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Johnson L, Burridge J, Ewings S, Demain S. A pilot cluster randomised controlled trial, of an IMPlicit learning approach versus standard care, on recovery of mobility following stroke (IMPS). Clin Rehabil 2024:2692155241267205. [PMID: 39105429 DOI: 10.1177/02692155241267205] [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: 08/07/2024]
Abstract
OBJECTIVES To evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting. DESIGN Pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation. SETTING Eight inpatient stroke units, UK. PARTICIPANTS People within 14 days of stroke onset, presenting with lower limb hemiplegia. INTERVENTIONS Participants at control clusters received usual care. Participants at intervention clusters received rehabilitation using an Implicit Learning Approach (ILA); primarily consisting of reduced frequency instructions/feedback, and promotion of an external focus of attention. Video recording was used to understand the ability of intervention site therapists to adhere to the implicit learning principles, and to compare differences between groups. MEASURES Ability to recruit and retain clusters/participants; suitability and acceptability of data collection processes; appropriateness of fidelity monitoring methods; and appropriateness of chosen outcome measures. RESULTS Eight stroke units participated, with four assigned to each group (intervention/control). Fifty-one participants were enrolled (intervention group 21; control group 30). Mean time since stroke was 6 days (SD 3.42; 0-14); mean age was 73 years (SD 14, 25-94). Of those approached to take part, 72% agreed. We found clear differences between groups with respect to the frequency and type of instructional statement. The ILA was acceptable to both patients and therapists. CONCLUSION It is feasible to evaluate the application and effectiveness of motor learning principles within acute stroke rehabilitation, using a cluster randomised design. A larger study is required to evaluate the benefits of each approach; we provide a range of sample size estimates required for this.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Sean Ewings
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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2
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Tishkovskaya SV, Sutton CJ, Thomas LH, Watkins CL. Determining the sample size for a cluster-randomised trial using knowledge elicitation: Bayesian hierarchical modelling of the intracluster correlation coefficient. Clin Trials 2023; 20:293-306. [PMID: 37036110 PMCID: PMC10262340 DOI: 10.1177/17407745231164569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND The intracluster correlation coefficient is a key input parameter for sample size determination in cluster-randomised trials. Sample size is very sensitive to small differences in the intracluster correlation coefficient, so it is vital to have a robust intracluster correlation coefficient estimate. This is often problematic because either a relevant intracluster correlation coefficient estimate is not available or the available estimate is imprecise due to being based on small-scale studies with low numbers of clusters. Misspecification may lead to an underpowered or inefficiently large and potentially unethical trial. METHODS We apply a Bayesian approach to produce an intracluster correlation coefficient estimate and hence propose sample size for a planned cluster-randomised trial of the effectiveness of a systematic voiding programme for post-stroke incontinence. A Bayesian hierarchical model is used to combine intracluster correlation coefficient estimates from other relevant trials making use of the wealth of intracluster correlation coefficient information available in published research. We employ knowledge elicitation process to assess the relevance of each intracluster correlation coefficient estimate to the planned trial setting. The team of expert reviewers assigned relevance weights to each study, and each outcome within the study, hence informing parameters of Bayesian modelling. To measure the performance of experts, agreement and reliability methods were applied. RESULTS The 34 intracluster correlation coefficient estimates extracted from 16 previously published trials were combined in the Bayesian hierarchical model using aggregated relevance weights elicited from the experts. The intracluster correlation coefficients available from external sources were used to construct a posterior distribution of the targeted intracluster correlation coefficient which was summarised as a posterior median with a 95% credible interval informing researchers about the range of plausible sample size values. The estimated intracluster correlation coefficient determined a sample size of between 450 (25 clusters) and 480 (20 clusters), compared to 500-600 from a classical approach. The use of quantiles, and other parameters, from the estimated posterior distribution is illustrated and the impact on sample size described. CONCLUSION Accounting for uncertainty in an unknown intracluster correlation coefficient, trials can be designed with a more robust sample size. The approach presented provides the possibility of incorporating intracluster correlation coefficients from various cluster-randomised trial settings which can differ from the planned study, with the difference being accounted for in the modelling. By using expert knowledge to elicit relevance weights and synthesising the externally available intracluster correlation coefficient estimates, information is used more efficiently than in a classical approach, where the intracluster correlation coefficient estimates tend to be less robust and overly conservative. The intracluster correlation coefficient estimate constructed is likely to produce a smaller sample size on average than the conventional strategy of choosing a conservative intracluster correlation coefficient estimate. This may therefore result in substantial time and resources savings.
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Affiliation(s)
- Svetlana V Tishkovskaya
- Lancashire Clinical Trials Unit, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Chris J Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lois H Thomas
- Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Caroline L Watkins
- Lancashire Clinical Trials Unit, Faculty of Health and Care, University of Central Lancashire, Preston, UK
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3
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Tabaei-Aghdaei Z, McColl-Kennedy JR, Coote LV. Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020. Med Care Res Rev 2023; 80:145-164. [PMID: 35904147 DOI: 10.1177/10775587221113228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.
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Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch Phys Med Rehabil 2019; 100:1515-1533. [DOI: 10.1016/j.apmr.2019.02.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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Smit EB, Bouwstra H, Hertogh CM, Wattel EM, van der Wouden JC. Goal-setting in geriatric rehabilitation: a systematic review and meta-analysis. Clin Rehabil 2018; 33:395-407. [PMID: 30537854 PMCID: PMC6416788 DOI: 10.1177/0269215518818224] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: To explore the effect of goal-setting on physical functioning, quality of
life and duration of rehabilitation in geriatric rehabilitation compared to
care as usual. Data sources: Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from
initiation to October 2018. Methods: We included randomized controlled trials (RCTs), controlled before–after
studies and studies using historic controls of older patients (mean age
⩾55 years) receiving rehabilitation for acquired disabilities. Our primary
outcome was physical functioning; secondary outcomes were quality of life
and rehabilitation duration. Cochrane guidelines were used to assess the
risk of bias of the studies and extract data. Only RCT data were pooled
using standardized mean difference (SMD). Results: We included 14 studies consisting of a total of 1915 participants with a mean
age ranging from 55 to 83 years. Ten out of the 14 studies had a randomized
controlled design, 7 of which could be pooled for the primary outcome. The
risk of bias was judged high in several domains in all included studies. The
meta-analysis showed no statistically significant differences between
goal-setting and care as usual for physical functioning (SMD −0.11 (−0.32 to
0.10)), quality of life (SMD 0.09 (−0.56 to 0.75)) and rehabilitation
duration (MD 13.46 days (−2.46 to 29.38)). Conclusion: We found low-quality evidence that goal-setting does not result in better
physical functioning compared to care as usual in geriatric rehabilitation.
For quality of life and duration of rehabilitation, we could not exclude a
clinically relevant effect.
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Affiliation(s)
- Ewout B Smit
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Hylco Bouwstra
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees Mpm Hertogh
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Elizabeth M Wattel
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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6
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Cheng WLS. The effects of mutual goal-setting practice in older adults with chronic illness. Geriatr Nurs 2017; 39:143-150. [PMID: 28826976 DOI: 10.1016/j.gerinurse.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/15/2017] [Accepted: 07/24/2017] [Indexed: 11/17/2022]
Abstract
Goal setting is a strategy that can enhance performance. The purpose of this study was to examine how engaging older adults with chronic illness in setting goals for their care would affect their performance in achieving those goals. This study employed a quasi-experimental design with repeated measures to evaluate the effect of an intervention, namely mutual goal-setting (MGS) practice, on elderly patients with chronic illness. Eighty such patients receiving nursing care at home were recruited for the study. Repeated measures showed that the intervention group achieved a higher percentage of their goals, though insignificant group and time interaction effects between groups were found in perceived functional disability, perceived functional health and self-efficacy in self-managing chronic illness. The findings of this study with a specific group, namely elderly patients with chronic illness, support the general premise that patients who participate in determining their care are more likely to improve in physical and mental well-being.
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Wray F, Clarke D, Forster A. Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia. Disabil Rehabil 2017; 40:1237-1251. [DOI: 10.1080/09638288.2017.1294206] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Faye Wray
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK
| | - David Clarke
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK
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8
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Yang SY, Lin CY, Lee YC, Chang JH. The Canadian occupational performance measure for patients with stroke: a systematic review. J Phys Ther Sci 2017; 29:548-555. [PMID: 28356652 PMCID: PMC5361031 DOI: 10.1589/jpts.29.548] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated whether the Canadian Occupational Performance Measure is a suitable outcome measure for assessing patients with stroke in research and clinical settings. [Subjects and Methods] The study included into two parts: (1) an investigation of the reliability and validity of the Canadian Occupational Performance Measure for patients with stroke and (2) an exploration of Canadian Occupational Performance Measure results in randomized controlled trials of patients with stroke. For this review, the study searched the MEDLINE, PubMed, and CINAHL Plus with Full Text databases for articles published before September 2015. [Results] Finally, three eligible articles were collected in part 1, and ten randomized controlled trials studies were collected in part 2. The findings of part 1 revealed that the Canadian Occupational Performance Measure had efficient test-retest reliability, however, the Canadian Occupational Performance Measure revealed weak associations with other assessment tools such as Barthel Index used for patients with stroke. Six of the randomized controlled trials studies used the Canadian Occupational Performance Measure as a primary outcome and two as a secondary outcome, while the other two as a goal-setting instrument. [Conclusion] This review indicates that the Canadian Occupational Performance Measure is appropriate for clinicians, including physiotherapists, in assessing outcome for patients with stroke. The Canadian Occupational Performance Measure can assist patients in identifying their outcome performance and provide therapists with directions on interventions.
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Affiliation(s)
- Shang-Yu Yang
- Department of Occupational Therapy, Shu Zen Junior College
of Medicine and Management, Taiwan
- Institute of Allied Health Science, College of Medicine,
National Cheng Kung University: No.1 University Road, Tainan City 701, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health
and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and
Health Science, Asia University, Taiwan
| | - Jer-Hao Chang
- Institute of Allied Health Science, College of Medicine,
National Cheng Kung University: No.1 University Road, Tainan City 701, Taiwan
- Department of Occupational Therapy, College of Medicine,
National Cheng Kung University, Taiwan
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Tokolahi E, Hocking C, Kersten P, Vandal AC. Quality and Reporting of Cluster Randomized Controlled Trials Evaluating Occupational Therapy Interventions: A Systematic Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2015; 36:14-24. [PMID: 27504689 PMCID: PMC4766971 DOI: 10.1177/1539449215618625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Growing use of cluster randomized control trials (RCTs) in health care research requires careful attention to study designs, with implications for the development of an evidence base for practice. The objective of this study is to investigate the characteristics, quality, and reporting of cluster RCTs evaluating occupational therapy interventions to inform future research design. An extensive search of cluster RCTs evaluating occupational therapy was conducted in several databases. Fourteen studies met our inclusion criteria; four were protocols. Eleven (79%) justified the use of a cluster RCT and accounted for clustering in the sample size and analysis. All full studies reported the number of clusters randomized, and five reported intercluster correlation coefficients (50%): Protocols had higher compliance. Risk of bias was most evident in unblinding of participants. Statistician involvement was associated with improved trial quality and reporting. Quality of cluster RCTs of occupational therapy interventions is comparable with those from other areas of health research and needs improvement.
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Affiliation(s)
| | | | | | - Alain C Vandal
- Auckland University of Technology, New Zealand Health Intelligence & Informatics, Ko Awatea, Auckland, New Zealand
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10
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Park MG, Ha Y. [Effectiveness of a self-management program using goal setting based on a G-AP for patients after a stroke]. J Korean Acad Nurs 2015; 44:581-91. [PMID: 25381789 DOI: 10.4040/jkan.2014.44.5.581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to develop a self-management program using goal setting for patients after a stroke. The program was based on a theory-based Goal setting and Action Planning framework (G-AP), and the effectiveness of the program was examined. METHODS A non-equivalent control group pretest-posttest design was used. The experimental group (n=30) received the self-management program using goal setting based on the G-AP over 7 weeks. The education was delivered individually with a specifically designed stroke workbook. The control group (n=30) received only patient information leaflets about stroke. RESULTS There were significant differences between the two groups. Stroke knowledge, self-efficacy, and health behavior compliance were significantly higher (all p<.001), and hospital anxiety (p<.001) and depression (p<.001) were significantly lower in the experimental group compared to the control group. CONCLUSION This self-management program using goal setting based on a G-AP was found to be useful and beneficial for patients in stroke rehabilitation settings.
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Affiliation(s)
| | - Yeongmi Ha
- College of Nursing; Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.
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Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: A systematic scoping review. Brain Inj 2015; 29:1515-29. [DOI: 10.3109/02699052.2015.1075152] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Levack WMM, Weatherall M, Hay‐Smith EJC, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev 2015; 2015:CD009727. [PMID: 26189709 PMCID: PMC8941379 DOI: 10.1002/14651858.cd009727.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation. OBJECTIVES To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability. DATA COLLECTION AND ANALYSIS Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information. MAIN RESULTS We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation. AUTHORS' CONCLUSIONS There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.
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Affiliation(s)
- William MM Levack
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Mark Weatherall
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - E. Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Sarah G Dean
- University of ExeterUniversity of Exeter Medical SchoolVeysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
| | - Kathryn McPherson
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
| | - Richard J Siegert
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
- Auckland University of TechnologySchool of Public Health and Psychosocial StudiesAucklandNew Zealand
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Eldridge SM, Costelloe CE, Kahan BC, Lancaster GA, Kerry SM. How big should the pilot study for my cluster randomised trial be? Stat Methods Med Res 2015; 25:1039-56. [PMID: 26071431 DOI: 10.1177/0962280215588242] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is currently a lot of interest in pilot studies conducted in preparation for randomised controlled trials. This paper focuses on sample size requirements for external pilot studies for cluster randomised trials. We consider how large an external pilot study needs to be to assess key parameters for input to the main trial sample size calculation when the primary outcome is continuous, and to estimate rates, for example recruitment rates, with reasonable precision. We used simulation to provide the distribution of the expected number of clusters for the main trial under different assumptions about the natural cluster size, intra-cluster correlation, eventual cluster size in the main trial, and various decisions made at the piloting stage. We chose intra-cluster correlation values and pilot study size to reflect those commonly reported in the literature. Our results show that estimates of sample size required for the main trial are likely to be biased downwards and very imprecise unless the pilot study includes large numbers of clusters and individual participants. We conclude that pilot studies will usually be too small to estimate parameters required for estimating a sample size for a main cluster randomised trial (e.g. the intra-cluster correlation coefficient) with sufficient precision and too small to provide reliable estimates of rates for process measures such as recruitment or follow-up rates.
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Affiliation(s)
- Sandra M Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Ceire E Costelloe
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Gillian A Lancaster
- Postgraduate Statistics Centre, Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK
| | - Sally M Kerry
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Scobbie L, Duncan EA, Brady MC, Wyke S. Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey. Disabil Rehabil 2014; 37:1291-8. [PMID: 25243765 DOI: 10.3109/09638288.2014.961652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. METHODS We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. RESULTS Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. CONCLUSIONS Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.
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Affiliation(s)
- Lesley Scobbie
- Nursing, Midwifery and Allied Health Profession (NMAHP) Research Unit, University of Stirling , Stirling, Scotland , UK
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Brown M, Levack W, McPherson KM, Dean SG, Reed K, Weatherall M, Taylor WJ. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2013; 36:1020-6. [DOI: 10.3109/09638288.2013.825653] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Koerner M, Wirtz M, Michaelis M, Ehrhardt H, Steger AK, Zerpies E, Bengel J. A multicentre cluster-randomized controlled study to evaluate a train-the-trainer programme for implementing internal and external participation in medical rehabilitation. Clin Rehabil 2013; 28:20-35. [PMID: 23858525 DOI: 10.1177/0269215513494874] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Evaluation of the effect of the train-the-trainer programme 'Fit for Shared Decision-Making' on internal (team) and external (patient) participation in medical rehabilitation from a patient and staff perspective. DESIGN A multicentre, cluster-randomized controlled study. SETTING Eleven medical rehabilitation clinics, divided into intervention and control groups. SUBJECTS A staff and a patient survey were conducted pre- and post-intervention, plus a further patient survey six months later. INTERVENTION Train-the-trainer programme 'Fit for Shared Decision-Making' for interprofessional settings. MAIN MEASURES Each survey measured internal participation with a self-compiled six-item scale (Internal Participation Scale, IPS), and external participation by means of a nine-item Shared Decision-Making Questionnaire (SDM-Q-9) for the patients and for healthcare professionals. RESULTS Patient samples numbered 402 for the pre-, 463 for the post-intervention data collection period and 461 six months after the intervention. Patients' appraisal of external participation (Fperiod x group (2) = 0.256, p=0.774, η(2)=0.000) showed no change, whereas internal participation (Fperiod x group (2) = 3.785, p=0.023, η(2)=0.007) showed a significant increase. A total of 195 healthcare professionals participated in the pre- and 168 in the post-intervention staff survey. Here external participation was significantly enhanced in the intervention group (F(period x group) (1) = 4.893, p=0.028, η(2)=0.014). CONCLUSIONS The train-the-trainer approach can be recommended for implementing internal and external participation in interprofessional settings such as medical rehabilitation clinics. However, there is a need for more intensive staff training for internal participation and an additional intervention for patients to achieve success in all aspects.
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Affiliation(s)
- Mirjam Koerner
- 1Department of Medical Psychology and Medical Sociology, University Freiburg, Freiburg, Germany
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Current World Literature. Curr Opin Support Palliat Care 2013; 7:116-28. [DOI: 10.1097/spc.0b013e32835e749d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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