1
|
Ashford SA, Morris G, Smith MJ. Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework. Arch Rehabil Res Clin Transl 2023; 5:100299. [PMID: 38163024 PMCID: PMC10757174 DOI: 10.1016/j.arrct.2023.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity. Design Delphi study. Setting International, web-based survey. Participants A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15). Interventions In round 1, open-ended questions were posed relating to potential scope of practice for 'ultrasound imaging in spasticity management'; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated. Outcome measures 5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above. Results Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated. Conclusion Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.
Collapse
Affiliation(s)
- Stephen A. Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University healthcare NHS Trust & Department of Palliative Care, King's College London, London, England
| | - Gary Morris
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
- Hywel Dda University Health Board, Carmarthen, Wales
| | - Michael J. Smith
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
| |
Collapse
|
2
|
Crowe CS, Pino PA, Rhee PC. Expert consensus on the surgical evaluation and management of upper extremity spasticity in adults. J Hand Surg Eur Vol 2023; 48:986-997. [PMID: 37717178 DOI: 10.1177/17531934231192843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
In the last decade there has been incredible interest and advancement in the surgical care of adult patients with upper motor neuron (UMN) injuries. Spasticity represents a prevalent and debilitating feature of UMN syndrome, which can result from cerebral palsy, spinal cord injury, cerebrovascular accident and traumatic or anoxic brain injury. While several diagnostic tools and management strategies have been described for upper limb spasticity, evidence-based practice guidelines do not currently exist due to low patient volume and a paucity of surgeons routinely performing surgeries in UMN syndrome patients. As such, expert consensus may help provide guidance for patients, therapists and clinicians alike. In this article an expert panel was assembled, and the Delphi method was utilized to present diagnostic considerations, define operative indications, discuss surgical treatment modalities and encourage a standard set of outcome measures for patients with upper extremity spasticity.
Collapse
Affiliation(s)
- Christopher S Crowe
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA
| | - Paula A Pino
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA
| | - Peter C Rhee
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
3
|
Chan NH, Ng SSM. Psychometric properties of the Chinese version of the Arm Activity Measure in people with chronic stroke. Front Neurol 2023; 14:1248589. [PMID: 37808490 PMCID: PMC10556664 DOI: 10.3389/fneur.2023.1248589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The Arm Activity Measure was developed to assess active and passive functions of the upper limb in people with unilateral paresis, but a Chinese version is not available and its psychometric properties have not been specifically tested in people with stroke. This study aimed to translate and culturally adapt the Chinese version of the Arm Activity Measure (ArmA-C) and establish its psychometric properties in people with chronic stroke. Methods The psychometric properties of ArmA-C were determined in 100 people with chronic stroke. Results The ArmA-C had good test-retest reliability (intraclass correlation coefficients [ICC] = 0.87-0.93; quadratic weighted Kappa coefficients = 0.53-1.00). A floor effect was identified in section A of the ArmA-C. The content validity and internal consistency (Cronbach's alpha coefficients = 0.75-0.95) were good. The construct validity of the ArmA-C was supported by acceptable fit to the two-factor structure model and significant correlations with the Fugl-Meyer Assessment for Upper Extremity score, grip strength, the Wolf Motor Function Test score, the Trail Walking Test completion time, and the Oxford Participation and Activities Questionnaire scores. Conclusions The ArmA-C is reliable and valid for assessing active and passive functions in people with chronic stroke.
Collapse
Affiliation(s)
- Nga Huen Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
4
|
Germanova K, Panidi K, Ivanov T, Novikov P, Ivanova GE, Villringer A, Nikulin VV, Nazarova M. Motor Decision-Making as a Common Denominator in Motor Pathology and a Possible Rehabilitation Target. Neurorehabil Neural Repair 2023; 37:577-586. [PMID: 37476957 DOI: 10.1177/15459683231186986] [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: 07/22/2023]
Abstract
Despite the substantial progress in motor rehabilitation, patient involvement and motivation remain major challenges. They are typically addressed with communicational and environmental strategies, as well as with improved goal-setting procedures. Here we suggest a new research direction and framework involving Neuroeconomics principles to investigate the role of Motor Decision-Making (MDM) parameters in motivational component and motor performance in rehabilitation. We argue that investigating NE principles could bring new approaches aimed at increasing active patient engagement in the rehabilitation process by introducing more movement choice, and adapting existing goal-setting procedures. We discuss possible MDM implementation strategies and illustrate possible research directions using examples of stroke and psychiatric disorders.
Collapse
Affiliation(s)
- K Germanova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
- Laboratory of the neurovisceral integration and neuromodulation, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - K Panidi
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
| | - T Ivanov
- FSBI "Federal Center for Brain and Neurotechnologies" of FMBA of Russian Federation, Moscow, Russia
| | - P Novikov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
| | - G E Ivanova
- FSBI "Federal Center for Brain and Neurotechnologies" of FMBA of Russian Federation, Moscow, Russia
| | - A Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - V V Nikulin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - M Nazarova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
5
|
Villepinte C, Cormier C, Couderc M, Lebely C, Chih H, de Boissezon X, Ranka J, Gasq D. Task and ecologically based assessment of upper-limb passive function before and after botulinum injections in adults with stroke using the Upper-Limb Performance Assessment: French cross-cultural adaptation and feasibility pilot study. Disabil Rehabil 2023; 45:1087-1096. [PMID: 35701095 DOI: 10.1080/09638288.2022.2055164] [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: 11/03/2022]
Abstract
PURPOSE To test feasibility of a French translation and cross-cultural adaptation of the Upper-Limb Performance Assessment (ULPA) for task and ecologically based assessment of individualized passive function of upper-limb (UL) performance in adults treated with botulinum toxin-A. MATERIALS AND METHODS A case series with seven adults with stroke (29-74 years) for spastic hypertonia management with passive use objectives (hygiene or positioning) established through Goal Attainment Scaling (GAS). Scores on ULPA Task Performance Mastery (TPM) were obtained through clinical and home-based performances before and after treatment. RESULTS Time administration per task ranged from 5-10 min. Median (range) ULPA, Task Performance Mastery (ULPA-TPM) scores pre-intervention of 58 mastery (35-71) improved to 75 (58-88). Tau-U demonstrated significant large effect sizes (≥.65) for five participants. Complementary measures demonstrated improvement of passive performance for five participants and improvements in GAS for six participants. Testing indicates excellent intra-rater (ICC = 0.90) and moderate inter-rater (ICC = 0.64) reliability, with SDC of 10.16 and 18.23%, respectively. CONCLUSIONS French use of ULPA is a promising standardized, objective and ecologically based assessment of passive performance in adults with stroke. Preliminary findings after TCCA support feasibility for measurement of individualized goals for UL passive use. Future studies may explore other tasks and environments. Implications for rehabilitationULPA is a performance-based, criterion-referenced and ecological measure of individualized goals based on task-analysis of upper-limb (UL) performance in real-life situations providing an interest for individualized assessment of activity and participation.The measure provides a standardized and quantitative approach, applicable to passive use of UL across environments, promoting ecological validity of assessment.Preliminary data will support clinical interpretation of change before and after botulinum injections of UL passive performance.Access to a transculturally validated French version of ULPA complements standardized assessment of UL impairment, perceived performance and goal attainment.
Collapse
Affiliation(s)
- Claire Villepinte
- ToNIC, NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- School of Occupational Therapy, PREFMS, University Hospital of Toulouse, Toulouse, France
| | - Camille Cormier
- ToNIC, NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France
| | - Mathilde Couderc
- Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France
| | - Claire Lebely
- ToNIC, NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- Department of Physical Medicine and Rehabilitation, University Hospital of Toulouse, Toulouse, France
| | - HuiJun Chih
- School of Public Health Sciences, Curtin University, Perth, Australia
| | - Xavier de Boissezon
- ToNIC, NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- Department of Physical Medicine and Rehabilitation, University Hospital of Toulouse, Toulouse, France
| | - Judy Ranka
- Occupational Performance Network, Sydney, Australia
- School of Occupational Therapy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Gasq
- ToNIC, NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France
| |
Collapse
|
6
|
Hayden CD, Murphy BP, Hardiman O, Murray D. Measurement of upper limb function in ALS: a structure review of current methods and future directions. J Neurol 2022; 269:4089-4101. [PMID: 35612658 PMCID: PMC9293830 DOI: 10.1007/s00415-022-11179-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Measurement of upper limb function is critical for tracking clinical severity in amyotrophic lateral sclerosis (ALS). The Amyotrophic Lateral Sclerosis Rating Scale-revised (ALSFRS-r) is the primary outcome measure utilised in clinical trials and research in ALS. This scale is limited by floor and ceiling effects within subscales, such that clinically meaningful changes for subjects are often missed, impacting upon the evaluation of new drugs and treatments. Technology has the potential to provide sensitive, objective outcome measurement. This paper is a structured review of current methods and future trends in the measurement of upper limb function with a particular focus on ALS. Technologies that have the potential to radically change the upper limb measurement field and explore the limitations of current technological sensors and solutions in terms of costs and user suitability are discussed. The field is expanding but there remains an unmet need for simple, sensitive and clinically meaningful tests of upper limb function in ALS along with identifying consensus on the direction technology must take to meet this need.
Collapse
Affiliation(s)
- C D Hayden
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse St, Dublin 2, D02 R590, Ireland.
| | - B P Murphy
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, Dublin 2, Ireland
| | - O Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse St, Dublin 2, D02 R590, Ireland.,Neurocent Directorate, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - D Murray
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse St, Dublin 2, D02 R590, Ireland.,Neurocent Directorate, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| |
Collapse
|
7
|
Bavikatte G, Subramanian G, Ashford S, Allison R, Hicklin D. Early Identification, Intervention and Management of Post-stroke Spasticity: Expert Consensus Recommendations. J Cent Nerv Syst Dis 2021; 13:11795735211036576. [PMID: 34566442 PMCID: PMC8461119 DOI: 10.1177/11795735211036576] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/27/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke patients with spasticity usually require long-lasting care and interventions but frequently report that outpatient and community treatment is limited, reflecting a significant unmet need in health and social care provision. Rehabilitation and spasticity management services are essential for patient recovery, with improvements in both activity and participation reducing the burden on patients, family and society. Current clinical guidance provides scope for improvements in both post-stroke management and spasticity prevention. However, access to specialist services can be limited and the patient journey does not always match national recommendations. Identification of spasticity and its predictors and lack of subsequent referral to rehabilitation or specialist spasticity services are key issues in the management of post-stroke spasticity. Implementation of a traffic light classification system prioritises patients at an increased risk of spasticity and promotes early and consistent management across the spectrum of primary and secondary care. The proposed system is based on clinical evidence, expert consensus and recent clinical guidelines. It provides simple and straightforward criteria for management, multidisciplinary consultation and referral to specialist spasticity services, with patients allocated by monitoring requirements and a low (green/periodic monitoring), medium (amber/routine referral) or high risk (red/urgent referral) of spasticity.
Collapse
Affiliation(s)
- Ganesh Bavikatte
- Neuro-Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ganesh Subramanian
- Department of Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust; King’s College London & Centre for Nursing Midwifery and Allied Health Research, University College London Hospitals/University College London, London, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torbay, Devon, UK
| | | |
Collapse
|
8
|
Ramström T, Bunketorp-Käll L, Wangdell J. Arm activity measure (ArmA): psychometric evaluation of the Swedish version. J Patient Rep Outcomes 2021; 5:39. [PMID: 33982227 PMCID: PMC8116475 DOI: 10.1186/s41687-021-00310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patient Reported Outcomes Measure (PROM) are commonly used in research and essential to understand the patient experience when receiving treatment. Arm Activity Measure (ArmA) is a valid and reliable self-report questionnaire for assessing passive (section A) and active (section B) real-life arm function in patients with disabling spasticity. The original English version of ArmA has been psychometrically tested and translated into Thai. Aims Translate and cross-culturally adapt ArmA to Swedish language and context. Further, to evaluate the reliability, validity and sensitivity of the Swedish version of the questionnaire (ArmA-S) in patients with disabling upper limb spasticity caused by injuries to the central nervous system (CNS). Materials and methods ArmA was translated and cross-culturally adapted according to established guidelines. Validity and reliability were evaluated in 61 patients with disabling spasticity. Face and content validity was evaluated by expert opinions from clinicians and feedback from patients with upper limb spasticity. Internal consistency reliability was assessed with Cronbach’s alpha and test-retest reliability was assessed using the quadratic weighted kappa. Results ArmA-S was shown to be clinically feasible, with good face and content validity and no floor or ceiling effects. Internal consistency of ArmA-S was high and equivalent to ArmA; with Chronbach´s alpha coefficients values of 0.94 and 0.93 for section A and B, respectively. Test-retest reliability was good, with kappa values of 0.86 and 0.83 for section A and B, respectively. Some layout modifications of ArmA-S were made to further increase the user-friendliness, test-retest reliability, and responsiveness. Conclusion ArmA-S was shown to be a reliable and valid self-report questionnaire for use in clinical practice and research to assess improvements in passive and active upper limb function in patients with disabling spasticity. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00310-4.
Collapse
Affiliation(s)
- Therese Ramström
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, House U1, Level 6, SE-431 80, Mölndal, Sweden. .,Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lina Bunketorp-Käll
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, House U1, Level 6, SE-431 80, Mölndal, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johanna Wangdell
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, House U1, Level 6, SE-431 80, Mölndal, Sweden.,Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
9
|
Buntragulpoontawee M, Khunachiva J, Euawongyarti P, Wongpakaran N, Wongpakaran T, Kaewma A, Ashford S. Investigating psychometric properties of the arm activity measure - Thai version (ArmA-TH) sub-scales using the Rasch model. BMC Med Res Methodol 2021; 21:46. [PMID: 33750313 PMCID: PMC7944894 DOI: 10.1186/s12874-021-01238-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the ArmA-TH sub-scale measurement properties based on item response theory using the Rasch model. METHODS Patients with upper limb hemiplegia resulting from cerebrovascular and other brain disorders were asked to complete the ArmA-TH questionnaire. Rasch analysis was performed to test how well the ArmA-TH passive and active function sub-scales fit the Rasch model by investigating unidimensionality, response category functioning, reliability of person and item, and differential item functioning (DIF) for age, sex, and education. RESULTS Participants had stroke or other acquired brain injury (n = 185), and the majority were men (126, 68.1 %), with a mean age of 55 (SD 22). Most patients (91, 49.2 %) had graduated from elementary/primary school. For the ArmA-TH passive function scale, all items had acceptable fit statistics. The scale's unidimensionality and local independence were supported. The reliability was acceptable. A disordered threshold was found for five items, and none indicated DIF. For the ArmA-TH active function scale, one item was misfit and three were locally dependent. The reliability was good. No items showed DIF. All items had disordered thresholds, and the data fitted the Rasch model better after rescoring. CONCLUSIONS Both sub-scales of ArmA-TH fitted the Rasch model and were valid and reliable. The disordered thresholds should be further investigated.
Collapse
Affiliation(s)
- Montana Buntragulpoontawee
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, 50200, Chiang Mai, Thailand.
| | - Jeeranan Khunachiva
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, 50200, Chiang Mai, Thailand
| | - Patreeya Euawongyarti
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, 50200, Chiang Mai, Thailand
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai, 50200, Chiang Mai, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai, 50200, Chiang Mai, Thailand.
| | - Atcharee Kaewma
- Department of Rehabilitation Medicine, Nakornping Hospital, Chiang Mai, Thailand
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, London, UK.,Centre for Nursing, Midwifery and Allied Health Research, University College London Hospitals, University College London, London, UK.,Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| |
Collapse
|
10
|
Pike S, Cusick A, Wales K, Cameron L, Turner-Stokes L, Ashford S, Lannin NA. Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation-A systematic review. PLoS One 2021; 16:e0246288. [PMID: 33571238 PMCID: PMC7877653 DOI: 10.1371/journal.pone.0246288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. METHODS 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. RESULTS 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). CONCLUSIONS The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013190.
Collapse
Affiliation(s)
- Shannon Pike
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
- Wagga Wagga Ambulatory Rehabilitation Service, Murrumbidgee Local Health District, Wagga Wagga, New South Wales, Australia
| | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kylie Wales
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | | | - Lynne Turner-Stokes
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, United Kingdom
- King’s College London, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, United Kingdom
- King’s College London, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- Centre for Nursing, Midwifery and Allied health led Research, University College London Hospitals, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Natasha A. Lannin
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Wallace AC, Talelli P, Crook L, Austin D, Farrell R, Hoad D, O'Keeffe AG, Marsden JF, Fitzpatrick R, Greenwood R, Rothwell JC, Werring DJ. Exploratory Randomized Double-Blind Placebo-Controlled Trial of Botulinum Therapy on Grasp Release After Stroke (PrOMBiS). Neurorehabil Neural Repair 2019; 34:51-60. [PMID: 31747825 DOI: 10.1177/1545968319887682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. OnabotulinumtoxinA injections improve upper-limb spasticity after stroke, but their effect on arm function remains uncertain. Objective. To determine whether a single treatment with onabotulinumtoxinA injections combined with upper-limb physiotherapy improves grasp release compared with physiotherapy alone after stroke. Methods. A total of 28 patients, at least 1 month poststroke, were randomized to receive either onabotulinumtoxinA or placebo injections to the affected upper limb followed by standardized upper-limb physiotherapy (10 sessions over 4 weeks). The primary outcome was time to release grasp during a functionally relevant standardized task. Secondary outcomes included measures of wrist and finger spasticity and strength using a customized servomotor, clinical assessments of stiffness (modified Ashworth Scale), arm function (Action Research Arm Test [ARAT], Nine Hole Peg Test), arm use (Arm Measure of Activity), Goal Attainment Scale, and quality of life (EQ5D). Results. There was no significant difference between treatment groups in grasp release time 5 weeks post injection (placebo median = 3.0 s, treatment median = 2.0 s; t(24) = 1.20; P = .24; treatment effect = -0.44, 95% CI = -1.19 to 0.31). None of the secondary measures passed significance after correcting for multiple comparisons. Both groups achieved their treatment goals (placebo = 65%; treatment = 71%), and made improvements on the ARAT (placebo +3, treatment +5) and in active wrist extension (placebo +9°, treatment +11°). Conclusions. In this group of stroke patients with mild to moderate spastic hemiparesis, a single treatment with onabotulinumtoxinA did not augment the improvements seen in grasp release time after a standardized upper-limb physiotherapy program.
Collapse
Affiliation(s)
| | | | - Lucinda Crook
- UCL Institute of Neurology, Queen Square, London, UK
| | - Duncan Austin
- UCL Institute of Neurology, Queen Square, London, UK
| | - Rachel Farrell
- UCL Institute of Neurology, Queen Square, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Damon Hoad
- UCL Institute of Neurology, Queen Square, London, UK
| | | | | | | | - Richard Greenwood
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - David J Werring
- UCL Institute of Neurology, Queen Square, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| |
Collapse
|
12
|
Ashford SA, Siegert RJ, Williams H, Nair A, Orridge S, Turner-Stokes L. Psychometric evaluation of the leg activity measure (LegA) for outcome measurement in people with brain injury and spasticity. Disabil Rehabil 2019; 43:976-987. [PMID: 31328963 DOI: 10.1080/09638288.2019.1643933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study is to evaluate the properties of the Leg Activity measure according to COnsensus-based Standards for the selection of health Measurement INstruments. METHOD Participants were assessed at baseline, one day, 6 weeks and 12 weeks, following treatment for leg spasticity with botulinum toxin and physical interventions. RESULTS In stage 1, 64 participants were recruited to evaluate the initial psychometric properties of Leg Activity measure. In stage 2, 100 additional participants were recruited, to evaluate the scaling properties. Total sample of 164 participants was used. Construct validity was supported for "passive function", "active function" and "impact on quality of life". Cronbach's alpha was 0.86, 0.97 and 0.87 respectively for the scales. Item level test-retest agreement ranged from 91-97% (Kappa 0.75-0.95). Following treatment for spasticity (n = 64), the Leg Activity measure "passive function" and "impact on life" scales were responsive to change. Principal components analysis confirmed the constructs and a unidimensional Rasch Partial Credit Model was subsequently established for each scale. Transformation to an interval scale was achieved. Using the ordinal-to-interval conversion tables, parametric statistical analysis may be used. CONCLUSION The study provides support for the Leg Activity measure being valid, reliable and responsive.Implications for rehabilitationThe Leg Activity measure is the only published self-report measure in the current literature that addresses passive and active function as well as impact on quality of life, of the paretic leg in a comprehensive manner.The initial evaluation of Leg Activity measure psychometric properties, in relation to the COnsensus-based Standards for the selection of health Measurement INstruments checklist and Medical Outcomes Trust Quality Criteria, supports its measurement properties for clinical and research use.The Leg Activity measure as a valid, reliable and responsive tool for the evaluation of treatment in leg spasticity including condition specific (spasticity) quality-of-life.
Collapse
Affiliation(s)
- Stephen A Ashford
- 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.,Centre for Nursing and Midwifery led Research, University College London Hospital, London, UK
| | - Richard J Siegert
- Department of Psychology, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - Heather Williams
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - Ajoy Nair
- Alderbourne Rehabilitation Unit, Hillingdon Hospital, 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
| |
Collapse
|
13
|
Shiner CT, Vratsistas-Curto A, Bramah V, Faux SG, Watanabe Y. Prevalence of upper-limb spasticity and its impact on care among nursing home residents with prior stroke. Disabil Rehabil 2019; 42:2170-2177. [PMID: 30929536 DOI: 10.1080/09638288.2018.1555620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Post-stroke spasticity can impair motor function and may cause pain, limb deformity, contracture, and difficulties with limb care. This study aimed to assess the prevalence and burden of post-stroke upper-limb spasticity among nursing home residents.Materials and methods: A multisite, cross-sectional study was conducted across three nursing home facilities. Participants included residents with a confirmed diagnosis of stroke, and nursing staff involved in their care. Residents were assessed using the Tardieu Scale, passive range-of-motion, Abbey Pain scale, Modified Rankin Scale and observation of limb position and skin condition. Nursing staff completed the Arm Activity Measure (ArmA).Results: 264 individuals were screened, 51 had a diagnosis of stroke (19.3%), and 23 consented to participate. 16 participants (70%) demonstrated upper-limb spasticity of at least one joint, median Tardieu score 2 [IQR 2-3]. Pain scores and nurse-rated passive ArmA were significantly higher for patients with spasticity compared to those without (p = 0.003 and p < 0.001, respectively). Greater spasticity correlated with higher pain (rs =0.44) and ArmA scores (rs =0.71).Conclusions: A high proportion (70%) of nursing home residents with stroke demonstrated upper-limb spasticity, associated with pain and passive care difficulties. These data suggest there is an unmet need for spasticity management among nursing-home residents.Implications for rehabilitationUpper-limb spasticity is prevalent among nursing home residents with prior stroke; here, observed in 70% of cases.Spasticity was associated with increased pain and more difficult passive limb care in this population.There is an unmet need for spasticity management among nursing home residents with prior stroke.Efforts should be made to improve access to multidisciplinary spasticity treatment for this vulnerable patient population.
Collapse
Affiliation(s)
- Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | | | - Valerie Bramah
- Department of Rehabilitation, St Vincent's Hospital Sydney, Sydney, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Yuriko Watanabe
- Department of Rehabilitation, St Vincent's Hospital Sydney, Sydney, Australia
| |
Collapse
|
14
|
Niama Natta DD, Batcho CS, Stoquart GG, Alagnidé E, Kpadonou T, Lejeune TM. Evaluation of manual ability in stroke patients in Benin: cultural adaptation and Rasch validation of the ABILHAND-Stroke questionnaire. Eur J Phys Rehabil Med 2019; 55:19-28. [DOI: 10.23736/s1973-9087.18.05195-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Buntragulpoontawee M, Euawongyarti P, Wongpakaran T, Ashford S, Rattanamanee S, Khunachiva J. Preliminary evaluation of the reliability, validity and feasibility of the arm activity measure - Thai version (ArmA-TH) in cerebrovascular patients with upper limb hemiplegia. Health Qual Life Outcomes 2018; 16:141. [PMID: 30012165 PMCID: PMC6048836 DOI: 10.1186/s12955-018-0971-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Upper limb hemiplegia following cerebrovascular diseases can result in significant functional limitation. To assess such functional disturbance requires a comprehensive, valid and reliable tool. The Arm Activity Measure (ArmA) is a comprehensive, valid and reliable self-report questionnaire to assess real-life function for upper limb hemiplegia. However, it has never been translated for use in different languages. The purpose of this study is to translate and cross-culturally adapt the Arm Activity Measure (ArmA) questionnaire into a Thai version and to evaluate content validity, internal consistency and feasibility. Methods The ArmA was translated and culturally adapted according to published cross-cultural adaptation guidelines resulting in the Thai version of ArmA (ArmA-TH). Forty Thai patients with upper limb hemiplegia resulting from cerebrovascular disorders participated in field-testing of the ArmA-TH. Its feasibility was evaluated. Content validity index for item (I-CVI) and score (S-CVI) were examined. Inter-rater reliability was evaluated by Gwet’s AC2. Internal consistency was measured using Cronbach’s alpha coefficient. Results Forty patients (29 males, 11 females) with upper limb spasticity due to stroke or TBI were included. The average age of patients was 54.5 years (SD 15.0). Twenty-seven patients (67.5%) completed the questionnaire within 5 min or less, average time taken was 4.45 (1.73) min. For both subscales, patients reported the ArmA-TH to be relevant (85%) and easy to use (67.5%). More than 80% of patients found the passive subscale useful, almost 80% found the active subscale useful. Overall S-CVI was 0.83, S-CVI for passive and active function subscale was 0.79 and 0.86 respectively. The inter-rater reliability coefficients for ArmA-TH was 0.81. Cronbach’s alpha was 0.90 for the overall ArmA, 0.89 and 0.88 for the passive and active function subscales. Conclusions The ArmA-TH was a feasible self-report questionnaire to assess hemiplegic upper limb function with good content validity, inter-rater reliability and internal consistency.
Collapse
Affiliation(s)
- Montana Buntragulpoontawee
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Patreeya Euawongyarti
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit London North West Healthcare NHS Trust & Department of Palliative Care, Policy and Rehabilitation, King's College London, London, WC2R 2LS, UK
| | - Somprartthana Rattanamanee
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Jeeranan Khunachiva
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| |
Collapse
|
16
|
Does botulinum toxin treatment improve upper limb active function? Ann Phys Rehabil Med 2018; 62:234-240. [PMID: 29960017 DOI: 10.1016/j.rehab.2018.05.1320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and can be focally relieved by intramuscular injections of botulinum toxin (BT). Functional improvements of the affected upper limb after a BT focal treatment remain controversial. OBJECTIVE We aimed to assess the functional effects of BT treatment on upper-limb spasticity in the literature, identify flaws and deficiencies in proving these effects and propose leads for future trials. METHODS We searched the MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing the effect of BT injection in upper-limb spasticity. This was a non-systematic narrative review, and the selection of articles was based on the authors' expertise. The review focused on stroke-related spasticity and disability. RESULTS Patients' therapeutic targets involved use of the disability assessment scale (DAS) or goal attainment scale (GAS). Impairments and passive function goals prevailed for active function and participation and were more frequently achieved for the former than the latter. Meta-analyses showed no to mild effect sizes for improvement in upper-limb function but failed to show higher and/or better use of the paretic upper limb in activities of daily living after BT injection. CONCLUSION BT injections for impairment and passive function are related to improved kinematic parameters; however, the relation between relief of spasticity and improved upper-limb activity has not been established. Possible explanations for the lack of functional effect in studies are first, disability is mainly due to muscle weakness rather than spasticity, so patients with the best underlying motricity may benefit the most from BT injections; second, assessment methods may not be adapted to screen eligible patients; third, most studies' endpoints were at 4 to 12 weeks after a single injection, but repeated treatment sessions might be needed to observe functional outcome on the upper limbs; and finally, the association of rehabilitation programs or non-pharmacological treatments may enhance the functional effects of BT injections.
Collapse
|
17
|
Ashford S, Nair A, Williams H, Esdon J, Steed A, Nyein K, Turner-Stokes L. Spasticity management with botulinum toxin: A comparison of UK physiotherapy and rehabilitation medicine injectors. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.5.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: To compare patient outcomes following botulinum toxin (BoNT) injection by either physiotherapy or rehabilitation medicine (medical) professionals over a 3-year period. Methods: A retrospective, observational cohort study was conducted in a specialised rehabilitation service providing spasticity management including BoNT injection and physical therapy (group therapy, individual therapy, self-exercise, and physical management programmes). Individualised goals were established before treatment using goal attainment scaling (GAS) by the multidisciplinary team. The Arm Activity measure (ArmA) was used to evaluate upper limb function and the Modified Ashworth Scale (MAS) used to evaluate spasticity. Findings: A total of 262 patients were injected. Mean GAS T-score after treatment for the group was 50.2 ± 6.7. GAS T-score for physiotherapy injectors (n=214 (82% of participants)) was 50.2 ± 6.4 and for rehabilitation medicine injectors (n=48 (18%)) 50.3 ± 7.9. No significant differences were identified in terms of goal achievement, upper limb passive function, or spasticity reduction between physiotherapy and rehabilitation medicine injectors. Differences were identified at both baseline (physiotherapist mean 49.7; rehabilitation medicine mean 46.6) and follow-up for active function (physiotherapist mean=49.7; rehabilitation medicine mean=47.8) (ArmA active function subscale; p=0.03). No reportable adverse effects were recorded. No difference in the complexity of injection (such as complex clinical presentation, anticoagulation, or technical difficulty) between the injector groups was identified. Conclusions: Clinical outcomes were comparable between physiotherapy and rehabilitation medicine injectors. No difference in side effect profile or complexity of injection was identified. In this cohort, injection of BoNT by a physiotherapist was as effective in terms of GAS as that undertaken by a rehabilitation medicine physician.
Collapse
Affiliation(s)
- Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London; King's College London, Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Ajoy Nair
- Alderbourne Rehabilitation Unit, Hillingdon Hospital, Hillingdon Foundation Trust, Uxbridge, UK
| | - Heather Williams
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - James Esdon
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Aideen Steed
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Kyaw Nyein
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Lynne Turner-Stokes
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital,, London, UK; King's College London, Faculty of Nursing, Midwifery and Palliative Care, London, UK
| |
Collapse
|
18
|
Hill B, Williams G, Olver J, Ferris S, Bialocerkowski A. Preliminary Psychometric Evaluation of the Brachial Assessment Tool Part 2: Construct Validity and Responsiveness. Arch Phys Med Rehabil 2018; 99:736-742. [DOI: 10.1016/j.apmr.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 10/29/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
|
19
|
Abstract
Objective To develop a clinically useful patient-reported screening tool for health care providers to identify patients with spasticity in need of treatment regardless of etiology. Design Eleven spasticity experts participated in a modified Delphi panel and reviewed and revised 2 iterations of a screening tool designed to identify spasticity symptoms and impact on daily function and sleep. Spasticity expert panelists evaluated items pooled from existing questionnaires to gain consensus on the screening tool content. The study also included cognitive interviews of 20 patients with varying spasticity etiologies to determine if the draft screening tool was understandable and relevant to patients with spasticity. Results The Delphi panel reached an initial consensus on 21 of 47 items for the screening tool and determined that the tool should have no more than 11 to 15 items and a 1-month recall period for symptom and impact items. After 2 rounds of review, 13 items were selected and modified by the expert panelists. Most patients (n = 16 [80%]) completed the cognitive interview and interpreted the items as intended. Conclusions Through the use of a Delphi panel and patient interviews, a 13-item spasticity screening tool was developed that will be practical and easy to use in routine clinical practice.
Collapse
|
20
|
Ashford S, Jackson D, Mahaffey P, Vanderstay R, Turner-Stokes L. Conceptualization and Development of the Leg Activity Measure (LegA) for Patient and Carer Reported Assessment of Activity in the Paretic Leg. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [DOI: 10.1002/pri.1660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/07/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit; Northwick Park Hospital; London UK
- King's College London, Faculty of Life Science and Medicine; Department of Palliative Care, Policy and Rehabilitation; London UK
| | - Diana Jackson
- King's College London, Faculty of Life Science and Medicine; Department of Palliative Care, Policy and Rehabilitation; London UK
| | - Patrick Mahaffey
- Regional Hyper-acute Rehabilitation Unit; Northwick Park Hospital; London UK
| | - Roxana Vanderstay
- King's College London, Faculty of Life Science and Medicine; Department of Palliative Care, Policy and Rehabilitation; London UK
| | - Lynne Turner-Stokes
- Regional Hyper-acute Rehabilitation Unit; Northwick Park Hospital; London UK
- King's College London, Faculty of Life Science and Medicine; Department of Palliative Care, Policy and Rehabilitation; London UK
| |
Collapse
|
21
|
Cusick A, Lannin N, Kinnear BZ. Upper limb spasticity management for patients who have received Botulinum Toxin A injection: Australian therapy practice. Aust Occup Ther J 2015; 62:27-40. [PMID: 25649033 DOI: 10.1111/1440-1630.12142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM To describe Australian physiotherapy and occupational therapy practice for patients who receive upper-limb Botulinum Toxin-A (BoNT-A). METHOD Anonymous online survey asking about practice experience. Convenience sample of 128 BoNT-A experienced occupational therapists and physiotherapists. RESULTS The primary work setting was multidisciplinary inpatient or outpatient rehabilitation services where therapists had automatic referral to BoNT-A patients. Patients expected BoNT-A to improve functional movement, reduce hypertonicity, increase passive range, reduce pain, improve appearance and hand hygiene. Most patients were injected in multidisciplinary public hospital clinics and had median 2 pre-injection (range 0-30) and 8 post-injection (range 0-50) therapy sessions. Biceps, flexor digitorum profundus/superficialis and brachoradialis were most frequently injected. Injectors used therapist assessment information to select sites 68% of the time; only 44% of services had assessment protocols. Standardised therapy assessments examined motor performance, pain and function in that order of frequency. The greater the awareness and perceived relevance of an assessment the more often therapists used it. All therapists set goals, most collaboratively, and these mirrored patient expectations. The most common treatments were stretch, task-specific functional training, strength training and home programmes. CONCLUSION While trends in Australian assessment, goals and treatment practice were observed, greater consistency could be achieved if therapy practice guidelines existed. The gap is exacerbated by the absence of Australian BoNT-A organisation and process of care spasticity management guidelines. This creates an environment where practice variability is inevitable. Recommendations to improve local service quality are made.
Collapse
Affiliation(s)
- Anne Cusick
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | | | | |
Collapse
|
22
|
Poltawski L, Allison R, Briscoe S, Freeman J, Kilbride C, Neal D, Turton AJ, Dean S. Assessing the impact of upper limb disability following stroke: a qualitative enquiry using internet-based personal accounts of stroke survivors. Disabil Rehabil 2015. [PMID: 26200448 PMCID: PMC4819828 DOI: 10.3109/09638288.2015.1068383] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose: Upper limb disability following stroke may have multiple effects on the individual. Existing assessment instruments tend to focus on impairment and function and may miss other changes that are personally important. This study aimed to identify personally significant impacts of upper limb disability following stroke. Methods: Accounts by stroke survivors, in the form of web-based diaries (blogs) and stories, were sought using a blog search engine and in stroke-related web-sites. Thematic analysis using the World Health Organisation’s International Classification of Functioning Disability and Health (ICF) was used to identify personal impacts of upper limb disability following stroke. Results: Ninety-nine sources from at least four countries were analysed. Many impacts were classifiable using the ICF, but a number of additional themes emerged, including emotional, cognitive and behavioural changes. Blogs and other web-based accounts were easily accessible and rich sources of data, although using them raised several methodological issues, including potential sample bias. Conclusions: A range of impacts was identified, some of which (such as use of information technology and alienation from the upper limb) are not addressed in current assessment instruments. They should be considered in post-stroke assessments. Blogs may help in the development of more comprehensive assessments.Implications for Rehabilitation A comprehensive assessment of the upper limb following stroke should include the impact of upper limb problems on social participation, as well as associated emotional, cognitive and behavioural changes. Using personalised assessment instruments alongside standardised measures may help ensure that these broader domains are considered in discussions between clinicians and patients. Rehabilitation researchers should investigate whether and how these domains could be addressed and operationalised in standard upper limb assessment instruments.
Collapse
Affiliation(s)
- Leon Poltawski
- a Institute of Health Research, University of Exeter Medical School , Exeter , UK
| | - Rhoda Allison
- b Torbay & Southern Devon NHS Care Trust , Torquay , UK
| | - Simon Briscoe
- a Institute of Health Research, University of Exeter Medical School , Exeter , UK
| | - Jennifer Freeman
- c Faculty of Health & Human Sciences , University of Plymouth , Exeter , UK
| | - Cherry Kilbride
- d School of Health Sciences and Social Care, Centre for Research in Rehabilitation, Brunel University London , Uxbridge, Middlesex , UK
| | - Debbie Neal
- e School of Health and Social Care, University of Bournemouth , Poole, Dorset , UK .,f Department of Physiotherapy , Yeovil District Hospital , Higher Kingston, Yeovil , UK , and
| | - Ailie J Turton
- g Department of Allied Health Professionals , University of the West of England , Bristol , UK
| | - Sarah Dean
- a Institute of Health Research, University of Exeter Medical School , Exeter , UK
| |
Collapse
|
23
|
Ashford S, Fheodoroff K, Jacinto J, Turner-Stokes L. Common goal areas in the treatment of upper limb spasticity: a multicentre analysis. Clin Rehabil 2015; 30:617-22. [DOI: 10.1177/0269215515593391] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/06/2015] [Indexed: 11/15/2022]
Abstract
Objective: We aimed to develop a goal classification of individualised goals for spasticity treatment incorporating botulinum toxin intervention for upper limb spasticity to under-pin a more structured approach to future goal setting. Design: Individualised goals for spasticity treatment incorporating botulinum toxin intervention for upper limb spasticity ( n=696) were analysed initially from four studies published in 2008-2012, spanning a total of 18 centres (12 in the UK and 6 in Australia). Goals were categorised and mapped onto the closest matching domains of the WHO International Classification of Functioning. Confirmatory analysis included a further 927 goals from a large international cohort study spanning 22 countries published in 2013. Results: Goal categories could be assigned into two domains, each subdivided into three key goal areas: Domain 1: symptoms/impairment n=322 (46%): a. pain/discomfort n=78 (11%), b. involuntary movements n=75 (11%), c. range of movement/contracture prevention n=162 (23%). Domain 2: Activities/function n=374 (54%): a. passive function (ease of caring for the affected limb) n=242 (35%), b active function (using the affected limb in active tasks) n=84 (12%), c. mobility n=11 (2%). Over 99% of the goals from the large international cohort fell into the same six areas, confirming the international applicability of the classification. Conclusions: Goals for management of upper limb spasticity, in worldwide clinical practice, fall into six main goal areas.
Collapse
Affiliation(s)
- Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
- King’s College London, Faculty of Life Science and Medicine, Department of Palliative Care, Policy and Rehabilitation, UK
| | | | - Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos 3, Estoril, Portugal
| | - Lynne Turner-Stokes
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
- King’s College London, Faculty of Life Science and Medicine, Department of Palliative Care, Policy and Rehabilitation, UK
| |
Collapse
|
24
|
Ashford S, Siegert RJ, Alexandrescu R. Rasch measurement: the Arm Activity measure (ArmA) passive function sub-scale. Disabil Rehabil 2015; 38:384-90. [PMID: 25918961 DOI: 10.3109/09638288.2015.1041613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the conformity of the Arm Activity measure (ArmA) passive function sub-scale to the Rasch model. METHODS A consecutive cohort of patients (n = 92) undergoing rehabilitation, including upper limb rehabilitation and spasticity management, at two specialist rehabilitation units were included. Rasch analysis was used to examine scaling and conformity to the model. Responses were analysed using Rasch unidimensional measurement models (RUMM 2030). The following aspects were considered: overall model and individual item fit statistics and fit residuals, internal reliability, item response threshold ordering, item bias, local dependency and unidimensionality. RESULTS ArmA contains both active and passive function sub-scales, but in this analysis only the passive function sub-scale was considered. Four of the seven items in the ArmA passive function sub-scale initially had disordered thresholds. These items were rescored to four response options, which resulted in ordered thresholds for all items. Once the items with disordered thresholds had been rescored, item bias was not identified for age, global disability level or diagnosis, but with a small difference in difficulty between males and females for one item of the scale. Local dependency was not observed and the unidimensionality of the sub-scale was supported and good fit to the Rasch model was identified. The person separation index (PSI) was 0.95 indicating that the scale is able to reliably differentiate at least two groups of patients. CONCLUSIONS The ArmA passive function sub-scale was shown in this evaluation to conform to the Rasch model once disordered thresholds had been addressed. Using the logit scores produced by the Rasch model it was possible to convert this back to the original scale range. Implications for Rehabilitation The ArmA passive function sub-scale was shown, in this evaluation, to conform to the Rasch model once disordered thresholds had been addressed and therefore to be a clinically applicable and potentially useful hierarchical measure. Using Rasch logit scores it has be possible to convert back to the original ordinal scale range and provide an indication of real change to enable evaluation of clinical outcome of importance to patients and clinicians.
Collapse
Affiliation(s)
- Stephen Ashford
- a Regional Rehabilitation Unit , Northwick Park Hospital , Middlesex , UK .,b Department of Palliative Care, Policy and Rehabilitation , King's College London, School of Medicine , London , UK , and
| | - Richard J Siegert
- c Department of Psychology, Faculty of Health and Environmental Sciences , AUT University , Auckland , New Zealand
| | - Roxana Alexandrescu
- b Department of Palliative Care, Policy and Rehabilitation , King's College London, School of Medicine , London , UK , and
| |
Collapse
|
25
|
Goal setting, using goal attainment scaling, as a method to identify patient selected items for measuring arm function. Physiotherapy 2015; 101:88-94. [DOI: 10.1016/j.physio.2014.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 04/05/2014] [Indexed: 11/18/2022]
|
26
|
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
| |
Collapse
|
27
|
Ashford S, Turner-Stokes L. Systematic review of upper-limb function measurement methods in botulinum toxin intervention for focal spasticity. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2013; 18:178-89. [PMID: 23630050 DOI: 10.1002/pri.1554] [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] [Received: 10/04/2012] [Revised: 01/22/2013] [Accepted: 03/27/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE This paper aimed to select studies evaluating botulinum toxin (BoNT) intervention applied for upper-limb spasticity and from these identify outcome measures that are a) applicable in the hemiparetic upper limb and b) include evaluation of functional outcome in the context of everyday real-life activities. METHODS A systematic search was used to identify peer-reviewed papers evaluating BoNT intervention for focal spasticity management in the upper limb. From these papers, outcome evaluation methods were identified, which attempted to capture 'active function' improvement (functional use of the hand and/or arm) or passive function improvement (care for the affected limb, for example to maintain hygiene and dress or support the arm). RESULTS The search yielded 411 studies. Seventy papers were identified following a final review of the abstracts as potentially including evaluation of functional outcome (active and/or passive function). Following the review of the papers, a total of 22 studies contained specific methods for evaluating functional outcome in the upper limb. DISCUSSION Three different patient-focused methods to evaluate functional outcome following focal spasticity intervention using BoNT have been identified: 1) use of patient report of upper-limb items (including the Leeds Adult Spasticity Impact Scale and the Disability Assessment Scale), 2) use of a composite measure of function incorporating functional items and 3) Goal Attainment Scaling. None of these methods fully address evaluation of functional outcome in this context but may go some way to recording these improvements. An alternative or complementary measure, recently published, is the Arm Activity Measure for evaluation of active and passive function in this context. The Arm Activity Measure addresses active and passive function changes from the perspective of patients and carers and has been developed for application in this context.
Collapse
Affiliation(s)
- Stephen Ashford
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK.
| | | |
Collapse
|
28
|
Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P, Zakine B. Upper limb international spasticity study: rationale and protocol for a large, international, multicentre prospective cohort study investigating management and goal attainment following treatment with botulinum toxin A in real-life clinical practice. BMJ Open 2013; 3:bmjopen-2012-002230. [PMID: 23512837 PMCID: PMC3612778 DOI: 10.1136/bmjopen-2012-002230] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This article provides an overview of the Upper Limb International Spasticity (ULIS) programme, which aims to develop a common core dataset for evaluation of real-life practice and outcomes in the treatment of upper-limb spasticity with botulinum toxin A (BoNT-A). Here we present the study protocol for ULIS-II, a large, international cohort study, to describe the rationale and steps to ensure the validity of goal attainment scaling (GAS) as the primary outcome measure. METHODS AND ANALYSIS DESIGN: An international, multicentre, observational, prospective, before-and-after study, conducted at 84 centres in 22 countries across three continents. PARTICIPANTS 468 adults presenting with poststroke upper limb spasticity in whom a decision had already been made to inject BoNT-A (5-12 consecutive participants recruited per centre). INTERVENTIONS Physicians were free to choose targeted muscles, BoNT-A preparation, injected doses/technique and timing of follow-up in accordance with their usual practice and the goals for treatment. PRIMARY OUTCOME MEASURE GAS. SECONDARY OUTCOMES Measurements of spasticity, standardised outcome measures and global benefits. Steps to ensure validity included: (1) targeted training of all investigators in the use of GAS; (2) within-study validation of goal statements and (3) establishment of an electronic case report form with an in-built tracking facility for separation of baseline/follow-up data. ANALYSIS Efficacy population: all participants who had (1) BoNT-A injection and (2) subsequent assessment of GAS. Primary efficacy variable: percentage (95% CI) achievement of the primary goal from GAS following one BoNT-A injection cycle. ETHICS AND DISSEMINATION This non-interventional study is conducted in compliance with guidelines for good pharmacoepidemiology practices. Appropriate ethical approvals were obtained according to local regulations. ULIS-II will provide important information regarding treatment and outcomes from BoNT-A in real-life upper limb spasticity management. The results will be published separately. REGISTRATION ClinicalTrials.gov identifier: NCT01020500.
Collapse
Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, School of Medicine, King's College London, London, UK
| | | | - Jorge Jacinto
- Serviço de Reabilitação de adultos 3, Centro de Medicina de Reabilitaçãode Alcoitão, Estoril, Portugal
| | - Pascal Maisonobe
- Departments of Biostatistics & Data Management, Medical Affairs, Ipsen Pharma, Boulogne-Billancourt, France
| | - Benjamin Zakine
- Departments of Biostatistics & Data Management, Medical Affairs, Ipsen Pharma, Boulogne-Billancourt, France
| |
Collapse
|