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Hoffmann M, Gustafsson L, Di Tommaso A. Exploring stroke survivors' experiences and understandings of occupational therapy. Scand J Occup Ther 2020; 29:165-174. [PMID: 33054465 DOI: 10.1080/11038128.2020.1831060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Occupational therapists view people with stroke as occupational beings who may experience occupational issues. Concurrently, occupational therapy practice is guided by research evidence that supports predominantly impairment-based practices. There has been limited exploration of how people with stroke experience and understand occupational therapy in the context of the potential tension between the professional philosophy and the research-based evidence. AIMS/OBJECTIVE To explore the experience and understanding of occupational therapy with stroke survivors. MATERIAL AND METHODS Interpretative phenomenology guided semi-structured interviews with nine participants from five states across Australia. RESULTS Three themes emerged: Understanding of occupational therapy grows by 'doing' outlines how participants understood occupational therapy based on their individual experiences over time; Personal factors influence the experience highlights how participants had diverse expectations for recovery that influenced their occupational therapy experience. Context shapes occupational therapy experience identified that the therapeutic relationship and context of occupational therapy were important factors in shaping experiences. CONCLUSION Both impairment-based and occupation-based therapy were considered valuable aspects of occupational therapy, representing the proposed tension between the professional philosophy and research-based evidence. Occupation-based and client-centred practice was more often experienced in the outpatient setting, with challenges described for both within the inpatient setting.
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Affiliation(s)
- Mikhala Hoffmann
- Former Student Occupational Therapist, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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Ashford SA, Nair A, Hancock D, Orridge S, Williams H, Turner-Stokes L. The Leg Activity measure, a new measure of passive and active function and impact on quality of life; informing goal setting and outcome evaluation in leg spasticity. Disabil Rehabil 2019; 43:2366-2374. [PMID: 31800371 DOI: 10.1080/09638288.2019.1697765] [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: 10/25/2022]
Abstract
PURPOSE Application of the Leg Activity measure in acquired brain injury spasticity intervention to identify areas for goal setting prior to treatment, document the treatments applied and evaluate outcome. METHODS A prospective cohort from three specialist spasticity management centres was used. Primary outcome measures were, Leg Activity Measure, Modified Ashworth Scale and Goal Attainment Scaling - light. Measurement was completed at baseline, 6 and 12 weeks. The Leg-Therapy recording Schedule was used to record physical therapy intervention. RESULTS Participants (n = 64) included had a mean age of 51 (18-84) years, half (n = 32) were men. Significant changes were demonstrated over the 12-week period in MAS (Xr2 = 35.4; p < 0.001), the Leg Activity passive function scale (Xr2 = 32.2; p < 0.001) (e.g., improved ease of dressing, hygiene) and Leg Activity impact on quality of life scale (Xr2 = 32.2; p < 0.001). No change was identified in the Leg Activity active function scale. Goal achievement was demonstrated at 6 weeks and further improved at 12 weeks (Xr2 = 65.7; p < 0.001) and was associated with change in the relevant scale. Physical interventions were captured at each time-point. DISCUSSION Significant gains in passive-function and quality-of-life were recorded by the Leg Activity measure scales at 6 weeks, and at 12 weeks post-injection in the context of on-going physical treatment, primarily by self-management.Implications for rehabilitationThe Leg Activity measure is able to detected changes in passive function and impact on quality of life.Measurement of change in active function is also likely to be detected, but was not seen in the cohort studied.The Leg Activity measure was effective in this study in identifying problem areas to enable setting of treatment goals and planning of treatment intervention.
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Affiliation(s)
- Stephen A Ashford
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.,Centre for Nurse and Midwife led Research, University College London Hospitals, London, UK.,Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Ajoy Nair
- Alderbourne Rehabilitation Unit, Hillingdon Hospital, London, UK
| | - Denise Hancock
- Alderbourne Rehabilitation Unit, Hillingdon Hospital, London, UK
| | | | - Heather Williams
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - Lynne Turner-Stokes
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.,Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content. BMC Neurol 2016; 16:219. [PMID: 27835977 PMCID: PMC5106796 DOI: 10.1186/s12883-016-0740-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/03/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and content of a VR training intervention to a conventional task-oriented intervention (CT). METHODS A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standardized scoring form was used to analyze intensity, i.e. active use of the affected UL expressed in % of total time, total active time and total duration of a training session in minutes, content of training and feedback. Two raters collected data independently. Linear regression models as well as descriptive and graphical methods were used. RESULTS Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While in VR severely impaired patients spent 80.7 % (4.4 %) of the session time actively; they reached 60.6 (12.1) % in CT. VR and CT also differed in terms of tasks and feedback provided. CONCLUSION Our results indicate that patients with severely impaired UL motor function spent more time actively in VR training, which may influence recovery. The upcoming results of the VIRTUES trial will show whether this is correlated with an increased effect of VR compared to CT. TRIAL REGISTRATION ClinicalTrials.gov NCT02079103 , February 27, 2014.
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Merchant J, Kitsos G, Ashby S, Kitsos A, Hubbard IJ. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy? Stroke Res Treat 2016; 2016:1582706. [PMID: 27752389 PMCID: PMC5056288 DOI: 10.1155/2016/1582706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/18/2016] [Indexed: 12/04/2022] Open
Abstract
Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p > 0.0014) and indirect (p = 0.001) occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p = 0.001). Patients admitted to the metropolitan hospital received more face-to-face (p > 0.000) and indirect (p > 0.000) physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p > 0.000). Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient's first therapy session.
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Affiliation(s)
- Josie Merchant
- Occupational Therapy, School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Gemma Kitsos
- Neurology Department, Hunter New England Area Health Service, New Lambton Heights, NSW 2305, Australia
| | - Samantha Ashby
- Occupational Therapy, School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex Kitsos
- Hunter New England Area Health Service, New Lambton Heights, NSW 2305, Australia
| | - Isobel J. Hubbard
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
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Alexandrescu R, Siegert RJ, Turner-Stokes L. The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset. Disabil Rehabil 2015; 37:1976-83. [PMID: 25598001 PMCID: PMC4720035 DOI: 10.3109/09638288.2014.998779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose: To assess the internal reliability, construct and concurrent validity and responsiveness of the Northwick Park Therapy Dependency Assessment (NPTDA) scale. Method: A cohort of 2505 neurorehabilitation patients submitted to the UK Rehabilitation Outcomes Collaborative database. Cronbach’s coefficient-α was used to assess internal reliability and factor analysis (FA) to assess construct validity. We compared NPTDA scores at admission and discharge to determine responsiveness. Results: Coefficient-α for the whole scale was 0.74. The exploratory FA resulted in a four-factor model (Physical, Psychosocial, Discharge planning and Activities) that accounted for 43% of variance. This model was further supported by the confirmatory FA. The final model had a good fit: root-mean-square error of approximation of 0.069, comparative fit index/Tucker–Lewis index of 0.739/0.701 and the goodness of fit index of 0.909. The NPTDA scores at admission and discharge were significantly different for each of the factors. Expected correlations were seen between the admission scores for the NPTDA, the Rehabilitation Complexity Scale (r = 0.30, p < 0.01) and the Functional Independence Measure (r = −0.25, p < 0.01). Conclusions: The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA may be used to describe and quantify changes in therapy inputs in the course of a rehabilitation programme.Implications for Rehabilitation The Northwick Park Therapy Dependency Assessment (NPTDA) is designed as a measure therapy intervention, which reflects both quantitative and qualitative aspects of the inputs provided (including staff time and the different types of intervention) during inpatient rehabilitation. The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA is responsive to change in the therapy inputs provided during neurorehabilitation between admission and discharge.
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Affiliation(s)
- Roxana Alexandrescu
- a Department of Palliative Care, Policy and Rehabilitation , School of Medicine, King's College London , London , UK
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Smale KJ, Carr SE, Schwartz AF, das Nair R, Lincoln NB. An evaluation of treatment integrity in a randomised controlled trial of memory rehabilitation for people with multiple sclerosis. Clin Rehabil 2014; 29:493-9. [PMID: 25239086 DOI: 10.1177/0269215514548733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/26/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the treatment integrity of a memory rehabilitation programme for people with multiple sclerosis. SUBJECTS Data were drawn from the intervention group of a randomised controlled trial of memory rehabilitation. This comprised 24 participants with multiple sclerosis. MEASURES Four core session components were identified from the treatment manual: recap, activities, take-home activity and other. One video-recording of each of ten intervention sessions was transcribed and amount of time spent on components recorded. RESULTS There were no significant differences between early and late stages of the programme in time spent on the core components (recap Z= -0.87, P=0.49; activities Z = -0.29, P=0.89; take-home activity Z = -0.59, P=0.69; other Z = -0.58, P=0.69). Thus, adherence to the manual was good with no evidence of programme drift. CONCLUSIONS Good adherence indicates the intervention was delivered as described in the manual and strengthens confidence in the findings of the randomised controlled trial.
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Affiliation(s)
- Kathryn J Smale
- Division of Rehabilitation and Ageing, University of Nottingham, UK
| | | | | | - Roshan das Nair
- Division of Rehabilitation and Ageing, University of Nottingham, UK
| | - Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, UK
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Navalón N, Verdecho I, Llorens R, Colomer C, Sanchez-Leiva C, Martinez-Crespo G, Moliner B, Ferri J, Noé E. Progression of posturographic findings after acquired brain injury. Brain Inj 2014; 28:1417-24. [PMID: 24946127 DOI: 10.3109/02699052.2014.917200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study the characteristics of balance performance in a sample of patients with increasing postural instability after acquired brain injury (ABI) and to establish the clinical utility of a new computerized posturographic system (NedSVE/IBV). METHODS This study included 108 patients with ABI divided into five groups from minimal to severe postural impairment. All patients were assessed with the NedSVE/IBV system and with traditional balance measures. Posturographic analyses included the modified clinical test of sensory interaction on balance, the limits of stability and the weight-shifting test. Sensitivity to detect changes and reproducibility were evaluated in 63 patients who were followed-up for 6 months and in 20 patients who were evaluated on two separate occasions during the same week, respectively. RESULTS The patients showed reduced stability limits, abnormal postural responses and an increased reliance on visual input with differences in intensity directly related to their degree of balance impairment. Posturographic study showed excellent convergent validity, reproducibility and sensitivity to detect changes. CONCLUSION The data suggests that, regardless of the intensity of postural instability, there is a common mechanism of sensory processing to maintain balance after ABI. The NedSVE-IBV system is a valid tool to quantify balance after ABI.
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Affiliation(s)
- Nuria Navalón
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA , Valencia , Spain and
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Reliability of the Function in Sitting Test (FIST). Rehabil Res Pract 2014; 2014:593280. [PMID: 24757566 PMCID: PMC3976801 DOI: 10.1155/2014/593280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/21/2022] Open
Abstract
The function in sitting test (FIST) is a newly developed, performance-based measure examining deficits in seated postural control. The FIST has been shown to be internally consistent and valid in persons with neurological dysfunction but intra- and interrater reliability and test-retest reliability have not been previously described. Seven patients with chronic neurologic dysfunction were tested and videotaped performing the FIST on two consecutive days. Seventeen acute care and inpatient rehabilitation physical therapist raters scored six of the videotaped performance of the FIST on two occasions at least 2 weeks apart. Intraclass correlation coefficients were used to calculate the test-retest and intra- and interrater reliability of the FIST. ICC of 0.97 (95% CI 0.847–0.995) indicated excellent test-retest reliability of the FIST. Intra- and interrater reliability was also excellent with ICCs of 0.99 (95% CI 0.994–0.997) and 0.99 (95% CI 0.988–0.994), respectively. Physical therapists and other rehabilitation professionals can confidently use the FIST in a variety of clinical practice and research settings due to its favorable reliability characteristics. More studies are needed to describe the responsiveness and minimal clinically important level of change in FIST scores to further enhance clinical usefulness of this measure.
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Does Task-Oriented Practice Improve Upper Extremity Motor Recovery after Stroke? A Systematic Review. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/504910] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Stroke commonly affects upper extremity motor abilities, yet there has been very limited success in developing effective rehabilitation interventions to remediate motor impairments, particularly for the upper extremity. Objective. To determine if task-oriented practice administered soon after stroke is more effective than usual care in improving poststroke upper extremity motor recovery and to explore the optimal amount of practice. Methods. A systematic review of the literature was performed from 1950 to November 2012, to identify randomized controlled trials of task-oriented practice compared to usual care, or to different amounts of task-oriented practice to improve motor impairment and activity. Studies were excluded if specific types of interventions were used as comparators or if they were of poor methodological quality. Results. Six studies met the review criteria. Three of the six studies demonstrated a statistically significant effect of task-oriented practice. Study results could not be pooled because of a lack of homogeneity in populations and intervention. Conclusions. The results demonstrate that an increase in the amount of task-oriented practice after stroke may result in less upper extremity impairment; further research on both effect and required dosage is needed as results are inconsistent.
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Ashford S, Slade M, Nair A, Turner-Stokes L. Arm Activity measure (ArmA) application for recording functional gain following focal spasticity treatment. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.1.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stephen Ashford
- Consultant Physiotherapist and Clinical Lecturer at the Regional Rehabilitation Unit, North West London Hospitals NHS Trust and King's College london, London, UK
| | - Mike Slade
- Professor of Health Services Research at King's College London, Health Service and Population Research Department, London, UK
| | - Ajoy Nair
- Consultant in Rehabilitation Medicine at Alderbourne Rehabilitation Unit, Hillingdon Hospital, London, UK
| | - Lynne Turner-Stokes
- Herbert Dunhill Chair of Rehabilitation and Director Regional at the Rehabilitation Unit, King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation
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Leeden MVD, Bart Staal J, Beekman E, Hendriks E, Mesters I, Rooij MD, Vries ND, Werkman M, Graaf-Peters VD, Bie RD, Hulzebos E, Sanden RNVD, Dekker J. Development of a framework to describe goals and content of exercise interventions in physical therapy: a mixed method approach including a systematic review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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12
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TRAK ontology: Defining standard care for the rehabilitation of knee conditions. J Biomed Inform 2013; 46:615-25. [DOI: 10.1016/j.jbi.2013.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
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van Langeveld SA, Post MW, van Asbeck FW, ter Horst P, Leenders J, Postma K, Rijken H, Lindeman E. Contents of physical therapy, occupational therapy, and sports therapy sessions for patients with a spinal cord injury in three Dutch rehabilitation centres. Disabil Rehabil 2011; 33:412-22. [DOI: 10.3109/09638288.2010.498548] [Citation(s) in RCA: 19] [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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Lokk J, Salman Roghani R, Delbari A. Effect of methylphenidate and/or levodopa coupled with physiotherapy on functional and motor recovery after stroke--a randomized, double-blind, placebo-controlled trial. Acta Neurol Scand 2011; 123:266-73. [PMID: 20569228 DOI: 10.1111/j.1600-0404.2010.01395.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Amphetamine-like drugs are reported to enhance motor recovery and activities of daily living (ADL) in stroke rehabilitation, but results from trials with humans are inconclusive. This study is aimed at investigating whether levodopa (LD) and/or methylphenidate (MPH) in combination with physiotherapy could improve functional motor recovery and ADL in patients with stroke. MATERIAL AND METHODS A randomized, double-blind, placebo-controlled trial with ischemic stroke patients randomly allocated to one of four treatment groups of either MPH, LD or MPH+LD or placebo combined with physiotherapy was performed. Motor function, ADL, and stroke severity were assessed by Fugl-Meyer (FM), Barthel index (BI), and National Institute of Health Stroke Scale (NIHSS) at baseline, 15, 90, and 180 days respectively. RESULTS All participants showed recovery of motor function and ADL during treatment and at 6-month follow-up. There were slightly but significant differences in BI and NIHSS compared to placebo at the 6-month follow-up. CONCLUSION Ischemic chronic stroke patients having MPH and/or LD in combination with physiotherapy showed a slight ADL and stroke severity improvement over time. Future studies should address the issue of the optimal therapeutic window and dosage of medications to identify those patients who would benefit most.
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Affiliation(s)
- J Lokk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Påhlman U, Gutiérrez-pérez C, Sävborg M, Knopp E, Tarkowski E. Cognitive function and improvement of balance after stroke in elderly people: the Gothenburg Cognitive Stroke Study in the Elderly. Disabil Rehabil 2011; 33:1952-62. [DOI: 10.3109/09638288.2011.553703] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Delbari A, Salman-Roghani R, Lokk J. Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial. Eur Neurol 2011; 66:7-13. [DOI: 10.1159/000329275] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 05/09/2011] [Indexed: 11/19/2022]
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Deutscher D, Horn SD, Smout RJ, DeJong G, Putman K. Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions. Arch Phys Med Rehabil 2010; 91:1722-30. [PMID: 21044717 DOI: 10.1016/j.apmr.2010.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 08/06/2010] [Accepted: 08/09/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess black-white differences in functional outcomes, controlling for patient characteristics, use of nontherapy ancillaries (NTAs), and use of physical (PT) and occupational therapy (OT) activities and interventions. DESIGN Multicenter prospective observational cohort study of poststroke rehabilitation. SETTING Six U.S. inpatient rehabilitation facilities. PARTICIPANTS Patients (N=732) subdivided into case-mix subgroups (CMGs; CMGs 104-107 for moderate strokes [n=397], CMGs 108-114 for severe strokes [n=335]). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Discharge Motor FIM. RESULTS Taking into account patient characteristics, NTAs, and therapy activities, multivariate regressions explained (R(2)) 54% and 69% of variation in outcomes between patients with moderate and severe stroke, respectively. Black race was associated with lower outcomes than white race in the severe group. However, race was no longer associated with outcomes after including interventions used within PT and OT activities. Including interventions within therapy activities increased R(2) to 64% and 74% for moderate and severe strokes, respectively. Some PT and OT activities were provided more to blacks than whites and vice versa. Greater intensity sometimes was associated with better and sometimes with poorer functional outcomes. CONCLUSIONS After controlling for interventions within activities, no racial differences were found in functional outcomes at discharge despite racial differences in rehabilitation care, possibly because each racial group received a mixture of interventions that were negatively and positively associated with outcome. Clinicians should provide therapies associated with better outcomes with high and similar intensities for black and white patients poststroke.
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Affiliation(s)
- Daniel Deutscher
- Physical Therapy Services, Maccabi Healthcare Services-HMO, Tel-Aviv, Israel.
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Horn SD, Deutscher D, Smout RJ, DeJong G, Putman K. Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation. Arch Phys Med Rehabil 2010; 91:1712-21. [PMID: 21044716 DOI: 10.1016/j.apmr.2010.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 04/16/2010] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To describe racial differences in patient characteristics, nontherapy ancillaries, physical therapy (PT), occupational therapy (OT), and functional outcomes at discharge in stroke rehabilitation. DESIGN Multicenter prospective observational cohort study of poststroke rehabilitation. SETTING Six U.S. inpatient rehabilitation facilities. PARTICIPANTS Black and white patients (n=732), subdivided in case-mix subgroups (CMGs): CMGs 104 to 107 for moderate strokes (n=397), and CMGs 108 to 114 for severe strokes (n= 335). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE FIM. RESULTS Significant black-white differences in multiple patient characteristics and intensity of rehabilitation care were identified. White subjects took longer from stroke onset to rehabilitation admission and were more ambulatory prior to stroke. Black subjects had more diabetes. For patients with moderate stroke, black subjects were younger, were more likely to be women, and had more hypertension and obesity with body mass index greater than or equal to 30. For patients with severe stroke, black subjects were less sick and had higher admission FIM scores. White subjects received more minutes a day of OT, although black subjects had significantly longer median PT and OT session duration. No black-white differences in unadjusted stroke rehabilitation outcomes were found. CONCLUSIONS Reasons for differences in rehabilitation care between black and white subjects should be investigated to understand clinicians' choice of treatments by race. However, we did not find black-white differences in unadjusted stroke rehabilitation outcomes.
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Affiliation(s)
- Susan D Horn
- Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT 84102, USA.
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Phillips J, Drummond A, Radford K, Tyerman A. Return to Work after Traumatic Brain Injury: Recording, Measuring and Describing Occupational Therapy Intervention. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12839367526138] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Low post-injury employment rates indicate that returning to work is difficult following traumatic brain injury (TBI). Occupational therapists assist people with TBI to return to work, but rarely is their intervention described. This has hindered research into vocational rehabilitation. As no existing tool was identified for recording intervention, a proforma was developed for this study. Using best practice guidelines and a consensus of expert opinion, 15 categories of the vocational rehabilitation process were identified. Time spent on each category was recorded in 10-minute units after each occupational therapy session. The records of 21 participants who received occupational therapy focused on vocational rehabilitation were analysed. The proforma was quick and simple to use. The analysis showed that assessment, work preparation, employer involvement, education and dealing with issues of immediate concern to participants accounted for almost 85% of face-to-face intervention. It also showed that for every 1 hour of face-to-face contact, an additional 2 hours was required for liaison and travel. This study showed that there is potential for using a proforma for quantifying and describing occupational therapy. This is the basis for further work to enable meaningful comparisons with other services and use in future studies.
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Affiliation(s)
| | | | | | - Andy Tyerman
- Community Head Injury Service, Cambourne Centre, Aylesbury, Buckinghamshire
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Turner-Stokes L, Shaw A, Law J, Rose H. Development and initial validation of the Northwick Park Therapy Dependency Assessment. Clin Rehabil 2009; 23:922-37. [PMID: 19779007 PMCID: PMC2841519 DOI: 10.1177/0269215509337447] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. DESIGN An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores. SETTING A tertiary specialist inpatient neurorehabilitation service. PARTICIPANTS A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts. METHODS The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with 'actual' therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). RESULTS NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70-0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice. CONCLUSION In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, UK.
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Tyson SF, Connell LA, Lennon S, Busse ME. What treatment packages do UK physiotherapists use to treat postural control and mobility problems after stroke? Disabil Rehabil 2009; 31:1494-500. [DOI: 10.1080/09638280802627686] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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A treatment schedule of conventional physical therapy provided to enhance upper limb sensorimotor recovery after stroke: Expert criterion validity and intra-rater reliability. Physiotherapy 2009; 95:110-9. [DOI: 10.1016/j.physio.2008.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/30/2008] [Accepted: 11/26/2008] [Indexed: 11/21/2022]
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Abstract
There are now about 50 randomized controlled trials into rehabilitation packages, physiotherapy or related specific and non-specific techniques in multiple sclerosis (MS). Generally these, and related systematic reviews, report benefits. Particular problems arise, however, with the blinding of assessment, determination of what is the active or beneficial input by the therapist, the use of multiple domains of assessment of quality of life and function without, sometimes, a clear statement of a trial hypothesis or primary outcome and the short-term nature of many studies. Therapy inputs can be broadly broken down into verbal interactions with the patient, physical inputs and referral/recommendation processes. Each may be relevant to the outcome. ‘Response-shift’ may be an important internal mechanism of mind whereby changes in ‘quality of life’ may not always parallel function emphasizing the case for clearly separating quality of life from functional assessment and attempting to make the latter as objective as possible. Trials of such complex interventions will need to randomize specified components of therapy against appropriate placebos or active treatment arms rather than no therapy, which will be ethically harder to sustain. Classification of physiotherapy inputs by type and ‘dosage’, a primary hypothesis under test and attention to concealed allocation of treatment, assessor blinding and intention to treat analysis together with improved measurements of function will assist in the consolidation of the evidence base for physiotherapy as an important component of management for MS patients.
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Affiliation(s)
- CM Wiles
- Department of Neurology, School of Medicine, Cardiff University, UK
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