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Caspersen CK, Ingemann-Molden S, Grove EL, Højen AA, Andreasen J, Klok FA, Rolving N. Performance-based outcome measures for assessing physical capacity in patients with pulmonary embolism: A scoping review. Thromb Res 2024; 235:52-67. [PMID: 38301376 DOI: 10.1016/j.thromres.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Up to 50 % of patients surviving a pulmonary embolism (PE) report persisting shortness of breath, reduced physical capacity and psychological distress. As the PE population is heterogeneous compared to other cardiovascular patient groups, outcome measures for assessing physical capacity traditionally used in cardiac populations may not be reliable for the PE population as a whole. This scoping review aims to 1) map performance-based outcome measures (PBOMs) used for assessing physical capacity in PE research, and 2) to report the psychometric properties of the identified PBOMs in a PE population. METHODS The review was conducted according to the Joanna Briggs Institute framework for scoping reviews and reported according to the PRISMA-Extension for Scoping Reviews guideline. RESULTS The systematic search of five databases identified 4585 studies, of which 243 studies met the inclusion criteria. Of these, 185 studies focused on a subgroup of patients with chronic thromboembolic pulmonary hypertension. Ten different PBOMs were identified in the included studies. The 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) were the most commonly used, followed by the (Modified) Bruce protocol and Incremental Shuttle Walk test. No studies reported psychometric properties of any of the identified PBOMs in a PE population. CONCLUSIONS Publication of studies measuring physical capacity within PE populations has increased significantly over the past 5-10 years. Still, not one study was identified, reporting the validity, reliability, or responsiveness for any of the identified PBOMs in a PE population. This should be a priority for future research in the field.
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Affiliation(s)
| | - Stian Ingemann-Molden
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Anette Arbjerg Højen
- Department of Health Science and Technology, Aalborg University, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark; Department of Health Science and Technology, Aalborg University, Denmark; Aalborg Health and Rehabilitation Centre, Aalborg Municipality, Denmark
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
| | - Nanna Rolving
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark; Department of Public Health, Aarhus University, Denmark.
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Rast FM, Jucker F, Labruyère R. Accuracy of Sensor-Based Measurement of Clinically Relevant Motor Activities in Daily Life of Children With Mobility Impairments. Arch Phys Med Rehabil 2024; 105:27-33. [PMID: 37329967 DOI: 10.1016/j.apmr.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study aimed to determine the accuracy of 3 sensor configurations and corresponding algorithms deriving clinically relevant outcomes of everyday life motor activities in children undergoing rehabilitation. These outcomes were identified in 2 preceding studies assessing the needs of pediatric rehabilitation. The first algorithm estimates the duration of lying, sitting, and standing positions and the number of sit-to-stand transitions with data from a trunk and a thigh sensor. The second algorithm detects active and passive wheeling periods with data from a wrist and a wheelchair sensor. The third algorithm detects free and assisted walking periods and estimates the covered altitude change during stair climbing with data from a single ankle sensor and a sensor placed on walking aids. DESIGN The participants performed a semi-structured activity circuit while wearing inertial sensors on both wrists, the sternum, and the thigh and shank of the less-affected side. The circuit included watching a movie, playing, cycling, drinking, and moving around between facilities. Video recordings, which 2 independent researchers labeled, served as reference criteria to determine the algorithms' performance. SETTING In-patient rehabilitation center. PARTICIPANTS Thirty-one children and adolescents with mobility impairments who were able to walk or use a manual wheelchair for household distances (N=31). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) The algorithms' activity classification accuracies. RESULTS The activity classification accuracy was 97% for the posture detection algorithm, 96% for the wheeling detection algorithm, and 93% for the walking detection algorithm. CONCLUSION(S) The 3 sensor configurations and corresponding algorithms presented in this study revealed accurate measurements of everyday life motor activities in children with mobility impairments. To follow-up on this promising results, the sensor systems needs to be tested in long-term measurements outside the clinic before using the system to determine the children's motor performance in their habitual environment for clinical and scientific purposes.
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Affiliation(s)
- Fabian Marcel Rast
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Florence Jucker
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rob Labruyère
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Rodriquez J, Bullock D, Cotsonis G, Clark PC, Blanton S. Neighborhood socioeconomic disadvantage measures in rehabilitation clinical trials: Lessons learned in recruitment. Appl Nurs Res 2023; 73:151718. [PMID: 37722786 DOI: 10.1016/j.apnr.2023.151718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/19/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity. METHODS Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device. RESULTS Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5-5, range 1-9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related. CONCLUSIONS The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.
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Affiliation(s)
- Josue Rodriquez
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - DeAndrea Bullock
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, United States of America.
| | - Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
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Brito Pinheiro CA, Bassi-Dibai D, Pinheiro JS, Pontes-Silva A, Soares Monteiro OL, de Oliveira Pires F, Torres Cabido CE, Fidelis-de-Paula-Gomes CA, Dibai-Filho AV. Unilateral seated shot-put test, muscle strength, and range of motion on recreational athletes with chronic shoulder pain: Cross-sectional study. J Bodyw Mov Ther 2023; 36:50-54. [PMID: 37949599 DOI: 10.1016/j.jbmt.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 04/20/2023] [Accepted: 05/28/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To correlate the functional performance assessed by means of the Unilateral Seated Shot-Put Test (SSPT) with shoulder muscle strength, range of motion (ROM), and handgrip strength in recreational athletes with chronic shoulder pain. METHODS AND MATERIALS The sample was composed of recreational athletes with nonspecific pain in the dominant shoulder ≥3 months, both sexes, aged between 18 and 45 years. We diagnosed shoulder pain by reporting pain intensity ≥3 points on the Numerical Rating Pain Scale and used the Shoulder Pain and Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Baecke Questionnaire. Moreover, shoulder muscle strength, handgrip strength, ROM, and functional performance using the SSPT were evaluated. We used the Spearman correlation coefficient to investigate the correlation between the variables. RESULTS Nineteen participants were included. Most of the sample consisted of adult women with adequate body mass and pain predominantly in the right shoulder. We observed higher correlation magnitudes of the SSPT with handgrip strength (rho = 0.818 to 0.833, p < 0.05). Correlations of the SPPT with shoulder musculature strength were of low to moderate magnitude (rho = 0.461 to 0.672, p < 0.05). The only significant correlation (p < 0.05) found was between the SSPT and ROM (horizontal adduction), however, with a weak magnitude (rho <0.50). CONCLUSION SSPT correlates strongly with handgrip strength and moderately with shoulder muscle strength in recreational athletes with chronic shoulder pain.
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Affiliation(s)
| | - Daniela Bassi-Dibai
- Postgraduate Program in Programs Management and Health Services, Universidade Ceuma, São Luís, MA, Brazil
| | - Jocassia Silva Pinheiro
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - André Pontes-Silva
- Postgraduate Program in Adult Health, Universidade Federal do Maranhão, São Luís, MA, Brazil; Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil. https://twitter.com/_psandre
| | | | - Flavio de Oliveira Pires
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil; Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Christian Emmanuel Torres Cabido
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil; Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | | | - Almir Vieira Dibai-Filho
- Postgraduate Program in Adult Health, Universidade Federal do Maranhão, São Luís, MA, Brazil; Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil; Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
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Rafferty M, Stoff L, Smith JD, Hansen P, Briody M, Diaz C, O'Donnell L, Heinemann AW, Brown CH, Lieber RL. Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation. Arch Phys Med Rehabil 2023; 104:1289-1299. [PMID: 36924817 PMCID: PMC10502191 DOI: 10.1016/j.apmr.2023.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/16/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To evaluate changes in clinicians' use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations. DESIGN Three repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility. SETTING Inpatient rehabilitation hospital. PARTICIPANTS Physicians, nurses, therapists, and other health care professionals (n=410, 442, and 448 respondents at Times 1, 2, and 3, respectively). INTERVENTIONS Implementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations. MAIN OUTCOME MEASURES Adapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients' Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis. RESULTS Response rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of EBP at Time 3 compared with Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; P=.043). Attitudes toward EBPs were similar over time. Acceptance of the new model of care was lower at Time 2 compared with Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; P<.0001; adj. meant3=3.51, SE=0.04; P<.0001). Analysis of open-ended responses suggested that clinicians' optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers. CONCLUSIONS Accelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians' changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur.
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Affiliation(s)
- Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | | | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT
| | - Piper Hansen
- Shirley Ryan AbilityLab, Chicago, IL; Occupational Therapy Department, Rush University, Chicago, IL
| | | | - Carmen Diaz
- Northwestern University, Kellogg School of Management, Chicago, IL
| | | | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Hines V.A. Medical Center, Hines, IL
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Aravena JM, Gajardo J, Saguez R, Hinton L, Gitlin LN. Nonpharmacologic Interventions for Family Caregivers of People Living With Dementia in Latin-America: A Scoping Review. Am J Geriatr Psychiatry 2022; 30:859-877. [PMID: 34848116 DOI: 10.1016/j.jagp.2021.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Dementia prevalence in Latin America (LATAM) is rapidly increasing, contributing to significant family burden. As families are responsible for care, supportive interventions are critical. To understand the state-of-the-science, a scoping review was conducted of non-pharmacologic interventions for caregivers of people living with dementia (PLWD) in LATAM. DESIGN Eight databases were searched (PubMed, Embase, PsycINFO, Scopus, Scielo, Lilacs, Redalyc, Google Scholar) for nonpharmacological intervention studies published up to July, 2021 in LATAM reporting at least 1 caregiver outcome. A qualitative synthesis examined study designs, participants, and outcomes characteristics. RESULTS Forty-five studies were identified from 25.8% (n = 8/31) of LATAM countries (28 = Brazil, 4 = Chile, 4 = Cuba, 4 = México, 2 = Colombia, 1 = Perú, 1 = Ecuador, 1 = Argentina): 29% (n = 17) were randomized clinical trials (RCT), 7% (n = 3) nonrandomized comparison trials, 42% (n = 19) pre-post trials, 9% (n = 4) postintervention analyses, and 4% (n = 2) single case studies, comprising a total of 1,171 caregivers and 817 PLWD. For 20 RCT and nonrandomized comparison trials, 31 interventions were tested of which 48.4% (n = 15) targeted caregivers and 32.3% (n = 10) dyads. Most studies involved daughters with less than 12 years of education and tested multicomponent interventions involving disease education (90%), and cognitive behavioral coping (45%). Half of interventions (51.6%; n = 16/31) tested were adapted from other countries, and reported benefits for caregiver depression, quality of life, and burden. CONCLUSION Studies were conducted in a limited number of LATAM countries and few were RCTs. Results of RCTs showed benefits for socially vulnerable caregivers on psychosocial outcomes. There is an urgent need to rigorously evaluate more country/culturally specific interventions addressing unmet familial needs beyond psychosocial support.
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Affiliation(s)
- José M Aravena
- Department of Social and Behavioral Sciences (JMA), Yale University School of Public Health, New Haven, CT; Instituto de Investigación y Postgrado Facultad de Ciencias de la Salud (JMA), Universidad Central de Chile, Santiago, Chile
| | - Jean Gajardo
- Facultad de Ciencias para el Cuidado de la Salud (JG), Universidad San Sebastián, Santiago, Chile; Department of Occupational Therapy and Occupational Science (JG), University of Chile, Santiago, Chile
| | - Rodrigo Saguez
- Public Nutrition Unit, The Nutrition and Food Technology Institute (INTA) (RS), University of Chile, Santiago, Chile
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences (LH), University of California Davis School of Medicine, Sacramento, CA
| | - Laura N Gitlin
- College of Nursing and Health Professions (LNG), Drexel University, Philadelphia, PA; Center for Innovative Care in Aging (LNG), Johns Hopkins University, Baltimore, MA.
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Belotti N, Bonfanti S, Locatelli A, Rota L, Ghidotti A, Vitali A. A Tele-Rehabilitation Platform for Shoulder Motor Function Recovery Using Serious Games and an Azure Kinect Device. Stud Health Technol Inform 2022; 293:145-152. [PMID: 35592974 DOI: 10.3233/shti220361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tele-rehabilitation is gaining importance due to the increasing need for objectiveness in the evaluation of patients with impaired motor functions. Low-cost marker-less motion capture systems are becoming key enabling technologies as support in the treatment of musculoskeletal diseases. OBJECTIVES The goal of this work is to investigate the use of the Microsoft Azure Kinect device to develop a tele-rehabilitation platform for shoulder motor function recovery. The platform comprehends a set of serious games, which are fundamental to increase the patients' engagement in shoulder rehabilitation. METHODS Starting from a set of functionalities identified together with the medical personnel of an Italian hospital, the Azure Kinect device has been used as motion capture system to interact with the serious games. Mobile applications for patients and physicians have been developed to manage the rehabilitation process. RESULTS The solution has been tested by the involved medical personnel. It has been considered interesting and promising. Further improvements in the design of the virtual environment of the serious games are required. CONCLUSION The presented platform is a starting point to develop a complete IT solution for the daily shoulder rehabilitation.
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Craven BC, Brisbois L, Pelletier C, Rybkina J, Heesters A, Verrier MC. Central Recruitment: A process for engaging and recruiting individuals with spinal cord injury/disease in research at Toronto Rehabilitation Institute. J Spinal Cord Med 2021; 44:S240-S249. [PMID: 34779741 PMCID: PMC8604526 DOI: 10.1080/10790268.2021.1970898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Insufficient recruitment is a barrier to research and limits statistical power. We describe an initiative aimed to streamline recruitment and consent processes for inpatients with spinal cord injury or disease (SCI/D) via implementation of a Central Recruitment (CR) process. The CR process adhered to ethical standards, reduced participant burden, and maximized research participation. METHODS In this CR process, the inpatient's nurse affirmed suitability for research approach based on fluency, cognition and health stability. A patient research liaison (PRL) was the sole contact for information regarding the research process, and introduced ongoing studies, screened for eligibility, and completed the consent process(es). RESULTS Over five and a half years, 1,561 inpatients with SCI/D were screened for eligibility upon admission, of whom 80% (1256/1561) were deemed suitable for the PRL approach. Of those suitable for the CR process, 80% (1001/1256) agreed to discuss current research opportunities, 46% (235/516) consented to participate in one or more studies, and 86% (856/1001) agreed to future research contact. CONCLUSION This process adhered to ethical procedures and reduced the burden of having multiple researchers approach each individual inpatient regarding research participation, with high consent rates for low-risk studies. Future evaluation of the process scalability is underway.
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Affiliation(s)
- B. Catharine Craven
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, KITE Research Institute, Toronto Rehab - University Health Network, 206-H 520 Sutherland Drive, Toronto, OntarioM4G3V9, Canada. Ph: 416-597-3422(6122).
| | - Louise Brisbois
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Chelsea Pelletier
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Ontario, Canada
| | - Julia Rybkina
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Ann Heesters
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada
| | - Mary Caroline Verrier
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Ontario, Canada
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Mangset M, Kitzmüller G, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne KJ, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation. Trials 2021; 22:850. [PMID: 34838094 PMCID: PMC8627040 DOI: 10.1186/s13063-021-05765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is "usual care." The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants' reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. METHODS Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur's interpretation theory guided the analysis. RESULTS The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants' feelings of control and their ability to cope. Other participants' statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. CONCLUSIONS RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02338869. Registered on October 4, 2014.
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Affiliation(s)
- Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Anne S. Evju
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Sanne Angel
- Department of Public Health – Research Unit for Nursing and Healthcare, Department of Science in Nursing, Aarhus University, 8000 Aarhus, Denmark
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
| | - Lena Aadal
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
- Hammel Neurorehabilitation Centre and University Research Clinic, 8450 Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, C, 8000 Aarhus, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
| | | | - Kari J. Kvigne
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
- The Faculty of Nursing and Health Sciences, Nord University, P.B. 1490, 8049 Bodø, Norway
| | - Line K. Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Ellen Gabrielsen Hjelle
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
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Zaman ACGNM, Tytgat KMAJ, Klinkenbijl JHG, Boer FCD, Brink MA, Brinkhuis JC, Bruinvels DJ, Dol LCM, van Duijvendijk P, Hemmer PHJ, Lamme B, Loosveld OJL, Mok MM, Rejda T, Rutten H, Schoorlemmer A, Sonneveld DJ, Stassen LPS, Veenstra RP, van de Ven A, Velzing ER, Frings-Dresen MHW, de Boer AGEM. Effectiveness of a Tailored Work-Related Support Intervention for Patients Diagnosed with Gastrointestinal Cancer: A Multicenter Randomized Controlled Trial. J Occup Rehabil 2021; 31:323-338. [PMID: 32880094 PMCID: PMC8172517 DOI: 10.1007/s10926-020-09920-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Purpose The aim of this research was to study the effectiveness on return to work (RTW) of an early tailored work-related support intervention in patients diagnosed with curative gastrointestinal cancer. Methods A multicenter randomized controlled trial was undertaken, in which patients were assigned randomly to the intervention or the control group (usual care). The intervention encompassed three psychosocial work-related support meetings, starting before treatment. Five self-reported questionnaires were sent over twelve months of follow-up. Primary outcome was days until RTW (fulltime or partial) and secondary outcomes included work status, quality of life, work ability, and work limitations. Descriptive analysis, Kaplan-Meier analysis, relative risk ratio and linear mixed models were applied. Results Participants (N = 88) had a mean age of 55 years; 67% were male and the most common cancer type was colon cancer (66%). Of the participants, 42 were randomized to the intervention group. The median time from sick leave until RTW was 233 days (range 187-279 days) for the control group, versus 190 days (range 139-240 days) for the intervention group (log-rank p = 0.37). The RTW rate at twelve months after baseline was 83.3% for the intervention group and 73.5% for the control group. Work limitations did statistically differ between the groups over time (p = 0.01), but quality of life and work ability did not. Conclusion Patients in the intervention group seem to take fewer days to RTW, albeit not to a statistically significant extent.Trial registration Trial NL4920 (NTR5022) (Dutch Trial Register https://www.trialregister.nl ).
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Affiliation(s)
- A. C. G. N. M. Zaman
- Amsterdam UMC (Location AMC), Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - K. M. A. J. Tytgat
- Amsterdam UMC (Location AMC), Department of Gastroenterology, University of Amsterdam, Amsterdam, The Netherlands
| | - J. H. G. Klinkenbijl
- Department of Surgery, Gelre Hospitals, Apeldoorn, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | - F. C. den Boer
- Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands
| | - M. A. Brink
- Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | | | | | - L. C. M. Dol
- Department of Surgery, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - P. H. J. Hemmer
- Department of Surgical Oncology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - B. Lamme
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - O. J. L. Loosveld
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - M. M. Mok
- Department of Surgery, OLVG (Location East), Amsterdam, The Netherlands
| | - T. Rejda
- Tomas Rejda Counselling (Oncological Occupational Physician), Alphen aan den Rijn, The Netherlands
| | - H. Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - A. Schoorlemmer
- Amsterdam UMC (Location AMC), Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - D. J. Sonneveld
- Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands
| | - L. P. S. Stassen
- Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - R. P. Veenstra
- Department of Gastroenterology, Martini Hospital, Groningen, The Netherlands
| | - A. van de Ven
- Department of General Surgery, Flevo Hospital, Almere, The Netherlands
| | - E. R. Velzing
- Vel.Onc@Work Counselling (Oncological Occupational Physician), Leidschendam, The Netherlands
| | - M. H. W. Frings-Dresen
- Amsterdam UMC (Location AMC), Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - A. G. E. M. de Boer
- Amsterdam UMC (Location AMC), Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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Balestra N, Sharma G, Riek LM, Busza A. Automatic Identification of Upper Extremity Rehabilitation Exercise Type and Dose Using Body-Worn Sensors and Machine Learning: A Pilot Study. Digit Biomark 2021; 5:158-166. [PMID: 34414353 PMCID: PMC8339513 DOI: 10.1159/000516619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Prior studies suggest that participation in rehabilitation exercises improves motor function poststroke; however, studies on optimal exercise dose and timing have been limited by the technical challenge of quantifying exercise activities over multiple days. OBJECTIVES The objectives of this study were to assess the feasibility of using body-worn sensors to track rehabilitation exercises in the inpatient setting and investigate which recording parameters and data analysis strategies are sufficient for accurately identifying and counting exercise repetitions. METHODS MC10 BioStampRC® sensors were used to measure accelerometer and gyroscope data from upper extremities of healthy controls (n = 13) and individuals with upper extremity weakness due to recent stroke (n = 13) while the subjects performed 3 preselected arm exercises. Sensor data were then labeled by exercise type and this labeled data set was used to train a machine learning classification algorithm for identifying exercise type. The machine learning algorithm and a peak-finding algorithm were used to count exercise repetitions in non-labeled data sets. RESULTS We achieved a repetition counting accuracy of 95.6% overall, and 95.0% in patients with upper extremity weakness due to stroke when using both accelerometer and gyroscope data. Accuracy was decreased when using fewer sensors or using accelerometer data alone. CONCLUSIONS Our exploratory study suggests that body-worn sensor systems are technically feasible, well tolerated in subjects with recent stroke, and may ultimately be useful for developing a system to measure total exercise "dose" in poststroke patients during clinical rehabilitation or clinical trials.
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Affiliation(s)
- Noah Balestra
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
- Department of Computer Science, University of Rochester, Rochester, New York, USA
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Linda M. Riek
- Department of Physical Therapy, Nazareth College, Rochester, New York, USA
| | - Ania Busza
- Department of Neurology, University of Rochester, Rochester, New York, USA
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Jones GD, Jones GL, James DC, Thacker M, Green DA. Identifying consistent biomechanical parameters across rising-to-walk subtasks to inform rehabilitation in practice: A systematic literature review. Gait Posture 2021; 83:67-82. [PMID: 33091746 DOI: 10.1016/j.gaitpost.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/07/2020] [Accepted: 10/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The best approach to rehabilitate the control of everyday whole-body movement (e.g. rise-to-walk) after pathology remains unclear in part because the associated controlled performance variables are not known. Rise-to-walk can be performed fluidly (sit-to-walk) or non-fluidly (sit-to-stand, proceeded by gait-initiation). Biomechanical variables that remain consistent in health regardless of how rise-to walk is performed represent controlled performance variable candidates which could monitor rehabilitative change. RESEARCH QUESTION To determine if any biomechanical parameters remain consistent across rising-to-walk (RTW) subtasks (sit-to-stand, gait-initiation, and sit-to-walk) in healthy adults for purposes of movement control assessment in clinical practice. METHODS Data sources included Medline, Cinahl, and Scopus databases, and the grey literature. Study selection was based on eligibility criteria and must have reported spatiotemporal, kinematic and/or kinetic biomechanical parameters featuring >1 RTW subtask. Data extraction and synthesis; standardised-mean-differences (SMDs) were calculated (pooled if replicated in >1 study) for each parameter. Consistency was determined if SMD95 %CIs included the zero-effect line. RESULTS Nine studies (n = 99) were included (40 ± 7.5yrs). Seven parameters were replicated in >1 study and subjected to meta-analysis (fixed-effect model). Two were consistent between sit-to-stand and sit-to-walk: flexion-momentum time (M(95 %CI) = 0.055(-0.423 to 0.533); p = 0.823) and peak whole-body-centre-of-mass vertical velocity (M(95 %CI)= -0.415(-0.898 to 0.069); p = 0.093); and centre-of-pressure to whole-body-centre-of-mass distance at toe-off (M(95 %CI)= -0.137(-0.712 to 0.439); p = 0.642) between gait-initiation and sit-to-walk. Another 20 parameters were consistent based on single-study SMDs. SIGNIFICANCE Consistent parameters might exist across RTW subtasks. However, the evidence is based on few studies with small samples and variable RTW protocols. Future studies designed to confirm consistency using a standardised RTW protocol are needed.
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Affiliation(s)
- Gareth D Jones
- Centre for Human and Applied Physiological Sciences (CHAPS), Shepherd's House, Guy's Campus, King's College London, London, SE1 1UL, UK; Physiotherapy Department, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Gareth L Jones
- Physiotherapy Department, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Darren C James
- Sport and Exercise Science Research Centre, London South Bank University, 103 Borough Road, London, SE1 0AA, UK.
| | - Michael Thacker
- Centre for Human and Applied Physiological Sciences (CHAPS), Shepherd's House, Guy's Campus, King's College London, London, SE1 1UL, UK; Physiotherapy Department, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - David A Green
- Centre for Human and Applied Physiological Sciences (CHAPS), Shepherd's House, Guy's Campus, King's College London, London, SE1 1UL, UK.
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Evans E, Kosar CM, Thomas KS. Positive Beliefs and the Likelihood of Successful Community Discharge From Skilled Nursing Facilities. Arch Phys Med Rehabil 2020; 102:480-487. [PMID: 32991871 DOI: 10.1016/j.apmr.2020.09.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine the association of patient and direct-care staff beliefs about patients' capability to increase independence with activities of daily living (ADL) and the probability of successful discharge to the community after a skilled nursing facility (SNF) stay. DESIGN Retrospective cohort study of SNF patients using 100% Medicare inpatient claims and Minimum Data Set resident assessment data. Linear probability models were used to estimate the probability of successful discharge based on patient and staff beliefs about the patient's ability to improve in function, as well as patient and staff beliefs together. Estimates were adjusted for demographics, health status, functional characteristics, and SNF fixed effects. PARTICIPANTS Fee-for-service Medicare beneficiaries (N=526,432) aged 66 years or older who were discharged to an SNF after hospitalization for stroke, hip fracture, or traumatic brain injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Successful community discharge (discharged alive within 90d of SNF admission and remaining in the community for ≥30d without dying or health care facility readmission). RESULTS Patients with positive beliefs about their capability to increase independence with ADLs had a higher adjusted probability of successful discharge than patients with negative beliefs (positive, 63.8%; negative, 57.8%; difference, 6.0%, 95% confidence interval [CI], 5.4-6.6). This remained true regardless of staff beliefs, but the difference in successful discharge probability between patients with positive and negative beliefs was larger when staff had positive beliefs. Conversely, the association between staff beliefs and successful discharge varied based on patient beliefs. If patients had positive beliefs, the difference in the probability of successful discharge between positive and negative staff beliefs was 2.5% (95% CI, 1.0-4.0). If patients had negative beliefs, the difference between positive and negative staff beliefs was -4.6% (95% CI, -6.0 to -3.2). CONCLUSIONS Patients' beliefs have a significant association with the probability of successful discharge. Understanding patients' beliefs is critical to appropriate goal-setting, discharge planning, and quality SNF care.
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Affiliation(s)
- Emily Evans
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI.
| | - Cyrus M Kosar
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI
| | - Kali S Thomas
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI; Providence VA Medical Center, Providence, RI
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Comber L, Peterson E, O'Malley N, Galvin R, Finlayson M, Coote S. Development of the Better Balance Program for People with Multiple Sclerosis: A Complex Fall-Prevention Intervention. Int J MS Care 2020; 23:119-127. [PMID: 34177384 DOI: 10.7224/1537-2073.2019-105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Approximately 56% of people with multiple sclerosis (MS) will fall in any 3-month period, with the potential for physical, psychological, and social consequences. Fall-prevention research for people with MS is in its infancy, with a timely need to develop theory-based interventions that reflect the complexity of falls. The clear articulation of the development of any complex intervention is paramount to its future evaluation, usability, and effectiveness. Our aim was to describe how the development of Better Balance, a complex multicomponent fall-prevention intervention for people with MS, was guided by the Medical Research Council framework for the development of complex interventions. Methods Sources of information included existing literature, original research, clinician interviews, and views of people with MS. These sources were synthesized and refined through an iterative process of intervention development involving researchers, clinicians, and people with MS. Results The resulting intervention is outlined through a variety of key tasks supplementing the original Medical Research Council framework. Use of this framework resulted in a theoretically based and user-informed complex intervention designed to address the physiological, personal, and behavioral risk factors associated with falls in people with MS. Conclusions The articulation of the systematic process used to develop Better Balance will inform the future evaluation and usability of the intervention.
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15
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Kinney AR, Eakman AM, Graham JE. Novel Effect Size Interpretation Guidelines and an Evaluation of Statistical Power in Rehabilitation Research. Arch Phys Med Rehabil 2020; 101:2219-2226. [PMID: 32272106 DOI: 10.1016/j.apmr.2020.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE First, to establish empirically-based effect size interpretation guidelines for rehabilitation treatment effects. Second, to evaluate statistical power in rehabilitation research. DATA SOURCES The Cochrane Database of Systematic Reviews was searched through June 2019. STUDY SELECTION Meta-analyses included in the Cochrane Database of Systematic Reviews with "rehabilitation" as a keyword and clearly evaluated a rehabilitation intervention. DATA EXTRACTION We extracted Cohen's d effect sizes and associated sample sizes for treatment and comparison groups. Two independent investigators classified the interventions into 4 categories using the Rehabilitation Treatment Specification System. The 25th, 50th, and 75th percentile values within the effect size distribution were used to establish interpretation guidelines for small, medium, and large effects, respectively. A priori power analyses established sample sizes needed to detect the empirically-based values for small, medium, and large effects. Post-hoc power analyses using median sample sizes revealed whether the "typical" rehabilitation study was sufficiently powered to detect the empirically-based values. Post hoc power analyses established the statistical power of each test based on the sample size and reported effect size. DATA SYNTHESIS We analyzed 3381 effect sizes extracted from 99 meta-analyses. Interpretation guidelines for small effects ranged from 0.08 to 0.15; medium effects ranged from 0.19 to 0.36; and large effects ranged from 0.41 to 0.67. We present sample sizes needed to detect these values based on a priori power analyses. Post hoc power analyses revealed that a "typical" rehabilitation study lacks sufficient power to detect the empirically-based values. Post hoc power analyses using reported sample sizes and effects indicated the studies were underpowered, with median power ranging from 0.14 to 0.23. CONCLUSIONS This study presented novel and empirically-based interpretation guidelines for small, medium, and large rehabilitation treatment effects. The observed effect size distributions differed across intervention categories, indicating that researchers should use category-specific guidelines. Furthermore, many published rehabilitation studies are underpowered.
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Affiliation(s)
- Adam R Kinney
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Aaron M Eakman
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado
| | - James E Graham
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado
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Rolls D, Khanna S, Lloyd N, Reeson A, Jayasena R, McCormick C, Hakkennes S. Before-after evaluation of patient length of stay in a rehabilitation context following implementation of an electronic patient journey board. Int J Med Inform 2019; 134:104042. [PMID: 31855847 DOI: 10.1016/j.ijmedinf.2019.104042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/04/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether the installation of electronic patient journey boards in an inpatient adult rehabilitation centre in Victoria, Australia, is associated with shorter lengths of stay for admitted adult rehabilitation patients. METHODS A retrospective before-after analysis of 3 259 adult inpatient rehabilitation episodes from 2013 to 2018 was performed, analysing case-mix adjusted lengths of stay. RESULTS A reduction in case-mix adjusted length of stay of 4.1 days per episode (95 % confidence interval: 2.0-6.4 days) was found. The corresponding reduction in hospital costs was estimated to be $3 738 per episode (95 % confidence interval $2 398-$4 983). CONCLUSIONS Installation of electronic patient journey boards was associated with shorter lengths of stay in an inpatient adult rehabilitation centre. Additional research is needed to 1) provide further evidence of the causal effect of the boards on length of stay, and 2) investigate the mechanisms by which they reduce lengths of stay (e.g., increased currency of information, changes to procedures, remote viewing) in rehabilitation settings.
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Affiliation(s)
- David Rolls
- The Australian e-Health Research Centre, CSIRO, Melbourne, VIC, 3052, Australia.
| | - Sankalp Khanna
- The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, 4029, Australia
| | | | | | - Rajiv Jayasena
- The Australian e-Health Research Centre, CSIRO, Melbourne, VIC, 3052, Australia
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Varriano B, Sulway S, Wetmore C, Dillon W, Misquitta K, Multani N, Anor C, Martinez M, Cacchione E, Rutka J, Tartaglia MC. Vestibular Exercises as a Fall Prevention Strategy in Patients with Cognitive Impairment. Can J Neurol Sci 2020; 47:126-30. [PMID: 31735189 DOI: 10.1017/cjn.2019.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vestibular impairment (VI) and cognitive impairment (CI) are risk factors for senior falls. We tested the feasibility of a self-directed 12-week vestibular rehabilitation (VR) program in Memory Clinic patients (65 years+) with a fall, CI and VI. We assessed recruitment, exercise adherence and ability to complete questionnaires/assessments. Twelve patients with CI and falls were screened and 8/12 (75% - prevalence) had VI. All patients completed the screening tests/questionnaires (100% - completeness); 7/8 patients were recruited (87.5% - recruitment); 1/7 (85.7% - attrition) patient attended follow-up. VI is prevalent in patients with CI experiencing falls but traditional VR is not feasible, so a novel delivery of VR must be explored.
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Boukrina O, Kucukboyaci NE, Dobryakova E. Considerations of power and sample size in rehabilitation research. Int J Psychophysiol 2019; 154:6-14. [PMID: 31655185 DOI: 10.1016/j.ijpsycho.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 05/22/2019] [Accepted: 08/23/2019] [Indexed: 01/26/2023]
Abstract
With the current emphasis on power and reproducibility, pressures are rising to increase sample sizes in rehabilitation research in order to reflect more accurate effect estimation and generalizable results. The conventional way of increasing power by enrolling more participants is less feasible in some fields of research. In particular, rehabilitation research faces considerable challenges in achieving this goal. We describe the specific challenges to increasing power by recruiting large sample sizes and obtaining large effects in rehabilitation research. Specifically, we discuss how variability within clinical populations, lack of common standards for selecting appropriate control groups; potentially reduced reliability of measurements of brain function in individuals recovering from a brain injury; biases involved in a priori effect size estimation, and higher budgetary and staffing requirements can influence considerations of sample and effect size in rehabilitation. We also describe solutions to these challenges, such as increased sampling per participant, improving experimental control, appropriate analyses, transparent result reporting and using innovative ways of harnessing the inherent variability of clinical populations. These solutions can improve statistical power and produce reliable and valid results even in the face of limited availability of large samples.
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Affiliation(s)
- Olga Boukrina
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - N Erkut Kucukboyaci
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Ekaterina Dobryakova
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA.
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Abstract
The article describes the rehabilitation services provided at Christian Medical College Vellore, a tertiary care medical college hospital in South India. The department was started by Dr Mary Verghese, who on completion of her medical training sustained spinal cord injury with resulting paraplegia. Following a section on the initial beginnings of the department, the current status of the department offering comprehensive rehabilitation by the multidisciplinary team is highlighted. The article ends with the challenges faced, including limitations in providing affordable solutions, architectural and attitudinal barriers, and inadequate number of rehabilitation physicians and comprehensive rehabilitation centers in the country.
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Affiliation(s)
- Raji Thomas
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
| | - George Tharion
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Masterson-Algar P, Burton CR, Rycroft-Malone J. The generation of consensus guidelines for carrying out process evaluations in rehabilitation research. BMC Med Res Methodol 2018; 18:180. [PMID: 30594133 PMCID: PMC6311071 DOI: 10.1186/s12874-018-0647-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although in recent years there has been a strong increase in published research on theories (e.g. realist evaluation, normalization process theory) driving and guiding process evaluations of complex interventions, there is limited guidance to help rehabilitation researchers design and carry out process evaluations. This can lead to the risk of process evaluations being unsystematic. This paper reports on the development of new consensus guidelines that address the specific challenges of conducting process evaluations alongside clinical trials of rehabilitation interventions. METHODS A formal consensus process was carried out based on a modified nominal group technique, which comprised two phases. Phase I was informed by the findings of a systematic review, and included a nominal group meeting with an expert panel of participants to rate and discuss the proposed statements. Phase II was an in depth semi-structured telephone interviews with expert panel participants in order to further discuss the structure and contents of the revised guidelines. Frequency of rating responses to each statement was calculated and thematic analysis was carried out on all qualitative data. RESULTS The guidelines for carrying out process evaluations within complex intervention rehabilitation research were produced by combining findings from Phase I and Phase II. The consensus guidelines include recommendations that are grouped in seven sections. These sections are theoretical work, design and methods, context, recruitment and retention, intervention staff, delivery of the intervention and results. These sections represent different aspects or stages of the evaluation process. CONCLUSION The consensus guidelines here presented can play a role at assisting rehabilitation researchers at the time of designing and conducting process evaluations alongside trials of complex interventions. The guidelines break new ground in terms of concepts and theory and works towards a consensus in regards to how rehabilitation researchers should go about carrying out process evaluations and how this evaluation should be linked into the proposed trials. These guidelines may be used, adapted and tested by rehabilitation researchers depending on the research stage or study design (e.g. feasibility trial, pilot trial, etc.).
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Affiliation(s)
- P. Masterson-Algar
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - C. R. Burton
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - J. Rycroft-Malone
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
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Simko LC, Chen L, Amtmann D, Gibran N, Herndon D, Kowalske K, Miller AC, Bulger E, Friedman R, Wolfe A, Chung KK, Mosier M, Jeng J, Giacino J, Zafonte R, Kazis LE, Schneider JC, Ryan CM. Challenges to the Standardization of Trauma Data Collection in Burn, Traumatic Brain Injury, Spinal Cord Injury, and Other Trauma Populations: A Call for Common Data Elements for Acute and Longitudinal Trauma Databases. Arch Phys Med Rehabil 2018; 100:891-898. [PMID: 31030731 DOI: 10.1016/j.apmr.2018.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/21/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Common data elements (CDEs) promote data sharing, standardization, and uniform data collection, which facilitate meta-analyses and comparisons of studies. Currently, there is no set of CDEs for all trauma populations, but their creation would allow researchers to leverage existing databases to maximize research on trauma outcomes. The purpose of this study is to assess the extent of common data collection among 5 trauma databases. DESIGN The data dictionaries of 5 trauma databases were examined to determine the extent of common data collection. Databases included 2 acute care databases (American Burn Association's National Burn Data Standard and American College of Surgeons' National Trauma Data Standard) and 3 longitudinal trauma databases (Burn, Traumatic Brain Injury, Spinal Cord Injury Model System National Databases). Data elements and data values were compared across the databases. Quantitative and qualitative variations in the data were identified to highlight meaningful differences between datasets. SETTING N/A. PARTICIPANTS N/A. INTERVENTIONS N/A. MAIN OUTCOME MEASURES N/A. RESULTS Of the 30 data elements examined, 14 (47%) were present in all 5 databases. Another 9 (30%) elements were present in 4 of the 5 databases. The number of elements present in each database ranged from 23 (77%) to 26 (86%). There were inconsistencies in the data values across the databases. Twelve of the 14 data elements present in all 5 databases exhibited differences in data values. CONCLUSIONS This study demonstrates inconsistencies in the documentation of data elements in 5 common trauma databases. These discrepancies are a barrier to database harmonization and to maximizing the use of these databases through linking, pooling, and comparing data. A collaborative effort is required to develop a standardized set of elements for trauma research.
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Affiliation(s)
- Laura C Simko
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Liang Chen
- Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, MA
| | | | - Nicole Gibran
- Harborview Medical Center, University of Washington, Seattle, WA
| | - David Herndon
- University of Texas Medical Branch, Shriners Hospitals for Children-Galveston, Galveston, TX
| | - Karen Kowalske
- University of Texas Southwestern Medical Center, Dallas, TX
| | - A Cate Miller
- The National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, Department of Health and Human Services, Washington, DC
| | - Eileen Bulger
- Harborview Medical Center, University of Washington, Seattle, WA
| | - Ryan Friedman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Audrey Wolfe
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Brooke Army Medical Center, Houston, TX
| | | | - James Jeng
- Mt. Sinai Beth Israel, Mt. Sinai School of Medicine, New York, NY
| | - Joseph Giacino
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Ross Zafonte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Lewis E Kazis
- Boston University School of Public Health, Boston, MA
| | | | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, MA.
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22
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Lombard-Vance R, O'Keeffe F, Desmond D, Coen R, Ryall N, Gallagher P. Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation. Arch Phys Med Rehabil 2018; 100:278-288.e2. [PMID: 30172643 DOI: 10.1016/j.apmr.2018.07.436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation. DESIGN Cross-sectional study as part of a longitudinal prospective cohort. SETTING A national tertiary rehabilitation hospital. PARTICIPANTS Adult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and nonvascular (n=18) LLA etiologies were included. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic and health information and a battery of standardized neuropsychological assessments. RESULTS Compared to normative data, impairment was evident in overall cognitive functioning (P≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all P≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group compared with expected frequencies in normative data (P≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and nonvascular LLA etiology. CONCLUSIONS Findings support the need for cognitive screening at rehabilitation admission regardless of etiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA, and further research is warranted in this area.
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Affiliation(s)
- Richard Lombard-Vance
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland; Dublin Psychoprosthetics Group, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- Department of Psychology, National Rehabilitation Hospital, Dún Laoghaire, Ireland
| | - Deirdre Desmond
- Dublin Psychoprosthetics Group, Dublin, Ireland; Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Robert Coen
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Nicola Ryall
- Department of Rehabilitation Medicine, National Rehabilitation Hospital, Dún Laoghaire, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland; Dublin Psychoprosthetics Group, Dublin, Ireland.
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23
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Abstract
Zusammenfassung. Reha-Forschung ist die Methode, um die Wirkung der diversen Interventionen, die in der Rehabilitation angewendet werden, zu testen. Um dieses anspruchsvolle Ziel zu erreichen, ist die muskuloskelettale Rehabilitation auf Grundlagenforschung, klinische Forschung und Versorgungsforschung angewiesen. Die Rehabilitationsforschung in der Schweiz sieht sich jedoch mit grossen Herausforderungen und mehreren Barrieren konfrontiert. Insgesamt lässt sich feststellen, dass es keine kohärenten und schweizweit akzeptierten Standards für die systematische Integration aktueller Forschungsergebnisse in die konkrete Reha-Praxis gibt. Als anwendungsbezogenen Handlungsbedarf in der Reha-Forschung in der Schweiz schlagen die Autoren u.a. die Entwicklung einer nationalen Agenda für Reha-Forschung und die Bildung von nationalen Forschungsnetzwerken unter Einbezug der Grundversorger, der Hochschulen, der Rehakliniken und Patientenorganisationen vor.
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Affiliation(s)
- Gere Luder
- 2 Massachusetts General Hospital (MGH), Institute for Health Professions, Rehabilitation Sciences Program, Boston, USA
| | - Martin L Verra
- 1 Institut für Physiotherapie, Inselspital, Universitätsspital Bern, Insel Gruppe
| | - Maurizio Trippolini
- 2 Massachusetts General Hospital (MGH), Institute for Health Professions, Rehabilitation Sciences Program, Boston, USA
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24
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Gerber LH, Nava A, Garfinkel S, Goel D, Weinstein AA, Cai C. A need for an augmented review when reviewing rehabilitation research. Disabil Health J 2016; 9:559-66. [PMID: 27522302 DOI: 10.1016/j.dhjo.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/14/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
There is a need for additional strategies for performing systematic reviews (SRs) to improve translation of findings into practice and to influence health policy. SRs critically appraise research methodology and determine level of evidence of research findings. The standard type of SR identifies randomized controlled trials (RCTs) as providing the most valid data and highest level of evidence. RCTs are not among the most frequently used research design in disability and health research. RCTs usually measure impairments for the primary research outcome rather than improved function, participation or societal integration. It forces a choice between "validity" and "utility/relevance." Other approaches have effectively been used to assess the validity of alternative research designs, whose outcomes focus on function and patient-reported outcomes. We propose that utilizing existing evaluation tools that measure knowledge, dissemination and utility of findings, may help improve the translation of findings into practice and health policy.
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Affiliation(s)
- Lynn H Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA.
| | - Andrew Nava
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | | | - Divya Goel
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | - Ali A Weinstein
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | - Cindy Cai
- American Institutes for Research, Washington DC, USA
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25
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Markert J, Herget S, Marschke S, Lehnert T, Falkenberg C, Blüher S. Case management via telephone counseling and SMS for weight maintenance in adolescent obesity: study concept of the TeAM program. BMC Obes 2014. [PMID: 26217500 PMCID: PMC4472620 DOI: 10.1186/2052-9538-1-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background In-patient obesity treatment programs for adolescents are associated with good success and substantial weight loss. However, maintaining weight loss remains a challenge. This article presents the concept of the TeAM (Telephone counseling as Adiposity Management) program. TeAM is an innovative, weight maintenance program for obese adolescents after in-patient therapy. It applies the case management approach in combination with new media (telephone counseling, web forum, and SMS messaging). Adolescents (14–18 years) were recruited via German rehabilitation hospitals. The intervention of the TeAM program consists of telephone counseling through trained case managers in order to maintain body weight reduction (expressed as BMI-SDS: body mass index standard deviation score) achieved during an in-patient obesity therapy. At baseline and after completion of the program, participants provide anthropometric measures (obtained by trained medical staff) as well as information on socio-demographics, usage of health services, psychosocial status, daily physical activity, media consumption, and eating behavior. The core of the intervention is regular telephone contact with the adolescent participants combined with tailored SMS messages. Telephone counseling is based on the systemic approach and addresses the topics of mental hygiene, physical activity, sedentary behavior, diet and eating behavior. Results Baseline data of the feasibility study: Thirty-eight adolescents were recruited for the feasibility study (14 male, 24 female; mean age 15.82 years); out of them, ten participants lived with a single parent; 68% planned to graduate from school without pre-requisites for university admission (O-level). The mean weight loss during in-patient treatment was 0.32 BMI-SDS units. Mean BMI at the start of intervention was 31.93 kg/m2, corresponding to a mean BMI-SDS of 2.48. Conclusions Weight maintenance treatment programs for adolescent obesity utilizing new media are a promising approach as they reach adolescents directly within their everyday life. Trial registration DRKS00004583.
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Affiliation(s)
- Jana Markert
- Leipzig University Medical Center, IFB Adiposity Diseases, University of Leipzig, Philipp-Rosenthal-Str. 27, Leipzig, D-04103 Germany
| | - Sabine Herget
- Leipzig University Medical Center, IFB Adiposity Diseases, University of Leipzig, Philipp-Rosenthal-Str. 27, Leipzig, D-04103 Germany
| | - Stefanie Marschke
- Leipzig University Medical Center, IFB Adiposity Diseases, University of Leipzig, Philipp-Rosenthal-Str. 27, Leipzig, D-04103 Germany
| | - Thomas Lehnert
- Leipzig University Medical Center, IFB Adiposity Diseases, University of Leipzig, Philipp-Rosenthal-Str. 27, Leipzig, D-04103 Germany ; Department for Medical Sociology and Health Economics, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, D-20246 Germany
| | - Christian Falkenberg
- German statutory pension insurance, Department North, Medical Rehabilitation Hospital "Satteldüne", Tanenwai 32, Nebel/Amrum, D-25946 Germany
| | - Susann Blüher
- Leipzig University Medical Center, IFB Adiposity Diseases, University of Leipzig, Philipp-Rosenthal-Str. 27, Leipzig, D-04103 Germany
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