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Kilkenny MF, Olaiya MT, Cameron J, Lannin NA, Andrew NE, Thrift AG, Hackett M, Kneebone I, Drummond A, Thijs V, Brancatisano O, Kim J, Reyneke M, Hancock S, Allan L, Ellery F, Cloud G, Grimley RS, Middleton S, Cadilhac DA. Statistical analysis plan for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke randomised controlled clinical trial. Trials 2024; 25:78. [PMID: 38263172 PMCID: PMC10804563 DOI: 10.1186/s13063-023-07864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Unplanned hospital presentations may occur post-stroke due to inadequate preparation for transitioning from hospital to home. The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial was designed to test the effectiveness of receiving a 12-week, self-management intervention, comprising personalised goal setting with a clinician and aligned educational/motivational electronic messages. Primary outcome is as follows: self-reported unplanned hospital presentations (emergency department/admission) within 90-day post-randomisation. We present the statistical analysis plan for this trial. METHODS/DESIGN Participants are randomised 1:1 in variable block sizes, with stratification balancing by age and level of baseline disability. The sample size was 890 participants, calculated to detect a 10% absolute reduction in the proportion of participants reporting unplanned hospital presentations/admissions, with 80% power and 5% significance level (two sided). Recruitment will end in December 2023 when funding is expended, and the sample size achieved will be used. Logistic regression, adjusted for the stratification variables, will be used to determine the effectiveness of the intervention on the primary outcome. Secondary outcomes will be evaluated using appropriate regression models. The primary outcome analysis will be based on intention to treat. A p-value ≤ 0.05 will indicate statistical significance. An independent Data Safety and Monitoring Committee has routinely reviewed the progress and safety of the trial. CONCLUSIONS This statistical analysis plan ensures transparency in reporting the trial outcomes. ReCAPS trial will provide novel evidence on the effectiveness of a digital health support package post-stroke. TRIAL REGISTRATION ClinicalTrials.gov ACTRN12618001468213. Registered on August 31, 2018. SAP version 1.13 (October 12 2023) Protocol version 1.12 (October 12, 2022) SAP revisions Nil.
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Affiliation(s)
- Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Janette Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Nadine E Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
- National Centre for Healthy Ageing, Monash University, Frankston, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Maree Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Kneebone
- Graduate School of Health, Faculty of Health, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Vincent Thijs
- Department of Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Brancatisano
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Megan Reyneke
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Shaun Hancock
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Liam Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Fiona Ellery
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Geoffrey Cloud
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Australia
- Stroke Services, Alfred Health, Melbourne, Australia
| | - Rohan S Grimley
- School of Medicine and Dentistry, Griffith University, Birtinya, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney and Australian Catholic University, Sydney, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
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2
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Allan LP, Beilei L, Cameron J, Olaiya MT, Silvera-Tawil D, Adcock AK, English C, Gall SL, Cadilhac DA. A Scoping Review of mHealth Interventions for Secondary Prevention of Stroke: Implications for Policy and Practice. Stroke 2023; 54:2935-2945. [PMID: 37800373 DOI: 10.1161/strokeaha.123.043794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Secondary prevention is a major priority for those living with stroke and may be improved through the use of mobile Health (mHealth) interventions. While evidence for the effectiveness of mHealth interventions for secondary prevention of stroke is growing, little attention has been given to the translation of these interventions into real-world use. In this review, we aimed to provide an update on the effectiveness of mHealth interventions for secondary prevention of stroke, and investigate their translation into real-world use. Four electronic databases and the gray literature were searched for randomized controlled trials of mHealth interventions for secondary prevention of stroke published between 2010 and 2023. Qualitative and mixed-methods evaluations of the trials were also included. Data were extracted regarding study design, population, mHealth technology involved, the intervention, and outcomes. Principal researchers from these trials were also contacted to obtain further translational information. From 1151 records, 13 randomized controlled trials and 4 evaluations were identified; sample sizes varied widely (median, 56; range, 24-4298). Short message service messages (9/13) and smartphone applications (6/13) were the main technologies used to deliver interventions. Primary outcomes of feasibility of the intervention were achieved in 4 trials, and primary outcomes of changes in risk factors, lifestyle behaviors, and adherence to medication improved in 6 trials. Only 1 trial had a hard end point (ie, stroke recurrence) as a primary outcome, and no significant differences were observed between groups. There was evidence for only 1 intervention being successfully translated into real-world use. Further evidence is required on the clinical effectiveness of mHealth interventions for preventing recurrent stroke, and the associated delivery costs and cost-effectiveness, before adoption into real-world settings.
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Affiliation(s)
- Liam P Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Lin Beilei
- The Nursing and Health School, Zhengzhou University, Henan, China (L.B.)
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian Centre for Heart Health, Royal Melbourne Hospital, Victoria, Australia (J.C.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
| | - David Silvera-Tawil
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Amelia K Adcock
- Cerebrovascular Division, Department of Neurology, West Virginia University, Morgantown (A.K.A.)
| | - Coralie English
- School of Health Sciences, University of Newcastle, New South Wales, Australia (C.E.)
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New South Wales, Australia (C.E.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.L.G.)
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia (S.L.G.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (D.A.C.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
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3
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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Cameron J, Lannin NA, Harris D, Andrew NE, Kilkenny MF, Purvis T, Thrift AG, Thayabaranathan T, Ellery F, Sookram G, Hackett M, Kneebone I, Drummond A, Cadilhac DA. A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention. Pilot Feasibility Stud 2022; 8:241. [PMCID: PMC9675218 DOI: 10.1186/s40814-022-01197-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-7237
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Affiliation(s)
- Janette Cameron
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Natasha A. Lannin
- grid.1002.30000 0004 1936 7857Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia ,grid.267362.40000 0004 0432 5259Alfred Health, Melbourne, Australia
| | - Dawn Harris
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Nadine E. Andrew
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.1002.30000 0004 1936 7857Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
| | - Monique F. Kilkenny
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Tara Purvis
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Amanda G. Thrift
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Tharshanah Thayabaranathan
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Fiona Ellery
- grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Garveeta Sookram
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Maree Hackett
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Kneebone
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Avril Drummond
- grid.4563.40000 0004 1936 8868Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Dominique A. Cadilhac
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
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Purvis T, Busingye D, Andrew NE, Kilkenny MF, Thrift AG, Li JC, Cameron J, Thijs V, Hackett ML, Kneebone I, Lannin NA, Cadilhac DA. Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self-management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE). Health Expect 2022; 25:2570-2581. [PMID: 35999689 PMCID: PMC9615081 DOI: 10.1111/hex.13584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/24/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Methods Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Results Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting: The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention): Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a ‘reminder’ to act. Overall trial satisfaction: Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. Conclusion The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Patient or Public Contribution Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design.
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Affiliation(s)
- Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Doreen Busingye
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Population Health, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,National Centre for Healthy Ageing, Monash University, Melbourne, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jonathan C Li
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Australian Centre for Heart Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Allied Health Directorate, Alfred Health, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
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Understanding of medications and associations with adherence, unmet needs, and perceived control of risk factors at two years post-stroke. Res Social Adm Pharm 2022; 18:3542-3549. [DOI: 10.1016/j.sapharm.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022]
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Barnden R, Cadilhac DA, Lannin NA, Kneebone I, Hersh D, Godecke E, Stolwyk R, Purvis T, Nicks R, Farquhar M, Gleeson S, Gore C, Herrmann K, Andrew NE. Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke. PEC INNOVATION 2021; 1:100008. [PMCID: PMC10194112 DOI: 10.1016/j.pecinn.2021.100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 06/17/2023]
Abstract
Objective Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units. Methods A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians' perspectives captured using semi-structured focus groups post-testing. Results The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time. Conclusion The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke. Innovation We developed an innovative approach to support structured person-centred goal setting in clinical and research settings.
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Affiliation(s)
- Rebecca Barnden
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Natasha A. Lannin
- School of Allied Health, Health Sciences Building 1, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
- Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ian Kneebone
- Graduate School of Health, Building 20, University of Technology Sydney, 100 Broadway, Ultimo, NSW 2007, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Rene Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Rd, Clayton, VIC 3800, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Rebecca Nicks
- Occupational Therapy Department, Eastern Health, 5 Arnold St, Box Hill, Melbourne, VIC 3128, Australia
| | | | - Stephanie Gleeson
- Occupational Therapy Department, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Carol Gore
- Subacute Care Services, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Kelsie Herrmann
- Lung Foundation Australia, 11 Finchley St, Milton, QLD 4064, Australia
| | - Nadine E. Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
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