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Lambe K, Guerra S, Salazar de Pablo G, Ayis S, Cameron ID, Foster NE, Godfrey E, Gregson CL, Martin FC, Sackley C, Walsh N, Sheehan KJ. Effect of inpatient rehabilitation treatment ingredients on functioning, quality of life, length of stay, discharge destination, and mortality among older adults with unplanned admission: an overview review. BMC Geriatr 2022; 22:501. [PMID: 35689181 PMCID: PMC9188066 DOI: 10.1186/s12877-022-03169-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To synthesise the evidence for the effectiveness of inpatient rehabilitation treatment ingredients (versus any comparison) on functioning, quality of life, length of stay, discharge destination, and mortality among older adults with an unplanned hospital admission. METHODS A systematic search of Cochrane Library, MEDLINE, Embase, PsychInfo, PEDro, BASE, and OpenGrey for published and unpublished systematic reviews of inpatient rehabilitation interventions for older adults following an unplanned admission to hospital from database inception to December 2020. Duplicate screening for eligibility, quality assessment, and data extraction including extraction of treatment components and their respective ingredients employing the Treatment Theory framework. Random effects meta-analyses were completed overall and by treatment ingredient. Statistical heterogeneity was assessed with the inconsistency-value (I2). RESULTS Systematic reviews (n = 12) of moderate to low quality, including 44 non-overlapping relevant RCTs were included. When incorporated in a rehabilitation intervention, there was a large effect of endurance exercise, early intervention and shaping knowledge on walking endurance after the inpatient stay versus comparison. Early intervention, repeated practice activities, goals and planning, increased medical care and/or discharge planning increased the likelihood of discharge home versus comparison. The evidence for activities of daily living (ADL) was conflicting. Rehabilitation interventions were not effective for functional mobility, strength, or quality of life, or reduce length of stay or mortality. Therefore, we did not explore the potential role of treatment ingredients for these outcomes. CONCLUSION Benefits observed were often for subgroups of the older adult population e.g., endurance exercise was effective for endurance in older adults with chronic obstructive pulmonary disease, and early intervention was effective for endurance for those with hip fracture. Future research should determine whether the effectiveness of these treatment ingredients observed in subgroups, are generalisable to older adults more broadly. There is a need for more transparent reporting of intervention components and ingredients according to established frameworks to enable future synthesis and/or replication. TRIAL REGISTRATION PROSPERO Registration CRD42018114323 .
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Affiliation(s)
- K Lambe
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - S Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - G Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Sydney, Australia
| | - N E Foster
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - E Godfrey
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - F C Martin
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - N Walsh
- Centre for Health and Clinical Research, University of the West of England Bristol, Bristol, UK
| | - K J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK.
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Goubar A, Ayis S, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ. The impact of the frequency, duration and type of physiotherapy on discharge after hip fracture surgery: a secondary analysis of UK national linked audit data. Osteoporos Int 2022; 33:839-850. [PMID: 34748023 PMCID: PMC8930962 DOI: 10.1007/s00198-021-06195-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Additional physiotherapy in the first postoperative week was associated with fewer days to discharge after hip fracture surgery. A 7-day physiotherapy service in the first postoperative week should be considered as a new key performance indicator in evaluating the quality of care for patients admitted with a hip fracture. INTRODUCTION To examine the association between physiotherapy in the first week after hip fracture surgery and discharge from acute hospital. METHODS We linked data from the UK Physiotherapy Hip Fracture Sprint Audit to hospital records for 5395 patients with hip fracture in May and June 2017. We estimated the association between the number of days patients received physiotherapy in the first postoperative week; its overall duration (< 2 h, ≥ 2 h; 30-min increment) and type (mobilisation alone, mobilisation and exercise) and the cumulative probability of discharge from acute hospital over 30 days, using proportional odds regression adjusted for confounders and the competing risk of death. RESULTS The crude and adjusted odds ratios of discharge were 1.24 (95% CI 1.19-1.30) and 1.26 (95% CI 1.19-1.33) for an additional day of physiotherapy, 1.34 (95% CI 1.18-1.52) and 1.33 (95% CI 1.12-1.57) for ≥ 2 versus < 2 h physiotherapy, and 1.11 (95% CI 1.08-1.15) and 1.10 (95% CI 1.05-1.15) for an additional 30-min of physiotherapy. Physiotherapy type was not associated with discharge. CONCLUSION We report an association between physiotherapy and discharge after hip fracture. An average UK hospital admitting 375 patients annually may save 456 bed-days if current provision increased so all patients with hip fracture received physiotherapy on 6-7 days in the first postoperative week. A 7-day physiotherapy service totalling at least 2 h in the first postoperative week may be considered a key performance indicator of acute care quality after hip fracture.
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Affiliation(s)
- A Goubar
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - L Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Johansen
- Cardiff Trauma Unit, University Hospital of Wales, Cardiff, UK
| | - M T Kristensen
- Department of Physical & Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
- Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - E Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - T O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - K J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
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Milton-Cole R, Ayis S, Lambe K, O’Connell MDL, Sackley C, Sheehan KJ. 661 PROGNOSTIC FACTORS OF DEPRESSION AFTER HIP FRACTURE SURGERY: SYSTEMATIC REVIEW. Age Ageing 2022. [DOI: 10.1093/ageing/afac035.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Patients with hip fracture and depression are less likely to recover. This review aimed to identify prognostic factors of depression up to one year after hip fracture surgery in adults. Secondary aims were to determine whether identified factors are modifiable or non-modifiable and describe proposed underlying mechanisms for their association with depression.
Methods
We searched MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection databases for published studies as well as grey literature. We did not impose any date, geographical, or language limitations. Two reviewers independently screened studies against predefined eligibility criteria to identify relevant papers. We included observational studies investigating prognostic factors of depression up to one year after surgery in adults surgically managed for non-pathological hip fracture. Two reviewers independently extracted data (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist) and completed quality appraisal (using Quality in Prognosis Studies tool).
Results
3,402 studies were identified; 2,915 studies were excluded leaving 13 studies included in this review. 3,769 patients were included across all studies with a mean age ranging from 76.21–81.82 years. A total of 39 prognostic factors were investigated and most studies failed to identify a primary prognostic factor of interest. Most of these factors were patient factors with only a few being process or structure factors.
Conclusion
Various potential prognostic factors of depression after hip fracture were identified however, Methodological quality and heterogeneity between studies limited the certainty of which prognostic factors were the strongest. High-quality research investigating prognostic factors using the same study design, Methodology and measurements is warranted to allow for comparisons of the predictive power of factors. As well as future research into the underlying mechanisms of prognostic factors.
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Affiliation(s)
- R Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - K Lambe
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - M D L O’Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - K J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
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Volkmer B, Sadler E, Lambe K, Martin FC, Ayis S, Beaupre L, Cameron ID, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Sackley C, Smith TO, Sobolev B. 660 PHYSIOTHERAPISTS PERCEPTIONS OF MECHANISMS FOR OBSERVED VARIATION IN PRACTICE DURING EARLY POSTOPERATIVE PHASE AFTER HIP FRACTURE. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To explore physiotherapists’ perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit.
Methods
A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings.
Results
Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting ‘postoperative physiotherapy’ as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services.
Conclusion
Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles.
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Goubar A, Martin F, Potter C, Jones G, Sackley C, Ayis S, Sheehan K. 30-day survival and recovery after hip fracture by mobilisation timing and dementia: A UK database study. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bearne L, Volkmer B, Dhouri A, Farran D, Fisher G, Galea Holmes M, Modarai B, Patel S, Peacock J, Sackley C, Weinman J, Bieles J. A physiotherapist-led, home-based walking intervention for peripheral arterial disease: MOtivating Structured walking Activity for Intermittent Claudication (MOSAIC) randomised controlled trial. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bieles J, Volkmer B, Holmes MG, Duvnjak S, Fisher G, Keane R, Modarai B, Peacock J, Weinman J, Sackley C, Bearne L. The impact of the motivating structured walking activity for intermittent claudication training for physiotherapists on therapeutic empathy and motivational interviewing. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Milton-Cole R, Ayis S, Lambe K, O'Connell MDL, Sackley C, Sheehan KJ. Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review. BMC Geriatr 2021; 21:537. [PMID: 34627160 PMCID: PMC8502369 DOI: 10.1186/s12877-021-02514-1] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. Methods We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. Results In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. Conclusion Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. Trial registration Prospero registration: CRD42019138690. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02514-1.
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Affiliation(s)
- R Milton-Cole
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.
| | - S Ayis
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - K Lambe
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - M D L O'Connell
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - C Sackley
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - K J Sheehan
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
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Sheehan KJ, Goubar A, Martin FC, Potter C, Jones GD, Sackley C, Ayis S. 500 30-DAY SURVIVAL AND RECOVERY AFTER HIP FRACTURE BY MOBILISATION TIMING AND DEMENTIA: A UK DATABASE STUDY. Age Ageing 2021. [DOI: 10.1093/ageing/afab118.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
To compare 30-day survival and recovery of prefracture ambulation between patients mobilised early (on the day of or day after surgery) and patients mobilised late (2 days of more after surgery) in England and Wales. To determine whether the presence of dementia influences the association between mobilisation timing and 30-day survival and recovery.
Methods
Secondary analysis of the UK National Hip Fracture Database linked to hospitalisation records for 126,897 patients 60 years or older who underwent surgery for nonpathological first hip fracture in England or Wales between 2014 and 2016. We used logistic regression to regress survival and ambulation recovery at 30-days with respect to mobilisation timing, overall and by dementia, with adjustment for confounding using a propensity score for mobilisation treatment with respect to confounders.
Results
Overall, 99,667 (79%) patients mobilised early. Among those who mobilised early compared to those who mobilised late, the weighted odds ratio of survival was 1.92 (95% CI 1.80–2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03–1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32–1.78) by 30 days. Early compared with late mobilisation led to a 3.8% increase in the weighted probability of survival, 22.8% increase in weighted probability of recovering outdoor ambulation and 10.0% increase in the weighted probability of recovering indoor ambulation, by 30-days. Patients with dementia were less likely to mobilise early but increases in survival and ambulation recovery were observed both for those with and without dementia.
Conclusion
Early mobilisation led to increase probability of survival and recovery for patients (with and without dementia) after hip fracture. Early mobilisation should be incorporated as a measured indicator of quality internationally. Reasons for failure to mobilise early should also be captured to inform quality improvement initiatives.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - A Goubar
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - F C Martin
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - C Potter
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - G D Jones
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - S Ayis
- Guy’s and St. Thomas’s National Health Service Foundation Trust, London, UK
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Sheehan KJ, Goubar A, Martin FC, Potter C, Jones GD, Sackley C, Ayis S. 501 DISCHARGE AFTER HIP FRACTURE SURGERY IN RELATION TO MOBILISATION TIMING BY PATIENT CHARACTERISTICS: A NATIONAL DATABASE STUDY. Age Ageing 2021. [DOI: 10.1093/ageing/afab118.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Early mobilisation leads to a two-fold increase in the odds of discharge by 30-days compared to late mobilisation. Whether this association varies by identified reasons for delayed mobilisation is unknown.
Methods
Audit data linked to hospitalisation records for patients 60 years or older surgically treated for hip fracture in England/Wales 2014–2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed for early compared with late mobilisation across subgroups defined by dementia, delirium, hypotension, prefracture ambulation and residence, accounting for competing risk of death.
Results
Overall, 34,253 patients presented with dementia, 9,818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 10%, 8%, 8%, 12%, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or from residential care mobilised early compared to those without dementia, delirium, hypotension, with outdoor ambulation prefracture, or from home. Adjusted odds ratios of discharge by 30-days for early compared with late mobilisation were 1.71 (95% CI 1.62–1.81) for those with dementia, 2.06 (95% CI 1.98–2.15) without dementia, 1.56 (95% CI 1.41–1.73) with delirium, 2.00 (95% CI 1.93–2.07) without delirium, 1.83 (95% CI, 1.66–2.02) with hypotension, 1.95 (95% CI, 1.89–2.02) without hypotension, 2.00 (95% CI 1.92–2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.70–1.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19–2.41) from home, and 1.64 (95% CI 1.51–1.77) from residential care.
Conclusion
Irrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of discharge by 30-days. Fewer patients with these conditions, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - A Goubar
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - F C Martin
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - C Potter
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - G D Jones
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - S Ayis
- Guy’s and St. Thomas’s National Health Service Foundation Trust, London, UK
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Goubar A, Almilaji O, Martin FC, Potter C, Jones GD, Sackley C, Ayis S, Sheehan KJ. 34 Discharge After Hip Fracture Surgery by Mobilisation Timing: Secondary Analysis of the UK National Hip Fracture Database. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To maximise the benefits of hip fracture surgery the National Institute for Health and Care Excellence Clinical Guideline recommends mobilisation on the day after hip fracture surgery based a low to moderate quality trial with a small sample size. There is a need to generate additional evidence to support early mobilisation as a new UK Best Practice Tariff (BPT).
Objective
To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30-days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death.
Method
We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between January 2014 and December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 hours of surgery) and those mobilised late accounting for potential confounders and the competing risk of in-hospital death.
Results
106,722 (79%) of patients first mobilised early. The average rate of discharge was 60.1 (95% CI 59.8–60.5) per 1,000 patient days, varying from 65.2 (95% CI 64.8–65.6) among those who mobilised early to 44.5 (95% CI 43.9–45.1) among those who mobilised late, accounting for the competing risk of death. By 30-days postoperatively, the crude and adjusted odds ratios of discharge were 2.26 (95% CI 2.2–2.32) and 1.93 (95% CI 1.86–1.99) respectively among those who first mobilised early compared to those who mobilised late, accounting for the competing risk of death.
Conclusion
Early mobilisation led to a near two fold increase in the adjusted odds of discharge by 30-days postoperatively. We recommend inclusion of mobilisation within 36 hours of surgery as a new UK BPT to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.
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Affiliation(s)
- A Goubar
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - O Almilaji
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - F C Martin
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
- Guy’s and St. Thomas’s National Health Service Foundation Trust
| | - C Potter
- Guy’s and St. Thomas’s National Health Service Foundation Trust
| | - G D Jones
- Guy’s and St. Thomas’s National Health Service Foundation Trust
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
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Sheehan KJ, Fitzgerald L, Hatherley S, Potter C, Ayis S, Martin FC, Gregson CL, Cameron ID, Beaupre LA, Wyatt D, Milton-Cole R, DiGiorgio S, Sackley C. Inequity in rehabilitation interventions after hip fracture: a systematic review. Age Ageing 2019; 48:489-497. [PMID: 31220202 DOI: 10.1093/ageing/afz031] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 10/21/2018] [Revised: 01/18/2019] [Accepted: 03/13/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes. DESIGN systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane's PROGRESS-Plus framework). RESULTS twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions. CONCLUSION the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated. PROSPERO CRD42018085930.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - L Fitzgerald
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - S Hatherley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C Potter
- Department of Physiotherapy, Guy’s and St. Thomas’s National Health Service Foundation Trust, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - F C Martin
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C L Gregson
- Translational Health Sciences, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK
| | - I D Cameron
- Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Australia
| | - L A Beaupre
- Department of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Canada
| | - D Wyatt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, NIHR Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, UK
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - S DiGiorgio
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
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Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, Bearne LM, Sackley C. Prognostic factors of functional outcome after hip fracture surgery: a systematic review. Age Ageing 2018; 47:661-670. [PMID: 29668839 DOI: 10.1093/ageing/afy057] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective this systematic review aimed to identify immutable and modifiable prognostic factors of functional outcomes and their proposed mechanism after hip fracture surgery. Design systematic search of MEDLINE, Embase, CINAHL, PEDRO, OpenGrey and ClinicalTrials.gov for observational studies of prognostic factors of functional outcome after hip fracture among surgically treated adults with mean age of 65 years and older. Study selection, quality assessment, and data extraction were completed independently by two reviewers. The Quality in Prognosis Studies Tool was used for quality assessment and assigning a level of evidence to factors. Proposed mechanisms for reported associations were extracted from discussion sections. Results from 33 studies of 9,552 patients, we identified 25 prognostic factors of functional outcome after hip fracture surgery. We organised factors into groups: demographics, injury and comorbidities, body composition, complications, and acute care. We assigned two factors a weak evidence level-anaemia and cognition. We assigned Parkinson's disease an inconclusive evidence level. We could not assign an evidence level to the remaining 22 factors due to the high risk of bias across studies. Frailty was the proposed mechanism for the association between anaemia and functional outcome. Medication management, perceived potential, complications and time to mobility were proposed as mechanisms for the association between cognition and functional outcome. Conclusion we identified one modifiable and one immutable prognostic factor for functional outcomes after hip fracture surgery. Future research may target patients with anaemia or cognitive impairment by intervening on the prognostic factor or the underlying mechanisms.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - L Williamson
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - J Alexander
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Filliter
- Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - L M Bearne
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
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Rowe FJ, Conroy EJ, Bedson E, Cwiklinski E, Drummond A, García- Fiñana M, Howard C, Pollock A, Shipman T, Dodridge C, MacIntosh C, Johnson S, Noonan C, Barton G, Sackley C. Choice of outcome measures for the VISION pilot trial of interventions for hemianopia. Acta Neurol Scand 2017; 136:551-553. [PMID: 28980307 DOI: 10.1111/ane.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Affiliation(s)
- F. J. Rowe
- Department of Health Services Research; University of Liverpool; Liverpool UK
| | - E. J. Conroy
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - E. Bedson
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - E. Cwiklinski
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - A. Drummond
- School of Health Sciences; University of Nottingham; Nottingham UK
| | | | - C. Howard
- Department of Orthoptics; Salford Royal NHS Foundation Trust; Manchester UK
| | - A. Pollock
- Nursing Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - T. Shipman
- Department of Orthoptics; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - C. Dodridge
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - C. MacIntosh
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - S. Johnson
- Eye Clinic Impact Team; Royal National Institute for the Blind; Birmingham UK
| | - C. Noonan
- Department of Ophthalmology; Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - G. Barton
- Department of Elderly Care; Warrington and Halton Hospitals NHS Foundation Trust; Warrington UK
| | - C. Sackley
- Division of Health and Social Care; King's College; London UK
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Rowe FJ, Conroy EJ, Bedson E, Cwiklinski E, Drummond A, García-Fiñana M, Howard C, Pollock A, Shipman T, Dodridge C, MacIntosh C, Johnson S, Noonan C, Barton G, Sackley C. A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia. Acta Neurol Scand 2017; 136:310-321. [PMID: 28028819 DOI: 10.1111/ane.12725] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only). METHODS Prospective, multicentre, parallel, single-blind, three-arm RCT across fifteen UK acute stroke units. PARTICIPANTS Stroke survivors with homonymous hemianopia. INTERVENTIONS Arm a (Fresnel prisms) for minimum 2 hours, 5 days per week over 6 weeks. Arm b (visual search training) for minimum 30 minutes, 5 days per week over 6 weeks. Arm c (standard care-information only). INCLUSION CRITERIA Adult stroke survivors (>18 years), stable hemianopia, visual acuity better than 0.5 logMAR, refractive error within ±5 dioptres, ability to read/understand English and provide consent. OUTCOMES Primary outcomes were change in visual field area from baseline to 26 weeks and calculation of sample size for a definitive trial. Secondary measures included Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual, Short Form-12 questionnaires and Radner reading ability. Measures were post-randomization at baseline and 6, 12 and 26 weeks. RANDOMIZATION Randomization block lists stratified by site and partial/complete hemianopia. BLINDING Allocations disclosed to patients. Primary outcome assessor blind to treatment allocation. RESULTS Eighty-seven patients were recruited: 27-Fresnel prisms, 30-visual search training and 30-standard care; 69% male; mean age 69 years (SD 12). At 26 weeks, full results for 24, 24 and 22 patients, respectively, were compared to baseline. Sample size calculation for a definitive trial determined as 269 participants per arm for a 200 degree2 visual field area change at 90% power. Non-significant relative change in area of visual field was 5%, 8% and 3.5%, respectively, for the three groups. Visual Function Questionnaire responses improved significantly from baseline to 26 weeks with visual search training (60 [SD 19] to 68.4 [SD 20]) compared to Fresnel prisms (68.5 [SD 16.4] to 68.2 [18.4]: 7% difference) and standard care (63.7 [SD 19.4] to 59.8 [SD 22.7]: 10% difference), P=.05. Related adverse events were common with Fresnel prisms (69.2%; typically headaches). CONCLUSIONS No significant change occurred for area of visual field area across arms over follow-up. Visual search training had significant improvement in vision-related quality of life. Prism therapy produced adverse events in 69%. Visual search training results warrant further investigation.
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Affiliation(s)
- F. J. Rowe
- Department of Health Services Research; University of Liverpool; Liverpool UK
| | - E. J. Conroy
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - E. Bedson
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - E. Cwiklinski
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - A. Drummond
- School of Health Sciences; University of Nottingham; Nottingham UK
| | - M. García-Fiñana
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - C. Howard
- Department of Orthoptics; Salford Royal NHS Foundation Trust; Manchester UK
| | - A. Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - T. Shipman
- Department of Orthoptics; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - C. Dodridge
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - C. MacIntosh
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - S. Johnson
- Eye Clinic Impact Team; Royal National Institute for the Blind; Birmingham UK
| | - C. Noonan
- Department of Ophthalmology; Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - G. Barton
- Department of Elderly Care; Warrington and Halton Hospitals NHS Foundation Trust; Warrington UK
| | - C. Sackley
- Division of Health and Social Care; King's College; London UK
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Smith TO, Mansfield M, Dainty J, Hilton G, Mann CJV, Sackley CM. Does physical activity change following hip and knee replacement? Matched case-control study evaluating Physical Activity Scale for the Elderly data from the Osteoarthritis Initiative. Physiotherapy 2017; 104:80-90. [PMID: 28917522 DOI: 10.1016/j.physio.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/23/2016] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether physical activity measured using the Physical Activity Scale for the Elderly (PASE), changes during the initial 24 months post-total hip (THR) or knee replacement (TKR), and how this compares to a matched non-arthroplasty cohort. DESIGN Case-controlled study analysis of a prospectively collected dataset. SETTING USA community-based. PARTICIPANTS 116 people post-THR, 105 people post-TKR compared to 663 people who had not undergone THR or TKR, or had hip or knee osteoarthritis. Cohorts were age-, gender- and BMI-matched. MAIN OUTCOME MEASURES Physical activity assessed using the 12-item PASE at 12 and 24 months post operatively. RESULTS There was no significant difference in total PASE score between pre-operative to 12 months (mean: 136 vs 135 points; p=0.860) or 24 months following THR (mean: 136 vs 132 points; p=0.950). Whilst there was no significant difference in total PASE score from pre-operative to 12 months post-TKR (126 vs 121 points; p=0.930), by 24 months people following TKR reported significantly greater physical activity (126 vs 142 points; p=0.040). There was no statistically significant difference in physical activity between the normative matched and THR (p≥0.140) or TKR (p≥0.060) cohorts at 12 or 24 months post joint replacement. CONCLUSIONS Physical activity is not appreciably different to pre-operative levels at 12 or 24 months post-THR, but was greater at 24 months following TKR. Health promotion strategies are needed to encourage greater physical activity participation following joint replacement, and particularly targeting those who undergo THR.
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Affiliation(s)
- T O Smith
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Queen's Building, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom.
| | - M Mansfield
- Guy's and St Thomas' Hospitals NHS Foundation Trust and Academic Department of Physiotherapy, King's College London, United Kingdom.
| | - J Dainty
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - G Hilton
- The Royal Ballet, Covent Garden, London, United Kingdom.
| | - C J V Mann
- Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
| | - C M Sackley
- Division of Health and Social Care Research, King's College, London, United Kingdom.
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Abstract
A survey was carried out in order to ascertain the treatment approaches used in stroke care by senior I occupational therapists in the Trent Region of the United Kingdom. A random selection of these therapists was subsequently interviewed using semi-structured interviews and a case vignette in order to obtain more detailed information. Of the 83 questionnaires sent, 61 (73%) were returned; 14 therapists were interviewed. The two most common approaches identified were the functional approach and the Bobath approach. The main indications for the choice of approach were the age of the patient, progress with other approaches and discharge date. Of concern in the current climate of evidence-based practice was the high number of occupational therapists who were unfamiliar with standardised assessments and unable to describe adequately the theoretical basis for the treatment used.
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Turton AJ, Cunningham P, van Wijck F, Smartt HJM, Rogers CA, Sackley CM, Jowett S, Wolf SL, Wheatley K, van Vliet P. Home-based Reach-to-Grasp training for people after stroke is feasible: a pilot randomised controlled trial. Clin Rehabil 2016; 31:891-903. [DOI: 10.1177/0269215516661751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: To determine feasibility of a randomised controlled trial (RCT) of home-based Reach-to-Grasp training after stroke. Design: single-blind parallel group RCT. Participants: Residual arm deficit less than 12 months post-stroke. Interventions: Reach-to-Grasp training in 14 one-hour therapist’s visits over 6 weeks, plus one hour self-practice per day (total 56 hours). Control: Usual care. Main Measures: Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), pre-randomisation, 7, 12, 24 weeks post-randomisation. Results: Forty-seven participants (Reach-to-Grasp=24, usual care=23) were randomised over 17 months. Reach-to-Grasp participants received a median (IQR) 14 (13,14) visits, and performed 157 (96,211) repetitions per visit; plus 30 minutes (22,45) self-practice per day. Usual care participants received 10.5 (5,14) therapist visits, comprising 38.6 (30,45) minutes of arm therapy with 16 (6,24) repetitions of functional tasks per visit. Median ARAT scores in the reach-to-grasp group were 8.5 (3.0,24.0) at baseline and 14.5 (3.5,26.0) at 24 weeks compared to median of 4 at both time points (IQR: baseline (3.0,14.0), 24 weeks (3.0,30.0)) in the usual-care group. Median WMFT tasks completed at baseline and 24 weeks were 6 (3.0,11.5) and 8.5 (4.5,13.5) respectively in the reach-to-grasp group and 4 (3.0,10.0), 6 (3.0,14.0) in the usual care group. Incidence of arm pain was similar between groups. The study was stopped before 11 patients reached the 24 weeks assessment. Conclusions: An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe. With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial.
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Affiliation(s)
- AJ Turton
- Department of Allied Health Professions, University of the West of England, UK
| | - P Cunningham
- Department of Allied Health Professions, University of the West of England, UK
| | - F van Wijck
- Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - HJM Smartt
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, UK
| | - CA Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, UK
| | - CM Sackley
- Institute of Health and Social Care Research, King’s College London, UK
| | - S Jowett
- School of Health and Population Sciences, University of Birmingham, UK
| | - SL Wolf
- Emory Rehabilitation Hospital, Emory University, Atlanta, USA
| | - K Wheatley
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - P van Vliet
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia, and Hunter Medical Research Institute, UK
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Abstract
Research over the past decade had indicated the effectiveness of visual feedback as a method of training stance symmetry and weight-transference after stroke. This study was carried out to assess the efficacy of the Balance Performance Monitor (BPM) in providing feedback. A reversal ABAB single-case experimental design was used with two patients at different stages poststroke. Assessments of motor function and independence in functional tasks (ADL) were made, as well as the measures of stance symmetry. The results indicated large improvements in symmetry, with both patients achieving levels within the normal range after five treatments. Functional skills also improved. Although the limitations of single-case studies are recognized, such dramatic improvements suggest that the BPM is an effective method of providing feedback and that this approach to treatment enhances the effects of physiotherapy and could be used more frequently after stroke.
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Affiliation(s)
- CM Sackley
- Division of Stroke Medicine, City Hospital, Nottingham
| | - BI Baguley
- Division of Stroke Medicine, City Hospital, Nottingham
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Abstract
The Rivermead Motor Assessment is a standardized assessment of physical recovery after stroke. One part, the gross function scale, was tested to see if it was reliable if administered verbally. Forty-nine volunteers were recruited six months after a stroke and asked to rate their own ability verbally and perform the test items with an independent assessor. There was a significant level of agreement between the scores using the Spearman Rank Correlation ( rs = 0.979; p < 0.001). It can be concluded that the gross function scale of the Rivermead Motor Assessment is reliable when administered verbally with patients late after stroke.
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Smith TO, Sackley CM. UK survey of occupational therapist's and physiotherapist's experiences and attitudes towards hip replacement precautions and equipment. BMC Musculoskelet Disord 2016; 17:228. [PMID: 27225033 PMCID: PMC4880834 DOI: 10.1186/s12891-016-1092-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Received: 11/13/2015] [Accepted: 05/21/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Total hip replacement (THR) is one of the most common orthopaedic procedures in the United Kingdom (UK). Historically, people following THR have been provided with hip precautions and equipment such as: raised toilet seats and furniture rises, in order to reduce the risks of dislocation post-operation. The purpose of this study was to determine current practices in the provision of these interventions in the UK for people following primary THR. METHODS A 27-question, self-administered online survey was developed and distributed to UK physiotherapists and occupational therapists involved in the management of people following primary THR (target respondents). The survey included questions regarding the current practices in the provision of equipment and hip precautions for THR patients, and physiotherapist's and occupational therapist's attitudes towards these practices. The survey was disseminated through print and web-based/social media channels. RESULTS 170 health professionals (87 physiotherapists and 83 occupational therapists), responded to the survey. Commonly prescribed equipment in respondent's health trusts were raised toilet seats (95 %), toilet frames and rails (88 %), furniture raises (79 %), helping hands/grabbers (77 %), perching stools (75 %) and long-handled shoe horns (75 %). Hip precautions were routinely prescribed by 97 % of respondents. Hip precautions were most frequently taught in a pre-operative group (52 % of respondents). Similarly equipment was most frequently provided pre-operatively (61 % respondents), and most commonly by occupational therapists (74 % respondents). There was variability in the advice provided on the duration of hip precautions and equipment from up to 6 weeks post-operatively to life-time usage. CONCLUSIONS Current practice on hip precautions and provision of equipment is not full representative of clinician's perceptions of best care after THR. Future research is warranted to determine whether and to whom hip precautions and equipment should be prescribed post-THR as opposed to the current 'blanket' provision of equipment and movement restriction provided in UK practice.
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Affiliation(s)
- T O Smith
- School of Health Sciences, University of East Anglia, Queen's Building, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - C M Sackley
- Division of Health and Social Care Research, King's College, London, UK
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van Vliet P, Cunningham P, Wijck F, Sackley C, Rogers C, Wolf S, Jowett S, Wheatley K, Turton A. Home-based reach-to-grasp training for people after stroke: a feasibility randomised controlled trial. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rowe FJ, Barton PG, Bedson E, Breen R, Conroy EJ, Cwiklinski E, Dodridge C, Drummond A, Garcia-Finana M, Howard C, Johnson S, MacIntosh C, Noonan CP, Pollock A, Rockliffe J, Sackley C, Shipman T. A randomised controlled trial to compare the clinical and cost-effectiveness of prism glasses, visual search training and standard care in patients with hemianopia following stroke: a protocol. BMJ Open 2014; 4:e005885. [PMID: 25034632 PMCID: PMC4120412 DOI: 10.1136/bmjopen-2014-005885] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Homonymous hemianopia is a common and disabling visual problem after stroke. Currently, prism glasses and visual scanning training are proposed to improve it. The aim of this trial is to determine the effectiveness of these interventions compared to standard care. METHODS AND ANALYSIS The trial will be a multicentre three arm individually randomised controlled trial with independent assessment at 6 week, 12 week and 26 week post-randomisation. Recruitment will occur in hospital, outpatient and primary care settings in UK hospital trusts. A total of 105 patients with homonymous hemianopia and without ocular motility impairment, visual inattention or pre-existent visual field impairment will be randomised to one of three balanced groups. Randomisation lists will be stratified by site and hemianopia level (partial or complete) and created using simple block randomisation by an independent statistician. Allocations will be disclosed to patients by the treating clinician, maintaining blinding for outcome assessment. The primary outcome will be change in visual field assessment from baseline to 26 weeks. Secondary measures will include the Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual-5D and Short Form-12 questionnaires. Analysis will be by intention to treat. ETHICS AND DISSEMINATION This study has been developed and supported by the UK Stroke Research Network Clinical Studies Group working with service users. Multicentre ethical approval was obtained through the North West 6 Research ethics committee (Reference 10/H1003/119). The trial is funded by the UK Stroke Association. Trial Registration: Current Controlled Trials ISRCTN05956042. Dissemination will consider usual scholarly options of conference presentation and journal publication in addition to patient and public dissemination with lay summaries and articles. TRIAL REGISTRATION Current Controlled Trials ISRCTN05956042.
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Affiliation(s)
- F J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - P G Barton
- Department of Elderly Care, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - E Bedson
- Clinical Trials Research Unit, University of Liverpool, Liverpool, UK
| | - R Breen
- Clinical Trials Research Unit, University of Liverpool, Liverpool, UK
| | - E J Conroy
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - E Cwiklinski
- Clinical Trials Research Unit, University of Liverpool, Liverpool, UK
| | - C Dodridge
- Department of Orthoptics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - M Garcia-Finana
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - C Howard
- Department of Orthoptics, Salford Royal NHS Foundation Trust, Manchester, UK
| | - S Johnson
- Eye Clinic Impact Team, Royal National Institute for the Blind, Birmingham, UK
| | - C MacIntosh
- Department of Orthoptics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - C P Noonan
- Department of Ophthalmology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - A Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - C Sackley
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - T Shipman
- Department of Orthoptics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Moran GM, Fletcher B, Feltham MG, Calvert M, Sackley C, Marshall T. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol 2014; 21:1258-67. [PMID: 24861479 DOI: 10.1111/ene.12469] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [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: 01/13/2014] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Abstract
Transient ischaemic attack (TIA) and minor stroke are characterized by short-lasting symptoms; however, anecdotal and empirical evidence suggests that these patients experience ongoing cognitive/psychological impairment for which they are not routinely treated. The aims were (i) to investigate the prevalence and time course of fatigue, anxiety, depression, post-traumatic stress disorder(PTSD) and cognitive impairment following TIA/minor stroke; (ii) to explore the impact on quality of life (QoL), change in emotions and return to work; and (iii) to identify where further research is required and potentially inform an intervention study. A systematic review of MEDLINE, EMBASE, PSYCINFO, CINAHL, the Cochrane libraries and the grey literature between January 1993 and April 2013 was undertaken. Literature was screened and data were extracted by two independent reviewers. Studies were included of adult TIA/minor stroke participants with any of the outcomes of interest: fatigue, anxiety, depression, PTSD, cognitive impairment, QoL, change in emotions and return to work. Random-effects meta-analysis pooled outcomes by measurement tool. Searches identified 5976 records, 289 were assessed for eligibility and 31 studies were included. Results suggest high levels of cognitive impairment and depression post-TIA/minor stroke which decreased over time. However, frequencies varied between studies. Limited information was available on anxiety, PTSD and fatigue. Meta-analysis revealed that the measurement tool administered influenced the prevalence of cognitive impairment: Mini-Mental State Examination 17% [95% confidence interval (CI) 7, 26]; neuropsychological test battery 39% (95% CI 28, 50); Montreal Cognitive Assessment 54% (95% CI 43, 66). There is evidence to suggest that TIA/minor stroke patients may experience residual impairments; however, results should be interpreted with caution because of the few high quality studies. Notwithstanding, it is important to raise awareness of potential subtle but meaningful residual impairments.
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Affiliation(s)
- G M Moran
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Feltham MG, Collett J, Izadi H, Wade DT, Morris MG, Meaney AJ, Howells K, Sackley C, Dawes H. Cardiovascular adaptation in people with multiple sclerosis following a twelve week exercise programme suggest deconditioning rather than autonomic dysfunction caused by the disease. Results from a randomized controlled trial. Eur J Phys Rehabil Med 2013; 49:765-774. [PMID: 23877228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Guidelines for optimal exercise doses in people with multiple sclerosis (MS) have to be established. We need to ascertain the basic physiological and perceptual response and adaptation to different exercise doses in this clinical population. AIM The aim of this paper was to explore the response during maximal and sub-maximal exercise in people with MS prior to and following two different twelve week exercise programmes. DESIGN Sub-analysis of per protocol exercise data of a two group, single blinded, randomised control trial. SETTING Multicentre (community leisure and rehabilitation centres). POPULATION Participants with MS assigned to a continuous (N.=12; mean±SE age=52.3±2.08; Barthel index median & range=19&13-20) or interval (N.=9; mean±SE age=49.3±3.5; Barthel index median & range=19&18-20) exercise programme. METHODS Cardiovascular, respiratory and perceptual exercise response and adaption was measured at maximal and sub-maximal levels of physical exercise prior to and following a twelve week exercise programme, delivered at different intensities. RESULTS Irrespective of the type of exercise programme followed, there was a significant increase in peak power (z=-1.98; P=0.05) and normalised oxygen uptake during unloaded cycling (z =-2.00; P=0.05). At discharge from the exercise programmes, the cardiovascular response to sub-maximal exercise had significantly changed (t(360) =-4.62; p<0.01). CONCLUSION The response in people with MS at maximal and sub-maximal levels of physical exercise following a twelve week programme is analogous to non-diseased adults. CLINICAL REHABILITATION IMPACT Cardiovascular adaptation in people with MS following a twelve week exercise programme suggests deconditioning rather than autonomic dysfunction caused by the disease.
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Affiliation(s)
- M G Feltham
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK -
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Durham KF, Sackley CM, Wright CC, Wing AM, Edwards MG, van Vliet P. Attentional focus of feedback for improving performance of reach-to-grasp after stroke: a randomised crossover study. Physiotherapy 2013; 100:108-15. [PMID: 23796803 DOI: 10.1016/j.physio.2013.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 09/13/2012] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate whether feedback inducing an external focus (EF) of attention (about movement effects) was more effective for retraining reach-to-grasp after stroke compared with feedback inducing an internal focus (IF) of attention (about body movement). It was predicted that inducing an EF of attention would be more beneficial to motor performance. DESIGN Crossover trial where participants were assigned at random to two feedback order groups: IF followed by EF or EF followed by IF. SETTING Research laboratory. PARTICIPANTS Forty-two people with upper limb impairment after stroke. INTERVENTION Participants performed three reaching tasks: (A) reaching to grasp a jar; (B) placing a jar forwards on to a table; and (C) placing a jar on to a shelf. Ninety-six reaches were performed in total over one training session. MAIN OUTCOME MEASURES Kinematic measures were collected using motion analysis. Primary outcome measures were movement duration, peak velocity of the wrist, size of peak aperture and peak elbow extension. RESULTS Feedback inducing an EF of attention produced shorter movement durations {first feedback order group: IF mean 2.53 seconds [standard deviation (SD) 1.85]; EF mean 2.12 seconds (SD 1.63), mean difference 0.41 seconds; 95% confidence interval -0.68 to 1.5; P=0.008}, an increased percentage time to peak deceleration (P=0.01) when performing Task B, and an increased percentage time to peak velocity (P=0.039) when performing Task A compared with feedback inducing an IF of attention. However, an order effect was present whereby performance was improved if an EF of attention was preceded by an IF of attention. CONCLUSIONS Feedback inducing an EF of attention may be of some benefit for improving motor performance of reaching in people with stroke in the short term; however, these results should be interpreted with caution. Further research using a randomised design is recommended to enable effects on motor learning to be assessed.
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Affiliation(s)
- K F Durham
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - C M Sackley
- Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK; Faculty of Medicine and Health, University of East Anglia, Queens Building, Earlham Road, Norwich, Norfolk, NR4 7TJUK
| | - C C Wright
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - A M Wing
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - M G Edwards
- School of Sport Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - P van Vliet
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK; School of Health Sciences, University of Newcastle, Hunter Building, University Drive, Callaghan, NSW, 2308, Australia.
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Lowe CJM, Wilson MS, Sackley CM, Barker KL. Blind outcome assessment: the development and use of procedures to maintain and describe blinding in a pragmatic physiotherapy rehabilitation trial. Clin Rehabil 2010; 25:264-74. [DOI: 10.1177/0269215510380824] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) To develop trial protocols which promote the achievement of blind outcome assessment. (2) To report outcome assessor beliefs regarding group allocation at follow-up assessments. (3) To document and describe instances of unblinding occurring during the trial to assist and inform rehabilitation researchers and clinicians. Design: Prospective longitudinal observational study. Setting: An NHS Hospital Trust specializing in orthopaedic surgery. Subjects: One hundred and seven patients participating in a prospective pragmatic randomized controlled trial investigating physiotherapy rehabilitation following total knee arthroplasty, plus three outcome assessors. Interventions: A protocol was developed using available research and designed to minimize instances of unblinding during a physiotherapy rehabilitation trial. Administrative, office, patient and research staff procedures were included. Main measures: Trial questionnaires measured blind outcome assessment responses at 3 and 12 months post surgery. The outcome assessor kept a field diary recording the events surrounding instances of unblinding. Data underwent descriptive and content analysis. Results: Blind outcome assessment was believed successful for n = 74 (81.32%) assessments at 3-month follow-up, and n = 83 (91.21%) at 12 months. Forty instances ( n = 28 participants) of unblinding were described in the field diary. While the main cause of unblinding was participants telling the outcome assessor, in 12.5% of events the assessor drew the wrong conclusion regarding group allocation. Not all unblinding events were remembered at subsequent assessments, even in this relatively small trial. Conclusions: Blind outcome assessment was considered achievable in this trial. Specific trial protocols enabled blinding beliefs to be reported and instances of unblinding to be described.
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Affiliation(s)
- CJ Minns Lowe
- Physiotherapy Research Unit, Nuffield Orthopaedics Centre NHS Trust, Oxford and Primary Care Clinical Sciences, University of Birmingham, Birmingham
| | - MS Wilson
- Physiotherapy Research Unit, Nuffield Orthopaedics Centre NHS Trust and OXVASC Stroke Prevention Research Unit, Oxford Radcliffe Hospitals NHS Trust, Oxford
| | - CM Sackley
- Primary Care Clinical Sciences, University of Birmingham, Birmingham
| | - KL Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre NHS Trust, Oxford, UK
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Hoppitt TJ, Sackley C, Wright C. Reply to Roberts et al's response. Age Ageing 2010. [DOI: 10.1093/ageing/afq063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Clarke CE, Furmston A, Morgan E, Patel S, Sackley C, Walker M, Bryan S, Wheatley K. Pilot randomised controlled trial of occupational therapy to optimise independence in Parkinson's disease: the PD OT trial. J Neurol Neurosurg Psychiatry 2009; 80:976-8. [PMID: 18339727 DOI: 10.1136/jnnp.2007.138586] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To perform a pilot trial of occupational therapy (OT) to optimise functional independence in Parkinson disease (PD) to assess accrual/withdrawal rates, acceptability, outcome measures, and inform sample-size calculation. METHOD Non-demented patients with idiopathic PD and difficulties with activities of daily living (ADL) were recruited provided they had not received OT in the last 2 years and/or physiotherapy in the last year. Patients were randomised to immediate OT or OT after completion of the trial. Patients randomised to OT were assessed at home by an experienced therapist and then received six home treatment sessions over 2 months. Interventions were targeted at functional independence and mobility goals. Outcome measures were: Nottingham Extended Activity of Daily Living Scale, Rivermead Mobility Index, Unified Parkinson's Disease Rating Scale ADL scale, Parkinson's Disease Questionnaire 39, EuroQol-EQ-5D, Hospital Anxiety and Depression Scale, and health economics analysis. RESULTS 39 patients (25 male; mean age 73 years) were recruited from four centres over 16 months. The mean difference in NEADL at 8 months was 3.5 (95% CI -3.2 to 10.2). The mean difference in PDQ-39 Summary Score was 3.8 (95% CI -4.94 to 12.6). There were strong correlations between the PDQ-39 and other outcomes. The intervention was acceptable to patients, with a low withdrawal rate and good questionnaire completion. CONCLUSION Randomisation to a trial of OT in PD is feasible. NEADL and PDQ-39 are relevant outcomes and provided data to inform sample size for an adequately powered randomised trial for which there is pressing need.
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Affiliation(s)
- C E Clarke
- Department of Neurology, City Hospital, Dudley Road, Birmingham B18 7QH, UK.
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Sackley C, Hoppitt T, Cardoso K, Levin S. The availability and use of allied health care in care homes in the Midlands, UK. International Journal of Therapy and Rehabilitation 2009. [DOI: 10.12968/ijtr.2009.16.4.41195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Sackley
- Primary Care Clinical Sciences, School of Health and Population Sciences, Primary Care Clinical Sciences Building, University of Birmingham, B15 2TT, UK
| | - T Hoppitt
- Primary Care Clinical Sciences, School of Health and Population Sciences, Primary Care Clinical Sciences Building, University of Birmingham, B15 2TT, UK
| | - K Cardoso
- Department of Primary Care and General Practice, University of Birmingham, UK
| | - S Levin
- Department of Primary Care and General Practice, University of Birmingham, UK
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van den Berg M, Sackley C, Hoppitt T, Patel S, Lett K, Hollands K, Wright C, Brittle N. P2.052 USE of the TUG in cognitively impaired care home residents. Parkinsonism Relat Disord 2008. [DOI: 10.1016/s1353-8020(08)70282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND "Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases. OBJECTIVES To conduct a systematic review of randomised trials of treatment for footdrop resulting from neuromuscular disease. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (July 2005), MEDLINE (January 1966 to July 2005), EMBASE (January 1980 to July 2005), AMED (January 1985 to July 2005) and CINAHL databases (January 1982 to July 2005). SELECTION CRITERIA Randomised and quasi-randomised trials of physical, orthotic and surgical treatments for footdrop resulting from lower motor neuron or muscle disease and related contractures were included. People with primary joint disease were excluded. Interventions included a 'wait and see' approach, physiotherapy, orthotics, surgery and pharmacological therapy. The primary outcome measure was ability to walk whilst secondary outcome measures included dorsiflexor torque and strength, measures of 'activity' and 'participation' and adverse effects. DATA COLLECTION AND ANALYSIS Methodological quality was evaluated by two authors using the van Tulder criteria. Three studies with altogether 139 participants were included in the review. Heterogeneity of the studies precluded pooling the data. MAIN RESULTS Early surgery did not significantly affect walking speed in a trial including 20 children with Duchenne muscular dystrophy. After one year, the mean difference (MD) of the 28 feet walking time was 0.00 seconds (95% confidence interval (CI) -0.83 to 0.83) and the MD of the 150 feet walking time was -2.88 seconds, (95% CI -8.18 to 2.42). In a trial with altogether 26 participants with Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy), long-term strength training significantly increased walking speed on a 6 metre timed walk (MD -0.70 seconds, 95% CI -1.17 to -0.23) but not on a 50 metre timed walk (MD -1.9 seconds, 95% CI -4.09 to 0.29). In a trial of a 24-week strength training programme in 28 participants with myotonic dystrophy, there was no significant change in walking speed on either a 6 or 50 metre walk. AUTHORS' CONCLUSIONS Using the primary outcome of ability to walk, only one study demonstrated a positive effect and that was an exercise programme for people with Charcot-Marie-Tooth disease. Surgery was not significantly effective in children with Duchenne Muscular Dystrophy. More evidence generated by methodologically sound trials is required.
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Affiliation(s)
- C Sackley
- University of Birmingham, Primary Care and General Practice, Primary Care Clinical Sciences Building, Edgbaston, Birmingham, UK, B15 2TT.
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van den Berg M, Dawes H, Wade DT, Newman M, Burridge J, Izadi H, Sackley CM. Treadmill training for individuals with multiple sclerosis: a pilot randomised trial. J Neurol Neurosurg Psychiatry 2006; 77:531-3. [PMID: 16543538 PMCID: PMC2077516 DOI: 10.1136/jnnp.2005.064410] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This pilot study investigated whether 4 weeks of aerobic treadmill training in individuals with multiple sclerosis (MS) improved mobility and reduced fatigue. Individuals with MS were recruited to this prospective, randomised controlled trial. Individuals were assessed at baseline, week 7 and 12 with a 10 metre timed walk, a 2 minute walk, the Rivermead Mobility Index, and the Fatigue Severity Scale. After a pre-assessment familiarisation session and a baseline assessment, individuals were randomly allocated to an initial intervention or delayed intervention group. Treadmill training consisted of 4 weeks of supervised aerobic exercise delivered weeks 3-6 in the immediate group and 8-11 in the delayed group. Of the initial 19 recruits, 16 individuals completed the study. There was a significant difference in walking endurance between the delayed and immediate groups at baseline (p<0.05). On reassessment in week 7, decreases in 10 metre walk time were found in both groups, which was significant in the immediate group (p<0.05). The 2 minute walk distance significantly increased in both groups (p<0.05). In the training group, reassessed at week 12 after training ceased, there was a return towards baseline scores. No significant changes in fatigue scores were found. This study showed that in individuals with MS, aerobic treadmill training is feasible and well tolerated. Walking speed and endurance increased following training with no increase in reported fatigue. Detraining occurred in the period following training. A larger randomised clinical trial is warranted.
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Affiliation(s)
- M van den Berg
- School of Health Sciences, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK.
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Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, Gutnikov SA, Edwards P, Mant D, Sackley CM, Farmer A, Sandercock PAG, Dennis MS, Warlow CP, Bamford JM, Anslow P. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004; 363:1925-33. [PMID: 15194251 DOI: 10.1016/s0140-6736(04)16405-2] [Citation(s) in RCA: 706] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The incidence of stroke is predicted to rise because of the rapidly ageing population. However, over the past two decades, findings of randomised trials have identified several interventions that are effective in prevention of stroke. Reliable data on time-trends in stroke incidence, major risk factors, and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence. We aimed to obtain these data. METHODS We ascertained changes in incidence of transient ischaemic attack and stroke, risk factors, and premorbid use of preventive treatments from 1981-84 (Oxford Community Stroke Project; OCSP) to 2002-04 (Oxford Vascular Study; OXVASC). FINDINGS Of 476 patients with transient ischaemic attacks or strokes in OXVASC, 262 strokes and 93 transient ischaemic attacks were incident events. Despite more complete case-ascertainment than in OCSP, age-adjusted and sex-adjusted incidence of first-ever stroke fell by 29% (relative incidence 0.71, 95% CI 0.61-0.83, p=0.0002). Incidence declined by more than 50% for primary intracerebral haemorrhage (0.47, 0.27-0.83, p=0.01) but was unchanged for subarachnoid haemorrhage (0.83, 0.44-1.57, p=0.57). Thus, although 28% more incident strokes (366 vs 286) were expected in OXVASC due to demographic change alone (33% increase in those aged 75 or older), the observed number fell (262 vs 286). Major reductions were recorded in mortality rates for incident stroke (0.63, 0.44-0.90, p=0.02) and in incidence of disabling or fatal stroke (0.60, 0.50-0.73, p<0.0001), but no change was seen in case-fatality due to incident stroke (17.2% vs 17.8%; age and sex adjusted relative risk 0.85, 95% CI 0.57-1.28, p=0.45). Comparison of premorbid risk factors revealed substantial reductions in the proportion of smokers, mean total cholesterol, and mean systolic and diastolic blood pressures and major increases in premorbid treatment with antiplatelet, lipid-lowering, and blood pressure lowering drugs (all p<0.0001). INTERPRETATION The age-specific incidence of major stroke in Oxfordshire has fallen by 40% over the past 20 years in association with increased use of preventive treatments and major reductions in premorbid risk factors.
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Affiliation(s)
- P M Rothwell
- Stroke Prevention Research Unit, Department of Clinical Neurology, University of Oxford, Oxford, UK.
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Disler P, Turner-Stokes L, Wade D, Sackley C. Rehabilitation interventions for foot drop in neuromuscular disease. Hippokratia 2002. [DOI: 10.1002/14651858.cd003908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Previous work suggests that the quality of life associated with severe disability after stroke is rated very poorly by members of the public, often as being worse than death. Other evidence suggests that experience of illness alters perceptions of its severity. This was tested for severe stroke. Eleven patients with severely disabling stroke, but able to complete a standard gamble interview, 22 age and sex matched controls, and 20 health professionals participated. A standard gamble interview was carried out to determine the quality of life (utility) associated with three hypothetical scenarios representing mild, moderate, and severe stroke, and current health. A sample was retested for reliability, and comparisons were made with other measures of health status. All three subject groups showed wide variation in the utilities they attached to each of the scenarios. The control subjects' valuations were lower than those of either patients or staff members, especially for moderate stroke (median 0.30, 0.73, and 0.68 respectively). There were weak to moderate correlations between utilities and other measures of health status including the Barthel index (r=0.51) and Rivermead mobility score (r=0.24). Test retest-reliability was modest (reliability coefficient 0.75), but indicators of the internal validity of the results were good. In conclusion, it cannot be assumed that general population valuations are valid for patient groups. In clinical practice it is unsafe to make any assumption about subjective quality of life after stroke, due to the wide range of valuations given, although many people rate severe and moderate stroke at least as bad as death.
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Affiliation(s)
- R Murphy
- Health Care of the Elderly, A Floor East Block, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Abstract
PURPOSE To argue the case that patients who are severely disabled by stroke may benefit from rehabilitation. To identify critical areas where more research may be helpful. METHOD Discussion of four negative views which could be cited as drawbacks to rehabilitation in this group. These are: (1) that patients with severe stroke do not recover; (2) that they are too ill to receive rehabilitation; (3) that rehabilitation is ineffective even when possible; and (4) that even if rehabilitation is effective, it is not cost-effective. RESULTS There is little work in this area. There are problems with measurement of disability in this group. None of the four negative views are supported by current evidence, and what little evidence there is provides grounds for optimism that further work could be worthwhile. CONCLUSIONS Specific recommendations for further work include: (1) the development of better measurement scales; (2) to determine the cost of care of severely disabled stroke patients; (3) to gain a better appreciation of the value of changes in disability states; and (4) to perform an overview analysis of rehabilitation interventions examining the degree to which severity of disability affects the response to treatment.
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Affiliation(s)
- J R Gladman
- Department of Health Care of the Elderly, University Hospital, Nottingham, UK
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Abstract
A number of before and after and single case design studies of visual feedback have shown improvements in stance symmetry after stroke, an associated improvement in function has been demonstrated. This study examines this promising technique further using a single-blind controlled trial. Twenty-six patients were recruited from a register of consecutive admissions and randomized into treatment and control groups. Both groups received additional therapy, only the treatment group received visual feedback. Assessments were carried out independently. Significant improvements were seen in the treatment group in measures of stance symmetry and sway and motor and ADL function. Between group differences had disappeared at three months. The results indicate that feedback training incorporated into functional physiotherapy treatment can improve stance symmetry and sway. Transfer of training was indicated by improvements in ADL and gross motor function. Three months later the improvement was maintained, but did not automatically continue without treatment.
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Affiliation(s)
- C M Sackley
- Stroke Research Unit, Nottingham City Hospital NHS Trust, UK
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Sackley CM, Baguley BI, Gent S, Hodgson P. The Use of a Balance Performance Monitor in the Treatment of Weight-bearing and Weight-transference Problems after Stroke. Physiotherapy 1992. [DOI: 10.1016/s0031-9406(10)60498-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
This study examines the relationship between falls, postural sway, stance symmetry, and length of hospital admission after stroke. Side of stroke, age, and sex differences are noted. A consecutive sample of 92 stroke patients underwent two assessments, four months apart, at between two and nine months post-stroke. Measurements of weight distribution and sway were made on the Nottingham Balance Platform. Any falls were recorded. A significant relationship was found between sway values at the first assessment and the number of falls (r = 0.27, p less than 0.01). Sway values improved with recovery (z = 2.9, p less than 0.01). Stance symmetry was significantly related to length of stay (r = 0.27, p less than 0.01) and age (r = 0.28, p less than 0.01), but not to falls. A significant difference was found between the weight distribution of right- and left-sided hemiplegias (t = 8.2, p less than 0.001) and stance symmetry improved with recovery (z = 2.9, p less than 0.01). No sex differences were apparent. This suggests that stance symmetry is another index of stroke severity, but that sway and falls frequency are not. However, an important relationship between sway and falls was revealed.
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Affiliation(s)
- C M Sackley
- Stroke Research Unit, General Hospital, Nottingham, GB
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