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Wiebe M, Mackay M, Krishnan R, Tian J, Larsson J, Modanloo S, Job McIntosh C, Sztym M, Elton-Smith G, Rose A, Ho C, Greenshaw A, Cao B, Chan A, Hayward J. Feasibility characteristics of wrist-worn fitness trackers in health status monitoring for post-COVID patients in remote and rural areas. PLOS DIGITAL HEALTH 2024; 3:e0000571. [PMID: 39172978 PMCID: PMC11340956 DOI: 10.1371/journal.pdig.0000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/04/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Common, consumer-grade biosensors mounted on fitness trackers and smartwatches can measure an array of biometrics that have potential utility in post-discharge medical monitoring, especially in remote/rural communities. The feasibility characteristics for wrist-worn biosensors are poorly described for post-COVID conditions and rural populations. METHODS We prospectively recruited patients in rural communities who were enrolled in an at-home rehabilitation program for post-COVID conditions. They were asked to wear a FitBit Charge 2 device and biosensor parameters were analyzed [e.g. heart rate, sleep, and activity]. Electronic patient reported outcome measures [E-PROMS] for mental [bi-weekly] and physical [daily] symptoms were collected using SMS text or email [per patient preference]. Exit surveys and interviews evaluated the patient experience. RESULTS Ten patients were observed for an average of 58 days and half [N = 5] were monitored for 8 weeks or more. Five patients [50%] had been hospitalized with COVID [mean stay = 41 days] and 4 [36%] had required mechanical ventilation. As baseline, patients had moderate to severe levels of anxiety, depression, and stress; fatigue and shortness of breath were the most prevalent physical symptoms. Four patients [40%] already owned a smartwatch. In total, 575 patient days of patient monitoring occurred across 10 patients. Biosensor data was usable for 91.3% of study hours and surveys were completed 82.1% and 78.7% of the time for physical and mental symptoms, respectively. Positive correlations were observed between stress and resting heart rate [r = 0.360, p<0.01], stress and daily steps [r = 0.335, p<0.01], and anxiety and daily steps [r = 0.289, p<0.01]. There was a trend toward negative correlation between sleep time and physical symptom burden [r = -0.211, p = 0.05]. Patients reported an overall positive experience and identified the potential for wearable devices to improve medical safety and access to care. Concerns around data privacy/security were infrequent. CONCLUSIONS We report excellent feasibility characteristics for wrist-worn biosensors and e-PROMS as a possible substrate for multi-modal disease tracking in post-COVID conditions. Adapting consumer-grade wearables for medical use and scalable remote patient monitoring holds great potential.
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Affiliation(s)
- Madeleine Wiebe
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Marnie Mackay
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ragur Krishnan
- Department of Electrical and Computer Engineering, Faculty of Engineering University of Alberta, Edmonton, Canada
| | - Julie Tian
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jakob Larsson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Setayesh Modanloo
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Christiane Job McIntosh
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Melissa Sztym
- Covenant Health Rural Health Services, Edmonton, Canada
| | | | - Alyssa Rose
- Covenant Health Rural Health Services, Edmonton, Canada
| | - Chester Ho
- Glenrose Rehabilitation Hospital, Edmonton, Canada
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Chan
- Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Jake Hayward
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Chouliara N, Cameron T, Ballard-Ridley S, Fisher RJ, Kettlewell J, Kidd L, Luxton L, Pomeroy V, Stockley RC, Thomas S, Gordon AL. Investigating the Implementation of Community-Based Stroke Telerehabilitation in England; A Realist Synthesis Study Protocol. Healthcare (Basel) 2024; 12:1027. [PMID: 38786437 PMCID: PMC11120767 DOI: 10.3390/healthcare12101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient-family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke.
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Affiliation(s)
- Niki Chouliara
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
| | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
| | | | | | - Jade Kettlewell
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
| | - Lisa Kidd
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| | - Leanna Luxton
- Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK;
| | - Valerie Pomeroy
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Rachel C. Stockley
- School of Nursing and Midwifery, University of Central Lancashire, Lancashire PR1 2HE, UK;
| | - Shirley Thomas
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
| | - Adam L. Gordon
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
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Chouliara N, Cameron T, Byrne A, Fisher R. Getting the message across; a realist study of the role of communication and information exchange processes in delivering stroke Early Supported Discharge services in England. PLoS One 2024; 19:e0298140. [PMID: 38457416 PMCID: PMC10923427 DOI: 10.1371/journal.pone.0298140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/17/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Stroke early supported discharge (ESD) involves the co-ordinated transfer of care from hospital to home. The quality of communication processes between professionals delivering ESD and external stakeholders may have a role to play in streamlining this process. We explored how communication and information exchange were achieved and influenced the hospital-to-home transition and the delivery quality of ESD, from healthcare professionals' perspectives. METHODS Six ESD case study sites in England were purposively selected. Under a realist approach, we conducted interviews and focus groups with 117 staff members, including a cross-section of the multidisciplinary team, service managers and commissioners. RESULTS Great variation was observed between services in the type of communication processes they employed and how organised these efforts were. Effective communication between ESD team members and external stakeholders was identified as a key mechanism driving the development of collaborative and trusting relationships and promoting coordinated care transitions. Cross-boundary working arrangements with inpatient services helped clarify the role and remit of ESD, contributing to timely hospital discharge and response from ESD teams. Staff perceived honest and individualised information provision as key to effectively prepare stroke survivors and families for care transitions and promote rehabilitation engagement. In designing and implementing ESD, early stakeholder involvement ensured the services' fit in the local pathway and laid the foundations for communication and partnership working going forward. CONCLUSIONS Findings highlighted the interdependency between services delivering ESD and local stroke care pathways. Maintaining good communication and engagement with key stakeholders may help achieve a streamlined hospital discharge process and timely delivery of ESD. ESD services should actively manage communication processes with external partners. A shared cross-service communication strategy to guide the provision of information along to continuum of stroke care is required. Findings may inform efforts towards the delivery of better coordinated stroke care pathways.
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Affiliation(s)
- Niki Chouliara
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham, United Kingdom
| | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Adrian Byrne
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Clinical Policy Unit, NHS England, Nottingham, United Kingdom
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O Connor E, Dolan E, Horgan F, Galvin R, Robinson K. Healthcare professionals' experiences of delivering a stroke Early Supported Discharge service - An example from Ireland. Clin Rehabil 2024; 38:414-426. [PMID: 38058183 PMCID: PMC10829421 DOI: 10.1177/02692155231217363] [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: 04/03/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To explore healthcare professionals' experiences of the development and delivery of Early Supported Discharge for people after stroke, including experiences of the COVID-19 pandemic. DESIGN Qualitative descriptive study using one-to-one semi-structured interviews. Data were analysed using reflexive thematic analysis. SETTING Nine Early Supported Discharge service sites in Ireland. PARTICIPANTS Purposive sampling identified 16 healthcare professionals. RESULTS Five key themes were identified (1) Un-coordinated development of services, (2) Staff shortages limit the potential of Early Supported Discharge, (3) Limited utilisation of telerehabilitation post COVID-19 pandemic, (4) Families need information and support, and (5) Early Supported Discharge involves collaboration with people after stroke and their families. CONCLUSIONS Findings highlight how Early Supported Discharge services adapted during the COVID-19 pandemic and how gaps in the service impacts on service delivery. Practice implications include the need to address staff recruitment and retention issues to prevent service shortages and ensure consistent access to psychology services. Early Supported Discharge services should continue to work closely with families and address their information and support needs. Future research on how telerehabilitation can optimally be deployed and the impact of therapy assistants in Early Supported Discharge is needed.
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Affiliation(s)
- Elaine O Connor
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Eamon Dolan
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
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Ong PL, Seah JD, Chua KSG. Inpatient Rehabilitation Outcomes after Primary Severe Haemorrhagic Stroke: A Retrospective Study Comparing Surgical versus Non-Surgical Management. Life (Basel) 2023; 13:1766. [PMID: 37629627 PMCID: PMC10455087 DOI: 10.3390/life13081766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Haemorrhagic stroke, accounting for 10-20% of all strokes, often requires decompressive surgery as a life-saving measure for cases with massive oedema and raised intracranial pressure. This study was conducted to compare the demographics, characteristics and rehabilitation profiles of patients with severe haemorrhagic stroke who were managed surgically versus those who were managed non-surgically. METHODS A single-centre retrospective study of electronic medical records was conducted over a 3-year period from 1 January 2018 to 31 December 2020. The inclusion criteria were first haemorrhagic stroke, age of >18 years and an admission Functional Independence Measure (FIM™) score of 18-40 upon admission to the rehabilitation centre. The primary outcome measure was discharge FIM™. Secondary outcome measures included modified Rankin Scale (mRS), rehabilitation length of stay (RLOS) and complication rates. RESULTS A total of 107 patients' records were analysed; 45 (42.1%) received surgical intervention and 62 (57.9%) patients underwent non-surgical management. Surgically managed patients were significantly younger than non-surgical patients, with a mean age of [surgical 53.1 (SD 12) vs. non-surgical 61.6 (SD 12.3), p = 0.001]. Admission FIM was significantly lower in the surgical vs. non-surgical group [23.7 (SD6.7) vs. 26.71 (SD 7.4), p = 0.031). However, discharge FIM was similar between both groups [surgical 53.91 (SD23.0) vs. non-surgical 57.0 (SD23.6), p = 0.625). Similarly, FIM gain (surgical 30.1 (SD 21.1) vs. non-surgical 30.3 (SD 21.1), p = 0.094) and RLOS [surgical 56.2 days (SD 21.5) vs. non-surgical 52.0 days (SD 23.4), p = 0.134) were not significantly different between groups. The majority of patients were discharged home (surgical 73.3% vs. non-surgical 74.2%, p = 0.920) despite a high level of dependency. CONCLUSIONS Our findings suggest that patients with surgically managed haemorrhagic stroke, while older and more dependent on admission to rehabilitation, achieved comparable FIM gains, discharge FIM and discharge home rates after ~8 weeks of rehabilitation. This highlights the importance of rehabilitation, especially for surgically managed haemorrhagic stroke patients.
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Affiliation(s)
- Poo Lee Ong
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore; (J.D.S.); (K.S.G.C.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
| | - Justin Desheng Seah
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore; (J.D.S.); (K.S.G.C.)
| | - Karen Sui Geok Chua
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore; (J.D.S.); (K.S.G.C.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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