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Samuel R, Bagdesar M, Brown TDG, Kong AC, Shetty S, George A, Ajwani S. Perceptions of patients towards oral health care in a spinal cord injury rehabilitation unit: A qualitative study. J Oral Rehabil 2024. [PMID: 38886619 DOI: 10.1111/joor.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 12/02/2023] [Accepted: 05/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Individuals with spinal cord injuries (SCIs) are at an increased risk of poor oral health compared to the general population. However, little is known about the related barriers and facilitators experienced by these individuals within the hospital setting. OBJECTIVES Understand the oral health knowledge, attitudes and practices of people with SCIs, barriers and facilitators to managing their oral health, and recommendations to improve oral care at acute/rehabilitation hospital settings. METHODS Semi-structured interviews were conducted with 11 participants, from a major metropolitan hospital in Sydney, Australia. The interviews were thematically analysed. RESULTS Three themes were constructed. Participants believed that the onus was on them to manage their oral health. Individuals also had limited knowledge of its importance to general health, and placed a lower priority on oral health compared to other aspects of health. All participants identified a combination of factors, such as cost, time, resources and prior negative experiences, that contributed to the neglect of their oral care. Participants also discussed the need of support from the multidisciplinary team and family/carers to facilitate oral care and identified various appropriate oral health education formats. CONCLUSION This study highlighted some areas where oral health knowledge among people with SCIs could be improved. It also identified the need for oral health training for the multidisciplinary team, as well as carers, to better integrate oral care during rehabilitation in the hospital. The development of oral health interventions would need to utilise a co-design approach to best support clients and their carers to facilitate oral care self-management.
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Affiliation(s)
- Rebecca Samuel
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
| | - Mary Bagdesar
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
| | - Travis D G Brown
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
| | - Ariana C Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sachin Shetty
- Spinal Injuries Unit. Prince of Wales Hospital, Randwick, New South Wales, Australia
- Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ajesh George
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Shilpi Ajwani
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Sydney Dental Hospital, Oral Health Services, Sydney Local Health District, Surry Hills, New South Wales, Australia
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Oquendo B, Nouhaud C, Jarzebowski W, Leger A, Oasi C, Ba M, Lafuente-Lafuente C, Belmin J. Better functional recovery after acute stroke in older patients managed in a new dedicated post-stroke geriatric unit compared to usual management. J Nutr Health Aging 2024; 28:100033. [PMID: 38341964 DOI: 10.1016/j.jnha.2023.100033] [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: 08/11/2023] [Accepted: 12/08/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVES A Stroke care Pathway dedicated to the ELders (SPEL) for patients with acute stroke was created in 2013 at the hospitals Pitié-Salpêtrière-Charles Foix (Paris, France). It is characterized by a stroke unit dedicated to emergency stroke care, and a post stroke geriatric unit (PSGU) including rehabilitation and management of geriatric syndromes. The aim of the study was to compare the functional recovery of patients transferred to PSGU versus other rehabilitation care in patients over 70 years of age after stroke. DESIGN A cohort observational study over a 4-year period. SETTING Hospitals Pitié-Salpêtrière and Charles Foix (Paris, France). PARTICIPANTS We studied patients over 70 years admitted to the participating stroke unit for acute stroke consecutively hospitalized from January 1, 2013, to January 1, 2017. INTERVENTION Patients transferred in the PSGU were compared to those admitted in other rehabilitation units. MEASUREMENTS The primary outcome was 3-month functional recovery after stroke. The secondary outcomes were the hospital length of stay and the returning home rate. A multivariable logistic regression was applied to adjust for confounding variables (age, sex, NIHSS score and Charlson's comorbidity score). RESULTS Among the 262 patients included in the study, those in the PGSU were significantly older, had a higher Charlson's comorbidity score and a higher initial NIHSS severity score. As compared to the other patients, functional recovery at 3 months was better in the PSGU (Rankin's score decreased by 0.80 points versus 0.41 points, p = 0.01). The average total length of stay was reduced by 16 days in the patients referred to the PSGU (p = 0.002). There was no significant difference in the returning home rate between the two groups (p = 0.88). CONCLUSION The SPEL which includes a post-stroke geriatric unit (PSGU) has been associated with improved recovery and had a positive impact in the management of older post-stroke patients.
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Affiliation(s)
- Bruno Oquendo
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France; Sorbonne Université, Paris, France.
| | | | | | - Anne Leger
- Urgences Cérébro-Vasculaires, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Christel Oasi
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
| | - Massamba Ba
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
| | - Carmelo Lafuente-Lafuente
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France; Sorbonne Université, Paris, France
| | - Joel Belmin
- Service de Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France; Sorbonne Université, Paris, France
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McGlinchey MP, Faulkner-Gurstein R, Sackley CM, McKevitt C. Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke - an ethnographic study. Disabil Rehabil 2024; 46:672-684. [PMID: 36734838 DOI: 10.1080/09638288.2023.2172463] [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: 05/30/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. MATERIAL AND METHODS An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. RESULTS Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors' clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors' treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. CONCLUSIONS Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.Implications for rehabilitationMultiple factors guide therapist decision making after severely disabling stroke, some of which result in the use of interventions that do not fully address stroke survivors' clinical needs.Therapists should critically reflect upon their personal beliefs and attitudes about severely disabling stroke to reduce potential sources of bias on decision making.Therapists should consider the timing and intensity of therapy delivery as well as their treatment approach to optimise outcomes after severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- Neurorehabilitation Service, Integrated Local Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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McIntyre A, Viana R, Cao P, Janzen S, Saikaley M, Harnett A, Teasell R. A national survey of evidence-based stroke rehabilitation intervention use in clinical practice among Canadian occupational therapists. NeuroRehabilitation 2023; 52:463-475. [PMID: 37005899 DOI: 10.3233/nre-220279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND: More than 1,000 randomized controlled trials have been published examining the effectiveness of stroke rehabilitation interventions. OBJECTIVE: The objective of this study was to explore the use and non-use of evidence-based stroke rehabilitation interventions in clinical practice among Occupational Therapists across various stroke rehabilitation settings in Canada. METHODS: Participants were recruited from medical centres providing rehabilitation to stroke patients in each of the ten provinces across Canada (January-July 2021). Adult (18 + years) Occupational Therapists who provide direct rehabilitative care to individuals after a stroke completed a survey in either English or French. Therapists rated their awareness, use, and reasons for non-use of stroke rehabilitation interventions. RESULTS: 127 therapists (female = 89.8%), largely from Ontario or Quebec (62.2%) were included; most worked full-time (80.3%) in moderate-large (86.1%) cities. The greatest use of interventions were those applied to the body peripherally, without a technological component. Few individuals were aware of interventions applied to the brain (priming or stimulating) with a technological component, and they were rarely, if ever, used. CONCLUSION: Significant efforts should be made to increase the awareness of interventions which are supported by strong evidence through knowledge translation and implementation initiatives, particularly for those with a technological component.
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Affiliation(s)
- Amanda McIntyre
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Ricardo Viana
- Parkwood Institute Research, Parkwood Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Physical Medicine and Rehabilitation, St. Joseph's Health Care, Parkwood Institute, London, ON, Canada
| | - Peiwen Cao
- Parkwood Institute Research, Parkwood Institute, London, ON, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Parkwood Institute, London, ON, Canada
| | - Marcus Saikaley
- Parkwood Institute Research, Parkwood Institute, London, ON, Canada
| | - Amber Harnett
- Parkwood Institute Research, Parkwood Institute, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute Research, Parkwood Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Physical Medicine and Rehabilitation, St. Joseph's Health Care, Parkwood Institute, London, ON, Canada
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Ma J, Chan A, Singh C, Elashi M, Gerevas K, Idle M, Lundie J, Urbina M, Pace A, Hoens A. Current Practices in and Barriers to Physiotherapists’ Use of Resistance Exercise with Older Adults in Acute Care. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this cross-sectional study was to describe physiotherapists’ current use of resistance exercise (REx) with older adults in acute care and to identify barriers to its use with this population. Methods: We developed an online questionnaire guided by the theoretical domains framework and distributed it to physiotherapists across British Columbia. We used thematic analysis to code open-text questionnaire responses. Results:One hundred five physiotherapists completed the questionnaire (78% female; mean age 39.9 [SD 10.3] years; mean years of experience 12.4 [SD 10.3]). Respondents reported frequently performing functional testing (95%) and assessing muscle strength (70%) in older adults, but few often prescribed REx (34%). The greatest barriers to use of REx that respondents identified were lack of prioritization of REx among other duties and perceived poor patient motivation. Open-text data analysis revealed that respondents felt that some patients were unable to perform REx and that physiotherapists lacked a clear definition of REx and sufficient support personnel. Conclusions: Addressing treatment priorities, patient motivation, and staffing resources can support physiotherapists in increasing REx use, an important strategy for reducing the incidence of hospital-associated deconditioning among older adults in acute care settings.
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Affiliation(s)
- Jasmin Ma
- University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Amber Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Chiara Singh
- University of British Columbia, Vancouver, British Columbia, Canada
- Surrey Memorial Hospital, Surrey, British Columbia, Canada
- Fraser Health, Surrey, British Columbia, Canada
| | - Maha Elashi
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Kristi Gerevas
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Melissa Idle
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Janet Lundie
- University of British Columbia, Vancouver, British Columbia, Canada
- Fraser Health, Surrey, British Columbia, Canada
| | - Maylinda Urbina
- University of British Columbia, Vancouver, British Columbia, Canada
- Fraser Health, Surrey, British Columbia, Canada
- Burnaby General Hospital, Burnaby, British Columbia, Canada
| | - Angela Pace
- Northern Health, Prince George, British Columbia, Canada
| | - Alison Hoens
- University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Gibson E, Koh CL, Eames S, Bennett S, Scott AM, Hoffmann TC. Occupational therapy for cognitive impairment in stroke patients. Cochrane Database Syst Rev 2022; 3:CD006430. [PMID: 35349186 PMCID: PMC8962963 DOI: 10.1002/14651858.cd006430.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. Occupational therapists use a range of interventions when working with people who have cognitive impairment poststroke. This is an update of a Cochrane Review published in 2010. OBJECTIVES To assess the impact of occupational therapy on activities of daily living (ADL), both basic and instrumental, global cognitive function, and specific cognitive abilities in people who have cognitive impairment following a stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, four other databases (all last searched September 2020), trial registries, and reference lists. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that evaluated an intervention for adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or considered within the scope of occupational therapy practice as defined in the review. We excluded studies focusing on apraxia or perceptual impairments or virtual reality interventions as these are covered by other Cochrane Reviews. The primary outcome was basic activities of daily living (BADL) such as dressing, feeding, and bathing. Secondary outcomes were instrumental ADL (IADL) (e.g. shopping and meal preparation), community integration and participation, global cognitive function and specific cognitive abilities (including attention, memory, executive function, or a combination of these), and subdomains of these abilities. We included both observed and self-reported outcome measures. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies that met the inclusion criteria, extracted data, and assessed the certainty of the evidence. A third review author moderated disagreements if consensus was not reached. We contacted trial authors for additional information and data, where available. We assessed the certainty of key outcomes using GRADE. MAIN RESULTS: We included 24 trials from 11 countries involving 1142 (analysed) participants (two weeks to eight years since stroke onset). This update includes 23 new trials in addition to the one study included in the previous version. Most were parallel randomised controlled trials except for one cross-over trial and one with a two-by-two factorial design. Most studies had sample sizes under 50 participants. Twenty studies involved a remediation approach to cognitive rehabilitation, particularly using computer-based interventions. The other four involved a compensatory and adaptive approach. The length of interventions ranged from 10 days to 18 weeks, with a mean total length of 19 hours. Control groups mostly received usual rehabilitation or occupational therapy care, with a few receiving an attention control that was comparable to usual care; two had no intervention (i.e. a waiting list). Apart from high risk of performance bias for all but one of the studies, the risk of bias for other aspects was mostly low or unclear. For the primary outcome of BADL, meta-analysis found a small effect on completion of the intervention with a mean difference (MD) of 2.26 on the Functional Independence Measure (FIM) (95% confidence interval (CI) 0.17 to 4.22; P = 0.03, I2 = 0%; 6 studies, 336 participants; low-certainty evidence). Therefore, on average, BADL improved by 2.26 points on the FIM that ranges from 18 (total assist) to 126 (complete independence). On follow-up, there was insufficient evidence of an effect at three months (MD 10.00, 95% CI -0.54 to 20.55; P = 0.06, I2 = 53%; 2 studies, 73 participants; low-certainty evidence), but evidence of an effect at six months (MD 11.38, 95% CI 1.62 to 21.14, I2 = 12%; 2 studies, 73 participants; low-certainty evidence). These differences are below 22 points which is the established minimal clinically important difference (MCID) for the FIM for people with stroke. For IADL, the evidence is very uncertain about an effect (standardised mean difference (SMD) 0.94, 95% CI 0.41 to 1.47; P = 0.0005, I2 = 98%; 2 studies, 88 participants). For community integration, we found insufficient evidence of an effect (SMD 0.09, 95% CI -0.35 to 0.54; P = 0.68, I2 = 0%; 2 studies, 78 participants). There was an improvement of clinical importance in global cognitive functional performance after the intervention (SMD 0.35, 95% CI 0.16 to 0.54; P = 0.0004, I2 = 0%; 9 studies, 432 participants; low-certainty evidence), equating to 1.63 points on the Montreal Cognitive Assessment (MoCA) (95% CI 0.75 to 2.52), which exceeds the anchor-based MCID of the MoCA for stroke rehabilitation patients of 1.22. We found some effect for attention overall (SMD -0.31, 95% CI -0.47 to -0.15; P = 0.0002, I2 = 20%; 13 studies, 620 participants; low-certainty evidence), equating to a difference of 17.31 seconds (95% CI 8.38 to 26.24), and for executive functional performance overall (SMD 0.49, 95% CI 0.31 to 0.66; P < 0.00001, I2 = 74%; 11 studies, 550 participants; very low-certainty evidence), equating to 1.41 points on the Frontal Assessment Battery (range: 0-18). Of the cognitive subdomains, we found evidence of effect of possible clinical importance, immediately after intervention, for sustained visual attention (moderate certainty) equating to 15.63 seconds, for working memory (low certainty) equating to 59.9 seconds, and thinking flexibly (low certainty), compared to control. AUTHORS' CONCLUSIONS The effectiveness of occupational therapy for cognitive impairment poststroke remains unclear. Occupational therapy may result in little to no clinical difference in BADL immediately after intervention and at three and six months' follow-up. Occupational therapy may slightly improve global cognitive performance of a clinically important difference immediately after intervention, likely improves sustained visual attention slightly, and may slightly increase working memory and flexible thinking after intervention. There is evidence of low or very low certainty or insufficient evidence for effect on other cognitive domains, IADL, and community integration and participation. Given the low certainty of much of the evidence in our review, more research is needed to support or refute the effectiveness of occupational therapy for cognitive impairment after stroke. Future trials need improved methodology to address issues including risk of bias and to better report the outcome measures and interventions used.
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Affiliation(s)
- Elizabeth Gibson
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Sally Eames
- Community and Oral Health Innovation and Research Centre, Metro North Hospital and Health Service, Brisbane, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
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Howe J, Chua W, Sumner E, Drozdowska B, Laverick R, Bevins RL, Jean-Baptiste E, Russell M, Rotshtein P, Wing AM. The efficacy of a task model approach to ADL rehabilitation in stroke apraxia and action disorganisation syndrome: A randomised controlled trial. PLoS One 2022; 17:e0264678. [PMID: 35239707 PMCID: PMC8893688 DOI: 10.1371/journal.pone.0264678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Apraxia and action disorganization syndrome (AADS) after stroke can disrupt activities of daily living (ADL). Occupational therapy has been effective in improving ADL performance, however, inclusion of multiple tasks means it is unclear which therapy elements contribute to improvement. We evaluated the efficacy of a task model approach to ADL rehabilitation, comparing training in making a cup of tea with a stepping training control condition. Methods Of the 29 stroke survivors with AADS who participated in this cross-over randomized controlled feasibility trial, 25 were included in analysis [44% females; mean(SD) age = 71.1(7.8) years; years post-stroke = 4.6(3.3)]. Participants attended five 1-hour weekly tea making training sessions in which progress was monitored and feedback given using a computer-based system which implemented a Markov Decision Process (MDP) task model. In a control condition, participants received five 1-hour weekly stepping sessions. Results Compared to stepping training, tea making training reduced errors across 4 different tea types. The time taken to make a cup of tea was reduced so the improvement in accuracy was not due to a speed-accuracy trade-off. No improvement linked to tea making training was evident in a complex tea preparation task (making two different cups of tea simultaneously), indicating a lack of generalisation in the training. Conclusions The clearly specified but flexible training protocol, together with information on the distribution of errors, provide pointers for further refinement of task model approaches to ADL rehabilitation. It is recommended that the approach be tested under errorless learning conditions with more impaired patients in future research. Trial registration Retrospectively registered at ClinicalTrials.gov on 5th August 2019 [NCT04044911] https://clinicaltrials.gov/ct2/show/NCT04044911?term=Cogwatch&rank=1
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Affiliation(s)
- Jo Howe
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Pharmacy, Aston University, Birmingham, United Kingdom
| | - Winnie Chua
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Emily Sumner
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Bogna Drozdowska
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rosanna Laverick
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rachel L. Bevins
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Emilie Jean-Baptiste
- School of Electronic, Electrical and Systems Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Martin Russell
- School of Electronic, Electrical and Systems Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Pia Rotshtein
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alan M. Wing
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
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8
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McGlinchey MP, McKevitt C, Faulkner-Gurstein R, Sackley CM. The rehabilitation of physical function after severely disabling stroke: a survey of UK therapist practice. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Individuals who are severely disabled from stroke (survivors of severely disabling stroke) experience poorer outcomes compared to those who are less disabled from stroke. However, there is a paucity of evidence describing current therapy practice in the management of severely disabling stroke. The aim of the study was to describe intervention and outcome measure use by physiotherapists and occupational therapists in the rehabilitation of physical function of survivors of severely disabling stroke. Methods A mixed-methods survey was conducted, involving an online questionnaire and follow-up interviews. Survey participants were UK-based physiotherapists and occupational therapists with experience treating stroke. Questionnaire data were analysed with descriptive and inferential statistics. Interview data were analysed using content analysis. Results A total of 452 therapists (59% physiotherapists) responded to the questionnaire. Out of the respondents, 18 self-selected therapists participated in follow-up interviews to explain questionnaire data. Whole body positioning, training of upper limb handling and positioning, and sitting balance practice were the most frequently used interventions. Inpatient-based therapists performed more active rehabilitation interventions, whereas community-based therapists performed more training and education. The Barthel Index, Modified Rankin Scale and National Institutes for Health Stroke Scale were the most frequently used outcome measures. Outcome measure use was generally low and was more likely to be completed when it was part of a national audit. Reasons for low outcome measure use were perceived lack of time and insensitivity to detect clinical change. Conclusions A variety of interventions and outcome measures are used in the rehabilitation of survivors of severely disabling stroke. There is a need to evaluate the effectiveness of frequently used interventions and identify outcome measures that are sensitive to the needs of survivors of severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Physiotherapy Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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9
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James J, McGlinchey MP. How active are stroke patients in physiotherapy sessions and is this associated with stroke severity? Disabil Rehabil 2021; 44:4408-4414. [PMID: 33794718 DOI: 10.1080/09638288.2021.1907459] [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: 10/21/2022]
Abstract
PURPOSE Exercise improves functional outcome post-stroke, but how long patients with differing severity spend undertaking active exercise within physiotherapy sessions is unknown. We aimed to investigate if stroke severity is associated with time undertaking active exercise in physiotherapy sessions, and if any differences between planned and actual physiotherapy session length existed. MATERIALS AND METHODS A prospective observational study of 107 stroke rehabilitation sessions in a UK acute stroke unit. Data recorded included patient demographics (age, gender, time post-stroke and Barthel Index score) and session attributes (planned and actual session length, time undertaking active exercise, grade of treating therapist). RESULTS There was a significant negative association between increasing stroke severity and percentage of time undertaking active exercise in physiotherapy sessions (p < 0.001). No other observed factors were associated with time undertaking active exercise. Mean session length across all levels of stroke severity was 32 min (SD 9.26) which was significantly less than planned (p < 0.05). There was no difference in mean session length or between planned and actual physiotherapy session length between patients of differing severity. CONCLUSIONS Patients with greater stroke severity participate in less active exercise in physiotherapy sessions than those with lesser stroke severity. Reasons for this disparity warrant further investigation.Implications for rehabilitationStroke patients with higher levels of severity engage in less active exercise during rehabilitation.A discrepancy exists between patients' planned physiotherapy session lengths and actual session lengths during stroke rehabilitation.Physiotherapists should be mindful in how to adapt their sessions (particularly with severe stroke patients) to maximise the amount of activity they undertake.Physiotherapists should be flexible in their delivery of rehabilitation to ensure that the length of patient sessions reflect patients' needs.
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Affiliation(s)
- Jimmy James
- Department of Physiotherapy, St. Thomas' Hospital, London, UK
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10
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Gittins M, Vail A, Bowen A, Lugo-Palacios D, Paley L, Bray B, Gannon B, Tyson S. Factors influencing the amount of therapy received during inpatient stroke care: an analysis of data from the UK Sentinel Stroke National Audit Programme. Clin Rehabil 2020; 34:981-991. [PMID: 32508132 PMCID: PMC7324910 DOI: 10.1177/0269215520927454] [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: 11/15/2022]
Abstract
OBJECTIVES To understand why most stroke patients receive little therapy. We investigated the factors associated with the amount of stroke therapy delivered. METHODS Data regarding adults admitted to hospital with stroke for at least 72 hours (July 2013-July 2015) were extracted from the UK's Sentinel Stroke National Audit Programme. Descriptive statistics and multilevel mixed effects regression models explored the factors that influenced the amount of therapy received while adjusting for confounding. RESULTS Of the 94,905 patients in the study cohort (mean age: 76 (SD: 13.2) years, 78% had a mild or moderate severity stroke. In all, 92% required physiotherapy, 87% required occupational therapy, 57% required speech therapy but only 5% were considered to need psychology. The average amount of therapy ranged from 2 minutes (psychology) to 14 minutes (physiotherapy) per day of inpatient stay. Unmodifiable characteristics (such as stroke severity) dominated the variation in the amount of therapy. However important, modifiable organizational factors were the day and time of admission, type of stroke team, timely therapy assessments, therapy and nursing staffing levels (qualified and support staff), and presence of weekend or early supported discharge services. CONCLUSION The amount of stroke therapy is associated with unmodifiable patient-related characteristics and modifiable organizational factors in that more therapy was associated with higher therapy and nurse staffing levels, specialist stroke rehabilitation services, timely therapy assessments, and the presence of weekend and early discharge services.
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Affiliation(s)
- Matthew Gittins
- Centre for Biostatistics, School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Andy Vail
- Centre for Biostatistics, School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David Lugo-Palacios
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Brenda Gannon
- School of Economics and Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
| | - Sarah Tyson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
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11
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Gittins M, Lugo-Palacios D, Vail A, Bowen A, Paley L, Bray B, Gannon B, Tyson SF. Delivery, dose, outcomes and resource use of stroke therapy: the SSNAPIEST observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Therapy is key to effective stroke care, but many patients receive little.
Objectives
To understand how stroke therapy is delivered in England, Wales and Northern Ireland, and which factors are associated with dose, outcome and resource use.
Design
Secondary analysis of the Sentinel Stroke National Audit Programme, using standard descriptive statistics and multilevel mixed-effects regression models, while adjusting for all known and measured confounders.
Setting
Stroke services in England, Wales and Northern Ireland.
Participants
A total of 94,905 adults admitted with stroke, who remained an inpatient for > 72 hours.
Results
Routes through stroke services were highly varied (> 800), but four common stroke pathways emerged. Seven distinct impairment-based patient subgroups were characterised. The average amount of therapy was very low. Modifiable factors associated with the average amount of inpatient therapy were type of stroke team, timely therapy assessments, staffing levels and model of therapy provision. More (of any type of) therapy was associated with shorter length of stay, less resource use and lower mortality. More occupational therapy, speech therapy and psychology were also associated with less disability and institutionalisation. Large amounts of physiotherapy were associated with greater disability and institutionalisation.
Limitations
Use of observational data does not infer causation. All efforts were made to adjust for all known and measured confounding factors but some may remain. We categorised participants using the National Institutes of Health Stroke Scale, which measures a limited number of impairments relatively crudely, so mild or rare impairments may have been missed.
Conclusions
Stroke patients receive very little therapy. Modifiable organisational factors associated with greater amounts of therapy were identified, and positive associations between amount of therapy and outcome were confirmed. The reason for the unexpected associations between large amounts of physiotherapy, disability and institutionalisation is unknown. Prospective work is urgently needed to investigate further. Future work needs to investigate (1) prospectively, the association between physiotherapy and outcome; (2) the optimal amount of therapy to provide for different patient groups; (3) the most effective way of organising stroke therapy/rehabilitation services, including service configuration, staffing levels and working hours; and (4) how to reduce unexplained variation in resource use.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 17. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Matthew Gittins
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David Lugo-Palacios
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Andy Vail
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Lizz Paley
- Sentinel Stroke National Audit Programme, Department of Population Health Sciences, King’s College London, London, UK
| | - Benjamin Bray
- Sentinel Stroke National Audit Programme, Department of Population Health Sciences, King’s College London, London, UK
| | - Brenda Gannon
- School of Economics, The University of Queensland, Brisbane, QLD, Australia
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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McGlinchey MP, James J, McKevitt C, Douiri A, Sackley C. The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review. BMJ Open 2020; 10:e033642. [PMID: 32029489 PMCID: PMC7045156 DOI: 10.1136/bmjopen-2019-033642] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke. DESIGN Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength. RESULTS 28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence. CONCLUSIONS There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required. PROSPERO REGISTRATION NUMBER CRD42017077737.
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Affiliation(s)
- Mark P McGlinchey
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Jimmy James
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Abdel Douiri
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
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13
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Levy T, Killington M, Lannin N, Crotty M. Viability of using a computer tablet to monitor an upper limb home exercise program in stroke. Physiother Theory Pract 2019; 37:331-341. [PMID: 31172867 DOI: 10.1080/09593985.2019.1625092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: To evaluate the feasibility of using a tablet computer to monitor the amount of upper limb practice completed by stroke patients prescribed with a home program and to explore factors that influence adherence. Method: Ten consecutive participants randomized to the intervention arm of a randomized controlled trial investigating therapy after spasticity management for stroke patients (ACTRN 12615000616572) were recruited for this sub-study. Participants were asked to perform and record a prescribed 60-min upper limb program, based on the Graded Arm Supplementary Program, on a tablet computer daily. Four randomly selected recorded sessions for each participant were analyzed by the physiotherapist to assess adherence to the amount of exercise and content. Results: Mean score for the System Usability Scale was 85.5 (range 47.5-100) indicating that participants were accepting of the technology. Participants performed exercises on average for 50.32 min (range 26.42-68.37). Self-reported practice time was 59.44 min (range 48-67.5). Conclusion: Monitoring of patient practice using a tablet computer is feasible and may prove more reliable than self-report. There is variability in the amount of upper limb exercise stroke patients do at home.
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Affiliation(s)
- Tamina Levy
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Maggie Killington
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Natasha Lannin
- School of Allied Health, La Trobe University , Bundoora, Australia.,Occupational Therapy, Alfred Health , Prahran, Australia
| | - Maria Crotty
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
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14
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McLaren R, Signal N, Lord S, Taylor S, Henderson J, Taylor D. The volume and timing of upper limb movement in acute stroke rehabilitation: still room for improvement. Disabil Rehabil 2019; 42:3237-3242. [PMID: 30951402 DOI: 10.1080/09638288.2019.1590471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To observe upper limb activity patterns of people with stroke during sub-acute rehabilitation to inform the development of treatment strategies for upper limb rehabilitation. Design: Observational study of upper limb activity. Methods: Twenty participants admitted for sub-acute rehabilitation following stroke were observed during a week day for 1 minute every 10 min between 7 am and 7 pm. Upper limb activity was recorded and categorized into five types of movement. Results: Participants used either one or both upper limbs for 45.8% of the observation time. The affected arm moved 26.4% of the time, with most movement occurring in conjunction with the unaffected arm (18.9% of the time) and only 7.5% of the time being movement of the affected arm by itself. The largest proportion of upper limb activity was observed during mealtimes. Conclusions: Recognition of the need to improve upper limb outcomes after stroke has not yet translated into changes in the amount of upper limb activity undertaken during sub-acute rehabilitation. Opportunities to rehabilitate the hemiplegic upper limb are not fully realized. The dominance of bilateral movement in the early stages after stroke may provide scope for interventions that maximize this aspect of motor control.IMPLICATIONS FOR REHABILITATIONDespite advances in rehabilitation, time spent in upper limb activity following stroke is very low, particularly in the affected arm.Most movement of the affected arm occurs in conjunction with the unaffected arm.There is an urgent need to redress this low level of movement, given the importance of upper limb recovery to quality of life for people following stroke.
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Affiliation(s)
- Ruth McLaren
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sue Lord
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Steve Taylor
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Jeanette Henderson
- Assessment, Treatment and Rehabilitation Department, Waitakere Hospital, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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15
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Tetzlaff B, Barzel A, Stark A, Ketels G, Scherer M. To what extent does therapy of chronic stroke patients address participation? A content analysis of ambulatory physical and occupational therapy based on the International Classification of Functioning, Disability, and Health framework. Disabil Rehabil 2018; 42:545-551. [PMID: 30451030 DOI: 10.1080/09638288.2018.1503732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The study aim was to analyze whether ambulatory therapy of chronic stroke patients contains elements that specifically address "Activity and participation", and to what extent participation as a major goal in rehabilitation is realized in ambulatory care.Method: Qualitative and quantitative content analysis of standard therapy of 71 chronic stroke patients with upper limb impairment. 469 statements on therapy of 34 therapists were analyzed using data-driven and concept-driven coding based on the International Classification of Functioning, Disability and Health framework.Results: Almost half of therapy provided to stroke patients was related to "Upper extremity" (47.5%), as one out of seven identified main categories. Regarding International Classification of Functioning, Disability, and Health framework, 75.1% of therapeutic practices in ambulatory therapy covered "Body functions," but only 13.2% addressed "Activities and participation". Some statements contained specific therapeutic concepts (9.4%) or isolated notes (2.1%) and were not linkable to the International Classification of Functioning, Disability and Health framework.Conclusions: Ambulatory therapy of chronic stroke patients is related, in part, to participation. There is potential for an increase in participation by applying therapeutic approaches, which actively involve the patients in goal-setting and therapeutic exercises to specifically address activities and participation.Implications for rehabilitationTo realize participation as a major goal in the rehabilitation process ambulatory therapy of chronic stroke patients, one should focus on therapeutic approaches and exercises that specifically address activities and participation.Structured goal-setting, which actively involve patients, can be used to identify goals relevant to individual activities and participation.
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Affiliation(s)
- Britta Tetzlaff
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Barzel
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anne Stark
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gesche Ketels
- Physiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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McGlinchey MP, James J, McKevitt C, Douiri A, McLachlan S, Sackley CM. The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke-protocol for a systematic review. Syst Rev 2018; 7:197. [PMID: 30447698 PMCID: PMC6240323 DOI: 10.1186/s13643-018-0870-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/02/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stroke rehabilitation aims to optimise function and reduce complications post-stroke. Rehabilitation to optimise physical function post-stroke has beneficial effects for survivors of mild to moderate stroke. However, little is known about the effectiveness of interventions to rehabilitate physical function or manage immobility-related complications for survivors of severe stroke. The systematic review aims to evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke and identify topics for future research in this area. METHODS A systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, AMED, PEDro, DORIS and CENTRAL) between January 1987 and July 2017 will be undertaken to identify eligible published randomised controlled trials (RCTs) in any language. Ongoing RCTs will be identified by searching health-care trial registers (Stroke Trials Registry, ClinicalTrials.gov). Hand searches of identified study reference lists will also be performed. The PRISMA statement will be used to guide the systematic review. Two reviewers will screen search results, select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Studies comparing the effect of one type of rehabilitation intervention to another or usual care on physical function and immobility-related complications for patients with severe stroke will be included. Studies may include participants with all levels of stroke severity but must provide sub-group analysis based on stroke severity. Studies will focus on any phase of the stroke rehabilitation pathway and will be grouped and analysed according to their timeframe post-stroke into acute and early sub-acute (up to 3 months post-stroke), early sub-acute to late sub-acute (from 3 to 6 months post-stroke) and chronic (greater than 6 months post-stroke). If sufficient studies demonstrate homogeneity, a meta-analysis will pool results of individual outcomes. The GRADE approach will be used to assess the evidence strength. DISCUSSION The results of this systematic review will summarise the strength of evidence for rehabilitation interventions used in the rehabilitation of physical function and immobility-related complications in severe stroke and identify gaps in evidence. SYSTEMATIC REVIEW REGISTRATION The systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO)-registration number CRD77737 .
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Affiliation(s)
- Mark P. McGlinchey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
- Physiotherapy Department, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - Jimmy James
- Physiotherapy Department, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Sarah McLachlan
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Catherine M. Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
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17
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Lefeber N, De Keersmaecker E, Henderix S, Michielsen M, Kerckhofs E, Swinnen E. Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight-Supported Gait After Stroke. Neurorehabil Neural Repair 2018; 32:1043-1054. [PMID: 30417724 DOI: 10.1177/1545968318810810] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Physiological responses are rarely considered during walking after stroke and if considered, only during a short period (3-6 minutes). The aims of this study were to examine physiological responses during 30-minute robot-assisted and body weight-supported treadmill and overground walking and compare intensities with exercise guidelines. METHODS A total of 14 ambulatory stroke survivors (age: 61 ± 9 years; time after stroke: 2.8 ± 2.8 months) participated in 3 separate randomized walking trials. Patients walked overground, on a treadmill, and in the Lokomat (60% robotic guidance) for 30 minutes at matched speeds (2.0 ± 0.5 km/h) and matched levels of body weight support (BWS; 41% ± 16%). Breath-by-breath gas analysis, heart rate, and perceived exertion were assessed continuously. RESULTS Net oxygen consumption, net carbon dioxide production, net heart rate, and net minute ventilation were about half as high during robot-assisted gait as during body weight-supported treadmill and overground walking ( P < .05). Net minute ventilation, net breathing frequency, and net perceived exertion significantly increased between 6 and 30 minutes (respectively, 1.8 L/min, 2 breaths/min, and 3.8 units). During Lokomat walking, exercise intensity was significantly below exercise recommendations; during body weight-supported overground and treadmill walking, minimum thresholds were reached (except for percentage of heart rate reserve during treadmill walking). CONCLUSION In ambulatory stroke survivors, the oxygen and cardiorespiratory demand during robot-assisted gait at constant workload are considerably lower than during overground and treadmill walking at matched speeds and levels of body weight support. Future studies should examine how robotic devices can be Future studies should examine how robotic devices can be exploited to induce aerobic exercise.
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Affiliation(s)
- Nina Lefeber
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emma De Keersmaecker
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Eric Kerckhofs
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
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18
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Clarke DJ, Burton LJ, Tyson SF, Rodgers H, Drummond A, Palmer R, Hoffman A, Prescott M, Tyrrell P, Brkic L, Grenfell K, Forster A. Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units. Clin Rehabil 2018; 32:1119-1132. [PMID: 29582712 PMCID: PMC6068965 DOI: 10.1177/0269215518765329] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/24/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify why the National Clinical Guideline recommendation of 45 minutes of each appropriate therapy daily is not met in many English stroke units. DESIGN Mixed-methods case-study evaluation, including modified process mapping, non-participant observations of service organisation and therapy delivery, documentary analysis and semi-structured interviews. SETTING Eight stroke units in four English regions. SUBJECTS Seventy-seven patients with stroke, 53 carers and 197 stroke unit staff were observed; 49 patients, 50 carers and 131 staff participants were interviewed. RESULTS Over 1000 hours of non-participant observations and 433 patient-specific therapy observations were undertaken. The most significant factor influencing amount and frequency of therapy provided was the time therapists routinely spent, individually and collectively, in information exchange. Patient factors, including fatigue and tolerance influenced therapists' decisions about frequency and intensity, typically resulting in adaptation of therapy rather than no provision. Limited use of individual patient therapy timetables was evident. Therapist staffing levels were associated with differences in therapy provision but were not the main determinant of intensity and frequency. Few therapists demonstrated understanding of the evidence underpinning recommendations for increased therapy frequency and intensity. Units delivering more therapy had undertaken patient-focused reorganisation of therapists' working practices, enabling them to provide therapy consistent with guideline recommendations. CONCLUSION Time spent in information exchange impacted on therapy provision in stroke units. Reorganisation of therapists' work improved alignment with guidelines.
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Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Sarah F Tyson
- School of Health Sciences, Manchester
Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Helen Rodgers
- Stroke Research Group, Institute of
Neuroscience, Newcastle University, Newcastle, UK
| | - Avril Drummond
- Faculty of Medicine and Health Sciences,
University of Nottingham, Nottingham, UK
| | - Rebecca Palmer
- Health Services Research, School of
Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alex Hoffman
- Sentinel Stroke National Audit
Programme, Royal College of Physicians, London, UK
| | - Matthew Prescott
- Physiotherapy Department, Bradford
Teaching Hospitals NHS Trust, Bradford, UK
| | - Pippa Tyrrell
- Salford Royal NHS Foundation Trust and
Manchester Academic Health Science Centre, The University of Manchester, Manchester,
UK
| | - Lianne Brkic
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
- Stroke Research Group, Institute of
Neuroscience, Newcastle University, Newcastle, UK
| | - Katie Grenfell
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
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19
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Richards CL, Malouin F, Nadeau S, Fung J, D'Amours L, Perez C, Durand A. Amount and Content of Sensorimotor Therapy Delivered in Three Stroke Rehabilitation Units in Quebec, Canada. Physiother Can 2018; 70:120-132. [PMID: 29755168 DOI: 10.3138/ptc.2016-66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose: This study creates a baseline clinical portrait of sensorimotor rehabilitation in three stroke rehabilitation units (SRUs) as a first step in implementing a multi-centre clinical research platform. Method: Participants in this cross-sectional, descriptive study were the patients and rehabilitation teams in these SRUs. Prospective (recording of therapy time and content and a Web-based questionnaire) and retrospective (chart audit) methods were combined to characterize the practice of the rehabilitation professionals. Results: The 24- to 39-bed SRUs admitted 100-240 inpatients in the year audited. The mean combined duration of individual occupational and physical therapy was 6.3-7.5 hours/week/patient. When evening hours and the contributions of other professionals as well as group therapy and self-practice were included, the total amount of therapy was 13.0 (SD 3) hours/patient/week. Chart audit and questionnaire data revealed the Berg Balance Scale was the most often used outcome measure (98%-100%), and other outcome measure use varied. Clinicians favoured task-oriented therapy (35%-100%), and constraint-induced movement therapy (0%-15%), electrical stimulation of the tibialis anterior (0%-15%), and body weight-supported treadmill training (0%-1%) were less often used. Conclusions: This study is the first to provide objective data on therapy time and content of stroke rehabilitation in Quebec SRUs.
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Affiliation(s)
- Carol L Richards
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS).,Département de réadaptation, Université Laval, Québec
| | - Francine Malouin
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS).,Département de réadaptation, Université Laval, Québec
| | - Sylvie Nadeau
- Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal.,Centre recherche interdisciplinaire en réadaptation.,École de réadaptation, Université de Montréal
| | - Joyce Fung
- Centre recherche interdisciplinaire en réadaptation.,Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, Que.,School of Physical and Occupational Therapy, McGill University, Montreal
| | - Line D'Amours
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
| | - Claire Perez
- School of Physical and Occupational Therapy, McGill University, Montreal.,Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, Que
| | - Anne Durand
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
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20
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Faria CDCDM, Araújo DC, Carvalho-Pinto BPDB. Assistance provided by physical therapists from primary health care to patients after stroke. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.003.ao11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Motor impairments, which are prevalent in stroke subjects, require physical therapy (PT) rehabilitation. In primary care in the Brazilian Public Health System, PT are part of the Núcleo de Apoio à Saúde da Família (NASF). Objective: To describe the PT assistance provided to stroke patients in a primary healthcare center. Methods: The records of all stroke patients (n = 44; 69.23 ± 13.12 years) identified by the health professionals were analyzed. Using keyword recognition, frequency analysis of the services offered by the PT was performed. Subjects were classified according to the Modified Rankin Scale. Results: In the 44 records, 45.5% had a description of the assistance provided by any professional of the NASF and 36.4% of the PT care. PT care was provided at the subject’s home (94.2%) and at the healthcare center (5.8%). The PT practices were identified as: orientation (93.8%), evaluation (87.5%), exercises (50%), follow-up (37.5%), referral to another service or to undergrad PT students (18.8%), and referral to other NASF professionals (12.5%). Most of the subjects were classified as having mild/moderate disability. Conclusion: The minority of records had registration of attendance by the NASF PT. The majority of the sessions occurred at the subject’s home, which reveals a practice focused on individual care. The orientation was common, which illustrates that in primary care there is a focus on empowerment for health self-improvement. Follow-up was not common, despite clinical guidelines state that stroke subjects should be monitored at least once a year by the rehabilitation team.
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21
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de Jong LD, van Wijck F, Stewart RE, Geurts ACH, Dijkstra PU. Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 23. [PMID: 28092139 DOI: 10.1002/pri.1683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/15/2016] [Accepted: 08/19/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions. METHODS Design: This is a retrospective analysis of randomized trial data. PARTICIPANTS 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands. PROCEDURE PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories. RESULTS PTs and OTs spent on average 4-7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on "moving around using transportation," "self care," and "household tasks" categories. CONCLUSIONS Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm-oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries.
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Affiliation(s)
- Lex D de Jong
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, The Netherlands.,Institute for Applied Health Research, School for Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Frederike van Wijck
- Institute for Applied Health Research, School for Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center Nijmegen, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, and Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
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22
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Swinnen E, Lefeber N, Willaert W, De Neef F, Bruyndonckx L, Spooren A, Michielsen M, Ramon T, Kerckhofs E. Motivation, expectations, and usability of a driven gait orthosis in stroke patients and their therapists. Top Stroke Rehabil 2016; 24:299-308. [PMID: 27996894 DOI: 10.1080/10749357.2016.1266750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the development of efficacious driven gait orthoses (DGO), it is an added value to consider patients' and therapists' perspectives concerning robot-assisted gait training (RAGT). A better understanding of these issues may improve the process of care and outcome. OBJECTIVES This study aimed to examine stroke patients' motivation and expectations of RAGT, and therapists' expectations and perspectives on the usability of RAGT. Additionally, the differences in expectations between stroke patients and their therapists were analyzed. METHODS A cross sectional, multi-center, three-group trial was conducted. Included were (1) stroke patients who have experience with RAGT (i.e. the stroke user group), (2) stroke patients who have no experience with RAGT (i.e. the stroke non-user group), and (3) therapists who have experience with RAGT (i.e. the therapist user group). The Intrinsic Motivation Inventory (IMI), Credibility/Expectancy Questionnaire (CEQ), and Usefulness, Satisfaction and Ease of Use Questionnaire (USE) were used. Descriptive statistics and non-parametric Kruskal-Wallis tests were conducted. RESULTS In total, 46 subjects were assessed (stroke user group: n = 23, stroke non-user group: n = 14, therapist user group: n = 9). IMI subscale scores ranged from 42 to 88%. Mean credibility and expectancy ranged from 80 to 85% and 57 to 72%, respectively, with no significant differences between groups. USE subscale scores ranged from 61 to 72%. CONCLUSIONS Stroke user group patients seem quite motivated to train with the DGO and both patients and therapists reasonably believe that this training could improve gait functioning. Therapists are moderately satisfied with the usability of the DGO, but there is room for improvement with respect to usefulness and ease of use.
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Affiliation(s)
- Eva Swinnen
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nina Lefeber
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ward Willaert
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Fallon De Neef
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lyn Bruyndonckx
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Annemie Spooren
- d Centre of Expertise - Care in Innovation , PXL University College , Hasselt , Belgium.,e Faculty of Medicine and Life Sciences, REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute , Hasselt University , Hasselt , Belgium
| | - Marc Michielsen
- f St. Ursula Rehabilitation Centre , Jessa Hospital , Herk-de-Stad , Belgium
| | - Tine Ramon
- g AZ Delta Hospital , Roeselare , Belgium
| | - Eric Kerckhofs
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
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23
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Evans M, Hocking C, Kersten P. Mapping the rehabilitation interventions of a community stroke team to the extended International Classification of Functioning, Disability and Health Core Set for Stroke. Disabil Rehabil 2016; 39:2544-2550. [DOI: 10.1080/09638288.2016.1239763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Melissa Evans
- Department of Occupational Science and Therapy, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Clare Hocking
- Department of Occupational Science and Therapy, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Paula Kersten
- School of Health Sciences, University of Brighton, Brighton, UK
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24
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Desmaele S, Putman K, De Wit L, Dejaeger E, Gantenbein AR, Schupp W, Steurbaut S, Dupont AG, De Paepe K. A comparative study of medication use after stroke in four countries. Clin Neurol Neurosurg 2016; 148:96-104. [DOI: 10.1016/j.clineuro.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/31/2016] [Accepted: 07/02/2016] [Indexed: 01/04/2023]
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25
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Hesamzadeh A, Dalvandi A, Bagher Maddah S, Fallahi Khoshknab M, Ahmadi F, Mosavi Arfa N. Family caregivers' experience of activities of daily living handling in older adult with stroke: a qualitative research in the Iranian context. Scand J Caring Sci 2016; 31:515-526. [PMID: 27530936 DOI: 10.1111/scs.12365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 05/16/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with stroke require additional support from family to live independently in the area of activities of daily living. Family members are usually the main caregivers of stroke patients. Comprehensive explanation of ADL handling from family caregivers' view is lacking. AIM This study explores and describes family caregivers' experiences about the strategies to handle activities of daily living (ADL) dependency of elderly patient with stroke in the Iranian context. METHOD A qualitative content analysis approach was conducted to analyse data. Nineteen family caregivers participated in the study from multiple physiotherapy clinics of physiotherapy in Sari (Iran) between September 2013 and May 2014. Data were generated through in-depth interviews, and content analysis method was used to analyse the data and determine themes. FINDINGS The findings show that family caregivers manage the ADL dependency of their elderly stroke patients through seven strategies including encouraging physical movements, providing personal hygiene, nutritional consideration, facilitating religious activities, filling leisure time, and facilitating transfer and assisting in financial issues. CONCLUSION Family has an important role in handling of elderly stroke patients' ADL dependency. Health practitioners can take benefit from the findings to help the stroke families play more active role in the handling ADL dependency of their patients after stroke.
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Affiliation(s)
- Ali Hesamzadeh
- Department of Nursing, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- Department of Nursing, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sadat Bagher Maddah
- Department of Nursing, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoud Fallahi Khoshknab
- Department of Nursing, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Nazila Mosavi Arfa
- Central Library, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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26
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De Wit L, Kamsteegt H, Yadav B, Verheyden G, Feys H, De Weerdt W. Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting. Development, validation and inter-rater reliability of a scoring list. Clin Rehabil 2016; 21:450-9. [PMID: 17613566 DOI: 10.1177/0269215507074385] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective : To develop a valid and reliable scoring list to define the content of individual physiotherapy and occupational therapy sessions for stroke patients in inpatient rehabilitation. Design : A list was developed based on previous lists, neurological textbooks and recorded therapy sessions. Content validity was verified and inter-rater reliability evaluated on videos of treatment sessions. In each of four rehabilitation centres, a researcher recorded and scored five physiotherapy and five occupational therapy sessions. These 40 treatment sessions were also scored by the first author. The scores of the researchers and first author were statistically compared. Settings and subjects : Forty stroke patients in four European rehabilitation centres. Results : The scoring list consists of 49 subcategories, divided into 12 categories: mobilization; selective movements; lying (balance); sitting (balance); standing (balance); sensory and visual perceptual training and cognition; transfers; ambulatory activities; personal activities of daily living; domestic activities of daily living; leisure- and work-related activities; and miscellaneous. Comparing the frequency of occurrence of the categories resulted in intraclass correlation coefficients, indicating high reliability for eight categories, good for one, and fair for two. One category was not observed. Spearman rank correlation coefficients were high to very high for 24 subcategories and moderate for four. Twenty-one subcategories contained too few observations to enable calculation of Spearman rank correlation coefficients. Average point-to-point percentage of agreement in time of the treatment sessions equalled 76.6 ± 16.2%. Conclusions : The list is a valid and reliable tool for describing the content of physiotherapy and occupational therapy for stroke patients.
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Affiliation(s)
- L De Wit
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium.
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27
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Takashima R, Murata W, Saeki K. Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study. Disabil Rehabil 2016; 38:1578-91. [DOI: 10.3109/09638288.2015.1107629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Clarke DJ, Forster A. Improving post-stroke recovery: the role of the multidisciplinary health care team. J Multidiscip Healthc 2015; 8:433-42. [PMID: 26445548 PMCID: PMC4590569 DOI: 10.2147/jmdh.s68764] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.
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Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
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29
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Clarke DJ, Tyson S, Rodgers H, Drummond A, Palmer R, Prescott M, Tyrrell P, Burton L, Grenfell K, Brkic L, Forster A. Why do patients with stroke not receive the recommended amount of active therapy (ReAcT)? Study protocol for a multisite case study investigation. BMJ Open 2015; 5:e008443. [PMID: 26307617 PMCID: PMC4550729 DOI: 10.1136/bmjopen-2015-008443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Increased frequency and intensity of inpatient therapy contributes to improved outcomes for stroke survivors. Differences exist in the amount of therapy provided internationally. In England, Wales and Northern Ireland it is recommended that a minimum of 45 min of each active therapy should be provided at least 5 days a week provided the therapy is appropriate and that the patient can tolerate this. Sentinel Stroke National Audit Programme (2014) data demonstrate this standard is not being achieved for most patients. No research been undertaken to explore how therapists in England manage their practice to meet time-specific therapy recommendations. The ReAcT study aims to develop an in-depth understanding of stroke therapy provision, including how the guideline of 45 min a day of each relevant therapy, is interpreted and implemented by therapists, and how it is experienced by stroke-survivors and their families. METHODS AND ANALYSIS A multisite ethnographic case study design in a minimum of six stroke units will include modified process mapping, observations of service organisation, therapy delivery and documentary analysis. Semistructured interviews with therapists and service managers (n=90), and with patients and informal carers (n=60 pairs) will be conducted. Data will be analysed using the Framework approach. ETHICS AND DISSEMINATION The study received a favourable ethical opinion via the National Research Ethics Service (reference number: 14/NW/0266). Participants will provide written informed consent or, where stroke-survivors lack capacity, a consultee declaration will be sought. ReAcT is designed to generate insights into the organisational, professional, social, practical and patient-related factors acting as facilitators or barriers to providing the recommended amount of therapy. Provisional recommendations will be debated in consensus meetings with stakeholders who have not participated in ReAcT case studies or interviews. Final recommendations will be disseminated to therapists, service managers, clinical guideline developers and policymakers and stroke-survivors and informal carers.
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Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Sarah Tyson
- Stroke & Vascular Research Centre, School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Helen Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Avril Drummond
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Rebecca Palmer
- Health Services Research, School of Health and Related Research, The University of Sheffield, Innovation Centre, Sheffield, UK
| | - Matthew Prescott
- Physiotherapy Department, Bradford Teaching Hospitals NHS Trust, St Luke's Hospital, Bradford, UK
| | - Pippa Tyrrell
- Clinical Sciences Building, Manchester Academic Health Sciences Centre, Salford Royal Hospitals’ NHS Foundation Trust, Salford, UK
| | - Louisa Burton
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Katie Grenfell
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Lianne Brkic
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
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30
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Teasell R, Meyer MJ, McClure A, Pan C, Murie-Fernandez M, Foley N, Salter K. Stroke Rehabilitation: An International Perspective. Top Stroke Rehabil 2015; 16:44-56. [DOI: 10.1310/tsr1601-44] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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31
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Tyson SF, Burton L, McGovern A. The effect of a structured programme to increase patient activity during inpatient stroke rehabilitation: a Phase I cohort study. Clin Rehabil 2015; 30:191-8. [PMID: 25758942 DOI: 10.1177/0269215515575335] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/07/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop an intervention and undertake a proof-of-concept evaluation of its feasibility, acceptability, and impact on recorded patient activity levels during inpatient stroke rehabilitation. DESIGN A longitudinal cohort design. SETTING Three inpatient stroke rehabilitation services. SUBJECTS Stroke survivors receiving inpatient rehabilitation. INTERVENTION A programme designed to increase patient activity, including individualised patient timetables, independent practice, therapeutic group work, and structured social activities was developed and implemented without additional resource. MAIN MEASURES Patients' recorded activity levels were compared for two weeks before and after implementation of the programme. Data regarding the estimated time spent in different types of activity were extracted from patient treatment records, patients' and therapists' diaries, or timetables (if used) to measure patient activity levels RESULTS At baseline, recorded activity levels were low; patients undertook a mean of 61 minutes (SD = 39) of activity per day. After implementation of the programme, recorded activity levels significantly increased to a mean of 123 minutes (SD = 88) per day (p = 0.0001). The time spent in all types of recorded activity increased (p = 0.0001-0.002), except psychology where the increase did not reach significance (p = 0.670). CONCLUSIONS A structured programme can significantly increase recorded patient activity levels during inpatient stroke rehabilitation without additional resource.
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Affiliation(s)
- S F Tyson
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - L Burton
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK Greater Manchester Strategic Clinical Network, Stockport, UK
| | - A McGovern
- Greater Manchester Strategic Clinical Network, Stockport, UK
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Pumpa LU, Cahill LS, Carey LM. Somatosensory assessment and treatment after stroke: An evidence-practice gap. Aust Occup Ther J 2015; 62:93-104. [DOI: 10.1111/1440-1630.12170] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Lloyd U. Pumpa
- Department of Occupational Therapy; La Trobe University; Bundoora Australia
| | - Liana S. Cahill
- Department of Occupational Therapy; La Trobe University; Bundoora Australia
- Department of Occupational Therapy; Royal Melbourne Hospital; Parkville Australia
- Neurorehabilitation and Recovery, Stroke Division; The Florey Institute of Neuroscience and Mental Health; University of Melbourne; Heidelberg Victoria Australia
| | - Leeanne M. Carey
- Department of Occupational Therapy; La Trobe University; Bundoora Australia
- Neurorehabilitation and Recovery, Stroke Division; The Florey Institute of Neuroscience and Mental Health; University of Melbourne; Heidelberg Victoria Australia
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33
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Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How is physical activity monitored in people following stroke? Disabil Rehabil 2014; 37:1717-31. [DOI: 10.3109/09638288.2014.978508] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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34
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Hubbard IJ, Carey LM, Budd TW, Parsons MW. Reorganizing therapy: changing the clinical approach to upper limb recovery post-stroke. Occup Ther Int 2014; 22:28-35. [PMID: 25327458 DOI: 10.1002/oti.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/14/2014] [Accepted: 09/05/2014] [Indexed: 11/06/2022] Open
Abstract
Stroke is the leading cause of adult disability, and as a consequence, most therapists will provide health care to patients with stroke during their professional careers. An increasing number of studies are investigating the association between upper limb recovery and changes in brain activation patterns following stroke. In this review, we explore the translational implications of this research for health professionals working in stroke recovery. We argue that in light of the most recent evidence, therapists should consider how best to take full advantage of the brain's natural ability to reorganize, when prescribing and applying interventions to those with a stroke-affected upper limb. The authors propose that stroke is a brain-based problem that needs a brain-based solution. This review addresses two topics, anticipating recovery and maximizing recovery. It proposes five practice-ready recommendations that are based on the evidence reviewed. The over-riding aim of this review and discussion is to challenge therapists to reconsider the health care they prescribe and apply to people with a stroke-affected upper limb.
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Affiliation(s)
- Isobel J Hubbard
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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35
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Dorsch AK, Thomas S, Xu X, Kaiser W, Dobkin BH. SIRRACT: An International Randomized Clinical Trial of Activity Feedback During Inpatient Stroke Rehabilitation Enabled by Wireless Sensing. Neurorehabil Neural Repair 2014; 29:407-15. [PMID: 25261154 DOI: 10.1177/1545968314550369] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Walking-related disability is the most frequent reason for inpatient stroke rehabilitation. Task-related practice is a critical component for improving patient outcomes. OBJECTIVE To test the feasibility of providing quantitative feedback about daily walking performance and motivating greater skills practice via remote sensing. METHODS In this phase III randomized, single blind clinical trial, patients participated in conventional therapies while wearing wireless sensors (triaxial accelerometers) at both ankles. Activity-recognition algorithms calculated the speed, distance, and duration of walking bouts. Three times a week, therapists provided either feedback about performance on a 10-meter walk (speed only) or walking speed feedback plus a review of walking activity recorded by the sensors (augmented). Primary outcomes at discharge included total daily walking time, derived from the sensors, and a timed 15-meter walk. RESULTS Sixteen rehabilitation centers in 11 countries enrolled 135 participants over 15 months. Sensors recorded more than 1800 days of therapy, 37 000 individual walking bouts, and 2.5 million steps. No significant differences were found between the 2 feedback groups in daily walking time (15.1 ± 13.1 vs 16.6 ± 14.3 minutes, P = .54) or 15-meter walking speed (0.93 ± 0.47 vs 0.91 ± 0.53 m/s, P = .96). Remarkably, 30% of participants decreased their total daily walking time over their rehabilitation stay. CONCLUSIONS In this first trial of remote monitoring of inpatient stroke rehabilitation, augmented feedback beyond speed alone did not increase the time spent practicing or improve walking outcomes. Remarkably modest time was spent walking. Wireless sensing, however, allowed clinicians to audit skills practice and provided ground truth regarding changes in clinically important, mobility-related activities.
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Affiliation(s)
| | - Seth Thomas
- University of California, Los Angeles, CA, USA
| | - Xiaoyu Xu
- University of California, Los Angeles, CA, USA
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Doyle SD, Bennett S, Dudgeon BJ. Sensory impairment after stroke: Exploring therapists' clinical decision making. Can J Occup Ther 2014; 81:215-225. [PMID: 29898498 DOI: 10.1177/0008417414540516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke survivors experience sensory impairments that significantly limit upper-limb functional use. Lack of clear research-based guidelines about their management exacerbates the uncertainty in occupational therapists' decision making to support these clients. PURPOSE This study explores occupational therapists' clinical decision making regarding upper-limb, post-stroke sensory impairments that can ultimately inform approaches to support therapists working with such clients. METHOD Twelve therapists participated in a qualitative descriptive study. Transcripts of semi-structured interviews were analyzed using content analysis. FINDINGS Three overarching categories were identified: deciding on the focus of interventions (describing intervention choices), it all depends (outlining factors considered when choosing interventions), and managing uncertainty in decision making (describing uncertainty and actions taken to resolve it). IMPLICATIONS Providing training about post-stroke sensory impairment and decision making may improve therapists' decision making and ultimately improve client outcomes. Further research is needed to understand the impact of uncertainty on occupational therapy decision making and resulting care practices.
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Connell LA, McMahon NE, Simpson LA, Watkins CL, Eng JJ. Investigating measures of intensity during a structured upper limb exercise program in stroke rehabilitation: an exploratory study. Arch Phys Med Rehabil 2014; 95:2410-9. [PMID: 24946084 DOI: 10.1016/j.apmr.2014.05.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/29/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To use 3 measures of intensity—time, observed repetitions, and wrist accelerometer activity counts—to describe the intensity of exercise carried out when completing a structured upper limb exercise program, and to explore whether a relationship exists between wrist accelerometer activity counts and observed repetitions. DESIGN Observational study design. SETTING Rehabilitation center research laboratory. PARTICIPANTS Community-dwelling stroke survivors (N=13) with upper limb hemiparesis. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Time engaged in exercise, total repetitions, and accelerometer activity counts for the affected upper limb. RESULTS Mean session time ± SD was 48.5±7.8 minutes. Participants were observed to be engaged in exercises for 63.8%±7.5% of the total session time. The median number of observed repetitions per session was 340 (interquartile range [IQR], 199-407), of which 251 (IQR, 80-309) were purposeful repetitions. Wrist accelerometers showed the stroke survivors' upper limbs to be moving for 75.7%±15.9% of the total session time. Purposeful repetitions and activity counts were found to be significantly correlated (ρ=.627, P<.05). CONCLUSIONS Stroke survivors were not actively engaged in exercises for approximately one third of each exercise session. Overall session time may not be the most accurate measure of intensity. Counting repetitions was feasible when using a structured exercise program and provides a clinically meaningful way of monitoring intensity and progression. Wrist accelerometers provided an objective measure for how much the arm moves, which correlated with purposeful repetitions. Further research using repetitions and accelerometers as measures of intensity is warranted.
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Affiliation(s)
- Louise A Connell
- Clinical Practice Research Unit, School of Health, University of Central Lancashire, Preston, United Kingdom.
| | - Naoimh E McMahon
- Clinical Practice Research Unit, School of Health, University of Central Lancashire, Preston, United Kingdom
| | - Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline L Watkins
- Clinical Practice Research Unit, School of Health, University of Central Lancashire, Preston, United Kingdom
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Rhoda A, Smith M, Putman K, Mpofu R, DeWeerdt W, DeWit L. Motor and functional recovery after stroke: a comparison between rehabilitation settings in a developed versus a developing country. BMC Health Serv Res 2014; 14:82. [PMID: 24559193 PMCID: PMC3974037 DOI: 10.1186/1472-6963-14-82] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 02/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery post stroke is well documented in the field of stroke rehabilitation. The structure and process of rehabilitation are different between developed and developing countries. The aim of the present study was to compare the motor and functional recovery of stroke patients in Germany versus stroke patients receiving rehabilitation in South Africa. METHODS This study used secondary data analysis of patient protocols collected in two independent studies conducted in Germany and South Africa respectively. A total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recovery were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant differences in motor and functional recovery were found, using the Wilcoxon rank sum test on admission to the centre, and at two and six months after stroke. A generalized linear mixed-methods model (GLIMMIX) was used to compare the recovery patterns between the participants from the two settings over time. RESULTS The results of the GLIMMIX revealed a significant difference in favour of the German participants for gross motor (RMA-GF) and upper limb (RMA-A) recovery, while no significant difference was found for lower limb (RMA-LT) and functional (BI) recovery patterns between the participants of the two settings. No significant differences existed in RMA-A and BI-scores on admission to the CHC/SRU. At two and six months after stroke, both the RMA-A and BI-scores were significantly lower in the South African than the German sample. CONCLUSION The results of this study provide empirical evidence for differential recovery patterns for patients in developed and developing countries. A detailed exploration of the factors to which this difference in recovery patterns can be attributed was beyond the scope of the present study, and is recommended for future research.
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Affiliation(s)
- Anthea Rhoda
- Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, 7535 Bellville, Western Cape, South Africa
| | - Mario Smith
- Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, 7535 Bellville, Western Cape, South Africa
| | - Koen Putman
- Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussel, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Ratie Mpofu
- Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, 7535 Bellville, Western Cape, South Africa
| | - Willy DeWeerdt
- Faculty of Kinesiology and Rehabilitation Sciences, Eekenhoornlaan 34, B-3210 Linden, Belgium
| | - Liesbet DeWit
- Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussel, Laarbeeklaan 103, 1090 Jette, Belgium
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Hart T, Ferraro M, Myers R, Ellis CA. Opening the Black Box: Lessons Learned From an Interdisciplinary Inquiry Into the Learning-Based Contents of Brain Injury Rehabilitation. Arch Phys Med Rehabil 2014; 95:S66-73. [DOI: 10.1016/j.apmr.2013.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/21/2013] [Indexed: 10/25/2022]
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Doyle S, Bennett S, Gustafsson L. Occupational Therapy for Upper Limb Post-Stroke Sensory Impairments: A Survey. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13807217284143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose: Upper limb post-stroke sensory impairments have an impact on a significant number of stroke survivors. There is limited research in this area and it is unclear how occupational therapists are addressing sensory impairments in clinical practice. This study aimed to investigate the clinical practice patterns of occupational therapists, perceived barriers to providing interventions and information sources used when addressing upper limb post-stroke sensory impairments. Methods: A survey was sent to 500 randomly selected occupational therapists in the United States. Findings: The majority of the 145 respondents reported frequently assessing sensation, and half reported providing interventions for sensory impairments. Interventions primarily focused on providing passive sensory stimulation followed by compensatory strategies. Most therapists provided patient/caregiver education about safety. Therapists cited lack of knowledge and skills, patients' short length of stay and lack of time as barriers to utilizing interventions. Most therapists reported not being up to date with current research and requested continuing education to support practice. Conclusion: This survey established a profile of American occupational therapists' practice with people with upper limb post-stroke sensory impairments. Therapists have a need for information and training in all aspects of the management of upper limb post-stroke sensory impairment. Further research, evaluating the effectiveness of interventions and exploring therapists' clinical decision making when choosing interventions, is also needed.
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Affiliation(s)
- Susan Doyle
- Clinical Assistant Professor, University of Puget Sound, Tacoma, WA USA and PhD student, University of Queensland, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Sally Bennett
- Senior Lecturer, University of Queensland, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Louise Gustafsson
- Head of Division, University of Queensland, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
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Schnitzler A, Woimant F, Nicolau J, Tuppin P, de Peretti C. Effect of Rehabilitation Setting on Dependence Following Stroke. Neurorehabil Neural Repair 2013; 28:36-44. [DOI: 10.1177/1545968313497828] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. In France in 2009, patients admitted to Multidisciplinary Inpatient Rehabilitation for stroke were sent to a neurological rehabilitation center (NRC) or a general or geriatric rehabilitation (GRC) service. Objective. To describe the functional outcome of stroke patients admitted for rehabilitation in France in 2009, both globally and as a function of the rehabilitation setting (GRC or NRC). Methods. Data from the French Hospital Discharge Diagnosis databases for 2009 were included. Two logistic regression models were used to analyze factors related to improvement in dependence score and discharge home. Odds ratios (ORs) were also calculated. Results. Among the 83 505 survivors of acute stroke in 2009, 28 201 were admitted for rehabilitation (33.8%). Of these, 19 553 went to GRC (69%) and 8648 to NRC (31%). On average, patients admitted to GRC were older (78.6 years vs 66.4 years), P < .001). At the start of rehabilitation, 50% of NRC patients and 56% of GRC patients were heavily dependent, but level of dependence was similar within each age-group. Rehabilitation in NRC lead to a greater probability of functional improvement (OR = 1.75, P < .001) and home discharge (OR = 1.61, P < .001) after adjustment for gender, age, Charlson’s comorbidity index, initial level of dependence, type of stroke, and total length of stay. Conclusion. This study confirms, on a national level, the functional benefit of specialized rehabilitation in NRC. These results should be useful in the improvement of care pathways, organization of rehabilitation, and discharge planning.
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Affiliation(s)
- Alexis Schnitzler
- Raymond Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, Garches, France
| | - France Woimant
- Agence régionale de santé d’Ile de France, hôpital Lariboisière, Paris, France
| | - Javier Nicolau
- Institut de veille sanitaire, Saint-Maurice Cedex, France
| | - Philippe Tuppin
- Caisse nationale d’assurance maladie des travailleurs salariés, Paris Cedex, France
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Kim JH, Park EY. Balance self-efficacy in relation to balance and activities of daily living in community residents with stroke. Disabil Rehabil 2013; 36:295-9. [DOI: 10.3109/09638288.2013.790488] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ringelstein EB, Chamorro A, Kaste M, Langhorne P, Leys D, Lyrer P, Thijs V, Thomassen L, Toni D. European Stroke Organisation Recommendations to Establish a Stroke Unit and Stroke Center. Stroke 2013; 44:828-40. [DOI: 10.1161/strokeaha.112.670430] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- E. Bernd Ringelstein
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Angel Chamorro
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Markku Kaste
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Peter Langhorne
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Didier Leys
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Philippe Lyrer
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Vincent Thijs
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Lars Thomassen
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
| | - Danilo Toni
- From the Department of Neurology, University Hospital, Münster, Germany (E.B.R.); Department of Clinical Neurosciences, University of Barcelona, Hospital Clinic, Barcelona, Spain (A.C.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (M.K.); Academic Section of Geriatric Medicine, University Hospital, Glasgow, United Kingdom (P.La.); Department of Neurology, University Hospital, Lille, France (D.L.); Department of Neurology, University Hospital, Basel, Switzerland
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Takashima R, Saeki K. Professional identities of occupational therapy practitioners in Japan. Health (London) 2013. [DOI: 10.4236/health.2013.56a2010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kaur G, English C, Hillier S. How physically active are people with stroke in physiotherapy sessions aimed at improving motor function? A systematic review. Stroke Res Treat 2012; 2012:820673. [PMID: 22567542 PMCID: PMC3337516 DOI: 10.1155/2012/820673] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/19/2011] [Accepted: 01/12/2012] [Indexed: 01/19/2023] Open
Abstract
Background. Targeted physical activity drives functional recovery after stroke. This review aimed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions. Summary of Review. A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions. Seven studies were included; six observational and one randomised controlled trial. People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration. The most common activities practiced in a physiotherapy session were walking, sitting, and standing with a mean (SD) practice time of 8.7 (4.3), 4.5 (4.0), and 8.3 (2.6) minutes, respectively. Conclusion. People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity. In light of dosage studies, practice time may be insufficient to drive optimal motor recovery.
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Affiliation(s)
- Gurpreet Kaur
- School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
| | - Coralie English
- School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
| | - Susan Hillier
- School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
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Celinder D, Peoples H. Stroke patients' experiences with Wii Sports® during inpatient rehabilitation. Scand J Occup Ther 2012; 19:457-63. [PMID: 22339207 DOI: 10.3109/11038128.2012.655307] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy in a controlled hospital setting. MATERIALS AND METHODS The study had a qualitative triangulation design that included semi-structured interviews and field notes. Nine Danish stroke patients participated, receiving between one and nine interventions with Wii Sports® during a three-week period. Responses were coded by qualitative content analysis. RESULTS Analysis revealed one overarching category, "Connecting to past, present, and future occupations", and three categories that encompassed patients' experiences with Wii: (i) variety, (ii) engagement, and (iii) obstacles and challenges. Interview findings were confirmed by field notes that included observations of engagement and challenges. DISCUSSION Stroke patients in hospital settings may experience Wii Sports® as a beneficial and challenging occupation for both rehabilitation and leisure. Incorporation of Wii Sports® into conventional occupational therapy services may benefit patient rehabilitation directly or provide motivation for alternative leisure activities.
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Affiliation(s)
- Dora Celinder
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Glostrup, Denmark.
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West T, Bernhardt J. Physical activity in hospitalised stroke patients. Stroke Res Treat 2011; 2012:813765. [PMID: 21966599 PMCID: PMC3182066 DOI: 10.1155/2012/813765] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 07/06/2011] [Accepted: 07/10/2011] [Indexed: 01/19/2023] Open
Abstract
The aim of this paper was to examine the amount and type of physical activity engaged in by people hospitalised after stroke. Method. We systematically reviewed the literature for observational studies describing the physical activity of stroke patients. Results. Behavioural mapping, video recording and therapist report are used to monitor activity levels in hospitalised stroke patients in the 24 included studies. Most of the patient day is spent inactive (median 48.1%, IQR 39.6%-69.3%), alone (median 53.7%, IQR 44.2%-60.6%) and in their bedroom (median 56.5%, IQR 45.2%-72.5%). Approximately one hour per day is spent in physiotherapy (median 63.2 minutes, IQR 36.0-79.5) and occupational therapy (median 57.0 minutes, IQR 25.1-58.5). Even in formal therapy sessions limited time is spent in moderate to high level physical activity. Low levels of physical activity appear more common in patients within 14 days post-stroke and those admitted to conventional care. Conclusions. Physical activity levels are low in hospitalised stroke patients. Improving the description and classification of post stroke physical activity would enhance our ability to pool data across observational studies. The importance of increasing activity levels and the effectiveness of interventions to increase physical activity after stroke need to be tested further.
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Affiliation(s)
- Tanya West
- School of Health Sciences, La Trobe University, Melbourne, VIC 3086, Australia
- Physiotherapy Department, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Julie Bernhardt
- School of Health Sciences, La Trobe University, Melbourne, VIC 3086, Australia
- Stroke Division, Florey Neuroscience Institutes (formerly National Stroke Research Institute), Heidelberg Heights, VIC 3084, Australia
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Culmer PR, Jackson AE, Makower SG, Cozens JA, Levesley MC, Mon-Williams M, Bhakta B. A novel robotic system for quantifying arm kinematics and kinetics: description and evaluation in therapist-assisted passive arm movements post-stroke. J Neurosci Methods 2011; 197:259-69. [PMID: 21414360 DOI: 10.1016/j.jneumeth.2011.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
We developed a system for quantitatively measuring arm movement. Our approach provides a method to simultaneously capture upper limb kinetic and kinematic data during assisted passive arm movements. Data are analysed with respect to Cartesian and upper limb coordinate systems to obtain upper limb joint angles and torques. We undertook an evaluation of the system in participants with stroke to show the feasibility of this approach. During rehabilitation after stroke, one aspect of treatment includes the physiotherapist applying assistive forces to move the impaired arm of the patient who remains passive. There is a dearth of published data on the relationship between upper limb kinematics and the underlying forces (kinetics) in this mode of physiotherapy treatment. Such quantitative data are crucial in facilitating research into therapy practice, for example by measuring variation in practice and determining dosage. An experienced therapist prescribed passive movements tailored to the needs of 16 participants with stroke (41-81 years) with a range of anthropometric sizes and motor impairments. Our novel measurement tool recorded kinematic and kinetic data at 100 Hz for 6-11 movements per participant. The kinetic data show that the majority of movements fall within upper limits of 36.7 N in shoulder elevation, 22.4N in shoulder protraction, 4.6 Nm in shoulder abduction, 12.8 Nm in shoulder flexion, 2.4 Nm in shoulder rotation and 5.5 Nm in elbow flexion. These data show the potential of this system to better understand arm movement, in particular to objectively evaluate physical therapy treatments and support development of robotic devices to facilitate upper limb rehabilitation.
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Affiliation(s)
- P R Culmer
- School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, West Yorks, UK.
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van Langeveld SA, Post MW, van Asbeck FW, ter Horst P, Leenders J, Postma K, Lindeman E. Reliability of a New Classification System for Mobility and Self-Care in Spinal Cord Injury Rehabilitation: The Spinal Cord Injury-Interventions Classification System. Arch Phys Med Rehabil 2009; 90:1229-36. [DOI: 10.1016/j.apmr.2008.12.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 12/18/2008] [Accepted: 12/26/2008] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Our understanding of the components of stroke rehabilitation critical to patients' outcomes is limited. Comparing practices and outcomes across countries may give clues to how to improve rehabilitation services. METHOD In the CERISE project (Collaborative Evaluation of Rehabilitation in Stroke across Europe), clinical and organisational aspects of stroke rehabilitation were compared among four European rehabilitation centres (United Kingdom, Belgium, Switzerland, and Germany). Main findings were summarised and interpreted. RESULTS Gross motor and functional recovery were significantly better in the German and Swiss centres compared to the British centre, respectively. Insights in admission criteria, patients' therapy time, content of therapy, and task characteristics of physiotherapists and occupational therapists were in line with the differences in recovery. In Germany, neurorehabilitation is more structured with clearly defined phases, each linked with specific criteria and reimbursement schemes. In Belgium, more variation exists in the rehabilitation trajectories. CONCLUSION Stroke rehabilitation services are embedded in health care systems, creating contextual constraints with various (dis)incentives. These constraints vary between countries, resulting in differences in the organisation of stroke rehabilitation. Studies on the effectiveness of stroke rehabilitation should incorporate contextual elements of the organisation of the unit.
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Affiliation(s)
- Koen Putman
- Health Services Research, Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Belgium
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