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Wingfield M, Hughes G, Fini NA, Brodtmann A, Williams G, Hayward KS. Considerations for developing complex post-stroke upper limb behavioural interventions: An international qualitative study. Clin Rehabil 2024:2692155241265271. [PMID: 39053023 DOI: 10.1177/02692155241265271] [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: 07/27/2024]
Abstract
OBJECTIVE To simultaneously explore the perspectives and opinions of different invested participant groups on the important considerations for development of upper limb behavioural interventions that drive optimal post-stroke upper limb motor recovery. DESIGN A qualitative descriptive study in a constructivist epistemology. PARTICIPANTS Purposively selected participant groups (preclinical research n = 9, clinical research n = 9, clinical experience n = 9 and lived experience n = 10). SETTING Research participants were selected from top internationally published authors. Experiential participants were recruited internationally, through networks. RESULTS Four themes were identified with embedded subthemes. Theme 1: 'Clinical relevance should be the core of a "good" research question' with two subthemes: 'Breaking down silos: forging interdisciplinary research teams', and 'Beyond the pipeline: bench to bedside and back'; theme 2: 'Balance restitution and compensation to maximise outcomes' with three subthemes: 'Good outcome: going beyond an outcome measure', 'Recovery is a puzzle: measure all the pieces', and 'Optimising capacity: knowing when and how'; theme 3: 'Stroke demands personalised solutions' with two subthemes: 'Condition-specific considerations', and 'Person-specific considerations'; theme 4: 'Upper limb recovery requires complex interventions' with four subthemes: 'Fuelling engagement', 'Content is crucial', 'Multidimensional dose', and 'Therapist sway'. CONCLUSIONS This study suggests that post-stroke upper limb motor interventions are the interactions of multiple intervention elements (e.g. dose and content) shaped by different contextual considerations (e.g. stroke and personal factors). Development of such interventions may need to consider both content and context of the intervention to drive optimal recovery.
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Affiliation(s)
- Matthew Wingfield
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Epworth Healthcare, Melbourne, Australia
| | - Gemma Hughes
- Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Natalie A Fini
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Amy Brodtmann
- Department of Medicine, Monash University, Melbourne, Australia
| | - Gavin Williams
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Epworth Healthcare, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia
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2
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of swallowing exercises in stroke rehabilitation: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:1017-1045. [PMID: 36471047 PMCID: PMC9899761 DOI: 10.1007/s00405-022-07735-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/29/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the dosages of swallowing exercises reported in intervention studies on post-stroke dysphagia through systematic review. METHODS Five electronic databases were searched from inception until February 2022 with reference tracing of included studies. Studies were included, where adults with post-stroke dysphagia received rehabilitative, behavioural swallowing exercises, pre/post outcomes were reported, and intervention dosage was described in detail, including frequency, intensity, time, and type of exercise. Two reviewers independently screened studies and rated quality using ASHA Levels of Evidence tool. Data was tabulated and narratively described. RESULTS 54 studies were included with a total 1501 participants. Studies included 28 randomised controlled trials, 8 non-randomised controlled trials, 12 pre/post studies, 3 retrospective case controls and 3 case studies. Results showed inconsistent reporting of intervention dosage, with intensity the least consistently reported dosage component. While swallowing intervention was most commonly provided five times per week for four weeks, there was a wide breadth of type, frequency, intensity and duration of swallowing exercises reported. Dosage under-reporting and variation was particularly observed in "standard care" co-interventions or control groups. Study strengths included following PRISMA guidelines, providing a comprehensive review of swallowing exercise methodology and dosages, and including non-English studies. The limitation was lack of meta-analysis due to the heterogeneity of included studies. CONCLUSIONS Dosages of swallowing exercises are inconsistently reported and vary significantly in post-stroke dysphagia studies. Results indicate the need for consistent and comprehensive dosage reporting in dysphagia studies, and for further research into evidence-based principles to optimise swallowing exercise dosages. SYSTEMATIC REVIEW REGISTRATION NUMBER 131294.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- HammondCare Braeside Hospital, Sydney, NSW, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Hans Bogaardt
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
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3
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Lee Friesen C, Lawrence M, Ingram TGJ, Boe SG. Home-based portable fNIRS-derived cortical laterality correlates with impairment and function in chronic stroke. Front Hum Neurosci 2022; 16:1023246. [PMID: 36569472 PMCID: PMC9780676 DOI: 10.3389/fnhum.2022.1023246] [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: 08/19/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Improved understanding of the relationship between post-stroke rehabilitation interventions and functional motor outcomes could result in improvements in the efficacy of post-stroke physical rehabilitation. The laterality of motor cortex activity (M1-LAT) during paretic upper-extremity movement has been documented as a useful biomarker of post-stroke motor recovery. However, the expensive, labor intensive, and laboratory-based equipment required to take measurements of M1-LAT limit its potential clinical utility in improving post-stroke physical rehabilitation. The present study tested the ability of a mobile functional near-infrared spectroscopy (fNIRS) system (designed to enable independent measurement by stroke survivors) to measure cerebral hemodynamics at the motor cortex in the homes of chronic stroke survivors. Methods Eleven chronic stroke survivors, ranging widely in their level of upper-extremity motor deficit, used their stroke-affected upper-extremity to perform a simple unilateral movement protocol in their homes while a wireless prototype fNIRS headband took measurements at the motor cortex. Measures of participants' upper-extremity impairment and function were taken. Results Participants demonstrated either a typically lateralized response, with an increase in contralateral relative oxyhemoglobin (ΔHbO), or response showing a bilateral pattern of increase in ΔHbO during the motor task. During the simple unilateral task, M1-LAT correlated significantly with measures of both upper-extremity impairment and function, indicating that participants with more severe motor deficits had more a more atypical (i.e., bilateral) pattern of lateralization. Discussion These results indicate it is feasible to gain M1-LAT measures from stroke survivors in their homes using fNIRS. These findings represent a preliminary step toward the goals of using ergonomic functional neuroimaging to improve post-stroke rehabilitative care, via the capture of neural biomarkers of post-stroke motor recovery, and/or via use as part of an accessible rehabilitation brain-computer-interface.
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Affiliation(s)
- Christopher Lee Friesen
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Michael Lawrence
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Tony Gerald Joseph Ingram
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Shaun Gregory Boe
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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4
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Savage WM, Harel NY. Reaching a Tipping Point for Neurorehabilitation Research: Obstacles and Opportunities in Trial Design, Description, and Pooled Analysis. Neurorehabil Neural Repair 2022; 36:659-665. [DOI: 10.1177/15459683221124112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The record-breaking pace of COVID-19 vaccine development and implementation depended heavily on collaboration among academic, government, and commercial stakeholders, especially through data-sharing and robust multicenter trials. Collaborative efforts have not been as fruitful in fields such as neurorehabilitation, where non-pharmacological interventions play a much larger role. Barriers to translating scientific advancements into clinical practice in neurorehabilitation include pervasively small study sizes, exacerbated by limited funding for non-pharmacological multicenter clinical trials; difficulty standardizing—and adequately describing—non-pharmacological interventions; and a lack of incentives for individual patient-level data-sharing. These barriers prevent reliable meta-analysis of non-pharmacological clinical studies in neurorehabilitation. This point-of-view will highlight these challenges as well as suggest practical steps that may be taken to improve the neurorehabilitation pipeline between evidence and implementation.
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Affiliation(s)
- William M. Savage
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Noam Y. Harel
- Department of Neurology and Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, James J. Peters Veterans Affairs Medical Center, New York, NY, USA
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5
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Ranganathan R, Doherty C, Gussert M, Kaplinski E, Koje M, Krishnan C. Scientific basis and active ingredients of current therapeutic interventions for stroke rehabilitation. Restor Neurol Neurosci 2022; 40:97-107. [DOI: 10.3233/rnn-211243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Despite tremendous advances in the treatment and management of stroke, restoring motor and functional outcomes after stroke continues to be a major clinical challenge. Given the wide range of approaches used in motor rehabilitation, several commentaries have highlighted the lack of a clear scientific basis for different interventions as one critical factor that has led to suboptimal study outcomes. Objective: To understand the content of current therapeutic interventions in terms of their active ingredients. Methods: We conducted an analysis of randomized controlled trials in stroke rehabilitation over a 2-year period from 2019-2020. Results: There were three primary findings: (i) consistent with prior reports, most studies did not provide an explicit rationale for why the treatment would be expected to work, (ii) most therapeutic interventions mentioned multiple active ingredients and there was not a close correspondence between the active ingredients mentioned versus the active ingredients measured in the study, and (iii) multimodal approaches that involved more than one therapeutic approach tended to be combined in an ad-hoc fashion, indicating the lack of a targeted approach. Conclusion: These results highlight the need for strengthening cross-disciplinary connections between basic science and clinical studies, and the need for structured development and testing of therapeutic approaches to find more effective treatment interventions.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Carson Doherty
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Michael Gussert
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Eva Kaplinski
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Mary Koje
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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HARADA K. Medical Rehabilitation Need, Case Complexity, and Related Issues among Patients in an Acute Stroke Rehabilitation Setting. Phys Ther Res 2022; 25:93-98. [PMID: 36819915 PMCID: PMC9910349 DOI: 10.1298/ptr.r0021] [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: 10/11/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
This narrative review introduces case complexity and medical rehabilitation needs in a stroke rehabilitation setting, and proposes methods to more efficiently enhance functional recovery in the acute stage after stroke onset. Therapists may measure a construct of individual need complexity around and beyond the basic and common needs for medical necessity, and thereby screen acute patients who could benefit more from additional rehabilitation inputs. This review also describes the clinical significance of medical rehabilitation needs and challenges for efficient stroke rehabilitation. Overall, we propose that challenging research trials should be conducted to compare the effectiveness of the arrangement of rehabilitation service allocation based on needs assessment after stroke with the usual care pathway.
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Affiliation(s)
- Kazuhiro HARADA
- Graduate School of Health Science Studies, Kibi International University, Japan
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7
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Brodtmann A, Werden E, Khlif MS, Bird LJ, Egorova N, Veldsman M, Pardoe H, Jackson G, Bradshaw J, Darby D, Cumming T, Churilov L, Donnan G. Neurodegeneration Over 3 Years Following Ischaemic Stroke: Findings From the Cognition and Neocortical Volume After Stroke Study. Front Neurol 2021; 12:754204. [PMID: 34744989 PMCID: PMC8570373 DOI: 10.3389/fneur.2021.754204] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Stroke survivors are at high risk of dementia, associated with increasing age and vascular burden and with pre-existing cognitive impairment, older age. Brain atrophy patterns are recognised as signatures of neurodegenerative conditions, but the natural history of brain atrophy after stroke remains poorly described. We sought to determine whether stroke survivors who were cognitively normal at time of stroke had greater total brain (TBV) and hippocampal volume (HV) loss over 3 years than controls. We examined whether stroke survivors who were cognitively impaired (CI) at 3 months following their stroke had greater brain volume loss than cognitively normal (CN) stroke participants over the next 3 years. Methods: Cognition And Neocortical Volume After Stroke (CANVAS) study is a multi-centre cohort study of first-ever or recurrent adult ischaemic stroke participants compared to age- and sex-matched community controls. Participants were followed with MRI and cognitive assessments over 3 years and were free of a history of cognitive impairment or decline at inclusion. Our primary outcome measure was TBV change between 3 months and 3 years; secondary outcomes were TBV and HV change comparing CI and CN participants. We investigated associations between group status and brain volume change using a baseline-volume adjusted linear regression model with robust standard error. Results: Ninety-three stroke (26 women, 66.7 ± 12 years) and 39 control participants (15 women, 68.7 ± 7 years) were available at 3 years. TBV loss in stroke patients was greater than controls: stroke mean (M) = 20.3 cm3 ± SD 14.8 cm3; controls M = 14.2 cm3 ± SD 13.2 cm3; [adjusted mean difference 7.88 95%CI (2.84, 12.91) p-value = 0.002]. TBV decline was greater in those stroke participants who were cognitively impaired (M = 30.7 cm3; SD = 14.2 cm3) at 3 months (M = 19.6 cm3; SD = 13.8 cm3); [adjusted mean difference 10.42; 95%CI (3.04, 17.80), p-value = 0.006]. No statistically significant differences in HV change were observed. Conclusions: Ischaemic stroke survivors exhibit greater neurodegeneration compared to stroke-free controls. Brain atrophy is greater in stroke participants who were cognitively impaired early after their stroke. Early cognitive impairment was associated greater subsequent atrophy, reflecting the combined impacts of stroke and vascular brain burden. Atrophy rates could serve as a useful biomarker for trials testing interventions to reduce post-stroke secondary neurodegeneration. Clinical Trail Registration:http://www.clinicaltrials.gov, identifier: NCT02205424.
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Affiliation(s)
- Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, Florey Institute and University of Melbourne, Parkville, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Laura J Bird
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, Florey Institute and University of Melbourne, Parkville, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michele Veldsman
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Heath Pardoe
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Bradshaw
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, VIC, Australia
| | - David Darby
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, Florey Institute and University of Melbourne, Parkville, VIC, Australia
| | - Toby Cumming
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Geoffrey Donnan
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
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8
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Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review. J Neuroeng Rehabil 2021; 18:43. [PMID: 33627126 PMCID: PMC7905577 DOI: 10.1186/s12984-021-00819-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies. Results Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks). Conclusion From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance. Registration: PROSPERO CRD42017072799—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72799
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9
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Dalton EJ, Churilov L, Lannin NA, Corbett D, Campbell BCV, Hayward KS. Early-phase dose articulation trials are underutilized for post-stroke motor recovery: A systematic scoping review. Ann Phys Rehabil Med 2021; 65:101487. [PMID: 33429089 DOI: 10.1016/j.rehab.2021.101487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To enable development of effective interventions, there is a need to complete systematic early-phase dose articulation research. This scoping review aimed to synthesize dose articulation research of behavioral motor interventions for stroke recovery. METHODS MEDLINE and EMBASE were systematically searched for dose articulation studies. Preclinical experiments and adult clinical trials were classified based on the discovery pipeline and analyzed to determine which dose dimensions were articulated (time, scheduling or intensity) and how they were investigated (unidimensional vs multidimensional approach). Reporting of dose, safety and efficacy outcomes were summarized. The intervention description, risk of bias, and quality was appraised. RESULTS We included 41 studies: 3 of preclinical dose preparation (93 rodents), 2 Phase I dose ranging (21 participants), 9 Phase IIA dose screening (198 participants), and 27 Phase IIB dose finding (1879 participants). All studies adopted a unidimensional approach. Time was the most frequent dimension investigated (53%), followed by intensity (29%), and scheduling (18%). Overall, 95% studies reported an efficacy outcome; however, only 65% reported dose and 45% reported safety. Across studies, 61% were at high risk of bias, and the average percentage reporting of intervention description and quality was 61% and 67%, respectively. CONCLUSION This review highlights a need to undertake more high-quality, early-phase studies that systematically articulate intervention doses from a multidimensional perspective in the field of behavioral motor stroke recovery. To address this gap, we need to invest in adapting early phase trial designs, especially Phase I, to support multidimensional dose articulation.
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Affiliation(s)
- Emily J Dalton
- Melbourne School of Health Sciences, University of Melbourne, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia
| | - Dale Corbett
- Cellular & Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Kathryn S Hayward
- Melbourne School of Health Sciences and Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, 3084 Heidelberg, Australia.
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10
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Moxon JV, Trollope AF, Dewdney B, de Hollander C, Nastasi DR, Maguire JM, Golledge J. The effect of angiopoietin-1 upregulation on the outcome of acute ischaemic stroke in rodent models: A meta-analysis. J Cereb Blood Flow Metab 2019; 39:2343-2354. [PMID: 31581897 PMCID: PMC6893985 DOI: 10.1177/0271678x19876876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Clinical studies report that low circulating angiopoietin-1 concentration at presentation predicts worse outcomes after ischaemic stroke. Upregulating angiopoietin-1 may therefore have therapeutic benefit for ischaemic stroke. This systematic review assessed whether upregulating angiopoietin-1 improved outcomes in rodent models of ischaemic stroke. Random-effects models quantified the effect of angiopoietin-1 upregulation on stroke severity in terms of the size of cerebral infarction and the extent of blood-brain barrier permeability. Eleven studies utilising rat and mouse models of ischaemic stroke fulfilled the inclusion criteria. Meta-analyses demonstrated that angiopoietin-1 upregulation significantly reduced cerebral infarction size (standardised mean difference: -3.02; 95% confidence intervals: -4.41, -1.63; p < 0.001; n = 171 animals) and improved blood-brain barrier integrity (standardized mean difference: -2.02; 95% confidence intervals: -3.27, -0.77; p = 0.002; n = 129 animals). Subgroup analyses demonstrated that angiopoietin-1 upregulation improved outcomes in models of transient, not permanent cerebral ischaemia. Six studies assessed the effect of angiopoietin-1 upregulation on neurological function; however, inter-study heterogeneity prevented meta-analysis. In conclusion, published rodent data suggest that angiopoietin-1 upregulation improves outcome following temporary cerebral ischaemia by reducing cerebral infarction size and improving blood-brain barrier integrity. Additional research is required to examine the effect of angiopoietin-1 upregulation on neurological function during stroke recovery and investigate the benefit and risks in patients.
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Affiliation(s)
- Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Australia.,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Alexandra F Trollope
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Australia.,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.,Department of Anatomy, James Cook University, Townsville, Australia
| | - Brittany Dewdney
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - Domenico R Nastasi
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Australia
| | - Jane M Maguire
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Australia.,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
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11
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Dalton E, Churilov L, Lannin NA, Corbett D, Hayward KS. Dose Articulation in Preclinical and Clinical Stroke Recovery: Refining a Discovery Research Pipeline and Presenting a Scoping Review Protocol. Front Neurol 2019; 10:1148. [PMID: 31781018 PMCID: PMC6851169 DOI: 10.3389/fneur.2019.01148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/14/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction: Despite an increase in the quality of clinical trials in stroke recovery, interventions have failed to markedly impact the trajectory of recovery after stroke. Failure may be due to the lack of consideration for the complexity of dose and its articulation within research trials. Prior to commencing the scoping review, we identified two research gaps to be addressed. Firstly, transparent application of a multidimensional definition of dose to clinical trial phases and secondly, the development of a quality tool to critique the articulation of dose across the pipeline. Building on this, we present the protocol for a scoping review that aims to synthesis what is known about dose articulation in stroke recovery in preclinical and clinical populations, and characterize research designs and statistical approaches used in dose articulation trials, and the associated advantages and disadvantages. Methods: The scoping review will apply Arksey and O'Malley's methodological framework. Two systematic searches that target preclinical and clinical literature will be run in Medline and Embase, which will be complimented by consultation with field experts and hand searching of included trials and relevant reviews. Search results will be imported into Covidence for transparent management. One reviewer will screen all abstracts and titles. Two reviewers will screen full text and a third reviewer included to resolve discrepancies. A standardized data charting form will be used to extract information and appraise the intervention description, risk of bias, and quality of both preclinical and clinical studies. Results will be summarized in tabular and narrative format to inform the development of recommendations for future research. Ethics approval is not required as data used will be secondary and de-identified. Conclusion: Development of a new quality tool to appraise the quality of both preclinical and clinical dose studies may serve to strengthen collaborative efforts between the fields. The findings from this review will advance the use of a discovery pipeline in stroke recovery research to ultimately inform clinical practice.
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Affiliation(s)
- Emily Dalton
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia.,NHMRC CRE in Stroke Rehabilitation and Brain Recovery, University of Melbourne, Heidelberg, VIC, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Occupational Therapy, Alfred Health, Prahran, VIC, Australia
| | - Dale Corbett
- Cellular and Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn S Hayward
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC, Australia.,NHMRC CRE in Stroke Rehabilitation and Brain Recovery, University of Melbourne, Heidelberg, VIC, Australia.,AVERT Early Rehabilitation Research Group, Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
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