMID: 34780322 DOI: 10.1080/09638288.2021.1965226] [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: 10/19/2022]
Abstract
BACKGROUND Patients in hospital following stroke express a desire to continue therapy tasks outside of treatment activities. However, they commonly describe experiences of boredom and inactivity. An enriched environment aims to provide opportunities for physical, cognitive and social activity and informed the development of a Communication Enhanced Environment (CEE) model to promote patient engagement in language activities. PURPOSE Explore patient perceptions of a CEE model, and barriers and facilitators to engagement in the model. METHODS A qualitative description study from a larger project that implemented a CEE model into acute and rehabilitation private hospital wards in Western Australia. Semi-structured interviews were conducted with seven patients, including four with aphasia, within 22 days post-stroke who had access to the CEE model. RESULTS Patients described variable experiences accessing different elements of the CEE model which were influenced by individual patient factors, staff factors, hospital features as well as staff time pressures. Those who were able to access elements of the CEE model described positive opportunities for engagement in language activities. CONCLUSIONS While findings are encouraging, further exploration of the feasibility of a CEE model in this complex setting is indicated to inform the development of this intervention.Implications for rehabilitationPatient access to a CEE model is challenging in a hospital setting.Patients who were able to access elements of the CEE model described positive opportunities for engagement in language activities.Patients' access to the CEE model was influenced by patient factors, staff factors, hospital features as well as staff time pressures.
Collapse
Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Heidi Janssen
- School of Health Sciences, Hunter New England Local Health District, NSW Health, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| |
Collapse
|
19
|
Hobo K, Kurita H, Momose K. The relationship between energy expenditure and physical functions in patients hospitalised for stroke. Sci Rep 2021; 11:21685. [PMID: 34737355 PMCID: PMC8568978 DOI: 10.1038/s41598-021-01135-3] [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: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed the relationship between energy expenditure (EE) and Functional Independence Measure motor items (FIM-M) score, Berg Balance Scale (BBS) score, and comfortable walking speed (CWS) in patients hospitalised for stroke. The total EE per day (TEE), EE during rehabilitation (REE), and EE during activities other than rehabilitation (OEE) were measured using a single-axis acceleration sensor in 36 patients hospitalised for the first stroke episode. In addition, the relationships between each type of EE and FIM-M, BBS, and CWS were investigated. In these patients (mean age 66.2 ± 10.6 years), the median values of TEE, REE, and OEE were 41.8 kcal, 18.5 kcal, and 16.6 kcal, respectively. Correlations were observed between each EE type and all physical function indices. Following the stratification of patients into two groups (high and low) based on the level of physical function, a significant correlation between EE type and physical function was observed only in the low BBS group. EE was correlated with overall physical function indices, but the trend differed depending on physical ability. When patients were stratified based on ability, there were several groups with no significant correlation. Therefore, several patients were unable to achieve an appropriate EE for their level of physical function.
Collapse
Affiliation(s)
- Kota Hobo
- Department of Rehabilitation, Setagaya Rehabilitation Hospital, 6-37-1 Matsubara, Setagaya, Tokyo, 156-0043, Japan.
| | - Hideaki Kurita
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Kimito Momose
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Japan
| |
Collapse
|
20
|
Effects of Different Intervention Time Points of Early Rehabilitation on Patients with Acute Ischemic Stroke: A Single-Center, Randomized Control Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1940549. [PMID: 34493977 PMCID: PMC8418926 DOI: 10.1155/2021/1940549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
Objective To investigate effects of different intervention time points of early rehabilitation on patients with acute ischemic stroke. Methods We enrolled patients diagnosed with acute ischemic stroke in our hospital's rehabilitation ward from November 2013 to December 2015. Patients were randomly assigned to an ultraearly rehabilitation program (started within 72 hours of onset) or an early rehabilitation program (started from 72 hours to 7 days after onset). The efficacy was assessed by the NIH Stroke Scale (NIHSS) International, Barthel Index, and Fugl-Meyer Assessment at one and three months after rehabilitation. Data were analyzed by variance analysis of two-factor repeated measurement. Covariance analysis was used to adjust confounding factors for the determination of statistical differences. Results 41 patients were enrolled in the ultraearly rehabilitation group, while 45 patients were in the early rehabilitation group. There were no differences between the two groups at baseline data. Compared with the early rehabilitation group, patients in the ultraearly rehabilitation group have significantly improved NIHSS score, BMI score, and FMA score at one month and three months (P < 0.001). After adjusting for confounding factors (gender, age, severity of NIHSS score, location of stroke, hypertension, diabetes, atrial fibrillation, and coronary heart disease), the significant difference still existed between the two groups at one month and three months (P < 0.001). Conclusion Our study indicated a higher efficacy in the ultraearly rehabilitation group than the early rehabilitation group. The result suggests an important practical significance in favor of the clinical treatment of stroke.
Collapse
|
21
|
Kelly LP, Devasahayam AJ, Chaves AR, Curtis ME, Randell EW, McCarthy J, Basset FA, Ploughman M. Task-Oriented Circuit Training as an Alternative to Ergometer-Type Aerobic Exercise Training after Stroke. J Clin Med 2021; 10:jcm10112423. [PMID: 34070731 PMCID: PMC8198652 DOI: 10.3390/jcm10112423] [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: 04/15/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Moderate-intensity aerobic exercise training is an important treatment strategy to enhance functional recovery and decrease cardiometabolic risk factors after stroke. However, stroke related impairments limit access to ergometer-type exercise. The aims of the current study were (1) to evaluate whether our task-oriented circuit training protocol (intermittent functional training; IFT) could be used to sustain moderate-intensity aerobic workloads over a 10-week intervention period, and (2) to investigate its preliminary effects on cardiorespiratory fitness and metabolic profiles compared to constant-load ergometer-type exercise (CET). Forty chronic hemiparetic stroke survivors were randomized to receive 30 sessions of IFT or CET over ten weeks. Similar proportions of participants were randomized to IFT (7/19) and CET (9/18) sustained workloads associated with moderate-intensity aerobic exercise over the study period (p = 0.515). However, CET was associated with more substantial changes in maximal oxygen uptake (MD = 2.79 mL min−1 kg−1 CI: 0.84 to 4.74) compared to IFT (MD = 0.62 mL min−1 kg−1 CI: −0.38 to 1.62). Pre to post changes in C-reactive protein (−0.9 mg/L; p =0.017), short-term glycemia (+14.7 µmol/L; p = 0.026), and resting whole-body carbohydrate oxidation (+24.2 mg min−1; p = 0.046) were observed when considering both groups together. Accordingly, IFT can replicate the aerobic intensities sustained during traditional ergometer-type exercise training. More work is needed to evaluate the dose–response effects of such task-oriented circuit training protocols on secondary prevention targets across the continuum of stroke recovery.
Collapse
Affiliation(s)
- Liam P. Kelly
- Recovery and Performance Laboratory, L.A. Miller Centre, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (A.R.C.); (M.E.C.); (J.M.)
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada;
- Correspondence: (L.P.K.); (M.P.); Tel.: +1-709-777-2099 (M.P.)
| | - Augustine J. Devasahayam
- Recovery and Performance Laboratory, L.A. Miller Centre, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (A.R.C.); (M.E.C.); (J.M.)
| | - Arthur R. Chaves
- Recovery and Performance Laboratory, L.A. Miller Centre, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (A.R.C.); (M.E.C.); (J.M.)
| | - Marie E. Curtis
- Recovery and Performance Laboratory, L.A. Miller Centre, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (A.R.C.); (M.E.C.); (J.M.)
| | - Edward W. Randell
- Discipline of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
| | - Jason McCarthy
- Recovery and Performance Laboratory, L.A. Miller Centre, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (A.R.C.); (M.E.C.); (J.M.)
| | - Fabien A. Basset
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada;
| | - Michelle Ploughman
- Recovery and Performance Laboratory, L.A. Miller Centre, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (A.R.C.); (M.E.C.); (J.M.)
- Correspondence: (L.P.K.); (M.P.); Tel.: +1-709-777-2099 (M.P.)
| |
Collapse
|
22
|
Huang MZ, Yoon YS, Yang J, Yang CY, Zhang LQ. In-Bed Sensorimotor Rehabilitation in Early and Late Subacute Stroke Using a Wearable Elbow Robot: A Pilot Study. Front Hum Neurosci 2021; 15:669059. [PMID: 34108868 PMCID: PMC8180557 DOI: 10.3389/fnhum.2021.669059] [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: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objects: To evaluate the feasibility and effectiveness of in-bed wearable elbow robot training for motor recovery in patients with early and late subacute stroke. Methods: Eleven in-patient stroke survivors (male/female: 7/4, age: 50.7 ± 10.6 years, post-stroke duration: 2.6 ± 1.9 months) received 15 sessions of training over about 4 weeks of hospital stay. During each hourly training, participants received passive stretching and active movement training with motivating games using a wearable elbow rehabilitation robot. Isometric maximum muscle strength (MVC) of elbow flexors and extensors was evaluated using the robot at the beginning and end of each training session. Clinical measures including Fugl-Meyer Assessment of upper extremity (FMA-UE), Motricity Index (MI) for upper extremities, Modified Ashworth Scale (MAS) were measured at baseline, after the 4-week training program, and at a 1-month follow-up. The muscle strength recovery curve over the training period was characterized as a logarithmic learning curve with three parameters (i.e., initial muscle strength, rate of improvement, and number of the training session). Results: At the baseline, participants had moderate to severe upper limb motor impairment {FMA-UE [median (interquartile range)]: 28 (18-45)} and mild spasticity in elbow flexors {MAS [median (interquartile range)]: 0 (0-1)}. After about 4 weeks of training, significant improvements were observed in FMA-UE (p = 0.003) and MI (p = 0.005), and the improvements were sustained at the follow-up. The elbow flexors MVC significantly increased by 1.93 Nm (95% CI: 0.93 to 2.93 Nm, p = 0.017) and the elbow extensor MVC increased by 0.68 Nm (95% CI: 0.05 to 1.98 Nm, p = 0.036). Muscle strength recovery curve showed that patients with severe upper limb motor impairment had a greater improvement rate in elbow flexor strength than those with moderate motor impairment. Conclusion: In-bed wearable elbow robotic rehabilitation is feasible and effective in improving biomechanical and clinical outcomes for early and late subacute stroke in-patients. Results from the pilot study suggested that patients with severe upper limb motor impairment may benefit more from the robot training compared to those with moderate impairment.
Collapse
Affiliation(s)
- Mei Zhen Huang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Yong-Soon Yoon
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonbuk, South Korea
| | - Jisu Yang
- Department of Neuroscience and Behavioral Biology, College of Arts and Sciences, Emory University, Atlanta, GA, United States
| | - Chung-Yong Yang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, The Seum Hospital, Jeonbuk, South Korea
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States.,Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
| |
Collapse
|
23
|
Kārkliņa A, Chen E, Bērziņa G, Stibrant Sunnerhagen K. Patients' physical activity in stroke units in Latvia and Sweden. Brain Behav 2021; 11:e02110. [PMID: 33759379 PMCID: PMC8119825 DOI: 10.1002/brb3.2110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE A prospective, observational study to describe levels of physical activity in patients with stroke in a comprehensive stroke unit in Sweden and Latvia, comparing data between countries. METHODS The study was performed at stroke units in one hospital in Sweden (data were acquired over a 2-month period in 2017) and two hospitals in Latvia (data were acquired over a 3-month period between 2016 and 2017). Patients with stroke were observed for 1 min every 10 min. The level of physical activity, location, and the people present were noted at each time-point. RESULTS A total of 27 patients were observed in Latvia and 25 patients in Sweden. Patients from both countries were in bed half of the time and spent the majority of the day in their bedroom and alone. Patients in Sweden had higher physical activity levels, spent more time outside their bedroom and spent more time with rehabilitation specialists and visitors. CONCLUSION Patients are inactive and alone for a majority of the time during hospitalization at a comprehensive stroke unit in both countries. There are differences in environment in the stroke unit between countries.
Collapse
Affiliation(s)
- Agnese Kārkliņa
- Department of RehabilitationRiga East University HospitalRigaLatvia
| | - Erik Chen
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologyThe University of GothenburgGothenburgSweden
| | - Guna Bērziņa
- Department of RehabilitationRiga East University HospitalRigaLatvia
- Faculty of RehabilitationRiga Stradiņš UniversityRigaLatvia
| | | |
Collapse
|
24
|
Janssen H, Ada L, Middleton S, Pollack M, Nilsson M, Churilov L, Blennerhassett J, Faux S, New P, McCluskey A, Spratt NJ, Bernhardt J. Altering the rehabilitation environment to improve stroke survivor activity: A Phase II trial. Int J Stroke 2021; 17:299-307. [PMID: 33739202 DOI: 10.1177/17474930211006999] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Environmental enrichment involves organization of the environment and provision of equipment to facilitate engagement in physical, cognitive, and social activities. In animals with stroke, it promotes brain plasticity and recovery. AIMS To assess the feasibility and safety of a patient-driven model of environmental enrichment incorporating access to communal and individual environmental enrichment. METHODS A nonrandomized cluster trial with blinded measurement involving people with stroke (n = 193) in four rehabilitation units was carried out. Feasibility was operationalized as activity 10 days after admission to rehabilitation and availability of environmental enrichment. Safety was measured as falls and serious adverse events. Benefit was measured as clinical outcomes at three months, by an assessor blinded to group. RESULTS The experimental group (n = 91) spent 7% (95% CI -14 to 0) less time inactive, 9% (95% CI 0-19) more time physically, and 6% (95% CI 2-10) more time socially active than the control group (n = 102). Communal environmental enrichment was available 100% of the time, but individual environmental enrichment was rarely within reach (24%) or sight (39%). There were no between-group differences in serious adverse events or falls at discharge or three months or in clinical outcomes at three months. CONCLUSIONS This patient-driven model of environmental enrichment was feasible and safe. However, the very modest increase in activity by people with stroke, and the lack of benefit in clinical outcomes three months after stroke do not provide justification for an efficacy trial.
Collapse
Affiliation(s)
- Heidi Janssen
- 5260Hunter New England Local Health District, Australia.,Hunter Medical Research Institute, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Louise Ada
- Faculty of Medicine and Health, University of Sydney, Australia
| | - Sandy Middleton
- Faculty of Health Sciences Department, Nursing Research Institute, Australia.,Department of Medicine, University of Melbourne, Australia
| | - Michael Pollack
- 5260Hunter New England Local Health District, Australia.,Hunter Medical Research Institute, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Michael Nilsson
- Hunter Medical Research Institute, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | | | | | - Steven Faux
- Departments of Rehabilitation Medicine and Pain Medicine, St Vincent's Hospital, Australia
| | - Peter New
- Department of Medicine & Rehabilitation and Aged Services Program, 2538Monash Health, Australia.,Monash Medical School & Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Annie McCluskey
- Faculty of Medicine and Health, University of Sydney, Australia
| | - Neil J Spratt
- 5260Hunter New England Local Health District, Australia.,Hunter Medical Research Institute, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | | |
Collapse
|
25
|
Studer B, Timm A, Sahakian BJ, Kalenscher T, Knecht S. A decision-neuroscientific intervention to improve cognitive recovery after stroke. Brain 2021; 144:1764-1773. [PMID: 33742664 PMCID: PMC8320292 DOI: 10.1093/brain/awab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Functional recovery after stroke is dose-dependent on the amount of rehabilitative training. However, rehabilitative training is subject to motivational hurdles. Decision neuroscience formalizes drivers and dampers of behaviour and provides strategies for tipping motivational trade-offs and behaviour change. Here, we used one such strategy, upfront voluntary choice restriction (‘precommitment’), and tested if it can increase the amount of self-directed rehabilitative training in severely impaired stroke patients. In this randomized controlled study, stroke patients with working memory deficits (n = 83) were prescribed daily self-directed gamified cognitive training as an add-on to standard therapy during post-acute inpatient neurorehabilitation. Patients allocated to the precommitment intervention could choose to restrict competing options to self-directed training, specifically the possibility to meet visitors. This upfront choice restriction was opted for by all patients in the intervention group and highly effective. Patients in the precommitment group performed the prescribed self-directed gamified cognitive training twice as often as control group patients who were not offered precommitment [on 50% versus 21% of days, Pcorr = 0.004, d = 0.87, 95% confidence interval (CI95%) = 0.31 to 1.42], and, as a consequence, reached a 3-fold higher total training dose (90.21 versus 33.60 min, Pcorr = 0.004, d = 0.83, CI95% = 0.27 to 1.38). Moreover, add-on self-directed cognitive training was associated with stronger improvements in visuospatial and verbal working memory performance (Pcorr = 0.002, d = 0.72 and Pcorr = 0.036, d = 0.62). Our neuroscientific decision add-on intervention strongly increased the amount of effective cognitive training performed by severely impaired stroke patients. These results warrant a full clinical trial to link decision-based neuroscientific interventions directly with clinical outcome.
Collapse
Affiliation(s)
- Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| | - Alicja Timm
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| | | | - Tobias Kalenscher
- Comparative Psychology, Institute of Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| |
Collapse
|
26
|
Delayed Exercise-induced Upregulation of Angiogenic Proteins and Recovery of Motor Function after Photothrombotic Stroke in Mice. Neuroscience 2021; 461:57-71. [PMID: 33667592 DOI: 10.1016/j.neuroscience.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/02/2023]
Abstract
Treatments promoting post-stroke functional recovery continue to be an unmet therapeutic problem with physical rehabilitation being the most reproduced intervention in preclinical and clinical studies. Unfortunately, physiotherapy is typically effective at high intensity and early after stroke - requirements that are hardly attainable by stroke survivors. The aim of this study was to directly evaluate and compare the dose-dependent effect of delayed physical rehabilitation (daily 5 h or overnight voluntary wheel running; initiated on post-stroke day 7 and continuing through day 21) on recovery of motor function in the mouse photothrombotic model of ischemic stroke and correlate it with angiogenic potential of the brain. Our observations indicate that overnight but not 5 h access to running wheels facilitates recovery of motor function in mice in grid-walking test. Western blotting and immunofluorescence microscopy experiments evaluating the expression of angiogenesis-associated proteins VEGFR2, doppel and PDGFRβ in the peri-infarct and corresponding contralateral motor cortices indicate substantial upregulation of these proteins (≥2-fold) in the infarct core and surrounding cerebral cortex in the overnight running mice on post-stroke day 21. These findings indicate that there is a dose-dependent relationship between the extent of voluntary exercise, motor recovery and expression of angiogenesis-associated proteins in this expert-recommended mouse ischemic stroke model. Notably, our observations also point out to enhanced angiogenesis and presence of pericytes within the infarct core region during the chronic phase of stroke, suggesting a potential contribution of this tissue area in the mechanisms governing post-stroke functional recovery.
Collapse
|
27
|
Rosbergen ICM, Tonello I, Clark RA, Grimley RS. Does hospital design impact on patient activity levels and time spent alone? Disabil Rehabil 2020; 44:3173-3180. [PMID: 33336598 DOI: 10.1080/09638288.2020.1861117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to quantify changes in patients' activity levels, location and people present, within one acute stroke unit (ASU) and one inpatient rehabilitation unit (IRU) with respect to change in hospital design. METHODS A prospective observational study using behavioural mapping. We observed participants from 8 am till 5 pm every 10 minutes across two days and compared participant activity (physical, social and cognitive), location and people present pre and post-transition to new units. Built design, staffing levels and models of care were contrasted. RESULTS We recruited 73 participants (63% stroke): old-ASU (n = 19); new-ASU (n = 15); old-IRU (n = 19); new-IRU (n = 20). Compared to old, new units had more single rooms, larger floor spaces and higher staffing levels. We found no significant change in participants' activity levels between the old and new ASU. Participants in the new IRU showed increased physical activity (43.4% vs. 54.4%, p = 0.02) but social and cognitive activity remained similar. Participants were more alone (ASU 47.4% vs. 66.7%, p = 0.01; IRU 41.7% vs. 58.3%, p < 0.001), and less often with nursing staff (ASU 17.7% vs. 6.7%, p = 0.04; IRU 18.8% vs. 5.7%, p < 0.001) in new units. CONCLUSION Hospital design appears to impact on patients' physical activity. Single rooms may increase isolation and reduce interaction with nursing staff.Implications for rehabilitationDesign of new rehabilitation units needs to consider patients' social engagement with family, friends, other patients and staff in addition to privacy and infection control.A change in built design of rehabilitation units should prompt observation of patients' activity levels and engagement with people and available space to ensure optimal use of new environments.Promotion of communal spaces and activities away from the bedroom to encourage social engagement is recommended for patients recovering in rehabilitation facilities.Less time in contact with nursing staff in rehabilitation environments with predominantly single rooms suggests a review of clinical practice and patient safety is warranted.
Collapse
Affiliation(s)
- I C M Rosbergen
- Allied Health Services, Sunshine Coast Hospital and Health Services, Birtinya, Australia.,Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - I Tonello
- Allied Health Services, Sunshine Coast Hospital and Health Services, Birtinya, Australia
| | - R A Clark
- School of Health and Sports Science, University of the Sunshine Coast, Sippy Downs, Australia
| | - R S Grimley
- Medical Service Division, Sunshine Coast Hospital and Health Services, Birtinya, Australia.,Sunshine Coast Clinical School, School of Medicine, Griffith University, Birtinya, Australia
| |
Collapse
|
28
|
|
29
|
Kramer SF, Cumming T, Johnson L, Churilov L, Bernhardt J. Determining Maximal Tolerable Aerobic Training Intensity in the Acute Phase after Stroke: a Novel Dose Ranging Trial Protocol. J Stroke Cerebrovasc Dis 2020; 29:105359. [PMID: 33045625 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105359] [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: 04/01/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION There is strong evidence that cardiorespiratory fitness (CRF) training improves fitness and mobility after stroke. Despite the large number of studies, the most efficacious dose is yet to be determined. Furthermore, the safety of early post-stroke training, while theoretically beneficial, remains uncertain. The aim of this study is to determine the maximum safe and tolerable intensity of CRF training early post-stroke. METHODS This is a stratified (low to moderate exercise capacity), Phase I, 5+5 dose ranging trial protocol. Participants will be recruited within one month post-stroke and stratified by their exercise-capacity (i.e. low and moderate capacity). Cohorts of five participants will perform 12 interval-based training sessions for four-weeks at a pre-determined target-intensity. The intensity will increase in each consecutive cohort, in each stratum according to pre-defined rules until the maximum safe and tolerable intensity is reached, as determined by the occurrence of dose-limiting events and occurrence of adverse events. Dose-limiting events are defined as symptoms indicative of over-training including pain and inability to perform usual activities. STUDY OUTCOME Maximum safe and tolerable intensity of CRF training in stroke survivors with low and moderate exercise capacity. DISCUSSION This study is a first step in the systematic development of a CRF training intervention. We believe similar dose ranging designs may be useful for development of other rehabilitation interventions in different study populations.
Collapse
Affiliation(s)
- Sharon F Kramer
- Florey Institute of Neuroscience and Mental Health, University of Melbourne,245 Burgundy Street, 3084, Heidelberg, Victoria, Australia; NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, 245 Burgundy Street, 3084, Heidelberg, Victoria, Australia.
| | - Toby Cumming
- Florey Institute of Neuroscience and Mental Health, University of Melbourne,245 Burgundy Street, 3084, Heidelberg, Victoria, Australia.
| | - Liam Johnson
- School of Health Sciences, Australian Catholic University, 115 Victoria Parade, 3065 Melbourne, Victoria, Australia.
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, 245 Burgundy Street, 3084, Heidelberg, Victoria, Australia.
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne,245 Burgundy Street, 3084, Heidelberg, Victoria, Australia; NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, 245 Burgundy Street, 3084, Heidelberg, Victoria, Australia.
| |
Collapse
|
30
|
Studer B, Geniole SN, Becker ML, Eisenegger C, Knecht S. Inducing illusory control ensures persistence when rewards fade and when others outperform us. Psychon Bull Rev 2020; 27:809-818. [PMID: 32424621 PMCID: PMC7399668 DOI: 10.3758/s13423-020-01745-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Persisting even when the rewards of continued effort are fading is essential for achieving long-term goals, skills, and good health, alike. Yet, we often quit when things get hard. Here, we tested whether augmenting the feeling of control through external measures increases persistence under such discouraging circumstances. In two laboratory experiments, we first induced illusory control by manipulating the base-rate of positive outcomes and then tested the effect of this elevation of participants' perceived control upon their persistence under diminishing returns and in a competition against a stronger opponent. Induced illusory control significantly enhanced people's persistence in both of these motivationally challenging situations. Our findings demonstrate that motivation is dependent upon perceived, rather than objective, control, and reveal that this can be leveraged to counteract quitting behavior when things get hard, for instance in rehabilitation, physical activity interventions, or other training settings.
Collapse
Affiliation(s)
- Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany.
| | - Shawn N Geniole
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
- Social-Neuroendocrinology Laboratory, Department of Psychology, Nipissing University, North Bay, Ontario, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
| | - Maike L Becker
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Christoph Eisenegger
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| |
Collapse
|
31
|
Implementation of a randomized controlled trial on an inpatient stroke rehabilitation unit: Lessons learned. Contemp Clin Trials Commun 2020; 18:100563. [PMID: 32617429 PMCID: PMC7322803 DOI: 10.1016/j.conctc.2020.100563] [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: 11/25/2019] [Revised: 03/09/2020] [Accepted: 03/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background/Aims The objective of this manuscript is to present challenges and solutions that arose during a mid-sized single-site RCT of a rehabilitation intervention performed in an inpatient stroke rehabilitation setting. Methods Seventy-six participants from an inpatient stroke rehabilitation unit were randomized to experimental and control groups. All participants did 30–45 min of virtual reality (VR) daily for 10–12 sessions. The experimental group did VR targeting sitting balance while the control group did VR with limited arm movement. Challenges during the implementation of the RCT were documented and strategies to mitigate them were applied. Results Challenges were placed into five categories: 1. Recruitment. Our recruitment procedures required multiple steps prior to initiating direct patient contact; one solution would be to have patients consent to be approached about research upon admission to the inpatient unit. 2. Patient-specific Issues. Fatigue, pain, vision problems and engagement were managed through scheduling, increasing the workload slowly and personalized modifications to the VR. 3./4. Scheduling and Staffing. Recruitment and attendance at VR sessions were maximized through good communication, flexibility and cooperation, between research staff, clinical staff, volunteers, students and participants. 5. Technology. Because hospital internet service was poor, a mobile internet data plan was purchased to ensure the system's reliability. Conclusions We have identified challenges in delivering a rehabilitation intervention on an inpatient stroke rehabilitation unit and some of the measures taken to surmount these challenges. Through good planning, flexibility and collaboration, almost all of the challenges were successfully addressed. Clinical trial registration number URL: http://www.clinicaltrials.gov. Unique identifier: NCT02285933.
Collapse
|
32
|
Poststroke Impairment and Recovery Are Predicted by Task-Specific Regionalization of Injury. J Neurosci 2020; 40:6082-6097. [PMID: 32605940 DOI: 10.1523/jneurosci.0057-20.2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 01/01/2023] Open
Abstract
Lesion size and location affect the magnitude of impairment and recovery following stroke, but the precise relationship between these variables and functional outcome is unknown. Herein, we systematically varied the size of strokes in motor cortex and surrounding regions to assess effects on impairment and recovery of function. Female Sprague Dawley rats (N = 64) were evaluated for skilled reaching, spontaneous limb use, and limb placement over a 7 week period after stroke. Exploration and reaching were also tested in a free ranging, more naturalistic, environment. MRI voxel-based analysis of injury volume and its likelihood of including the caudal forelimb area (CFA), rostral forelimb area (RFA), hindlimb (HL) cortex (based on intracranial microstimulation), or their bordering regions were related to both impairment and recovery. Severity of impairment on each task was best predicted by injury in unique regions: impaired reaching, by damage in voxels encompassing CFA/RFA; hindlimb placement, by damage in HL; and spontaneous forelimb use, by damage in CFA. An entirely different set of voxels predicted recovery of function: damage lateral to RFA reduced recovery of reaching, damage medial to HL reduced recovery of hindlimb placing, and damage lateral to CFA reduced recovery of spontaneous limb use. Precise lesion location is an important, but heretofore relatively neglected, prognostic factor in both preclinical and clinical stroke studies, especially those using region-specific therapies, such as transcranial magnetic stimulation.SIGNIFICANCE STATEMENT By estimating lesion location relative to cortical motor representations, we established the relationship between individualized lesion location, and functional impairment and recovery in reaching/grasping, spontaneous limb use, and hindlimb placement during walking. We confirmed that stroke results in impairments to specific motor domains linked to the damaged cortical subregion and that damage encroaching on adjacent regions reduces the ability to recover from initial lesion-induced impairments. Each motor domain encompasses unique brain regions that are most associated with recovery and likely represent targets where beneficial reorganization is taking place. Future clinical trials should use individualized therapies (e.g., transcranial magnetic stimulation, intracerebral stem/progenitor cells) that consider precise lesion location and the specific functional impairments of each subject since these variables can markedly affect therapeutic efficacy.
Collapse
|
33
|
Beckwée D, Lefeber N, Bautmans I, Cuypers L, De Keersmaecker E, De Raedt S, Kerckhofs E, Nagels G, Njemini R, Perkisas S, Scheys E, Swinnen E. Muscle changes after stroke and their impact on recovery: time for a paradigm shift? Review and commentary. Top Stroke Rehabil 2020; 28:104-111. [PMID: 32588773 DOI: 10.1080/10749357.2020.1783916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In stroke rehabilitation there is a growing body of evidence that not all patients have the same potential to recover. Understanding the processes that give rise to the heterogeneous treatment responses in stroke survivors will lay foundations for any conceivable advance in future rehabilitation interventions. This review was set out to shine new light on the debate of biomarkers in stroke rehabilitation by linking fundamental insights from biogerontological sciences to neurorehabilitation sciences. In particular, skeletal muscle changes and inflammation are addressed as two potential constructs from which biomarkers for stroke rehabilitation can be derived. Understanding the interplay between these constructs as well as their relation to recovery could enhance stroke rehabilitation in the future. The rationale for the selection of these constructs is three-fold: first, recent stroke literature emphasizes the importance of identifying muscle wasting (also called stroke-induced muscle wasting) in stroke patients, a concept that is widely investigated in geriatrics but less in the stroke population. Second, insights from transdisciplinary research domains such as gerontology have shown that inflammation has severe catabolic effects on muscles, which may impede rehabilitation outcomes such as gait recovery. Last, it has been proven that (high-intensity) muscle strengthening exercises have strong anti-inflammatory effects in a non-stroke population. Therefore, an evidence-based rationale is presented for developing research on individual changes of muscle and inflammation after a stroke.
Collapse
Affiliation(s)
- David Beckwée
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Frailty in Ageing Research Department, Vrije Universiteit Brussel , Brussels, Belgium.,Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp , Wilrijk, Belgium
| | - Nina Lefeber
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Ivan Bautmans
- Frailty in Ageing Research Department, Vrije Universiteit Brussel , Brussels, Belgium
| | - Lotte Cuypers
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Emma De Keersmaecker
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Sylvie De Raedt
- Universitair Ziekenhuis Brussel , Neurology Department, Jette, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| | - Guy Nagels
- Universitair Ziekenhuis Brussel , Neurology Department, Jette, Belgium
| | - Rose Njemini
- Frailty in Ageing Research Department, Vrije Universiteit Brussel , Brussels, Belgium
| | - Stany Perkisas
- University Center of Geriatrics, University of Antwerp , Antwerp, Belgium
| | - Ellen Scheys
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel , Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel , Brussels, Belgium.,Human Robotic Research Center (Brubotics), Vrije Universiteit Brussel , Brussels, Belgium
| |
Collapse
|
34
|
McRae P, Bew P, Smith S, Mudge A. An observational study of physical, cognitive and social activities in rehabilitation inpatients. Australas J Ageing 2020; 39:217-224. [PMID: 32096897 DOI: 10.1111/ajag.12785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe patient behaviour related to mobility in a rehabilitation inpatient setting and compare intensive and Transition Care Program (TCP, slow-stream rehabilitation) models. METHODS Prospective cross-sectional design including weekday and weekend sampling in two rehabilitation wards (one intensive and one TCP) in a publicly funded facility. A single trained observer undertook behavioural mapping, observing patient location, mobility, activity and company on all inpatients 8 am-4 pm using a structured 2-minute observation protocol. Observations were summarised and compared between wards. RESULTS We observed 74 inpatients on a Tuesday and 77 on a Sunday. Participants spent 7% (median) of daytime standing or walking. They spent 62%-87% in their room, 22%-40% sleeping or resting and 74%-86% alone. The only significant difference between wards was time spent off ward on Tuesday. Activity was lower on Sunday. CONCLUSIONS Time spent in physical, cognitive and social activities is low in inpatient rehabilitation and TCP wards.
Collapse
Affiliation(s)
- Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Paul Bew
- Brighton Health Campus, Brisbane, Qld, Australia
| | - Simon Smith
- Institute for Social Science Research, The University of Queensland, Brisbane, Qld, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| |
Collapse
|
35
|
Studer B, Koch C, Knecht S, Kalenscher T. Conquering the inner couch potato: precommitment is an effective strategy to enhance motivation for effortful actions. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180131. [PMID: 30966912 PMCID: PMC6335452 DOI: 10.1098/rstb.2018.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Letting effort-free gratification derail us from effort-requiring goals is one reason why we fail to realize health-relevant intentions like 'exercise regularly'. We tested the effectiveness of the self-control strategy precommitment in such effort-related conflicts, using a novel laboratory choice paradigm, where participants could precommit to an effort-requiring large reward by pre-eliminating an effort-free small reward from their choice set. Our participants used precommitment frequently and effectively, such that they reached effort-requiring large rewards more often. Using computational modelling and Bayesian model comparisons, we assessed whether participants employed precommitment to avoid anticipated willpower failures (i.e. as a self-regulatory measure) or to maximize their motivation to choose the effort-requiring option (i.e. as a self-motivational measure). Observed choices and precommitment decisions were consistent with the motivation maximization hypothesis, but not the willpower hypothesis. Our findings show that offering precommitment is effective in helping individuals optimize their motivation and choice behaviour and thereby achieve effort-requiring goals, and strongly encourage application of precommitment schemes in exercise and rehabilitation interventions. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.
Collapse
Affiliation(s)
- Bettina Studer
- 1 Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf , Moorenstrasse 5, 40225 Düsseldorf , Germany.,2 Mauritius Hospital Meerbusch , Strümperstraße 111, 40670 Meerbusch , Germany
| | - Carolin Koch
- 1 Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf , Moorenstrasse 5, 40225 Düsseldorf , Germany
| | - Stefan Knecht
- 1 Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf , Moorenstrasse 5, 40225 Düsseldorf , Germany.,2 Mauritius Hospital Meerbusch , Strümperstraße 111, 40670 Meerbusch , Germany
| | - Tobias Kalenscher
- 3 Comparative Psychology, Institute of Experimental Psychology, University of Düsseldorf , Universitätsstrasse 1, 40225 Düsseldorf , Germany
| |
Collapse
|
36
|
Tijsen LM, Derksen EW, Achterberg WP, Buijck BI. Challenging rehabilitation environment for older patients. Clin Interv Aging 2019; 14:1451-1460. [PMID: 31496672 PMCID: PMC6697645 DOI: 10.2147/cia.s207863] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/07/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these patients in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support and the environment on a rehabilitation ward. However, since literature on the principles of CRE is scarce, this review aimed to explore and describe the principles of CRE. Methods A search was made in PubMed for relevant literature concerning CRE. Then, articles were hand searched for relevant keywords (ie, task-oriented training, therapy intensity, patient-led therapy, group training), references were identified, and topics categorized. Results After evaluating 51 articles, 7 main topics of CRE were identified: 1) Therapy time; ie, the level of (physical) activity; the intensity of therapy and activity is related to rehabilitation outcomes, 2) group training; used to increase practice time and can be used to achieve multiple goals (eg, activities of daily living, mobility), 3) patient-regulated exercise; increases the level of self-management and practice time, 4) family participation; may lead to increased practice time and have a positive effect on rehabilitation outcomes, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this challenges rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals during rehabilitation and good communication in a transdisciplinary team improve the quality of rehabilitation. Discussion This is the first description of CRE based on literature; however, the included studies discussed rehabilitation mainly after stroke and for few other diagnostic groups. Conclusion Seven main topics related to CRE were identified that may help patients to improve their rehabilitation outcomes. Further research on the concept and effectivity of CRE is necessary.
Collapse
Affiliation(s)
- Lian Mj Tijsen
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Oktober , Bladel, The Netherlands.,De Zorgboog , Bakel, The Netherlands
| | - Els Wc Derksen
- Department Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wilco P Achterberg
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Bianca I Buijck
- Oktober , Bladel, The Netherlands.,De Zorgboog , Bakel, The Netherlands
| |
Collapse
|
37
|
Ahn S, Hwang S. Virtual rehabilitation of upper extremity function and independence for stoke: a meta-analysis. J Exerc Rehabil 2019; 15:358-369. [PMID: 31316927 PMCID: PMC6614763 DOI: 10.12965/jer.1938174.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/28/2019] [Indexed: 11/22/2022] Open
Abstract
We aimed to conduct a systematic literature review with a meta-analysis to investigate whether virtual reality (VR) approaches have beneficial effects on the upper extremity function and independent activities of stroke survivors. Experimental studies published between 2007 and 2017 were searched from two databases (EBSCOhost and PubMed). This study reviewed abstracts and assessed full articles to obtain evidence on qualitative studies. For the meta-analysis, the studies that estimated the standardized mean between the two groups analyzed the statistical values necessary for calculating the effect size. The present study also evaluated the statistical heterogeneity. In total, 34 studies with 1,604 participants were included, and the number of participants in each study ranged from 10 to 376. Nine studies were assessed to evaluate the quantitative statistical analysis for 698 patients with hemiparetic stroke. The results of the meta-analysis were as follows: The overall effect size was moderate (0.41, P<0.001). The 95% confidence interval ranged from 0.25 to 0.57. However, no significant heterogeneity and publication bias were observed. The results of this study showed that VR approaches are effective in improving upper extremity function and independent activities in stroke survivors.
Collapse
Affiliation(s)
- Sinae Ahn
- Department of Occupational Therapy, Cheongju University, Cheonju, Korea
| | - Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Korea
| |
Collapse
|
38
|
Støve MP, Larsen BT. Self-monitoring – usability evaluation of heart rate monitoring using wearable devices in patients with acquired brain injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1628300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Morten P. Støve
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Birgit T. Larsen
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| |
Collapse
|
39
|
Stewart C, Power E, McCluskey A, Kuys S. Development of a participatory, tailored behaviour change intervention to increase active practice during inpatient stroke rehabilitation. Disabil Rehabil 2019; 42:3516-3524. [PMID: 30982361 DOI: 10.1080/09638288.2019.1597178] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: An evidence-practice gap exists between the amount of active practice recommended and the amount completed by stroke inpatients. The aim of this paper is to describe steps in the design of a participatory, theoretically tailored staff behaviour change intervention to help staff use strategies to increase active practice by stroke inpatients.Methods: A staff behaviour change intervention was developed in one rehabilitation unit in Queensland, Australia using a six-step process guided by the Behaviour Change Wheel framework. Mixed methods were used including direct observation (behavioural mapping), and focus groups to identify barriers and facilitators to implementation. Barriers and facilitators were mapped to the behaviour change techniques, and a behaviour change intervention developed in participation with rehabilitation staff.Results: Staff chose to implement ward-based practice books. Barriers included patient factors (including low motivation and severity of stroke), environmental segregation and limited skills for motivating patients. Staff belief in increasing active practice was a facilitator to implementation. The staff intervention included a training programme about motivation, environmental restructuring, audit, and feedback.Conclusions: This example of collaborative implementation research can be used and adapted by clinicians and researchers in other rehabilitation services.IMPLICATIONS FOR REHABILITATIONRehabilitation staff can be actively involved in designing behaviour change interventions.Behaviour change interventions should target local barriers to increase activity levels and practice completed by stroke inpatients.The process of co-designing behaviour change interventions has the potential to improve the uptake of a strategy such as ward-based practice books, by more precisely identifying local barriers and possible solutions.
Collapse
Affiliation(s)
- Claire Stewart
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Allied Health Services, Sunshine Coast University Hospital, Birtinya, Australia
| | - Emma Power
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Suzanne Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Australia
| |
Collapse
|
40
|
van Delft LMM, Bor P, Valkenet K, Veenhof C. Hospital in Motion, a Multidimensional Implementation Project to Improve Patients' Physical Behavior During Hospitalization: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2019; 8:e11341. [PMID: 30964442 PMCID: PMC6477568 DOI: 10.2196/11341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/03/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022] Open
Abstract
Background Despite the evidence of the adverse consequences of immobility during hospitalization, patients spend most of the time in bed. Although physical activity is a modifiable factor that can prevent in-hospital functional decline, bed rest is deeply rooted in the hospital culture. To attack this, a multidimensional approach is needed. Therefore, Hospital in Motion, a multidimensional implementation project, was designed to improve physical behavior during hospitalization. Objective The primary objective of this study is to investigate the effectiveness of Hospital in Motion on inpatient physical behavior. Secondary objectives are to investigate the effectiveness on length of hospital stay and immobility-related complications of patients during hospitalization and to monitor the implementation process. Methods For this study, Hospital in Motion will be implemented within 4 wards (cardiology, cardiothoracic surgery, medical oncology, and hematology) in a Dutch University Medical Center. Per ward, multidisciplinary teams will be composed who follow a step-by-step multidimensional implementation approach including the development and implementation of tailored action plans with multiple interventions to stimulate physical activity in daily care. A prepost observational study design will be used to evaluate the difference in physical behavior before and 1 year after the start of the project, including 40 patients per time point per ward (160 patients in total). The primary outcome measure is the percentage of time spent lying, measured with the behavioral mapping method. In addition, a process evaluation will be performed per ward using caregivers’ and patient surveys and semistructured interviews with patients and caregivers. Results This study is ongoing. The first participant was enrolled in October 2017 for the premeasurement. The postmeasurements are planned for the end of 2018. The first results are expected to be submitted for publication in autumn 2019. Conclusions This study will provide information about the effectiveness of the Hospital in Motion project on physical behavior and about the procedures of the followed implementation process aimed to incorporate physical activity in usual care. These insights will be useful for others interested in changing physical behavior during hospitalization. Trial Registration Netherlands Trial Register NTR7109; https://www.trialregister.nl/trial/6914 (Archived by WebCite at http://www.webcitation.org/76dyhdjdd) International Registered Report Identifier (IRRID) DERR1-10.2196/11341
Collapse
Affiliation(s)
- Lotte Martine Maria van Delft
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
41
|
DePaul VG, Bosch J, Oczkowski WJ, Wishart L, O'Donnell M, Hart RG. Promoting Independent Mobility-related Physical ACTivity (IMPACT) in an inpatient stroke rehabilitation unit: a proof-of-concept evaluation of self-management intervention. Disabil Rehabil 2019; 42:3172-3181. [PMID: 30924713 DOI: 10.1080/09638288.2019.1587012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To establish proof-of-concept of a novel rehabilitation self-management program that aims to optimize walking recovery after stroke through engaging patients in independent walking-related practice outside of supervised physiotherapy sessions.Materials and Methods: The Independent Mobility-related Physical ACTivity (IMPACT) Program is a coach-supported intervention that uses self-management strategies to empower patients to engage in additional autonomous walking-related activities after stroke during and after inpatient rehabilitation. The aim of this study was to assess whether implementation of this intervention would be associated with targeted patient behaviors; goal setting, negotiation and completion of a walking-related practice plan outside of formal therapy sessions. Using a pre-intervention/post-intervention design, the Independent Mobility-related Physical Activity program was implemented with a convenience sample of 10 adults (mean age 62.3; SD 11.7 years) within an inpatient stroke rehabilitation unit (mean stroke onset 25.3 [SD 10.5] days).Results: All participants were able to set a personal goal, negotiate an autonomous walking-related activity practice plan, and partially or completely adhere to that plan. Patients completed an average of 36 min/day of practice outside of supervised physiotherapy, practicing on weekdays and weekend days. All patients indicated that the Independent Mobility-related Physical Activity program helped them increase their activity, and indicated they would continue to practice walking-related activities beyond the coaching period.Implications for rehabilitationThe IMPACT program is a feasible self-management strategy to facilitate walking-related practice outside of supervised therapy time during inpatient stroke rehabilitation.Patients were able to engage in goal-setting and practice plan development with support of a therapist-coach.Patients who are able to stand and walk with minimal assist were able to practice walking-related activities outside of formal therapy sessions.Therapists may benefit from specific training and support to adopt self-management strategies into practice.
Collapse
Affiliation(s)
- Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.,Population Health Research Institute, Hamilton, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Wieslaw J Oczkowski
- Population Health Research Institute, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Laurie Wishart
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Martin O'Donnell
- Population Health Research Institute, Hamilton, Canada.,Translational Medicine, National University of Ireland, Galway, Ireland
| | - Robert G Hart
- Population Health Research Institute, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
42
|
Bui T, King C, Llado A, Lee D, Leong G, Paraparum A, Li I, Scrivener K. App-based supplemental exercise during inpatient orthopaedic rehabilitation increases activity levels: a pilot randomised control trial. Pilot Feasibility Stud 2019; 5:47. [PMID: 30923628 PMCID: PMC6420741 DOI: 10.1186/s40814-019-0430-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/06/2019] [Indexed: 11/15/2022] Open
Abstract
Background There is a known positive relationship between time in therapy and therapy outcomes. Effective rehabilitation should therefore include larger doses of therapy. However, individuals participating in inpatient rehabilitation have low levels of activity throughout the day. This level of inactivity may limit rehabilitation potential. New technologies which deliver personalised exercise programs and track time spent on exercises may lead to greater activity levels and therefore improve functional outcomes in rehabilitation. This pilot randomised control trial aimed to investigate whether an app-based supplemental exercise program in orthopaedic rehabilitation will be feasible and acceptable to participants, increase activity levels and improve functional outcomes. Methods Participants were randomised to receive supplemental exercise via an app (PTPal™) on a tablet device additional to usual care or usual care alone. Primary outcome measures were participant satisfaction with app-based supplemental exercise, total repetitions of each activity and time in supplemental exercise programs. Secondary measures were 10-m walk test (10MWT), 6-min walk test (6MWT), Timed Up and Go (TUG), Functional Independence Measure and length of stay assessed by a blinded assessor. Results Twenty individuals admitted into an inpatient private general rehabilitation unit for orthopaedic rehabilitation over a 4-week duration were included in this study. High acceptance of the app-based supplemental exercise program was demonstrated. Those using the app completed an additional 549 exercise repetitions during their admission (694 supplemental app-based repetitions vs 146 supplemental paper-based repetitions in the control group, mean difference [MD] 549, 95% CI 95 to 1002, p = 0.02) and an additional 157 min in supplemental exercise throughout their admission (195.3 min vs 38.7 min, MD 157 min, 95% CI 0.9–312.3 min, p = 0.05). There was insufficient power to demonstrate statistical significance in functional outcomes, but a trend towards improved functional outcomes was observed in the intervention group. Conclusion An app-based exercise program increases activity levels, is feasible and is a safe intervention with the potential to improve functional outcomes. This pilot study should be followed with a larger study powered to demonstrate functional effects with more participants having greater impairment. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR); trial number ACTRN12617000817347. This study was retrospectively registered (registration date 05/06/2017).
Collapse
Affiliation(s)
- Tram Bui
- 1Royal Rehab, 235 Morrison Road, Ryde, NSW 2112 Australia
| | - Clayton King
- 1Royal Rehab, 235 Morrison Road, Ryde, NSW 2112 Australia
| | - Ana Llado
- 1Royal Rehab, 235 Morrison Road, Ryde, NSW 2112 Australia
| | - Darren Lee
- 1Royal Rehab, 235 Morrison Road, Ryde, NSW 2112 Australia
| | - Grace Leong
- 1Royal Rehab, 235 Morrison Road, Ryde, NSW 2112 Australia
| | | | - Ingrid Li
- MQ Health Physiotherapy, Suite 307, Level 3, 2 Technology Place, Macquarie Park, NSW 2109 Australia
| | - Katharine Scrivener
- 3Department of Health Professions, Macquarie University, Ground Floor, 75 Talavera Road, Macquarie Park, NSW 2113 Australia
| |
Collapse
|
43
|
Lipson-Smith R, Churilov L, Newton C, Zeeman H, Bernhardt J. A Framework for Designing Inpatient Stroke Rehabilitation Facilities: A New Approach Using Interdisciplinary Value-Focused Thinking. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:142-158. [PMID: 30799632 PMCID: PMC6745610 DOI: 10.1177/1937586719831450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aim: To use Value-Focused Thinking to investigate what is important in the design
of inpatient stroke rehabilitation facility buildings. Background: Many stroke patients require inpatient rehabilitation in a dedicated
facility. Rehabilitation facilities are healthcare spaces, but they are also
learning spaces where patients practice targeted tasks to acquire new skills
and to reacquire skills and abilities that were compromised as a result of
their stroke. There is currently no consensus regarding how the design of
inpatient rehabilitation facilities could be optimized for patients’
learning. Method: We used Value-Focused Thinking to develop a framework of what
interdisciplinary experts consider important for inpatient stroke
rehabilitation facility design. Two workshops were conducted. The following
experts were invited to participate: past patients with experience of stroke
rehabilitation; stroke rehabilitation clinicians; stroke rehabilitation
academics; healthcare environments academics; learning environments
academics; architects, designers, and wayfinders with experience designing
healthcare or learning environments; and healthcare design policy
makers. Results: Thirty experts participated. The experts’ final framework included 16
criteria that were considered fundamentally important for inpatient stroke
rehabilitation facility design, and 14 criteria that were considered
instrumentally important. Inpatient stroke rehabilitation facility design
should maximize efficiency, maximize effectiveness (i.e., patients’ clinical
and functional outcomes), foster emotional well-being, and maximize safety.
Opportunities to practice physical, cognitive, and social activity were
considered important for patients’ outcomes. Conclusions: Value-Focused Thinking was an effective and equitable means of engaging
experts from multiple disciplines. Designers, planners, and developers of
inpatient stroke rehabilitation facilities should consider the
rehabilitation-specific framework developed in this study alongside evidence
from other healthcare settings.
Collapse
Affiliation(s)
- Ruby Lipson-Smith
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Newton
- Faculty of Architecture, Building and Planning, University of Melbourne, Melbourne, Victoria, Australia
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,The Hopkins Centre Research for Rehabilitation and Resilience, Brisbane, Queensland, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
| |
Collapse
|
44
|
Scrivener K, Pocovi N, Jones T, Dean B, Gallagher S, Henrisson W, Thorburn M, Dean C. Observations of Activity Levels in a Purpose-Built, Inpatient, Rehabilitation Facility. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:26-38. [DOI: 10.1177/1937586718823519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Effective rehabilitation should include high levels of physical activity. The impact of the environmental design on activity levels has had minimal consideration. Purpose: This study investigates activity levels of inpatients undergoing rehabilitation in a new rehabilitation facility with innovative design and multidisciplinary care, comparing weekday and weekend activity levels, as well as changes over a 12-month period. Method: An observational study reporting participants’ location, people present, body position, and activity type on 2 weekdays and 1 weekend day using behavior mapping techniques. Fifteen participants were observed in a mixed rehabilitation unit with neurological, orthopedic, and other health conditions. Results: Results were calculated as the proportion of observations participants spent in each location, position, and performing activities (physical, cognitive, social), and time spent alone and inactive. On average, participants were engaged in activity for 86% (standard deviation [ SD] = 9) of the day, with physical activity accounting for 51% ( SD = 11), cognitive activity 28% ( SD = 10), and social activity 42% ( SD = 16). There was more physical activity (mean difference [ MD] 8% absolute, confidence interval [CI] = [4, 12], p < .01) and less social activity ( MD −6% absolute, CI [−11, −1], p = .02) on weekdays compared to weekends. Overall, participants were alone and inactive for 12% ( SD = 9) of the day. Participants observed in 2016 displayed similar results to those observed in 2015. Conclusion: High levels of activity were achieved in this facility that underwent environmental redesign, construction of new facilities, and implementation of evidence-based strategies.
Collapse
Affiliation(s)
- Katharine Scrivener
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Natasha Pocovi
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Taryn Jones
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Bridget Dean
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Shaun Gallagher
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Wesley Henrisson
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Michael Thorburn
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Catherine Dean
- Department of Health Professions, Macquarie University, New South Wales, Australia
| |
Collapse
|
45
|
Home-based aerobic exercise in patients with lacunar stroke: Design of the HITPALS randomized controlled trial. Contemp Clin Trials Commun 2019; 14:100332. [PMID: 30815618 PMCID: PMC6378897 DOI: 10.1016/j.conctc.2019.100332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/05/2018] [Accepted: 01/31/2019] [Indexed: 01/22/2023] Open
Abstract
Background The effects of physical exercise in patients with lacunar stroke, seem promising in secondary prevention and only few studies have investigated the effect of high-intensity interval training in patients with lacunar stroke. This study will be investigating whether high-intensity interval training improves cardiovascular fitness as well as cognitive- and endothelial function and potentially attenuating the risk of recurrent stroke. Methods A randomized controlled trial evaluating 12 weeks of home-based, high-intensity interval training compared with usual care. The intervention group will be exercising 15 min a day, 5 days a week, for 12 weeks. Outcomes will be evaluated at baseline, three, six and twelve months post-stroke with ‘The Graded Cycling Test with Talk Test’ as the primary outcome registered as power output in Watts. Additionally, an annually register-based follow-up will be performed for 5 years from date of inclusion with a composite endpoint of cardiovascular disease or death. Secondary outcomes will be: physical activity, endothelial response, mental well-being, cognition, mood, fatigue, stress, and MRI scan. Discussion This study is going to show if early initiated home-based high-intensity interval training is feasible and effective in patients with lacunar stroke. A self-chosen aerobic exercise modality allows a realistic implementation of practice, together with greater chance of long-term adherence. A limitation of the study is that recruitment bias cannot be ruled out, as there may be a preferential enrolment of patients who are self-motivated to engage in exercise.
Collapse
|
46
|
Loft MI, Poulsen I, Martinsen B, Mathiesen LL, Iversen HK, Esbensen BA. Strengthening nursing role and functions in stroke rehabilitation 24/7: A mixed-methods study assessing the feasibility and acceptability of an educational intervention programme. Nurs Open 2019; 6:162-174. [PMID: 30534406 PMCID: PMC6279726 DOI: 10.1002/nop2.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 04/24/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022] Open
Abstract
AIM To assess the feasibility of a nursing educational intervention for inpatient stroke rehabilitation and its acceptability from the nursing staff's perspective. BACKGROUND There is currently a lack of interventions that integrate the diversity of nurses' role and functions in stroke rehabilitation and explore their effect on patient outcomes. DESIGN We used a convergent, parallel, mixed-method design with data interviews and questionnaires. METHODS Data collection was undertaken between February - July 2016. Data from questionnaires (N = 31) were analysed using descriptive statistics. The interviews (N = 10) were analysed using deductive content analysis. RESULTS There was a high level of satisfaction with the educational programme in terms of its acceptability and feasibility. The qualitative findings disclosed the nursing staff's experiences with the educational programme. Mixed-methods analysis showed confirmatory results that were convergent and expanded. Only minor adjustments are required before an effect study can be conducted.
Collapse
Affiliation(s)
| | - Ingrid Poulsen
- Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC), Clinic of NeurorehabilitationTBI Unit RigshospitaletHvidovreDenmark
- Department of Nursing Science, Institute of Public HealthAarhus UniversityCopenhagenDenmark
| | - Bente Martinsen
- Department of Nursing Science, Institute of Public HealthAarhus UniversityCopenhagenDenmark
| | | | - Helle Klingenberg Iversen
- Department of NeurologyRigshospitaletGlostrupDenmark
- Clinical Research, Faculty of Health and Medical SciencesUniversity of CopenhagenGlostrupDenmark
| | - Bente Appel Esbensen
- Copenhagen Centre for Arthritis Research (COPECARE)Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, RigshospitaletGlostrupDenmark
- Faculty of Health and Medical Sciences, Department of Clinical MedicineUniversity of CopenhagenGlostrupDenmark
| |
Collapse
|
47
|
Lee JY, Kwon S, Kim WS, Hahn SJ, Park J, Paik NJ. Feasibility, reliability, and validity of using accelerometers to measure physical activities of patients with stroke during inpatient rehabilitation. PLoS One 2018; 13:e0209607. [PMID: 30596694 PMCID: PMC6312264 DOI: 10.1371/journal.pone.0209607] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022] Open
Abstract
Promoting physical activities is important for medical and functional recovery after stroke. Therefore, an accurate and convenient measurement of physical activities is necessary to provide feedback on functional status and effects of rehabilitative interventions. We assessed the feasibility, reliability, and validity of wearing accelerometers to monitor physical activities of stroke patients by estimating energy expenditure. This was a prospective observational quantitative study conducted in an inpatient rehabilitation unit. Twenty-four patients with subacute stroke were enrolled. They wore accelerometers on wrists and ankles for three consecutive weekdays. The feasibility was evaluated by daily wear-time. The test-retest reliability was determined by intra-class correlation coefficient. The validity was evaluated by comparing accelerometeric data to behavior mappings using Mann-Whitney U test, Spearman’s rho correlation coefficient (r) and Bland-Altman plots. Average wearing time for four accelerometers was 20.99 ± 3.28 hours per day. The 3-day accelerometer recording showed excellent test-retest reliability. For sedentary activities, wrist accelerometers showed higher correlation with direct observation than ankle accelerometers. For light to moderate activities, ankle accelerometers showed higher correlation with direct observation than wrist accelerometers. Overall, combined models of accelerometers showed higher correlation with direct observation than separate ones. Wearing accelerometers for 24 h may be useful for measuring physical activities in subjects with subacute stroke in an inpatient rehabilitation unit.
Collapse
Affiliation(s)
- Ji-Young Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - SuYeon Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Soo Jung Hahn
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
- * E-mail:
| |
Collapse
|
48
|
Kulnik ST, Mohapatra S, Gawned S, Jones F. Managing the severely impaired arm after stroke: a mixed-methods study with qualitative emphasis. Disabil Rehabil 2018; 42:1826-1834. [DOI: 10.1080/09638288.2018.1539777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK
| | - Sushmita Mohapatra
- Therapy Services, King’s College Hospital NHS Foundation Trust, London, UK
| | - Sara Gawned
- Therapies Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
| |
Collapse
|
49
|
Anåker A, von Koch L, Heylighen A, Elf M. "It's Lonely": Patients' Experiences of the Physical Environment at a Newly Built Stroke Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 12:141-152. [PMID: 30336696 PMCID: PMC6637812 DOI: 10.1177/1937586718806696] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients (n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.
Collapse
Affiliation(s)
- Anna Anåker
- 1 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,2 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- 1 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,3 Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Heylighen
- 4 Department of Architecture, Research[x]Design, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marie Elf
- 1 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,2 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,5 Department of Architecture and Civil Engineering, The School of Architecture, Chalmers University of Technology, Gothenburg, Sweden
| |
Collapse
|
50
|
Lawrie S, Dong Y, Steins D, Xia Z, Esser P, Sun S, Li F, Amor JD, James C, Izadi H, Cao Y, Wade D, Mayo N, Dawes H. Evaluation of a smartwatch-based intervention providing feedback of daily activity within a research-naive stroke ward: a pilot randomised controlled trial. Pilot Feasibility Stud 2018; 4:157. [PMID: 30323946 PMCID: PMC6173888 DOI: 10.1186/s40814-018-0345-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background The majority of stroke patients are inactive outside formal therapy sessions. Tailored activity feedback via a smartwatch has the potential to increase inpatient activity. The aim of the study was to identify the challenges and support needed by ward staff and researchers and to examine the feasibility of conducting a randomised controlled trial (RCT) using smartwatch activity monitors in research-naive rehabilitation wards. Objectives (Phase 1 and 2) were to report any challenges and support needed and determine the recruitment and retention rate, completion of outcome measures, smartwatch adherence rate, (Phase 2 only) readiness to randomise, adherence to protocol (intervention fidelity) and potential for effect. Methods First admission, stroke patients (onset < 4 months) aged 40-75, able to walk 10 m prior to stroke and follow a two-stage command with sufficient cognition and vision (clinically judged) were recruited within the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine. Phase 1: a non-randomised observation phase (to allow practice of protocol)-patients received no activity feedback. Phase 2: a parallel single-blind pilot RCT. Patients were randomised into one of two groups: to receive daily activity feedback over a 9-h period or to receive no activity feedback. EQ-5D-5L, WHODAS and RMI were conducted at baseline, discharge and 3 months post-discharge. Descriptive statistics were performed on recruitment, retention, completion and activity counts as well as adherence to protocol. Results Out of 470 ward admissions, 11% were recruited across the two phases, over a 30-week period. Retention rate at 3 months post-discharge was 48%. Twenty-two percent of patients dropped out post-baseline assessment, 78% completed baseline and discharge admissions, from which 62% were assessed 3 months post-discharge. Smartwatch data were received from all patients. Patients were correctly randomised into each RCT group. RCT adherence rate to wearing the smartwatch was 80%. Baseline activity was exceeded for 65% of days in the feedback group compared to 55% of days in the no feedback group. Conclusions Delivery of a smartwatch RCT is feasible in a research-naive rehabilitation ward. However, frequent support and guidance of research-naive staff are required to ensure completeness of clinical assessment data and protocol adherence. Trials registration ClinicalTrials.gov Identifier, NCT02587585-30th September 2015.
Collapse
Affiliation(s)
- Sophie Lawrie
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Yun Dong
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - Dax Steins
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Zhidao Xia
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Patrick Esser
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Shanbin Sun
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - Fei Li
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - James D Amor
- 3School of Engineering, University of Warwick, Coventry, CV4 7AL UK
| | | | - Hooshang Izadi
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Yi Cao
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - Derick Wade
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Nancy Mayo
- 4School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, Québec H3G 1Y5 Canada
| | - Helen Dawes
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | | |
Collapse
|