ORCID Profile
0000-0002-2066-8345
Current Organisations
Alfred Health
,
Monash University
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Publisher: Springer Science and Business Media LLC
Date: 04-12-2018
DOI: 10.1007/S10926-018-9820-8
Abstract: Purpose Addressing return to work early after neurological impairment from stroke or moderate and severe traumatic brain injury may improve likelihood of returning to employment, yet little is known about how best to organize work interventions for delivery in the inpatient hospital setting. The purpose of this scoping review was to identify knowledge gaps and inform program development in hospital-based work interventions. Method We searched MEDLINE, CINAHL, OTSeeker and Embase for English-language articles published from database inception until March 2018. Citations were then manually searched using reference lists of included papers and Google Scholar. Articles were included if they described programs providing return to work intervention within a hospital to adults with newly acquired neurological conditions, such as traumatic brain injury or stroke. After identifying and selecting relevant studies, we charted the data and then synthesized the results. Results Twenty-eight articles explored work intervention in an inpatient hospital setting. Interventions targeted a diagnostically heterogeneous population, mostly including adults who had suffered either a traumatic brain injury or stroke. Most interventions included a structured process for assessment, highlighted the importance of collaboration, and aimed to improve performance of work skills that could be facilitated within a hospital setting only (as opposed to all work skills). Thematic analysis of included studies resulted in four themes: structure, collaboration, clinician training, and belief in future work capacity. Conclusion Return to work intervention appears to be an important component of neurological rehabilitation. While studies to date have identified enablers for the integration of work interventions into the inpatient hospital setting, there is limited description of specific components of programs, and a lack of studies evaluating program effectiveness.
Publisher: Springer Science and Business Media LLC
Date: 23-01-2018
Publisher: MDPI AG
Date: 02-09-2020
Abstract: This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt “pretty well” or “very well” prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role.
Publisher: SAGE Publications
Date: 22-10-2018
Abstract: The quality of stroke care may diminish on weekends. We aimed to compare the quality of care and outcomes for patients with stroke/transient ischemic attack discharged on weekdays compared with those discharged on weekends. Data from the Australian Stroke Clinical Registry from January 2010 to December 2015 ( n = 45 hospitals) were analyzed. Differences in processes of care by the timing of discharge are described. Multilevel regression and survival analyses (up to 180 days postevent) were undertaken. Among 30,649 registrants, 2621 (8.6%) were discharged on weekends (55% male median age 74 years). Compared to those discharged on weekdays, patients discharged on weekends were more often patients with a transient ischemic attack (weekend 35% vs. 19% p 0.001) but were less often treated in a stroke unit (69% vs. 81% p 0.001), prescribed antihypertensive medication at discharge (65% vs. 71% p 0.001) or received a care plan if discharged to the community (47% vs. 53% p 0.001). After accounting for patient characteristics and clustering by hospital, patients discharged on weekends had a 1 day shorter length of stay (coefficient = −1.31, 95% confidence interval [CI] = −1.52, −1.10), were less often discharged to inpatient rehabilitation (aOR = 0.39, 95% CI = 0.34, 0.44) and had a greater hazard of death within 180 days (hazard ratio = 1.22, 95% CI = 1.04, 1.42) than those discharged on weekdays. Patients with stroke/transient ischemic attack discharged on weekends were more likely to receive suboptimal care and have higher long-term mortality. High quality of stroke care should be consistent irrespective of the timing of hospital discharge.
Publisher: Korean Academy of Rehabilitation Medicine
Date: 31-12-2021
DOI: 10.5535/ARM.21034
Abstract: Objective To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect.Methods This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect.Results The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3 95% confidence interval, 5.02–21.16).Conclusion Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.BJPT.2021.08.001
Abstract: Physical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy. Describe Australian physical therapists' awareness of guidelines reported practices and beliefs about capability, opportunity, motivation, and evidence. An online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework. 1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23-24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so. Australian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.
Publisher: Wiley
Date: 24-09-2012
DOI: 10.1111/J.1440-1630.2012.01035.X
Abstract: Legibility is important for functional, handwritten communication. Deficits in legibility can impair occupational performance following stroke or trauma. Few instruments are available to assess adult handwriting legibility during rehabilitation. The aim of this study was to compare inter-rater reliability of a new four-point legibility rating instrument with two existing instruments, and describe scale structure and item difficulty of each instrument. Three trained raters scored 60 handwriting s les using: (i) a Four-Point Scale (FPS) (ii) the modified Evaluation Tool of Children's Handwriting (mETCH) and (iii) the new modified FPS. Rater concordance and exact agreement were investigated using the intra-class correlation coefficient (ICC(3,1) ), multi-rater kappa (κ) and Krippendorff's alpha (α). Cronbach's alpha was calculated to examine internal consistency reliability, and Rasch modelling was used to examine scale structure and item difficulty. Rater concordance for the FPS was fair (ICC(3,1) = 0.37) exact agreement was poor (κ = 0.19 α = 0.19). Rater concordance for the two mETCH subtests was fair to moderate (ICC(3,1) = 0.39-0.50), but with no exact agreement (κ < 0.00). Rater concordance for three subtests of the modified FPS was slight to moderate (ICC(3,1) = 0.16-0.51) exact agreement ranged from nil to fair (κ = -0.06-0.30 α = -0.05-0.30). Rasch modelling confirmed internal consistency of instruments, but was low between-rater consistency (rater severity variability). A reliable instrument for measuring change over time remains elusive. In the meantime, these instruments can be used by in idual clinicians to diagnose and rate legibility.
Publisher: Mark Allen Group
Date: 02-01-2016
DOI: 10.12968/IJTR.2016.23.1.20
Abstract: An exploratory study of a novel approach to using the Goal Engagement Scale to examine patients', families' and health professionals' perceptions of patient engagement in goal setting. This mixed methods study was conducted from September 2013 to April 2014 in both inpatient trauma and rehabilitation units at an Australian health care service. Participants were 22 triads (patients with moderate to severe traumatic brain injury or stroke, their family member(s) and a treating health professional) participating in routine goal setting interviews. Goal setting interviews were audio recorded, transcribed and thematically analysed, drawing upon an iterative process of qualitative data analysis, while the Goal Engagement Scale scores were analysed descriptively, drawing comparison between triad participant findings. Perception of patient's level of engagement in goal setting differed between health professionals, patients and families. Health professionals' views dominated the goal setting process. Goal setting interview data revealed four main themes, highlighting the importance of reflective listening skills to build a trusting relationship with patients and families to support engagement in goal setting. The findings of this exploratory study both affirm the suitability of future research into goal setting engagement and provide clinically useful strategies to support engagement of patients and families in goal setting.
Publisher: SAGE Publications
Date: 31-12-2015
Abstract: Routine monitoring of the quality of stroke care is becoming increasingly important since patient outcomes could be improved with better access to proven treatments. It remains unclear how many countries have established a national registry for monitoring stroke care. To describe the current status of national, hospital-based stroke registries that have a focus on monitoring access to evidence-based care and patient outcomes and to summarize the main features of these registries. We undertook a systematic search of the published literature to identify the registries that are considered in their country to represent a national standardized dataset for acute stroke care and outcomes. Our initial keyword search yielded 5002 potential papers, of which we included 316 publications representing 28 national stroke registries from 26 countries. Where reported, data were most commonly collected with a waiver of patient consent (70%). Most registries used web-based systems for data collection (57%) and 25% used data linkage. Few variables were measured consistently among the registries reflecting their different local priorities. Funding, resource requirements, and coverage also varied. This review provides an overview of the current use of national stroke registries, a description of their common features relevant to monitoring stroke care in hospitals. Formal registration and description of registries would facilitate better awareness of efforts in this field.
Publisher: Springer Science and Business Media LLC
Date: 24-08-2022
DOI: 10.1186/S12984-022-01072-W
Abstract: Hospital-based stroke rehabilitation for stroke survivors in developing countries may be limited by staffing ratios and length of stay that could h er recovery potential. Thus, a home-based, gamified rehabilitation system (i.e., IntelliRehab) was tested for its ability to increase cerebral blood flow (CBF), and the secondary impact of changes on the upper limb motor function and functional outcomes. To explore the effect of IntelliRehab on CBF in chronic stroke patients and its correlation with the upper limb motor function. Two-dimensional pulsed Arterial Spin Labelling (2D-pASL) was used to obtain CBF images of stable, chronic stroke subjects (n = 8) over 3-months intervention period. CBF alterations were mapped, and the detected differences were marked as regions of interest. Motor functions represented by Fugl-Meyer Upper Extremity Assessment (FMA) and Stroke Impact Scale (SIS) were used to assess the primary and secondary outcomes, respectively. Regional CBF were significantly increased in right inferior temporal gyrus and left superior temporal white matter after 1-month (p = 0.044) and 3-months (p = 0.01) of rehabilitation, respectively. However, regional CBF in left middle fronto-orbital gyrus significantly declined after 1-month of rehabilitation (p = 0.012). Moreover, SIS-Q7 and FMA scores significantly increased after 1-month and 3-months of rehabilitation. There were no significant correlations, however, between CBF changes and upper limb motor function. Participants demonstrated improved motor functions, supporting the benefit of using IntelliRehab as a tool for home-based rehabilitation. However, within-participant improvements may have limited potential that suggests the need for a timely administration of IntelliRehab to get the maximum capacity of improvement.
Publisher: Wiley
Date: 09-2003
Publisher: Springer Science and Business Media LLC
Date: 14-03-2007
Abstract: Pre-discharge home visits aim to maximise independence in the community. These visits involve assessment of a person in their own home prior to discharge from hospital, typically by an occupational therapist. The therapist may provide equipment, adapt the home environment and/or provide education. The aims of this study were to investigate the feasibility of a randomised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation. Ten patients participating in an inpatient rehabilitation program were randomly assigned to receive either a pre-discharge home visit (intervention), or standard practice in-hospital assessment and education (control), both conducted by an occupational therapist. The pre-discharge home visit involved assessment of the older person's function and environment, and education, and took an average of 1.5 hours. The hospital-based interview took an average of 40 minutes. Outcome data were collected by a blinded assessor at 0, 2, 4, 8 and 12 weeks. Outcomes included performance of activities of daily living, reintegration to community living, quality of life, readmission and fall rates. Recruitment of 10 participants was slow and took three months. Observed performance of functional abilities did not differ between groups due to the small s le size. Difference in activities of daily living participation, as recorded by the Nottingham Extended Activities of Daily Living scale, was statistically significant but wide confidence intervals and low statistical power limit interpretation of results. Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible, but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting.
Publisher: Medical Journals Sweden AB
Date: 2011
Abstract: To determine the effectiveness of self-awareness interventions that involve a component of feedback for adults with brain injury. Systematic review. Randomized and non-randomized studies identified by searching CINAHL, Cochrane Systematic Review Database, Embase, Medline, OTSeeker, PsycBITE, PsycINFO, Web of Science, clinical trial registries, and reference lists of eligible articles. Twelve studies of varied methodological quality met the inclusion criteria, of which 3 were randomized controlled trials involving a total of 62 people with brain injury of mixed aetiology. The type of feedback intervention and outcomes assessed were heterogeneous. The pooled estimate of improvement in self-awareness after completing a feedback intervention was of moderate effect size (Hedges' adjusted g = 0.64 95% confidence interval: 0.11-1.16). Feedback interventions produced modest improvements in self-awareness. Further research is required to determine the effects of integrating feedback interventions into rehabilitation programmes and the impact of this on functional outcome.
Publisher: Springer Science and Business Media LLC
Date: 04-08-2018
DOI: 10.1007/S11136-018-1960-Y
Abstract: Approximately 30-50% of survivors experience problems with anxiety or depression post-stroke. It is important to understand the factors associated with post-stroke anxiety or depression to identify effective interventions. Patient-level data from the Australian Stroke Clinical Registry (years 2009-2013), from participating hospitals in Queensland (n = 23), were linked with Queensland Hospital Emergency and Admission datasets. Self-reported anxiety or depression was assessed using the EQ-5D-3L, obtained at 90-180 days post-stroke. Multivariable multilevel logistic regression, with manual stepwise elimination of variables, was used to investigate the association between self-reported anxiety or depression, patient factors and acute stroke processes of care. Comorbidities, including prior mental health problems (e.g. anxiety, depression and dementia) coded in previous hospital admissions or emergency presentations using ICD-10 diagnosis codes, were identified from 5 years prior to stroke event. 2853 patients were included (median age 74 45% female 72% stroke 24% transient ischaemic attack). Nearly half (47%) reported some level of anxiety or depression post-stroke. The factors most strongly associated with anxiety or depression were a prior diagnosis of anxiety or depression [Adjusted Odds Ratio (aOR) 2.37, 95% confidence interval (95% CI) 1.66-3.39 p < 0.001], dementia (aOR 1.91, 95% CI 1.24-2.93 p = 0.003), being at home with support (aOR 1.41, 95% CI 1.12-1.69 p = < 0.001), and low socioeconomic advantage compared to high (aOR 1.59, 95% CI 1.21-2.10 p = 0.001). Acute stroke processes of care were not independently associated with anxiety or depression. Identification of those with prior mental health problems for early intervention and support may help reduce the prevalence of post-stroke anxiety or depression.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.APMR.2015.01.013
Abstract: To investigate the effect of functional electrical stimulation (FES) in improving activity and to investigate whether FES is more effective than training alone. Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness. Randomized and controlled trials up to June 22, 2014, were included following predetermined search and selection criteria. Data extraction occurred by 2 people independently using a predetermined data collection form. Methodologic quality was assessed by 2 reviewers using the PEDro methodologic rating scale. Meta-analysis was conducted separately for the 2 research objectives. Eighteen trials (19 comparisons) were eligible for inclusion in the review. FES had a moderate effect on activity (standardized mean difference [SMD], .40 95% confidence interval [CI], .09-.72) compared with no or placebo intervention. FES had a moderate effect on activity (SMD, .56 95% CI, .29-.92) compared with training alone. When subgroup analyses were performed, FES had a large effect on upper-limb activity (SMD, 0.69 95% CI, 0.33-1.05) and a small effect on walking speed (mean difference, .08m/s 95% CI, .02-.15) compared with control groups. FES appears to moderately improve activity compared with both no intervention and training alone. These findings suggest that FES should be used in stroke rehabilitation to improve the ability to perform activities.
Publisher: Informa UK Limited
Date: 07-08-2050
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.REHAB.2021.101487
Abstract: To enable development of effective interventions, there is a need to complete systematic early-phase dose articulation research. This scoping review aimed to synthesize dose articulation research of behavioral motor interventions for stroke recovery. MEDLINE and EMBASE were systematically searched for dose articulation studies. Preclinical experiments and adult clinical trials were classified based on the discovery pipeline and analyzed to determine which dose dimensions were articulated (time, scheduling or intensity) and how they were investigated (unidimensional vs multidimensional approach). Reporting of dose, safety and efficacy outcomes were summarized. The intervention description, risk of bias, and quality was appraised. We included 41 studies: 3 of preclinical dose preparation (93 rodents), 2 Phase I dose ranging (21 participants), 9 Phase IIA dose screening (198 participants), and 27 Phase IIB dose finding (1879 participants). All studies adopted a unidimensional approach. Time was the most frequent dimension investigated (53%), followed by intensity (29%), and scheduling (18%). Overall, 95% studies reported an efficacy outcome however, only 65% reported dose and 45% reported safety. Across studies, 61% were at high risk of bias, and the average percentage reporting of intervention description and quality was 61% and 67%, respectively. This review highlights a need to undertake more high-quality, early-phase studies that systematically articulate intervention doses from a multidimensional perspective in the field of behavioral motor stroke recovery. To address this gap, we need to invest in adapting early phase trial designs, especially Phase I, to support multidimensional dose articulation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2020
DOI: 10.1161/STROKEAHA.120.030656
Abstract: A comprehensive understanding of the long-term impact of stroke assists in health care planning. We aimed to determine changes in rates, causes, and associated factors for hospital presentations among long-term survivors of stroke. Person-level data from the AuSCR (Australian Stroke Clinical Registry) during 2009 to 2013 were linked with state-based health department emergency department and hospital admission data. The study cohort included adults with first-ever stroke who survived the first 6 months after discharge from hospital. Annualized rates of hospital presentations (nonadmitted emergency department or admission) erson/year were calculated for 1 to 12 months prior, and 7 to 12 months (inclusive) after hospitalization. Multilevel, negative binomial regression was used to identify associated factors after adjustment for prestroke hospital presentations and stratification for perceived impairment status. Perceived impairments to health were defined according to the subscales and visual analog health status scores on the 5-Dimension European Quality of Life Scale. There were 7183 adults with acute stroke, 7-month survivors (median age 72 years 56% male 81% ischemic, and 42% with impairment at 90–180 days) from 39 hospitals included in this landmark analysis. Annualized presentations erson increased from 0.88 (95% CI, 0.86–0.91) to 1.25 (95% CI, 1.22–1.29) between the prestroke and poststroke periods, with greater rate increases in those with than without perceived impairment (55% versus 26%). Higher presentation rates were most strongly associated with older age (≥85 versus 65 years, incidence rate ratio, 1.52 [95% CI, 1.27–1.82]) and greater comorbidity score (incidence rate ratio, 1.06 [95% CI, 1.02–1.10]), whereas reduced rates were associated with greater social advantage (incidence rate ratio, 0.71 [95% CI, 0.60–0.84]). Poststroke hospital presentations (7–12 months) were most frequently related to recurrent cardiovascular and cerebrovascular events and sequelae of stroke. A large increase in annualized hospital presentation rates after stroke indicates the potential for improved community management and support for this vulnerable patient group.
Publisher: Medical Journals Sweden AB
Date: 2012
Abstract: To evaluate the reliability and validity of WHODAS II within the spinal cord injury population. Sixty-three people with traumatic spinal cord injury. The World Health Organization Disability Assessment Scale II (WHODAS II), Craig Handicap Assessment and Reporting Technique, and Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36) were administered at 2 years post discharge from rehabilitation. Distribution, reliability, discriminant validity, and convergent/ ergent validity were evaluated using classical tests. Rasch analyses were applied to assess dimensionality, item spread, and person/item reliability. Cronbach's alpha coefficients ranged from 0.61 (getting around) to 0.97 (participation). Ceiling effects were present in 4 out of 6 domains. WHODAS II discriminated between levels of impairment and work force status on 'self-care', 'getting around', 'life activities', and total score. Correlations with MOS SF-36 supported convergent/ ergent validity. Five items didn't fit the Rasch model. The item erson map reveald a shortage of items able to differentiate the more able person. WHODAS II demonstrated good person and item separation and reliability. This study provides preliminary support for reliability and validity of WHODAS II in a spinal cord injured population. Limitations were noted for dimensionality and item person distribution. Findings need to be confirmed in larger s les.
Publisher: JMIR Publications Inc.
Date: 27-06-2022
Abstract: esuming work after stroke is a common goal of working-age adults, yet there are few vocational rehabilitation programs designed to address the unique challenges faced following stroke. The WORK intervention was developed to address these gaps. his study aims to test the WORK intervention, by piloting the intervention and trial processes. he WORK trial is a two-arm prospective randomized, blinded-assessor study design with intention to treat analysis. Fifty-four adults of working age who have experienced a stroke months prior, will be randomized 1:1 to either (i) experimental group who will receive a 12-week early vocational intervention (WORK intervention) plus usual clinical rehabilitation, or (ii) control group who will receive only their usual clinical rehabilitation. utcomes include study and intervention feasibility and intervention benefit. In addition to evaluating the feasibility of delivering vocational intervention early after stroke, benefit will be assessed by measuring rates of vocational participation and quality of life improvements at 3- and 6-months follow-up. Process evaluation using data collected during the study, as well as post-intervention in idual interviews with participants and surveys with trial therapists will complement quantitative data he results of the trial will provide details of the feasibility of delivering the WORK intervention embedded within the clinical rehabilitation context and inform future trial processes. Pilot data will enable a future definitive trial so as to determine the clinical effectiveness of vocational rehabilitation when delivered in the early sub-acute phase of stroke recovery. ww.anzctr.og.au ACTRN12619001164189, Date registered 20/08/2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2007
DOI: 10.1161/01.STR.0000251722.77088.12
Abstract: Background and Purpose— Splints are commonly applied to the wrist and hand to prevent and treat contracture after stroke. However, there have been few randomized trials of this intervention. We sought to determine whether wearing a hand splint, which positions the wrist in either a neutral or an extended position, reduces wrist contracture in adults with hemiplegia after stroke. Methods— Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated. They were randomized to either a control group (routine therapy) or 1 of 2 intervention groups (routine therapy plus splint in either a neutral or an extended wrist position). Splints were worn overnight for, on average, between 9 and 12 hours, for 4 weeks. The primary outcome, measured by a blinded assessor, was extensibility of the wrist and long finger flexor muscles (angle of wrist extension at a standardized torque). Results— Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles. After 4 weeks, the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4° (95% CI, −5.4° to 8.2°), and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3° (95% CI, −4.9° to 2.4°) compared with the control condition. Conclusions— Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke. These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued.
Publisher: MDPI AG
Date: 23-02-2023
Abstract: Sleep disturbances are common after stroke and may affect recovery and rehabilitation outcomes. Sleep monitoring in the hospital environment is not routine practice yet may offer insight into how the hospital environment influences post-stroke sleep quality while also enabling us to investigate the relationships between sleep quality and neuroplasticity, physical activity, fatigue levels, and recovery of functional independence while undergoing rehabilitation. Commonly used sleep monitoring devices can be expensive, which limits their use in clinical settings. Therefore, there is a need for low-cost methods to monitor sleep quality in hospital settings. This study compared a commonly used actigraphy sleep monitoring device with a low-cost commercial device. Eighteen adults with stroke wore the Philips Actiwatch to monitor sleep latency, sleep time, number of awakenings, time spent awake, and sleep efficiency. A sub-s le (n = 6) slept with the Withings Sleep Analyzer in situ, recording the same sleep parameters. Intraclass correlation coefficients and Bland–Altman plots indicated poor agreement between the devices. Usability issues and inconsistencies were reported between the objectively measured sleep parameters recorded by the Withings device compared with the Philips Actiwatch. While these findings suggest that low-cost devices are not suitable for use in a hospital environment, further investigations in larger cohorts of adults with stroke are needed to examine the utility and accuracy of off-the-shelf low-cost devices to monitor sleep quality in the hospital environment.
Publisher: Wiley
Date: 12-2020
Abstract: Impaired self-awareness negatively impacts on how well persons with traumatic brain injury (TBI) learn and use strategies needed in daily life. Verbal feedback is a component of metacognitive strategy training recommended for addressing impaired self-awareness in TBI rehabilitation. Yet, it remains unknown how effectively verbal feedback on occupational performance improves self-awareness for the specific occupation involved. This study investigated the effect of verbal feedback on task-specific self-awareness for in iduals with TBI. A secondary analysis was conducted on selected data extracted from a randomised, assessor-blinded controlled trial in which 36 participants with impaired self-awareness post-TBI were allocated into two feedback intervention groups, verbal feedback and a control condition of experiential feedback only. All participants engaged in four sessions of meal preparation with an occupational therapist using a metacognitive strategy training approach. Participants in the verbal feedback group received feedback on their performance in a discussion with the occupational therapist following each session. Task-specific self-awareness was measured using discrepancy scores (therapist ratings minus self-ratings) on a Meal Independence Rating Scale (MIRS). Data were analysed using a mixed 2 × 2 analysis of variance. Positive MIRS discrepancy scores at pre-intervention reflected the propensity of participants to over-estimate their abilities There was a significant main effect of time, indicating overall gains in task-specific self-awareness at post-intervention (p = .01), but no significant group-by-time interaction. Changes in participants' self-ratings post-intervention were minimal. Instead, reduced MIRS discrepancy scores resulted largely from changes in therapists' ratings, indicating improvement in occupational performance. Participants in both groups demonstrated improvements in occupational performance, but this did not correspond with changes in task-specific self-awareness. In this small s le, there was no statistically significant improvement in self-awareness associated with the provision of verbal feedback after occupational performance over and above the benefits of experiential feedback.
Publisher: Informa UK Limited
Date: 18-02-2016
DOI: 10.3109/02699052.2015.1113569
Abstract: Discharge planning for patients with an acquired brain injury (ABI) is considered best practice for assisting the patient and caregiver to successfully transition from hospital to home and is complex because of the long-term care and support needs of the patient. This review aimed to describe and synthesize the perspectives of patients with ABI and their family/caregivers on the transition from hospital to home to better understand opportunities to optimize the process. Electronic medical databases (n = 5) and grey literature published between January-May 2015 were searched to identify qualitative studies on the experience of transition from the hospital to home setting following ABI. Relevant studies were appraised and narratively synthesized. Nine eligible studies that met the inclusion criteria were identified. Two major themes were identified-Engagement and Support. Three underlying sub-themes-poor communication, limited participation and disorganized arrangements for support services-were identified as key contributors to an unsatisfactory experience for patients and their family/caregivers. The transition for patients with an ABI and their family/caregivers was characterized as fragmented and unsatisfactory for supporting a successful return home. This review highlights the importance of tailored education and involvement of the patient and their family/caregiver to increase readiness for returning home and reduce unplanned re-admissions.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 08-2018
Publisher: Wiley
Date: 02-12-2020
DOI: 10.1111/HEX.13176
Abstract: Brain injury rehabilitation is an expensive and long‐term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked ‘What considerations are important to include in a model of care of brain injury rehabilitation?’ Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross‐examined by jurors over two days. Key themes related to the need for a model of rehabilitation to: be consumer‐focused and supporting the retention of hope be long‐term provide equitable access to services irrespective of funding source be inclusive of family provide advocacy raise public awareness and be delivered by experts in a suitable environment. A set of eight recommendations were made. Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services family involvement recruitment and retention of highly skilled staff and providing consumer‐focused services that prepare in iduals and their carers for the long term. As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.
Publisher: Medical Journals Sweden AB
Date: 07-08-2023
DOI: 10.2340/JRM.V55.4471
Abstract: Objective: This implementation study aimed to enhance the key elements of clinical practice goal-setting across 5 rehabilitation services.Design: This study followed a participatory action research approach guided by the Knowledge to Action framework.Methods: Medical record audits and structured client interviews were conducted prior to and following 12 weeks of implementation, in order to evaluate the success of the goal-setting implementation package.Results: Medical record audits and interviews conducted pre-implementation (audits n = 132, interviews n = 64), post-implementation (audits n = 130, interviews n = 56) and at 3-month follow-up (audits n = 30) demonstrated varied success across sites. Following implementation 2 sites significantly improved their common goal focus (site 1 p ≤ 0.001, site 2 p = 0.005), these sites also demonstrated a significant increase in clients reporting that they received copies of their rehabilitation goals (site 1 p ≤ 0.001, site 2 p ≤ 0.001). Four sites improved client action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. At 3-month follow-up 4 sites had continued to improve their common goal focus however, all sites decreased the specificity of their goal-setting.Conclusion: Elements of the implementation package were successful at enhancing the goal-setting process however, how the package is implemented within the team may impact outcomes. LAY ABSTRACTThere are 4 important elements of goal-setting in rehabilitation: including the client having a team focus on common goals setting specific and meaningful goals and including action planning feedback and review of goals. A goal-setting package was developed to assist healthcare workers to complete all important elements of goal-setting. This study aimed to evaluate the use of the goal-setting package in 5 rehabilitation services. Client medical records were reviewed and interviews with clients were undertaken to evaluate the success of the goal-setting package. In 2 sites, using the goal-setting package resulted in a significant increase in establishing common goals among the client and team and providing written information to clients about their goals. More action plans were developed to assist clients to work towards goals at 4 sites, whilst 3 sites improved in terms of setting more specific goals.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.RIDD.2018.04.019
Abstract: Identifying the characteristics of in iduals who are most likely to respond to a certain rehabilitation intervention is advantageous for the child, family, clinicians and the healthcare system. To investigate the in idual characteristics of children with cerebral palsy or brain injury who responded best to the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach. Post hoc analyses were conducted on 30 participants who participated in CO-OP within a larger randomized controlled trial. Inclusion: cerebral palsy or brain injury age 4-15 years Manual Abilities Classification System (MACS) I-IV goals related to hand function sufficient cognitive, language and behavioral ability to undertake CO-OP. Outcome measures were the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) collected immediately following the two week intervention period. Following CO-OP, 67% (n = 20) of participants showed a statistically significant response on the COPM, and 73%(n = 22) on the GAS. Nine participants were classified as best responders. When compared to non-responders, best responders were more likely to be female (p = .025) and to have received a higher dose of CO-OP (p = .028). Neither age nor MACS were predictors of response. To be successful in CO-OP, children should meet the prerequisites of CO-OP, particularly the language and cognitive ability to set goals and communicate effectively with the therapist. In this small s le, children with comorbidities were less likely to achieve goals, females were more likely to respond and dose of therapy was important to success.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-05-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
DOI: 10.1161/STROKEAHA.120.033133
Abstract: Although a target of 80% medication adherence is commonly cited, it is unclear whether greater adherence improves survival after stroke or transient ischemic attack (TIA). We investigated associations between medication adherence during the first year postdischarge, and mortality up to 3 years, to provide evidence-based targets for medication adherence. Retrospective cohort study of 1-year survivors of first-ever stroke or TIA, aged ≥18 years, from the Australian Stroke Clinical Registry (July 2010–June 2014) linked with nationwide prescription refill and mortality data (until August 2017). Adherence to antihypertensive agents, statins, and nonaspirin antithrombotic medications was based on the proportion of days covered from discharge until 1 year. Cox regression with restricted cubic splines was used to investigate nonlinear relationships between medication adherence and all-cause mortality (to 3 years postdischarge). Models were adjusted for age, sex, socioeconomic position, stroke factors, primary care factors, and concomitant medication use. Among 8363 one-year survivors of first-ever stroke or TIA (44% aged ≥75 years, 44% female, 18% TIA), 75% were supplied antihypertensive agents. In patients without intracerebral hemorrhage (N=7446), 84% were supplied statins, and 65% were supplied nonaspirin antithrombotic medications. Median adherence was ≈90% for each medication group. Between 1% and 100% adherence, greater adherence to statins or antihypertensive agents, but not nonaspirin antithrombotic agents, was associated with improved survival. When restricted to linear regions above 60% adherence, each 10% increase in adherence was associated with a reduction in all-cause mortality of 13% for antihypertensive agents (hazard ratio, 0.87 [95% CI, 0.81–0.95]), 13% for statins (hazard ratio, 0.87 [95% CI, 0.80–0.95]), and 15% for nonaspirin antithrombotic agents (hazard ratio, 0.85 [95% CI, 0.79–0.93]). Greater levels of medication adherence after stroke or TIA are associated with improved survival, even among patients with near-perfect adherence. Interventions to improve medication adherence are needed to maximize survival poststroke.
Publisher: SAGE Publications
Date: 06-06-2022
DOI: 10.1177/18333583221090277
Abstract: Stroke is a high-cost condition. Detailed patient-level assessments of the costs of care received and outcomes achieved provide useful information for organisation and optimisation of the health system. To describe the costs of hospital care for stroke and transient ischaemic attack (TIA) and investigate factors associated with costs. Retrospective cohort study using data from the Australian Stroke Clinical Registry (AuSCR) collected between 2009 and 2013 linked to hospital administrative data and clinical costing data in Queensland. Clinical costing data include standardised assignment of costs from hospitals that contribute to the National Hospital Costing programme. Patient-level costs for each hospital admission were described according to the demographic, clinical and treatment characteristics of patients. Multivariable median regression with clustering by hospital was used to determine factors associated with greater costs. Among 22 hospitals, clinical costing data were available for 3909 of 5522 patient admissions in the AuSCR (71%). Compared to those without clinical costing data, patients with clinical costing data were more often aged years (30% with cost data vs 24% without cost data, p 0.001) and male (56% with cost data vs 49% without cost data, p 0.001). Median cost of an acute episode was $7945 (interquartile range $4176 to $14970) and the median length of stay was 5 days (interquartile range 2 to 10 days). The most expensive cost buckets were related to medical ( n = 3897, median cost $1577), nursing ( n = 3908, median cost $2478) and critical care ( n = 434, median cost $3064). Factors associated with greater total costs were a diagnosis of intracerebral haemorrhage, greater socioeconomic position, in-hospital stroke and prior history of stroke. Medical and nursing costs were incurred by most patients admitted with stroke or TIA, and were relatively more expensive on average than other cost buckets such as imaging and allied health. Scaling this data linkage to national data collections may provide valuable insights into activity-based funding at public hospitals. Regular report of these costs should be encouraged to optimise economic evaluations.
Publisher: John Wiley & Sons, Ltd
Date: 08-10-2008
Publisher: BMJ
Date: 05-2018
Publisher: Springer Science and Business Media LLC
Date: 02-05-2023
DOI: 10.1186/S12913-023-09285-Y
Abstract: Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient’s readiness for discharge places a heavy reliance on a clinician’s judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians’ perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients’ discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16031
Abstract: Objective The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods A qualitative study was performed using in idual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients’ requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. What is known about the topic? Little is known about the drivers for referral to, or acceptance at, in-patient rehabilitation following acute hospital care for traumatic injury in Victoria, Australia, including who makes these decisions of behalf of patients and how these decisions are made. What does this paper add? This paper provides information regarding the perceptions of acute hospital consultant surgeons and allied health, as well as rehabilitation clinicians, in terms of discharge destination decision making from the acute hospital following trauma. The use of case studies further highlights differences between, and within, these specialities with regard to this decision making. This research also highlights the importance of financial considerations as drivers of decision making, and the lack of consistency of the factors thought to be important drivers of discharge between these different clinical groupings. What are the implications for practitioners? This research shows that financial factors are significant drivers of discharge destination decision making for trauma patients. The present study highlights opportunities to engage with stakeholders (acute care, rehabilitation, administration, government and patients) to develop more consistent discharge processes that optimise the use of rehabilitation resources for those patients who could benefit from in-patient rehabilitation.
Publisher: Informa UK Limited
Date: 25-12-2019
DOI: 10.1080/09638288.2017.1419293
Abstract: Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants' experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive s ling was used for recruitment all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor's safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Implications for rehabilitation Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers. A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.
Publisher: Informa UK Limited
Date: 15-08-2012
DOI: 10.3109/01942638.2011.602389
Abstract: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total, domain, and item scores were calculated. Total scores inter-rater reliability, Intra-class Correlation Coefficient (ICC) was 0.86, and for intra-rater reliability, ICC was 0.96. Domains had high reliability (ICC > 0.80) within raters and between raters except for grasp (moderate at ICC = 0.67). Item inter-rater reliability was moderate or better for 80% of items item intra-rater reliability was moderate or better for 87% of items. Total score internal consistency was high (α = 0.97). The QUEST has proven reliability for children with CP aged 18 months to 8 years. This study demonstrates strong reliability for children aged 2-12 years.
Publisher: Informa UK Limited
Date: 08-05-2017
DOI: 10.1080/09638288.2017.1323021
Abstract: To examine the internal consistency, construct validity and responsiveness of functional assessments tools when used with hospitalized older adults. The functional ability of 66 patients was assessed using a semi-structured interview scale (n = 16 tools). The assessment of motor and process skills was administered during hospital admission and again at three months post-discharge. Tools showed poor-to-excellent internal consistency (α = 0.27-0.92). Of the tools that were internally consistent, only two demonstrated change: the Groningen activity restriction scale (GARS) (smallest detectable change [SDC] 11.68, effect size -1.59) and the modified reintegration to normal living scale (SDC 7.04, effect size -1.20). Validity was supported by strong correlations between the functional independence measure™ (FIM™) and the GARS, FIM™ and Sunnaas activity daily living (ADL) index. Findings suggest that the GARS and the modified reintegration to normal living index (mRNLI) are internally consistent, valid and responsive to change over time when applied to a s le of hospitalized older adults. Further investigation of these tools in terms of inter and intra rater reliability in clinical practice is warranted. Implications for Rehabilitation Therapists and researchers need to choose standardized functional assessments carefully when working with hospitalized older adults, as not all assessments are reliable and valid in this population. The GARS and mRNLI are valid and responsive functional assessments for hospitalized older adults. Activity and participation have been viewed traditionally as only one component of function. Therapists and researchers can use standardized assessments of function that are activity or participation-based.
Publisher: Springer Science and Business Media LLC
Date: 04-02-2016
DOI: 10.1007/S11136-016-1234-5
Abstract: Understanding the relationship between health-related quality of life (HRQoL) and long-term unmet needs is important for guiding services to optimise life following stroke. We investigated whether HRQoL between 90 and 180 days following stroke was associated with long-term unmet needs. Data from Australian Stroke Clinical Registry (AuSCR) registrants who participated in the Australian Stroke Survivor Needs Survey were used. Outcome data, including the EQ-5D, are routinely collected in AuSCR between 90 and 180 days post-stroke. Unmet needs were assessed at a median of 2 years and categorised into: health everyday living work/leisure and support domains. Multivariable regression was used to determine associations between the EQ-5D dimensions and the likelihood of experiencing unmet needs and the visual analogue scale (VAS) (rating 0-100) and number of reported unmet needs. In total, 173 AuSCR registrants completed the Needs Survey (median age 69 years, 67 % male 77 % ischaemic stroke). VAS scores were negatively associated with the number of reported long-term unmet needs [irr 0.98, (95 % CI 0.97, 0 99) p < 0.001]. Having EQ-5D activity limitations was associated with unmet living needs (aOR 4.5, 95 % CI 1.1, 18.8). Requiring living supports at 90-180 days was associated with unmet health needs (aOR 4.9, 95 % CI 1.5, 16.1). Those with pain at 90-180 days were less likely to report unmet health (aOR 0.09, 95 % CI 0.02, 0.4) and support needs (aOR 0.2, 95 % CI 0.06, 0.6). Routinely collected HRQoL data can identify survivors at risk of experiencing long-term unmet needs. This information is important for targeting service delivery to optimise outcomes following stroke.
Publisher: Informa UK Limited
Date: 03-07-2015
Publisher: Wiley
Date: 21-05-2010
Publisher: Wiley
Date: 04-2013
Publisher: Springer Science and Business Media LLC
Date: 18-01-2019
Publisher: SAGE Publications
Date: 26-10-2018
Abstract: The Australian Stroke Clinical Registry (AuSCR) collects patient-reported outcomes at 90–180 days post-stroke. During telephone interviews, stroke survivors or their carers/family members often explain why they did not respond to a previously mailed survey. This feedback is useful to explore respondents’ experiences of the follow-up process. Three main reasons for not returning surveys included: health-related time constraints, confusion about survey questions, and stroke denial. Such information is helpful in improving procedures for clinical quality disease registries and researchers using postal questionnaires.
Publisher: Wiley
Date: 29-09-2011
DOI: 10.1111/J.1440-1630.2011.00960.X
Abstract: Handwriting is an important activity for people of all ages. Handwriting is frequently affected after stroke and other neurological conditions. However, research on the handwriting of healthy adults is difficult to find. This review aims to advance the development of evidence-informed handwriting assessment and retraining. The aim of this paper was to review factors that influence the handwriting performance of unimpaired adults, some of which are amenable to intervention. Searches were conducted of eight electronic databases up to April 2009 and again in November 2010. Reference lists were also used to identify potential studies of interest. No limits were placed on study design. Age: Younger adults write more legibly and faster than older adults. Gender: Women write faster and more legibly than men. Pengrip: Grips other than the traditional dynamic tripod are functional, producing legible text in an acceptable time. Pen pressure: Pressure varies with different letters, words, text size, speed and across a page of text. Error corrections and a mixed writing style occur in healthy adult handwriting. Research was inconclusive about the association between speed, pressure and upper limb movements on handwriting performance. Other factors able to predict adult handwriting legibility have been largely unexplored. A number of knowledge and research gaps about adult handwriting were identified, including the need for more contemporary normative data.
Publisher: Wiley
Date: 15-07-2013
DOI: 10.1111/DMCN.12205
Abstract: The aim of this review was to determine the effectiveness of hand splinting for improving hand function in children with cerebral palsy (CP) and brain injury. A systematic review with meta-analyses was conducted. Only randomized and quasi-randomized controlled trials in which all participants were children aged 0 to 18 years with CP or brain injury and a hand splint (cast, brace, or orthosis) were included. Six studies met the inclusion criteria. No study included participants with a brain injury therefore, the results relate only to CP. Five studies investigated 'non-functional hand splints' and one investigated a 'functional hand splint'. Moderate-quality evidence indicated a small benefit of non-functional hand splints plus therapy on upper limb skills over therapy alone (standard mean difference [SMD]=0.81, 95% confidence interval [CI]=0.03-1.58), although benefits were diminished 2 to 3 months after splint wearing stopped (SMD=0.35, CI -0.06 to 0.77). In children with CP, hand splints may have a small benefit for upper limb skills. However, results are diminished after splint wearing stops. Given the costs - potential negative cosmesis and discomfort for the child - clinicians must consider whether hand splinting is clinically worthwhile. Further methodologically sound research regarding hand splinting combined with evidence-based therapy is needed to investigate whether the small clinical effect is meaningful.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2022
DOI: 10.1186/S12913-022-08047-6
Abstract: Several active ingredients contribute to the purposes and mechanisms of goal-setting in rehabilitation. Active ingredients in the goal-setting process include, interdisciplinary teamworking, shared decision-making, having meaningful and specific goals, and including action planning, coping planning, feedback, and review. Clinicians have expressed barriers and enablers to implementing these active ingredients in rehabilitation teams. Interventions designed to improve goal-setting practices need to be tailored to address context specific barriers and enablers. Attempts to understand and enhance goal-setting practices in rehabilitation settings should be supported using theory, process models and determinant frameworks. Few studies have been undertaken to enhance goal-setting practices in varied case-mix rehabilitation settings. This study is part of a larger program of research guided by the Knowledge to Action (KTA) framework. A multisite, participatory, codesign approach was used in five sites to address three stages of the KTA. (1) Focus groups were conducted to understand barriers and enablers to implementing goal-setting at each site. Following the focus groups three staff co-design workshops and one consumer workshop were run at each site to (2) adapt knowledge to local context, and to (3) select and tailor interventions to improve goal-setting practices. Focus groups were analysed using the Theoretical Domains Framework (TDF) and informed the selection of behaviour change techniques incorporated into the implementation plan. Barriers and enablers identified in this study were consistent with previous research. Clinicians lacked knowledge and understanding of the differences between a goal and an action plan often confusing both terms. Clinicians were unable to demonstrate an understanding of the importance of comprehensive action planning and review processes that extended beyond initial goal-setting. Interventions developed across the sites included staff training modules, a client held workbook, educational rehabilitation service flyers, interdisciplinary goal-based case conference templates, communication goal boards and a key worker model. Implementation plans were specifically established for each site. Rehabilitation teams continue to struggle to incorporate a truly client-centred, interdisciplinary model of goal-setting in rehabilitation. Whilst clinicians continue to lack understanding of how they can use aspects of goal-setting to enhance client outcomes and autonomy in rehabilitation settings.
Publisher: American Academy of Pediatrics (AAP)
Date: 10-2009
Abstract: OBJECTIVE: The goal was to assess the effectiveness of an occupational therapy home program (OTHP), compared with no OTHP, with respect to function and parent satisfaction with child function, participation, goal attainment, and quality of upper limb skill in school-aged children with cerebral palsy. METHODS: Thirty-six children with cerebral palsy (mean age: 7.7 years male: 69% Gross Motor Function Classification System: level I, 47% level II, 14% level III, 16% level IV, 7% level V, 16% spasticity, 85% dyskinesia, 14% ataxia, 3%) were randomly and equally assigned to OTHPs for 8 or 4 weeks or to no OTHP. The primary end point was Canadian Occupational Performance Measure scores 8 weeks after baseline. Secondary measures were recorded at 4 and 8 weeks. RESULTS: Eight weeks of OTHP produced statistically significant differences in function and parent satisfaction with function, compared with no OTHP. Parents in the 4-week OTHP group did not discontinue use at 4 weeks, as instructed, and continued for 8 weeks results demonstrated statistically significant differences, compared with no OTHP. There was no difference in primary or secondary end point measures between intervention groups. CONCLUSION: Pediatricians can advise families that OTHPs developed with a collaborative, evidence-based approach and implemented by parents at home were clinically effective if implemented 17.5 times per month for an average of 16.5 minutes per session.
Publisher: Wiley
Date: 06-03-2017
Publisher: Elsevier BV
Date: 07-2023
Publisher: Informa UK Limited
Date: 17-03-2022
DOI: 10.1080/09638288.2021.1897693
Abstract: Guidelines recommend that carers of stroke survivors should be engaged early in rehabilitation. There has been limited research implementing exercise programs that include carers. The aims of this study were to develop, facilitate, and evaluate an intervention, the Carers Count group, an exercise-based group for stroke survivors and their carers. Over a 5-month period, a staged approach was used to design the intervention and implementation strategies which would maximise the chances of embedding the intervention within an inpatient stroke ward. Implementation strategies included planning, educating, restructuring, financing, and managing quality. Following development and facilitation of the intervention, outcomes were evaluated through collecting data about therapy time, surveys ( Thirty stroke survivors and their carers participated in the Carers Count group. Analysis of time spent in therapy showed that participation led to increased dose of physiotherapy time (service outcome). Survey and interview data suggested that participation in the group was a rewarding and engaging experience for participants (client outcomes). Using multifaceted strategies, a group designed to include carers was implemented on a stroke rehabilitation ward. The intervention provided positive outcomes in terms of increased therapy dose and satisfaction according to participant feedback. ANZCTR12620000708954Implications for rehabilitationIt is possible to develop modes of delivery in rehabilitation that include the carers of stroke survivors and these interventions are considered enjoyable and beneficial.Health professionals should consider interventions that are engaging and fun for stroke survivors and their carers.Health professionals should carefully plan and utilise appropriate implementation strategies when aiming to introduce a new intervention into an established health service.Health professionals should ensure stroke survivors and their carers have an understanding of recovery following stroke and how to maximise outcomes through increasing amount of practice.
Publisher: Wiley
Date: 03-2004
Publisher: Informa UK Limited
Date: 07-2018
DOI: 10.2147/PPA.S154581
Publisher: Wiley
Date: 11-12-2014
Abstract: Occupational therapists work together with their medical and nursing colleagues to ensure that patients are able to return to safe and legal driving upon discharge from the emergency department after a range of illnesses and/or injuries. This study aimed to determine the type of information that is provided nationally in emergency departments to people after mild traumatic brain injury (mTBI), with respect to fitness-to-drive. Cross-sectional electronic survey mailed to all emergency departments in Australia (N = 110). Responses were invited from medical, nursing, and allied-health professionals. The survey asked respondents to comment about the existence and use of fitness-to-drive management guidelines, as well as their opinion on when clearance should be given to return to driving post injury. 104 clinicians completed the survey the majority of respondents were medical staff (n = 46, 51%) followed by allied-health staff (n = 23, 25%), with the highest response rate provided from Victoria (n = 41, 45%). Just over one-third of respondents' emergency departments (n = 34, 36%) recommended a period of 'no driving' after mTBI, and within these departments, this recommendation was usually provided by medical staff (n = 25, 80%). Consensus was not displayed with respect to the safest time to return to driving after mTBI. Opinions from respondents strongly suggested that a review of fitness-to-drive management guidelines was required for mTBI patients (n = 78, 88%). No consensus exists in the fitness-to-drive recommendations provided to patients after mTBI, and clinicians have reported the need for a review of fitness-to-drive management guidelines in Australian emergency departments. With their understanding about the complex interplay of the skills required for safe driving, occupational therapists are positioned to help guide the development of protocols in this area.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-042879
Abstract: Somatosensory loss is common after stroke with one-in-two in iduals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke. Qualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory). Eight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia. Eighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively s led and participated in a knowledge translation study with staggered recruitment from 2014 to 2018. Three types of factors influenced therapists’ delivery of upper limb somatosensory rehabilitation: in idual (‘The uncertain, unskilled therapist’), patient (‘Patient understanding and priorities ’ ) and organisational (‘System pressures and resources ’ ). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach. Occupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the ‘frontline’. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists’ perceived legitimacy in using new somatosensory rehabilitation approaches. Results will inform the design of a tailored implementation strategy to increase the use of evidence-based somatosensory rehabilitation in Australia. Australian New Zealand Clinical Trials Registry (ACTRN12615000933550).
Publisher: Informa UK Limited
Date: 2003
Publisher: Informa UK Limited
Date: 27-08-2020
DOI: 10.1080/09638288.2020.1807619
Abstract: Translation of findings from stroke trials into clinical practice remains low. Little is known about planned translation activities from the perspective of trialists who generate the evidence. This study aims to investigate perceptions of Australian stroke clinical trialists' about implementation of their findings into practice, and what translation activities they embedded into trial protocols. A descriptive cohort design and electronic survey was conducted. Three databases were searched to identify Australian stroke rehabilitation trials published between 2007 and 2017. Corresponding authors of the included trials were invited to complete an anonymous online survey about implementation of their trial intervention. Fifty-one trialists were invited to participate and 38 completed the survey (74% response rate). The majority (79%) considered their trial results to be clinically significant and 68% had pre-planned knowledge translation activities. The most common planned translation activities were publication (89%), conference presentation (87%), and feedback of results to target audiences (58%). Mixed opinions were evident regarding
Publisher: Wiley
Date: 23-11-2012
Publisher: Wiley
Date: 02-2015
Abstract: To describe Australian physiotherapy and occupational therapy practice for patients who receive upper-limb Botulinum Toxin-A (BoNT-A). Anonymous online survey asking about practice experience. Convenience s le of 128 BoNT-A experienced occupational therapists and physiotherapists. The primary work setting was multidisciplinary inpatient or outpatient rehabilitation services where therapists had automatic referral to BoNT-A patients. Patients expected BoNT-A to improve functional movement, reduce hypertonicity, increase passive range, reduce pain, improve appearance and hand hygiene. Most patients were injected in multidisciplinary public hospital clinics and had median 2 pre-injection (range 0-30) and 8 post-injection (range 0-50) therapy sessions. Biceps, flexor digitorum profundus/superficialis and brachoradialis were most frequently injected. Injectors used therapist assessment information to select sites 68% of the time only 44% of services had assessment protocols. Standardised therapy assessments examined motor performance, pain and function in that order of frequency. The greater the awareness and perceived relevance of an assessment the more often therapists used it. All therapists set goals, most collaboratively, and these mirrored patient expectations. The most common treatments were stretch, task-specific functional training, strength training and home programmes. While trends in Australian assessment, goals and treatment practice were observed, greater consistency could be achieved if therapy practice guidelines existed. The gap is exacerbated by the absence of Australian BoNT-A organisation and process of care spasticity management guidelines. This creates an environment where practice variability is inevitable. Recommendations to improve local service quality are made.
Publisher: Wiley
Date: 19-10-2020
Abstract: Returning to work is a goal for many people after brain injury. The failure to return to work after injury brings both economic and personal (quality of life) costs to those living with stroke or brain injury, their families, and society. This study explored the barriers to providing work‐focused interventions during hospital‐based rehabilitation and co‐created solutions with rehabilitation providers to increase the provision of work‐focused intervention during inpatient rehabilitation. This study used an Intervention Mapping approach (a six‐step protocol that guides the design of complex interventions) based on an action research methodology. Focus group data, in addition to best evidence from systematic reviews, practice guidelines and key articles were combined with theoretical models for changing behaviour and clinician experience. This was then systematically operationalised into an intervention process using consensus among clinicians. The process was further refined through piloting and feedback from key stakeholders, and group consensus on the final process. A detailed five phase return to work intervention process for inpatient rehabilitation was developed. The key features of the process include having one key allied health clinician to coordinate the process, choosing assessments based on pre‐injury work demands, emphasising the importance of core work skills and considering the most appropriate service for referral at the conclusion of rehabilitation. We used a systematic approach, guided by the intervention mapping approach and behaviour change theory to tailor existing workfocused interventions to the inpatient setting.
Publisher: Oxford University Press (OUP)
Date: 2021
Abstract: Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI) however, research testing the efficacy of acute programmes is limited. This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness. Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4–11.6) versus 13.0 (4.5–21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA. Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%.
Publisher: Informa UK Limited
Date: 28-02-2019
Publisher: SAGE Publications
Date: 02-2015
Abstract: Limited evidence is available to support knowledge of the time-frame and capacity for fitness to drive after mild traumatic brain injury. The aim of this systematic review was to identify what methods and assessments are, or could be used to determine fitness to drive for this population. We undertook a systematic search of six electronic databases. Two authors rated all studies for methodological content and quality, and standardised data were extracted. Narrative analysis was conducted to understand the content of eligible studies. A total of 2022 articles were retrieved seven articles met the inclusion criteria. Self-reported questionnaires, non-standardised assessments, questionnaires completed by next-of-kin, and simulator tests were the primary methods used to determine fitness to drive. Only one assessment has been used to aid recommendations about fitness to drive in the acute hospital setting. Six additional standardised assessments were identified that have the potential to predict fitness to drive in this population group however, these assessments require further psychometric testing prior to use. While a variety of methods and assessments are currently used, there is little research evidence to suggest when in iduals are able to return to driving after mild traumatic brain injury. Research is urgently required to determine a consistent and standardised approach to assessing fitness to drive following mild traumatic brain injury.
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/JOCN.16835
Abstract: The aim of this study was to determine how much time nurses spend on direct and indirect patient care in acute and subacute hospital settings. Quantifying direct and indirect nursing care provided during inpatient stay is vital to optimise the quality of care and manage resources. Time and motion cross‐sectional observational study and reported the study according to the STROBE guideline. Nurses working in an acute or subacute medical wards of a single health service participated. Nurses were observed twice for 2 h on the same day with an observer break in between sessions. Real‐time task‐related data were digitally recorded using the Work Observation Method By Activity Timing (WOMBAT) tool by a single research assistant. Frequency and time spent on pre‐determined tasks were recorded and included direct care, indirect care, documentation, medication‐related tasks, communication (professional) and other tasks. Task interruptions and multitasking were also recorded. Twenty‐one nurses (acute n = 12, subacute n = 9) were observed during shifts between 7 AM and 9 PM in May–July 2021. A total of 7240 tasks were recorded. Nurses spent a third of their time on direct patient care (27% direct care and 3% medication administration). A total of 556 task interruptions occurred, mostly during documentation, and medication‐related tasks. A further 1385 tasks were performed in parallel with other tasks, that is multitasking. Time spent on tasks was similar regardless of the setting and was consistent with previous research. We found differences in the distribution of tasks throughout the day between settings, which could have implications for workforce planning and needs to be investigated further. Interruptions occurred during documentation, direct care and medication‐related tasks. Local‐level strategies should be in place and regularly revised to reduce interruptions and prevent errors. Relevance to clinical practice The association between interruption and increased risk of error is well‐established and should be an ongoing area of attention including observations and education provided in local settings.
Publisher: AMPCo
Date: 05-2017
DOI: 10.5694/MJA16.00525
Abstract: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate. Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence. Australian hospitals providing at least 200 episodes of acute stroke care, 2009-2014. Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs that is, RAMRs more than three standard deviations from the mean. In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients median age, 77 years women, 46% ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20% RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality. Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.
Publisher: Informa UK Limited
Date: 16-03-2022
DOI: 10.1080/09638288.2021.1894490
Abstract: To identify the impact of upper limb spasticity on stroke survivors by linking their shared experience to the International Classification of Functioning, Disability, and Health (ICF). Ten community dwelling adults with a chronic stroke and spasticity, who had completed an upper limb rehabilitation trial participated in semi-structured interviews. Data were analysed using content analysis and linked to the ICF Comprehensive Core Set for stroke using standard linking rules. Four hundred and thirty-nine meaningful concepts eligible for linking were identified. The majority ( Half of the Comprehensive Core Set categories for stroke were relevant, but to adequately capture experience an additional eight were needed. The ICF category profile may be unique to our participants or may suggest further research is needed to determine if additions to core set categories are required.Implications for rehabilitationOur ICF mapping demonstrated that the Brief Core Set for stroke was not sufficient to capture the range of experience for stroke survivors with upper limb spasticity, instead the Comprehensive Core Set for stroke supplemented with eight clinical-cohort specific second-level-categories should be used.Our findings suggest that rehabilitation may better reflect lived experience if it focuses on Body Function (Chapters 1, 2, 4, 7), Activity and Participation (Chapters 1-9), and Environment (Chapters 1, 2, 3, 5) because Body Structure was rarely mentioned in this or previous post-stroke ICF mapping research.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JHT.2017.09.006
Abstract: Two-group randomized controlled trial. Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence. The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury. A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group. After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13 standard deviation, 11.476) and the no orthotic group (mean, 14.07 standard deviation, 11.106 t[28], -0.954 P = .348 and 95% confidence interval, -12.380 to 4.513). In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a 'typical' position, may not lead to an immediate improvement in hand function. Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term.
Publisher: SAGE Publications
Date: 12-2003
DOI: 10.1191/0269215503CR682OA
Abstract: Background: Upper limb hemiplegia after stroke is common and disabling. Hand splints are widely used to prevent contracture and reduce spasticity. Objective: To assess the effectiveness of hand splinting on the hemiplegic upper extremity following stroke. Search strategy: A search was conducted of the Cochrane Central Register of Controlled Trials the electronic databases MEDLINE, EMBASE, CINAHL, PEDro, SCI, SSCI websites of professional associations reference lists in trial reports and other relevant articles. Selection criteria: Studies of the effect of upper extremity splinting on motor control, functional abilities, contracture, spasticity, or pain in the hand or wrist. Data collection and analysis: Validity of studies was assessed systematically and a content analysis was conducted of the methodologies used. Methodological quality of randomized trials was rated by two independent assessors using the PEDro scale. Results: Nineteen studies were appraised for content. Of these, most (63%) were reports of case series. Four studies (21%) were randomized controlled trials. Methodological scores of trials ranged from 2 to 8 (maximum possible score 10). One trial of nominally ‘medium’ quality reported that in‘atable arm splinting makes no difference to hand function (mean difference on Fugl-Meyer Assessment –0.12, 95% confidence interval (CI) –9.8 to 9.6). The remaining trials investigated effects of thermoplastic splints one trial of ‘high quality’ reported no difference in contracture formation in the wrist and finger ‘exor muscles after wearing a hand splint which positioned the wrist in the traditional functional position for 12 hours each night for four weeks (mean difference in range of movement after four weeks was 1°, 95% CI –3.7° to 6.1° power %). All remaining trials were of poor methodological quality. Limited research and lack of a no-splint control group in all trials to date limit the usefulness of these results. Reviewer's conclusion: There is insufficient evidence to either support or refute the effectiveness of hand splinting for adults following stroke.
Publisher: John Wiley & Sons, Ltd
Date: 12-12-2012
Publisher: Wiley
Date: 14-03-2012
DOI: 10.1111/J.1440-1630.2012.00998.X
Abstract: Occupational therapists working in brain injury rehabilitation use functional tasks as a means of providing feedback to improve self-awareness of people who have a brain injury and ultimately improve their occupational performance. To compare the effectiveness of video, verbal and experiential feedback for improving self-awareness in people with traumatic brain injury. A randomised controlled trial will be conducted to compare the efficacy of video and verbal feedback during occupational therapy. Fifty-four participants with traumatic brain injury will be randomly allocated into three intervention groups: (i) video plus verbal feedback, (ii) verbal feedback and (iii) experiential feedback (control condition). Participants will receive the allocated intervention based on performance of a meal preparation task. The intervention sessions will occur four times during a two-week period. Blinded assessment will occur at baseline, post-intervention, and two months follow up. The primary outcome will be a measure of on-line self-awareness (number of self-corrected and therapist corrected errors). Secondary outcomes to be assessed include levels of intellectual self-awareness, emotional distress, and acceptance of disability. Data will be analysed using an intention to treat approach. Linear mixed effects models will be used to investigate the intervention effects. Results will contribute to evidence-based guidelines to support therapists to choose the most effective form of feedback for people with decreased self-awareness after traumatic brain injury.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2023
DOI: 10.1161/STROKEAHA.122.041355
Abstract: Untreated poststroke mood problems may influence long-term outcomes. We aimed to investigate factors associated with receiving mental health treatment following stroke and impacts on long-term outcomes. Observational cohort study derived from the Australian Stroke Clinical Registry (AuSCR Queensland and Victorian registrants: 2012–2016) linked with hospital, primary care billing and pharmaceutical dispensing claims data. Data from registrants who completed the AuSCR 3 to 6 month follow-up survey containing a question on anxiety/depression were analyzed. We assessed exposures at 6 to 18 months and outcomes at 18 to 30 months. Factors associated with receiving treatment were determined using staged multivariable multilevel logistic regression models. Cox proportional hazards regression models were used to assess the impact of treatment on outcomes. Among 7214 eligible in iduals, 39% reported anxiety/depression at 3 to 6 months following stroke. Of these, 54% received treatment (88% antidepressant medication). Notable factors associated with any mental health treatment receipt included prestroke psychological support (odds ratio [OR], 1.80 [95% CI, 1.37–2.38]) or medication (OR, 17.58 [95% CI, 15.05–20.55]), self-reported anxiety/depression (OR, 2.55 [95% CI, 2.24–2.90]), younger age (OR, 0.98 [95% CI, 0.97–0.98]), and being female (OR, 1.30 [95% CI, 1.13–1.48]). Those who required interpreter services (OR, 0.49 [95% CI, 0.25–0.95]) used a health benefits card (OR, 0.73 [95% CI, 0.59–0.92]) or had continuity of primary care visits (ie, with a consistent physician OR, 0.78 [95% CI, 0.62–0.99]) were less likely to access mental health services. Among those who reported anxiety/depression, those who received mental health treatment had an increased risk of presenting to hospital (hazard ratio, 1.06 [95% CI, 1.01–1.11]) but no difference in survival (hazard ratio, 0.86 [95% CI, 0.58–1.27]). Nearly half of the people living with mood problems following stroke did not receive mental health treatment. We have highlighted subgroups who may benefit from targeted mood screening and factors that may improve treatment access.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/09638280701746538
Abstract: This study critically explores the experience of one clinician who developed the practitioner-researcher role in a remote hospital. One occupational therapist working in rehabilitation who had never previously done or been trained for research but who completed and published a randomized controlled trial. Government hospital rehabilitation ward in remote northern Australia. Data from a reflective journal and project records were content analysed using a conceptual framework of the metropolitan practitioner-researcher experience. The participant's experience was similar to that of metropolitan practitioner-researchers as it was not just a matter of doing research, but rather one of role change from practitioner to researcher. The remote context created structural conditions that discouraged and hindered research and made the task of researcher role development challenging with high personal costs. Research deterrents included a lack of: Research-related infrastructure (such as information technology), research development policy, research accommodations in job descriptions, dedicated funding to support research time release and training, and research support networks. These deterrents were a consequence of the remote setting. Investment of substantial personal time, money and use of pro bono city research advisers was required to compensate for structural deterrents to ensure project completion. Researcher role development was central to project success, the remote context dominated role development processes and personal resources were needed to compensate for structural research deterrents
Publisher: Wiley
Date: 27-10-2006
Publisher: Informa UK Limited
Date: 22-02-2023
Publisher: Oxford University Press (OUP)
Date: 11-2014
DOI: 10.2522/PTJ.20130408
Abstract: Botulinum toxin A (BoNT-A) injections are increasingly used to treat muscle spasticity and are often complemented by adjunctive rehabilitation therapies however, little is known about the effect of therapy after injection. The aim of this study was to identify and summarize evidence on rehabilitation therapies used after BoNT-A injections to improve motor function in adults with neurological impairments. Searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, National Research Register, metaRegistry of Controlled Trials, PEDro, and OTseeker. Randomized and quasi-randomized controlled trials were considered for inclusion. Participants with neurological impairments received BoNT-A to treat focal spasticity in limbs, with rehabilitation interventions provided to experimental groups only. Primary outcome measures were joint mobility, function of the affected limb, and spasticity. Eleven studies with 234 participants, most of whom had stroke, were included in the review. Two reviewers extracted study details and data. Methodological quality was rated using the PEDro scale. Both fixed-effects and random-effects models were used to calculate effect size. Studies were of variable quality: 3 were poor (PEDro score 1 to 4), and 8 were moderate (PEDro score 6 to 7). No study investigated effects for longer than 24 weeks (6 months). Included trials presented 9 therapy types, including ergometer cycling, electrical stimulation, stretch (casting, splinting, taping, or manual or exercise-induced stretch), constraint-induced movement therapy, task-specific motor training, and exercise programs. Statistical findings suggest that combined therapy and BoNT-A is slightly more effective than BoNT-A alone. Evidence relating to impact of adjunct therapy is available, but the heterogeneity of studies limits the opportunity to demonstrate overall impact. Researchers need to consider the benefits of greater consistency in study approaches and measures so that meaningful evaluations of overall adjunct therapy effects can be made.
Publisher: Wiley
Date: 05-07-2023
DOI: 10.1111/JOCN.16820
Abstract: To explore discharge planning with a range of key stakeholders in subacute care, including consumers. Qualitative descriptive study. Patients ( n = 16), families ( n = 16), clinicians ( n = 17) and managers ( n = 12) participated in semi‐structured interviews or focus groups. Following transcription, data were analysed thematically. The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient‐ and family‐centred decision‐making, early goal setting, strong inter‐ and intra‐disciplinary teamwork, and robust patient/family education. Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. Effective discharge planning processes are underpinned by effective inter‐ and intra‐disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post‐discharge. This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. COREQ guidelines were followed in reporting this study. No patient or public contribution in the design, data analysis or preparation of the manuscript.
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000484141
Abstract: b i Background: /i /b Given the potential differences in etiology and impact, the treatment and outcome of younger patients (aged 18–64 years) require examination separately to older adults (aged ≥65 years) who experience acute stroke. b i Methods: /i /b i /i Data from the Australian Stroke Clinical Registry (2010–2015) including demographic and clinical characteristics, provision of evidence-based therapies and health-related quality of life (HRQoL) post-stroke was used. Descriptive statistics and multilevel regression models were used for group comparisons. b i Results: /i /b Compared to older patients (age ≥65 years) among 26,220 registrants, 6,526 (25%) younger patients (age 18–64 years) were more often male (63 vs. 51% i /i & #x3c 0.001), born in Australia (70 vs. 63% i /i & #x3c 0.001), more often discharged home from acute care (56 vs. 38% i /i & #x3c 0.001), and less likely to receive antihypertensive medication (61 vs. 73% i /i & #x3c 0.001). Younger patients had a 74% greater odds of having lower HRQoL compared to an equivalent aged-matched general population (adjusted OR 1.74, 95% CI 1.56–1.93, i /i & #x3c 0.001). b i Conclusions: /i /b i /i Younger stroke patients exhibited distinct differences from their older counterparts with respect to demographic and clinical characteristics, prescription of antihypertensive medications and residual health status.
Publisher: Wiley
Date: 15-05-2006
Publisher: SAGE Publications
Date: 12-01-2018
Abstract: To explore the ways clinicians engage rehabilitation patients in patient-centered goal setting and identify factors influencing the goal-setting process. Ethnographic study utilizing observed practice-thematic analysis. Four rehabilitation wards of a large metropolitan hospital in Melbourne, Australia. Participants included 17 rehabilitation patients, 18 allied health clinicians and one family member. Disciplines represented were speech pathology, occupational therapy, social work and physiotherapy. Multiple qualitative methods were used. A total of 18 routine goal-setting interviews between clinicians and patients were audio recorded and transcribed. Together with associated entries in the patient medical record, transcripts were coded and developed into themes using thematic analysis. Finally, focus groups with clinicians were conducted to validate themes identified. Three themes were identified describing factors which influence patient centeredness: "a goal-setting collaboration"-the interpersonal exchange between client and clinician "the environment"-physical, temporal and structural and "clinician self-awareness"-clinicians' insight into the ways they influence goal setting. The practice of patient-centered goal setting varied considerably between clinicians. Goals developed were strongly influenced by the clinician's views, although strategies of respect for the patient and reflective listening skills increased patient participation and the patient centeredness of goals developed. Goals developed with rehabilitation patients are more likely to be patient-centered when the interaction encourages the patient to express their needs and preferences, and these are heard by the clinician. For this to influence treatment, it must occur in an environment structured to support and value patient-centered goals.
Publisher: SAGE Publications
Date: 14-06-2021
DOI: 10.1177/17474930211022678
Abstract: To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. S le size: To test our primary hypothesis, we estimated a s le size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the s le size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum s le capped at 1100. We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
Publisher: Informa UK Limited
Date: 21-10-2016
DOI: 10.1080/09638288.2016.1229364
Abstract: The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire is a patient reported outcome measure for evaluating upper limb function in people with musculoskeletal conditions. While the DASH has good psychometric properties when used with people with musculoskeletal conditions, it has not been tested with adults after stroke. Data for n = 61 adults following stroke (aged 32-93 years, 44% male) were analyzed to test validity and reliability of the DASH for use with a stroke population. Data included demographic and clinical attributes, DASH scores (baseline and four weeks later) and Patient Rated Wrist Evaluation (PRWE) measures. Internal consistency was good (Cronbach alpha 0.92, SEM 6.65). Factor analysis and Rasch modeling suggested that the questionnaire comprised three subscales: pain, impact and function. Concurrent validity between the DASH and PRWE (Spearman's Rho r The DASH is considered to have acceptable validity when used with adults following stroke. Test-retest reliability was low but further research is needed to establish whether this is a result of condition-related change or the stability of the measure. Implications for Rehabilitation The DASH questionnaire examines upper limb function in task performance and appears to be a useful tool, which is simple to administer in the clinical setting with adults following stroke. Upper limb function post stroke can be meaningfully assessed using the DASH as it has good internal consistency and moderate concurrent validity. Rasch analysis and factor analysis suggests that the tool appears to consist of three subscales: pain, impact and function. The total score of the DASH may be less meaningful than the totals of these subscales. The test-retest reliability of the DASH requires further research over a four-week period DASH stability was poor in a group of people with moderate to severe upper limb impairment.
Publisher: Informa UK Limited
Date: 22-06-2015
DOI: 10.3109/09638288.2015.1059495
Abstract: To test the feasibility of a handwriting retraining program with adults after stroke specifically the feasibility of: (i) recruiting people with stroke to the study, (ii) delivering the handwriting retraining program and (iii) outcome measures of handwriting performance. A quasi-experimental pre-test post-test design was used. A four-week, home-based handwriting retraining program was delivered by an occupational therapist using task-specific practice. Legibility, speed, pen control and self-perception of handwriting were measured at baseline and completion of the program. Legibility was scored by a blinded rater. Seven adults with stroke were recruited (eligibility fraction 43% of those screened, and enrolment fraction 78% of those eligible). There were no dropouts. Although, recruitment was slow the intervention was feasible and acceptable to adults with stroke. No statistically or clinically significant changes in legibility were reported in this small s le, but a ceiling effect was evident for some outcome measures. The study was not powered to determine efficacy. Delivery of a four-week handwriting intervention with eight supervised sessions in the community was feasible however, recruitment of an adequate s le size would require greater investment than the single site used in this pilot. Handwriting difficulty is common following hemiparesis after stroke, however research addressing handwriting retraining for adults with stroke is lacking. A four-week home-based handwriting program using task-specific practice and feedback was feasible to deliver and appropriate for adults with stroke. Improving handwriting legibility and neatness across a range of tasks were important goals for adults with handwriting impairment.
Publisher: Informa UK Limited
Date: 18-05-2019
Publisher: SAGE Publications
Date: 25-03-2009
Abstract: Objective: To determine the benefits of additional therapy specifically directed at the hand in people with acquired brain impairment. Design: An assessor-blinded randomized controlled trial. Setting: Rehabilitation hospital. Participants: A s le of 39 adults with hand impairment following stroke (90%) or traumatic brain injury (10%). The median (interquartile) time since injury was 1.6 months (0.5—3.5 months). Intervention: The experimental group (n = 20) received an additional one-hour session of task-specific motor training for the hand five times a week over a six-week period. The training was administered on a one-to-one basis. The control group (n = 19) received standard care which consisted of 10 minutes of hand therapy three times a week. Both groups continued to receive therapy directed at the shoulder and elbow. Outcome measures: Primary outcomes were the Action Research Arm and Summed Manual Muscle Tests measured at the beginning and end of the six-week period. Results: The mean (SD) Action Research Arm Test values for experimental participants improved from the beginning to the end of study from 10 points (15) to 21 points (23) and the equivalent values for the Summed Manual Muscle Test improved from 35% (33) to 49% (35). There were similar improvements in control participants. The mean between-group differences for the Action Research Arm and Summed Manual Muscle Tests were -6 points (95% confidence interval (CI), -20 to 8) and 3% (95% CI, -10 to 16), respectively. Conclusion: Hand and overall arm function of all participants improved over the six-week period, however there was not a clear benefit from providing additional hand therapy.
Publisher: Wiley
Date: 15-03-2010
DOI: 10.1002/9780470571224.PSE227
Abstract: This article focuses on issues and practical aspects of the context and conduct of paediatric clinical trials. Investigators should have a breadth of view on issues involved in paediatric trials to enable them to apply technical information to the context of paediatrics. Investigators should also be able to reflect on their own standpoint and responsibility as trial leaders, sponsors or team members who are knowingly putting infants, children or young people at some level of risk in order to answer a question.
Publisher: Informa UK Limited
Date: 21-01-2004
Publisher: Wiley
Date: 26-11-2015
Abstract: Male clients who attend community rehabilitation programs often have low engagement in meaningful occupations and thus suffer a disconnect with their community. The primary aim of this mixed methods study was to explore the feasibility of using a therapeutic woodwork group to engage male clients in community rehabilitation. In the context of a community rehabilitation setting, fourteen clients attended an 8-week woodwork group to engage in meaningful projects developed with an occupational therapist to achieve specific goals. The group also aimed to encourage male peer support and interaction in an outpatient group setting. Clients identified three rehabilitation goals which guided their rehabilitation intervention. Goal achievement was rated pre- and post-group using the Goal Attainment Scale one of two Quality of Life scales were administered to measure change in self-reported quality of life. Participants were interviewed pre- and post-group to measure woodwork experience and the group process. Results from the pilot project indicate that 85.7% of clients attained their expected level of goal achievement or higher on set rehabilitation goals. Consistent positive feedback was received from those who attended the group, particularly in the area of skill development and socialisation, although patients reported minimal changes in quality of life from baseline to end-of-group (P > 0.05). There remains an unmet need for meaningful engagement for men in the community who are not currently engaged in paid work. Community-based occupational therapy programs have the opportunity to play an important role in engaging clients in meaningful occupations, including woodwork, which was shown to increase socialisation and lead to goal attainment in our small s le. Future research should explore if rehabilitation woodwork groups can assist people to transition to participate in community-based Men's Sheds.
Publisher: Informa UK Limited
Date: 02-01-2023
Publisher: Informa UK Limited
Date: 04-2006
DOI: 10.1080/13638490500235581
Abstract: To investigate the relative utility of Canadian Occupational Performance Measure (COPM) (adapted for children) and Goal Attainment Scaling (GAS) as outcome measures for paediatric rehabilitation. A two-group pre-post design investigated the impact of a 3-month programme. Forty-one children with spastic hemiplegic cerebral palsy (mean 3.9 years GMPM level 1 21 boys, 10 girls) were randomized to occupational therapy only and occupational therapy plus one Botulinum Toxin A injection. The latter was considered a 'proven' intervention for the purpose of this instrumentation study. Intervention impact was investigated using GAS and COPM. Instrument sensitivity, convergent validity, goal roblem profiles and administration were evaluated. Both instruments were sensitive to within group change and detected significant between group change. Likert scale coding for GAS scores was more sensitive than the traditional weighted GAS or COPM. Different constructs were measured by each instrument. COPM was more time efficient in training, development and administration. Study aim, logistic and resource factors should guide the choice of COPM and/or GAS instruments as both are sensitive to change with a proven intervention and both evaluate different constructs.
Publisher: Wiley
Date: 08-05-2014
Abstract: The Western Neuro Sensory Stimulation Profile (WNSSP) is designed to measure disorders of consciousness in people with severe traumatic brain injury who are slow-to-recover. This study explores internal consistency reliability and concurrent validity of the WNSSP with function and two other consciousness measures. Retrospective chart audit of all severe traumatic brain injury patients admitted to a specialist neurological rehabilitation centre from January 2001 to December 2006 in a vegetative or minimally conscious state. Medical record of demographical, clinical and Glasgow Coma Scale (GCS) data were recorded. To be included in the study, patients needed admission and discharge WNSSP results plus Functional Independence Measure™ (FIM™) and Rancho Los Amigos Scale (RLAS) scores. Of 37 potential participants, 33 had required WNSSP results (mean age 28 years 27 male participants). Internal consistency reliability was very high (α = 0.933). Concurrent validity in relation to function was significant but weak at admission for FIM™ Total-scale but not subscales (rs = -0.146, P = 0.0424). At discharge, there was a modest relationship with FIM™ Motor-subscale (rs = 0.374 P = 0.045), and FIM™ Cognition-subscale (rs = 0.412 P = 0.026) scores, but not the FIM™ Total-scale. Concurrent validity in relation to the RLAS was strong at admission (rs = 0.693, P = 0.01) and discharge (rs = 0.788, P = 0.01). The WNSSP and GCS scores were not associated. The WNSSP is sensitive to behavioural change in slow-to-recover patients with severe traumatic brain injury. It demonstrates very high internal consistency reliability, and positive evidence of concurrent validity with FIM™ and the RLAS providing detailed description of cognitive-sensory behaviour within RLAS-levels.
Publisher: Springer Science and Business Media LLC
Date: 13-08-2021
DOI: 10.1186/S12913-021-06462-9
Abstract: Ensuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions. This implementation trial aims to determine both the clinical effectiveness of My Therapy on the outcomes of function and health-related quality of life, and cost-effectiveness per minimal clinically important difference (MCID) in functional independence achieved and per quality adjusted life year (QALY) gained, compared to usual care. Using a stepped-wedge cluster randomised design, My Therapy will be implemented across eight rehabilitation wards (inpatient and home-based) within two public and two private Australian health networks, over 54-weeks. We will include 2,160 patients aged 18 + years receiving rehabilitation for any diagnosis. Each ward will transition from the usual care condition (control group receiving usual care) to the experimental condition (intervention group receiving My Therapy in addition to usual care) sequentially at six-week intervals. The primary clinical outcome is achievement of a MCID in the Functional Independence Measure (FIM™) at discharge. Secondary outcomes include improvement in quality of life (EQ-5D-5L) at discharge, length of stay, 30-day re-admissions, discharge accommodation, follow-up rehabilitation services and adverse events (falls). The economic outcomes are the cost-effectiveness per MCID in functional independence (FIM™) achieved and per QALY gained, for My Therapy compared to usual care, from a health-care sector perspective. Cost of implementation will also be reported. Clinical outcomes will be analysed via mixed-effects linear or logistic regression models, and economic outcomes will be analysed via incremental cost-effectiveness ratios. The My Therapy implementation trial will determine the effect of adding self-management within inpatient rehabilitation care. The results may influence health service models of rehabilitation including recommendations for systemic change to the inpatient rehabilitation model of care to include self-management. Findings have the potential to improve patient function and quality of life, and the ability to participate in self-management. Potential health service benefits include reduced hospital length of stay, improved access to rehabilitation and reduced health service costs. This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831 registered 22/03/2021, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828& isReview=true ).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2021
DOI: 10.1161/STROKEAHA.120.032496
Abstract: Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose reporting guidelines (2) inadequate conceptualization of dose, which is multidimensional and (3) unclear and inconsistent terminology that incorporates the multiple dose dimensions. To address these challenges, we need a well-conceptualized and consistent approach to dose articulation that can be applied across stroke recovery domains to stimulate critical thinking about dose during intervention development, as well as promote reporting of planned intervention dose versus actually delivered dose. We followed the Design Research Paradigm to develop a framework that guides how to articulate dose, conceptualizes the multidimensional nature and systemic linkages between dose dimensions, and provides reference terminology for the field. Our framework recognizes that dose is multidimensional and comprised of a duration of days that contain in idual sessions and episodes that can be active (time on task) or inactive (time off task), and each in idual episode can be made up of information about length, intensity, and difficulty. Clinical utility of this framework was demonstrated via hypothetical application to preclinical and clinical domains of stroke recovery. The suitability of the framework to address dose articulation challenges was confirmed with an international expert advisory group. This novel framework provides a pathway for better articulation of nonpharmacological dose that will enable transparent and accurate description, implementation, monitoring, and reporting, in stroke recovery research.
Publisher: Mark Allen Group
Date: 2012
DOI: 10.12968/IJTR.2012.19.1.31
Abstract: Aims: To describe the handwriting of healthy young adults by exploring the types of handwriting activities performed and characteristics of handwriting such as speed, style, and legibility. Findings will help to inform the practice of rehabilitation therapists who assess and treat adults with impaired handwriting. Methods: Descriptive cross-sectional study. Sixteen healthy Australian adults aged 20-24 years were recruited using quota s ling methods. Both observational and survey methods were used. Participants used a digital pen and kept a log of handwriting occasions over three consecutive days. Findings: The mean age of participants was 21.6 years (SD=1.3). Participants wrote on few occasions each day (mean=2.4, SD=1.9), with a large variation in the number of words written per day (median=52.8, IQR=129.5). Notes, messages, and lists were most commonly written. Most occasions (78%) involved self-generated text. Many participants (31% when self-generating text) wrote at least a few illegible words, but the overall meaning of text could be understood. Conclusions: The quantity of text written per occasion er day by these young adults was small, but similar to that collected from older adults in an earlier study. Findings may help rehabilitation therapists to determine when handwriting is ‘impaired’, and whether their assessments are relevant for today's young adults.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2019.01.026
Abstract: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. To explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards. Forty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke. Among 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient = 0.01, 95% CI -0.06-0.09, P = .78). Patients managed in SUs more often received recommended management (e.g. swallowing screening). The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.
Publisher: Wiley
Date: 31-05-2018
Abstract: Functional electrical stimulation (FES) improves active movement of the hemiplegic upper and lower limbs following stroke. The use of FES by Australian allied health clinicians in stroke rehabilitation is, however, unknown. The purpose of this study was to understand the use of FES in clinical practice. Reasons for the use of FES and potential variables that influence decision-making were also investigated. Cross-sectional study of Victorian allied health clinicians, using a snowball recruitment method. Ninety-seven eligible therapists completed the anonymous online survey. Data were analysed using frequency distributions. The majority of respondents were occupational therapists (n = 60 62%). Approximately half of the respondents (n = 50 52%) reported using FES in the past two years to improve a stroke survivor's ability to use their arm in daily activities. Respondents suggested that receiving workplace training from colleagues to learn how to use FES is the preferred method of education. Of those who received education (n = 80), 50 participants reported using FES in their practice. There is variable use of FES in stroke rehabilitation to increase active movement after stroke. While there was moderate agreement about when to use FES and useful education approaches for learning to use FES, further research is needed to better understand strategies which could be implemented to support increased FES use in stroke rehabilitation.
Publisher: SAGE Publications
Date: 21-11-2019
Abstract: To review methods for measuring adherence to exercise or physical activity practice recommendations in the stroke population and evaluate measurement properties of identified tools. Two systematic searches were conducted in eight databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library of Systematic Reviews, Sports Discus, PEDro, PubMed and EMBASE). Phase 1 was conducted to identify measures. Phase 2 was conducted to identify studies investigating properties of these measures. Phase 1 articles were selected if they were published in English, included participants with stroke, quantified adherence to exercise or physical activity recommendations, were patient or clinician reported, were defined and reproducible measures and included patients years old. In phase 2, articles were included if they explored psychometric properties of the identified tools. Included articles were screened based on title/abstract and full-text review by two independent reviewers. In phase 1, seven methods of adherence measurement were identified, including logbooks ( n = 16), diaries ( n = 18), ‘record of practice’ ( n = 3), journals ( n = 1), surveys ( n = 2) and questionnaires ( n = 4). One measurement tool was identified, the Physical Activity Scale for In iduals with Physical Disabilities ( n = 4). In phase 2, no eligible studies were identified. There is not a consistent measure of adherence that is currently utilized. Diaries and logbooks are the most frequently utilized tools.
Publisher: Hindawi Limited
Date: 26-12-2021
DOI: 10.1111/HSC.13696
Abstract: Discharge communication is an important component of care transition between hospitals and community care, particularly for the complex needs of stroke survivors. Despite international research and regulation, ineffective information exchange during care transitions continues to compromise patient outcomes. Primary care practitioners are increasingly responsible for the provision of stroke care in the community, yet it is not known how their role is supported by discharge communication. The aim of this qualitative study was to describe the primary care practitioner perspective of discharge communication, identifying the barriers and enablers relative to continuity of care for stroke survivors. Semi-structured telephone interviews were conducted with primary care practitioners across Australia, between April and September 2020. Data were analysed using thematic analysis with a constant-comparison approach. The findings suggest that discharge communication is often inadequate for the complex care and recovery needs of stroke survivors. The challenges in accessing care plans were noted barriers to continuity of care, while shared understandings of stroke survivors' needs were identified as enablers. As discharge communication processes were perceived to be disconnected, primary care practitioners suggested a team approach across care settings. It is concluded that initiatives are required to increase primary care collaboration with hospital teams (which include stroke survivors and their caregivers) to improve continuity of care after stroke.
Publisher: Elsevier BV
Date: 2017
Publisher: Informa UK Limited
Date: 12-10-2015
DOI: 10.3109/11038128.2015.1082622
Abstract: People with mild traumatic brain injury (mTBI) commonly experience cognitive impairments. Occupational therapists working in acute general hospitals in Australia routinely access client Glasgow Coma Scale (GCS) scores, and assess cognitive status using standardized tools and by observing basic activity of daily living (ADL) performance. However, limited evidence exists to identify the best assessment(s) to determine client cognitive status. To determine whether cognitive status assessed by GCS score and the Cognistat are predictive of basic ADL performance among clients with mTBI in an acute general hospital and make inferences concerning the clinical utility of these assessment tools. Retrospective analysis of medical record data on demographics, Cognistat, GCS, and modified Barthel Index (MBI) using descriptive statistics, chi-square tests and linear regression. Data analysis of 166 participants demonstrated that no associations exist between GCS and Cognistat scores, or Cognistat scores and MBI dependency level. The presence of co-morbid multi-trauma injuries and length of stay were the only variables that significantly predicted MBI dependency level. While the MBI scores are of value in identifying clients with difficulty in basic ADLs, Cognistat and GCS scores are of limited use in differentiating client levels of cognitive impairment and the authors caution against the routine administration of the Cognistat following mTBI. Further research is required to identify more suitable assessments for use with a mTBI population.
Publisher: Informa UK Limited
Date: 10-07-2014
Publisher: JMIR Publications Inc.
Date: 07-2020
DOI: 10.2196/17249
Abstract: Oral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. This systematic review will (1) identify relevant ABI clinical practice guidelines and (2) appraise the oral care recommendations existing in the selected guidelines. A search strategy was developed based on a recent systematic review of clinical practice guidelines for ABI. The protocol includes a search of MEDLINE, EMBASE, and DynaMed Plus databases, as well as organizational and best-practice websites and reference lists of accepted guidelines. Search terms will include medical subject headings and user-defined terms. Guideline appraisal will involve the Appraisal of Guidelines for Research and Evaluation II ratings, followed by a descriptive synopsis for oral care recommendations according to the National Health and Medical Research Council evidence levels. This project started in April 2019, when we developed the search strategy. The preliminary search of databases and websites yielded 863 and 787 citations, respectively, for a total of 1650 citations. Data collection will start in August 2020 and we expect to begin disseminating the results in May 2021. Nursing staff may not have detailed recommendations on how to provide oral care for neurologically impaired patients. The findings of this review will explore the evidence for oral care in existing guidelines and improve outcomes for patients with ABI. We expect to provide adequate orientations to clinicians, inform policy and guidelines for best practices, and contribute to future directions for research in the ABI realm. PRR1-10.2196/17249
Publisher: SAGE Publications
Date: 19-03-2018
Abstract: Although clinical practice guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin-A in conjunction with therapy, there is currently no evidence to support the addition of therapy. To determine the effect and cost-benefit of adding evidence-based movement training to botulinum toxin-A. A total of 136 participants will be recruited in order to be able to detect a between-group difference of seven points on the Goal Attainment Scale T-score with 80% power at a two-tailed significance level of 0.05. The InTENSE trial is a national, multicenter, Phase III randomized trial with concealed allocation, blinded assessment and intention-to-treat analysis. Stroke survivors who are scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than three months ago, who have completed formal rehabilitation and have no significant cognitive impairment will be randomly allocated to receive botulinum toxin-A plus evidence-based movement training or botulinum toxin-A alone. The primary outcomes are goal attainment (Goal Attainment Scaling) and upper limb activity (Box and Block Test) at three months (end of intervention) and at 12 months (beyond the intervention). Secondary outcomes are spasticity, range of motion, strength, pain, burden of care and health-related quality of life. Direct costs, personal costs and health system costs will be collected at 12 months. The results of the InTENSE trial are anticipated to directly influence intervention for moderate to severe spasticity after stroke. ANZCTR12615000616572.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-10-2020
DOI: 10.1212/WNL.0000000000011083
Abstract: To investigate whether certain patient, acute care, or primary care factors are associated with medication initiation and discontinuation in the community after stroke or TIA. This is a retrospective cohort study using prospective data on adult patients with first-ever acute stroke/TIA from the Australian Stroke Clinical Registry (April 2010 to June 2014), linked with nationwide medication dispensing and Medicare claims data. Medication users were those with ≥1 dispensing in the year postdischarge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year postdischarge. Multivariable competing risks regression, accounting for death during the observation period, was conducted to investigate factors associated with time to medication discontinuation. Among 17,980 registry patients with stroke/TIA, 91.4% were linked to administrative datasets. Of these, 9,817 adults with first-ever stroke/TIA were included (45.4% female, 47.6% aged ≥75 years, and 11.4% intracerebral hemorrhage). While most patients received secondary prevention medications (79.3% antihypertensive, 81.8% antithrombotic, and 82.7% lipid-lowering medication), between one-fifth and one-third discontinued treatment over the subsequent year postdischarge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub–hazard ratio [SHR] 0.70 95% confidence interval [CI] 0.62–0.79), quarterly contact with a primary care physician (SHR 0.62 95% CI 0.57–0.67), and prescription by a specialist physician (SHR 0.87 95% CI 0.77–0.98) were all inversely associated with antihypertensive discontinuation. Patterns of use of secondary prevention medications after stroke/TIA are not optimal, with many survivors discontinuing treatment within 1 year postdischarge. Improving postdischarge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.
Publisher: Wiley
Date: 23-02-2011
DOI: 10.1111/J.1440-1630.2010.00911.X
Abstract: Discharge planning frequently involves occupational therapy pre-discharge home visiting as one component of intervention. Pre-discharge home visits aim to maximise a person's functional performance within the context of their home and community environment, bridging the transition between hospital and home. The aim of this study was to describe the pre-discharge home visiting practices of occupational therapy departments. This descriptive study used a postal survey which was sent to occupational therapists in 215 public and privately funded hospitals in New South Wales, Australia. The survey enquired about the number of pre-discharge home visits completed per month, who went on visits and time spent on visits. Descriptive statistics were used in analyses. Surveys were returned by occupational therapists from 53 departments, representing a response rate of 25%. Respondents estimated that they conducted approximately 13 pre-discharge home visits per month (range: 1-60). Visits were estimated to take an average of 1 hour and 20 minutes (excluding travel time). Approximately one-quarter of respondents felt that there was pressure to reduce the number of pre-discharge home visits conducted. Using their local hospital records, nine hospital departments estimated that the number of home visits completed per month had reduced by 50% compared with the number of home visits five years previously. Findings suggest a wide variation in current pre-discharge home visiting practice. There is a need for well-designed clinical trials that investigate the effectiveness of these costly and time-consuming visits on functional performance.
Publisher: John Wiley & Sons, Ltd
Date: 08-09-2010
Publisher: Wiley
Date: 30-03-2018
Abstract: Health-care expenditure is rapidly increasing in Australia with increasing pressure on health-care services to review processes, improve efficiency and ensure equity in service delivery. The nursing profession have improved efficiency and patient care by investigating time-use to describe current practice and support development of workforce planning models. There is, however, a lack of information to understand factors that impact on occupational therapists time-use in the clinical setting impacting the development of workforce planning models which adapt occupational therapy service delivery to match resources with demand. The objective of this review was to systematically identify known factors which impact on occupational therapists time-use in the clinical setting. A systematic review of Medline, PsycINFO and CINAHL databases and grey literature was completed in September 2016. Two authors independently screened studies for inclusion and quality was evaluated using the Downs and Black scale. Variables impacting on occupational therapists time-use were categorised and thematically analysed to synthesise key themes. Twenty studies met the inclusion criteria and were included in the review. Three key categories of factors influencing time-use were identified. These were: patient-related factors (e.g. level of function, therapy required, type, complexity of injury), therapist-related factors (e.g. experience, clinical vs non-clinical responsibility), and organisational-related factors (e.g. workplace characteristics, availability of staff, presence of students). Occupational therapist time-use in clinical settings is complex and difficult to quantify in research. How occupational therapists spend their time is impacted by a number of patient, clinician and service related factors reflecting the breadth of occupational therapy practice and client-centred nature of the profession.
Publisher: Wiley
Date: 09-01-2017
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.AAP.2015.03.014
Abstract: Little is known about the trajectory of recovery in fitness-to-drive after mild traumatic brain injury (mTBI). This means that health-care professionals have limited evidence on which to base recommendations to this cohort about driving. To determine fitness-to-drive status of patients with a mTBI at 24h and two weeks post injury, and to summarise issues reported by this cohort about return to driving. Quasi-experimental case-control design. Two groups of participants were recruited: patients with a mTBI (n=60) and a control group with orthopaedic injuries (n=60). Both groups were assessed at 24h post injury on assessments of fitness-to-drive. Follow-up occurred at two weeks post injury to establish driver status. Mini mental state examination, occupational therapy-drive home maze test (OT-DHMT), Road Law Road Craft Test, University of Queensland-Hazard Perception Test, and demographic/interview form collected at 24h and at two weeks. At the 24h assessment, only the OT-DHMT showed a difference in scores between the two groups, with mTBI participants being significantly slower to complete the test (p=0.01). At the two week follow-up, only 26 of the 60 mTBI participants had returned to driving. Injury severity combined with scores from the 24h assessment predicted 31% of the variance in time taken to return to driving. Delayed return to driving was reported due to: "not feeling 100% right" (n=14, 23%), headaches and pain (n=12, 20%), and dizziness (n=5, 8%). This research supports existing guidelines which suggest that patients with a mTBI should not to drive for 24h however, further research is required to map factors which facilitate timely return to driving.
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/BMJOPEN-2021-057311
Abstract: There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model. This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation. Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial. Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies. NCT04217330 .
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S40814-019-0531-5
Abstract: There is a need to provide a large amount of extra practice on top of usual rehabilitation to adults after stroke. The purpose of this study was to determine if it is feasible to add extra upper limb practice to usual inpatient rehabilitation and whether it is likely to improve upper limb activity and grip strength. A prospective, single-group, pre- and post-test study was carried out. Twenty adults with upper limb activity limitations who had some movement in the upper limb completed an extra hour of upper limb practice, 6 days per week for 4 weeks. Feasibility was measured by examining recruitment, intervention (adherence, efficiency, acceptability, safety) and measurement. Clinical outcomes were upper limb activity (Box and Block Test, Nine-Hole Peg Test) and grip strength (dynamometry) measured at baseline (week 0) and end of intervention (week 4). Of the 212 people who were screened, 42 (20%) were eligible and 20 (9%) were enrolled. Of the 20 participants, 12 (60%) completed the 4-week program 7 (35%) were discharged early, and 1 (5%) withdrew. Participants attended 342 (85%) of the possible 403 sessions and practiced for 324 (95%) of the total 342 h. In terms of safety, there were no study-related adverse events. Participants increased 0.29 blocks/s (95% CI 0.19 to 0.39) on the Box and Block Test, 0.20 pegs/s (95% CI 0.10 to 0.30) on the Nine-Hole Peg Test, and 4.4 kg (95% CI 2.9 to 5.9) in grip strength, from baseline to end of intervention. It appears feasible for adults who are undergoing inpatient rehabilitation and have some upper limb movement after stroke to undertake an hour of extra upper limb practice. The magnitude of the clinical outcomes suggests that further investigation is warranted and this study provides useful information for the design of a phase II randomized trial. Australian and New Zealand Clinical Trial Registry ( ACTRN12615000665538 ).
Publisher: Wiley
Date: 23-08-2022
DOI: 10.1111/HEX.13584
Abstract: Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Overall, 27/54 trial participants completed the survey (13 intervention: 52% 14 control: 48%) and 5/8 invited participants in the intervention group attended the focus group. Goal setting : The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention) : Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a ‘reminder’ to act. Overall trial satisfaction : Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design.
Publisher: Cambridge University Press (CUP)
Date: 12-2008
DOI: 10.1375/BRIM.9.3.237
Abstract: Objective: To summarise the effect of upper limb rehabilitation interventions on motor function in adults with traumatic brain injury. Data sources: Databases were last searched on August 2, 2008. Sources included the Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Database of Systematic Reviews, the Database of Effectiveness Reviews MEDLINE, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence database (OTseeker) Google Scholar and reference lists of included studies. Review methods: Two reviewers determined whether retrieved abstracts met the inclusion criteria: systematic reviews and randomised controlled trials (RCTs) English language adult participants ≥ 50% of study participants with a brain injury interventions designed to improve upper limb motor function. Included papers were appraised for: study design, participants, therapy approach, therapy protocol (indications, contra-indications, intensity and duration), safety and adverse events, and outcomes. The methodological quality of RCTs was rated using the PEDro scale (1–10 highest). Methodology of systematic reviews was rated using the QUOROM criteria. Results: Of the 333 references identified, six were appraised: three systematic reviews and three RCTs. Methodological quality was high for two RCTs, and moderate for one, based on the PEDro scale score. Interventions included upper limb casting, electrical stimulation, and coordination training using meal preparation tasks (making a sandwich and hot drink). In the latter trial, practice of functional kitchen tasks improved fine motor coordination speed on one of four Jebsen-Taylor hand function subtests by 9.38 seconds (95% CI, 1.1 to 17.7). Remaining trials reported non-significant effects for hand function. Small s le sizes and limited reporting of results reduce the interpretability of two RCTs. Conclusion: No conclusive evidence was found on which to base upper limb motor rehabilitation after brain injury, however, lack of evidence does not equate to evidence of no effect.
Publisher: Oxford University Press (OUP)
Date: 17-01-2013
Abstract: functional assessment is an important component of the management of older adults in the emergency department (ED) as the function level has been identified as a predictor of adverse events including ED re-presentation. A systematic review (SR) of all functional assessments utilised in EDs has not been undertaken making assessment selection, on the basis of evidence, difficult for staff. this SR: (i) identified functional assessments that have been utilised in ED settings, (ii) examined what psychometric properties analysis has been completed and (iii) established recommendations for practice. electronic database searching was completed utilising key search terms. Articles were reviewed using pre-determined inclusion criteria. Each study was appraised using quality criteria for aspects of validity and reliability in addition to clinical utility, interpretability and responsiveness. Recommendations for practice were determined on the basis of the extent of psychometric data generated in ED settings and whether or not the assessment was specifically developed for ED use. a total of 332 articles were identified of which 43 articles utilising 14 functional assessments were retained. Psychometric testing was scarce. Functional assessment has been reported internationally and only with older adults. Following appraisal four assessments [the Identification of Seniors at Risk (ISAR), Triage Risk Stratification Tool (TRST), Older Adult Resources and Services (OARS) and Functional Status Assessment of Seniors in Emergency Departments (FSAS-ED)] were recommended for practice with moderate reservations. the ISAR or TRST are suitable for fast screening, whereas the OARS or FSAS-ED are more suitable for a comprehensive understanding of functional performance. Further research is warranted and recommendations for ED assessment may change as more becomes known about psychometric properties and clinical applications of other assessments.
Publisher: SAGE Publications
Date: 22-01-2014
Abstract: To determine the effectiveness of personal digital assistant devices on achievement of memory and organization goals in patients with poor memory after acquired brain injury. Assessor blinded randomized controlled trial. Specialist brain injury rehabilitation hospital (inpatients and outpatients). Adults with acquired brain impairments (85% traumatic brain injury aged ≥17 years) who were assessed as having functional memory impairment on the Rivermead Behavioural Memory Test (General Memory Index). Training and support to use a personal digital assistant for eight weeks to compensate for memory failures by an occupational therapist. The control intervention was standard rehabilitation, including use of non-electronic memory aids. Goal Attainment Scale which assessed achievement of participants’ daily memory functioning goals and caregiver perception of memory functioning and General Frequency of Forgetting subscale of the Memory Functioning Questionnaire administered at baseline (pre-randomization) and post intervention (eight weeks later). Forty-two participants with memory impairment were recruited. Use of a personal digital assistant led to greater achievement of functional memory goals (mean difference 1.6 (95% confidence interval (CI) 1.0 to 2.2), P = 0.0001) and improvement on the General Frequency of Forgetting subscale (mean difference 12.5 (95% CI 2.0 to 22.9), P = 0.021). Occupational therapy training in the use of a handheld computer improved patients’ daily memory function more than standard rehabilitation.
Publisher: Springer Science and Business Media LLC
Date: 15-07-2014
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.APMR.2018.05.031
Abstract: The aim of this review was to critically appraise the quality of evidence-based clinical practice guidelines (CPGs) for the rehabilitation of children with moderate or severe acquired brain injury (ABI). A systematic search of MEDLINE, PsycINFO, Embase, CINAHL, and the Cochrane Library was conducted and an extensive website search of prominent professional rehabilitation society websites. CPGs were eligible for inclusion if they incorporated recommendation statements for inpatient and/or community rehabilitation for children with ABI and they were based on a systematic evidence search. Methodological quality of eligible CPGs were appraised by 3 independent reviewers using the AGREE II instrument. Characteristics of eligible CPGs and strength of supporting evidence for included recommendations were extracted. Of the 9 included guidelines, 2 covered all ABIs, 5 focused specifically on traumatic brain injury, and 2 on stroke. Five of the CPGs were classified as high quality and 4 were of average quality. In general, CPGs scored better for scope and purpose, rigor of development, and clarity of presentation. They scored most poorly in applicability, involvement of target users, and procedures for updating the guidelines. Interrater reliability for the AGREE II was generally high across domains. Very few of the 445 recommendations included across the 9 CPGs were evidence based. Despite variability in quality of the guideline development process, the included CPGs generally provided clear descriptions of their overall objectives, scope and purpose, employed systematic methods for searching, selecting, and appraising research evidence, and produced unambiguous, clearly identifiable recommendations for children with ABI. Overall, existing CPGs focusing on rehabilitation for children with ABI are based on low-quality evidence or expert consensus. Future work should focus on addressing the limitations of most of the current CPGs, particularly related to supporting implementation and integrating stakeholder involvement.
Publisher: Hindawi Limited
Date: 21-01-2017
DOI: 10.1111/HSC.12327
Abstract: Adults with moderate to severe traumatic brain injury (TBI) rely on assistance from paid and unpaid caregivers upon return to the community. An inability to move independently makes these adults highly dependent on caregivers for transfers and manual handling tasks. Evidence-based guidelines are therefore important to ensure that caregivers and people in the community are protected and that practices are standard and consistent. This study commenced with a rapid review of evidence-based recommendations between 2000 and 2015 pertaining to transfers and manual handling in people with TBI and ended with a structured stakeholder dialogue that reflected upon this evidence and gathered perspectives on how to address key issues in community-based manual handling following TBI. Three relevant guidelines were identified, providing nine recommendations encompassing assessment of the person's ability to assist caregivers, manual handling and appropriate equipment use. Due to the low number of recommendations and low level of supporting evidence, these recommendations alone could not provide comprehensive guidance. Three systematic reviews and two primary studies were also identified, and these suggest that comprehensive training programmes in transfers and manual handling tasks are effective. Further to this, a structured stakeholder dialogue was conducted, which revealed six major themes - (i) comprehensive risk assessment, (ii) presence of two caregivers, (iii) provision of training, (iv) home environment modification, (v) equipment, and (vi) policy implementation context. Recommendations for health professionals include providing information packs to caregivers, risk assessment and mitigation for those at high risk, and strategies to prevent and minimise injury in caregivers. Development of comprehensive guidance for caregivers in transfers and manual handling in people with moderate to severe TBI living in the community is a hidden but important priority.
Publisher: Informa UK Limited
Date: 14-12-2022
DOI: 10.1080/09638288.2020.1852616
Abstract: The aim of this study was to describe differences in long-term outcomes for patients discharged to inpatient rehabilitation facilities (IRFs) following stroke compared to patients discharged directly home or to residential aged care facilities (RACFs). Cohort study. Data from the Australian Stroke Clinical Registry were linked to hospital admissions records and the national death index. Main outcomes: death and hospital readmissions up to 12 months post-admission, Health-related Quality of Life (HRQoL) 90-180 days post-admission. Of 8,555 included patients (median age 75, 55% male, 83% ischemic stroke), 4,405 (51.5%) were discharged home, 3,442 (40.2%) to IRFs, and 708 (8.3%) to RACFs.No between-group differences were observed in hazard of death between patients discharged to IRFs versus home. Fewer patients discharged to IRFs were readmitted to hospital within 90, 180 or 365-days compared to patients discharged home (adjusted subhazard ratio [aSHR]:90-days 0.54, 95%CI 0.49, 0.61 aSHR:180-days 0.74, 95%CI 0.67, 0.82 aSHR:365-days 0.85, 95%CI 0.78, 0.93). Fewer patients discharged to IRFs reported problems with mobility compared to those discharged home (adjusted OR 0.54, 95%CI 0.47, 0.63), or to RACFs (aOR 0.35, 95%CI 0.25, 0.48). Overall HRQoL between 90-180 days was worse for people discharged to IRFs versus those discharged home and better than those discharged to RACFs. Several long-term outcomes differed significantly for patients discharged to different settings after stroke. Patients discharged to IRFs reported some better outcomes than people discharge directly home despite having markers of more severe stroke.Implications for rehabilitationPeople with mild strokes are usually discharged directly home, people with moderate severity strokes to inpatient rehabilitation, and people with very severe strokes are usually discharged to residential aged care facilities.People discharged to inpatient rehabilitation reported fewer problems with mobility and had a reduced risk of hospital readmission in the first year post-stroke compared to people discharged directly home after stroke.The median self-reported health-related quality of life for people discharged to residential aged care equated to 'worst health state imaginable'.
Publisher: SAGE Publications
Date: 21-02-2019
Abstract: Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. Patient-level data from the Australian Stroke Clinical Registry (2010–13 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included 3.1% developed a chest infection within 30 days. Associated factors included: admission to intensive care (OR: 8.26, 95% CI: 4.07, 16.76) and urinary tract infection (OR: 3.09, 95% CI: 1.89, 5.04). Patients not treated in stroke units had a two-fold greater odds of chest infections (OR: 1.96, 95% CI: 1.25, 3.05). Chest infection afforded a greater hazard of death at 90 days (HR: 1.42, 95% CI 1.04, 1.93). This was reduced for those admitted to a stroke unit (HR: 1.31, 95% CI 0.99, 1.75). Results emphasize the need for active prevention and highlight the importance of stroke unit care in mitigating risk and improving survival in those with stroke-related chest infections.
Publisher: Wiley
Date: 23-07-2019
Abstract: Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain 'best practice' recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified. To investigate occupational and physiotherapists' perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed-method study was conducted. Using an online survey and semi-structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free-text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework. Forty-six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence. Therapists identified that both motivators and barriers to implementing best-practice upper limb rehabilitation occur largely at the levels of the in idual and the environment. As such, intervention efforts should focus at both these levels to facilitate change.
Publisher: Informa UK Limited
Date: 08-12-2022
DOI: 10.1080/07380577.2021.2012734
Abstract: This study investigated outcomes of a community-based upper limb rehabilitation group for adult stroke survivors in metropolitan Australia. Pre-post data were extracted from medical records. Participants (n
Publisher: SAGE Publications
Date: 23-03-2018
Abstract: To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial. An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Medical and acute care wards of Australian hospitals ( n=5). A total of 400 people ≥ 70 years of age. Participants were randomized to either (1) an enhanced program (HOME), involving pre ost discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.
Publisher: Springer Science and Business Media LLC
Date: 13-06-2015
Publisher: Informa UK Limited
Date: 13-04-2023
Publisher: Informa UK Limited
Date: 09-09-2021
DOI: 10.1080/09638288.2021.1964620
Abstract: To characterise the assessments and treatments that comprise "usual care" for stroke patients with somatosensory loss, and whether usual care has changed over time. Comparison of cross-sectional, observational data from (1) Stroke Foundation National Audit of Acute (2007-2019) and Rehabilitation (2010-2018) Stroke Services and (2) the SENSe Implement multi-site knowledge translation study with occupational therapists and physiotherapists ( Acute hospitals ( Sensory assessment protocol use has increased over time while sensory-specific training has remained stable. Sensory rehabilitation in the context of everyday activities is a common treatment approach.
Publisher: Wiley
Date: 26-03-2009
Publisher: Wiley
Date: 23-05-2011
Publisher: Informa UK Limited
Date: 03-06-2019
Publisher: AMPCo
Date: 11-2013
DOI: 10.5694/MJA12.11821
Publisher: Springer Science and Business Media LLC
Date: 17-09-2014
Publisher: SAGE Publications
Date: 06-2010
DOI: 10.1111/J.1747-4949.2010.00430.X
Abstract: Disease registries assist with clinical practice improvement. The Australian Stroke Clinical Registry aims to provide national, prospective, systematic data on processes and outcomes for stroke. We describe the methods of establishment and initial experience of operation. Australian Stroke Clinical Registry conforms to new national operating principles and technical standards for clinical quality registers. Features include: online data capture from acute public and private hospital sites opt-out consent expert consensus agreed core minimum dataset with standard definitions outcomes assessed at 3 months post-stroke formal governance oversight and formative evaluations for improvements. Qualitative feedback from sites indicates that the web-tool is simple to use and the user manuals, data dictionary, and training are appropriate. However, sites desire automated data-entry methods for routine demography variables and the opt-out consent protocol has sometimes been problematic. Data from 204 patients (median age 71 years, 54% males, 60% Australian) were collected from four pilot hospitals from June to October 2009 (mean, 50 cases per month) including ischaemic stroke (in 72%), intracerebral haemorrhage (16%), transient ischaemic attack (9%), and undetermined (3%), with only one case opting out. Australian Stroke Clinical Registry has been well established, but further refinements and broad roll-out are required before realising its potential of improving patient care through clinician feedback and allowance of local, national, and international comparative data.
Publisher: SAGE Publications
Date: 15-09-2018
Abstract: The effectiveness of clinician-focused interventions to improve stroke care is uncertain. To determine whether an organizational intervention can improve the quality of stroke care over usual care. To detect an absolute 10% difference in overall performance (composite outcome), a minimum of 21 hospitals and 843 patients per group was determined. Before and after controlled design in hospitals in Queensland, Australia. Externally facilitated program (StrokeLink) using outreach workshops incorporating clinical performance feedback, patient outcomes (survival, quality of life at 90–180 days), local barrier assessments to best practice care, action planning, and ongoing support. Descriptive and multivariable analyses adjusted for patient correlations by hospital (intention-to-treat method). Concurrent implementation of financial incentives to increase stroke unit access and use of the Australian Stroke Clinical Registry for performance monitoring. Primary outcome: net change in composite score (i.e. total number of process indicators achieved ided by the sum of eligible indicators for each cohort). Secondary outcomes: change in in idual indicators, change in composite score comparing hospitals that did or did not develop action plans (per-protocol analysis), impact on 90–180-day health outcomes. Sensitivity analyses: hospital self-rated status, alternate cross-sectional audit data (Stroke Foundation). To account for temporal effects, comparison of Queensland hospital performance relative to other Australian hospitals will also be undertaken. Twenty-one hospitals were recruited however, one was unable to participate within the study time frame. Workshops were held between 11 March 2014 and 7 November 2014. Data are ready for analysis.
Publisher: Cambridge University Press (CUP)
Date: 19-04-2022
DOI: 10.1017/BRIMP.2022.3
Abstract: Rehabilitation therapy is a key part of the recovery pathway for people with severe acquired brain injury (ABI). The aim of this study was to explore inpatients’ and their family members’ experiences of a specialist ABI rehabilitation service. A cross sectional, prospective mixed method study was undertaken at a metropolitan specialist ABI rehabilitation unit in Victoria, Australia. All inpatients and their family members of the service were invited to complete a satisfaction survey. Employing purposive s ling, semi-structured interviews were conducted with inpatients and/or their family members. In total, 111 people completed the satisfaction survey and 13 were interviewed. High levels of satisfaction with the specialist service were reported the majority of inpatients (74%) and family members (81%) rated the overall quality of care received in the service as ‘high’ or ‘very high’. Interviews revealed four main themes: (i) satisfaction with rehabilitation services, (ii) inconsistent communication, (iii) variable nursing care, and (iv) strengths and weakness of the rehabilitation environment. Overall, important components of a positive experience were being involved in decision making and discharge planning, effective communication and information processes, and being able to form therapeutic relationships with staff. Key sources of dissatisfaction for inpatients and family members related to inconsistency in care, accessing information about treatments in a format easily understood, and communication. Specialised rehabilitation is valued by inpatients and their family members alike. The findings highlight the importance of exploring inpatient experiences to optimise service delivery in a tailored, specialised rehabilitation programme.
Publisher: Wiley
Date: 22-12-2018
Abstract: Allied health professionals frequently use surveys to collect data for clinical practice and service improvement projects. Careful development and piloting of purpose-designed surveys is important to ensure intended measuring (that respondents correctly interpret survey items when responding). Cognitive interviewing is a specific technique that can improve the design of self-administered surveys. The aim of this study was to describe the use of the cognitive interviewing process to improve survey design, which involved a purpose-designed, online survey evaluating staff use of functional electrical stimulation. A qualitative study involving one round of cognitive interviewing with three occupational therapists and three physiotherapists. The cognitive interviewing process identified 11 issues with the draft survey, which could potentially influence the validity and quality of responses. The raised issues included difficulties with: processing the question to be able to respond, determining a response to the question, retrieving relevant information from memory and comprehending the written question. Twelve survey amendments were made following the cognitive interviewing process, comprising four additions, seven revisions and one correction. The cognitive interviewing process applied during the development of a purpose-designed survey enabled the identification of potential problems and informed revisions to the survey prior to its use.
Publisher: Wiley
Date: 20-12-2018
Abstract: Scientific conferences provide a forum for clinicians, educators, students and researchers to share research findings. To be selected to present at a scientific conference, authors must submit a short abstract which is then rated on its scientific quality and professional merit and is accepted or rejected based on these ratings. Previous research has indicated that inter-rater variability can have a substantial impact on abstract selection decisions. For their 2015 conference, the Occupational Therapy Australia National Conference introduced a system to identify and adjust for inter-rater variability in the abstract ranking and selection process. Ratings for 1340 abstracts submitted for the 2015 and 2017 conferences were analysed using many-faceted Rasch analysis to identify and adjust for inter-rater variability. Analyses of the construct validity of the abstract rating instrument and rater consistency were completed. To quantify the influence of inter-rater variability of abstract selection decisions, comparisons were made between decisions made using Rasch-calibrated measure scores and decisions that would have been made based purely on raw average scores derived from the abstract ratings. Construct validity and measurement properties of the abstract rating tool were good to excellent (item fit MnSq scores ranged from 0.8 to 1.2 item reliability index = 1.0). Most raters (24 of 27, 89%) were consistent in their use of the rating instrument. When comparing abstract allocations under the two conditions, 25% of abstracts (n = 341) would have been allocated differently if inter-rater variability was not accounted for. This study demonstrates that, even with a strong abstract rating instrument and a small rater pool, inter-rater variability still exerts a substantial influence on abstract selection decisions. It is recommended that all occupational therapy conferences internationally, and scientific conferences more generally, adopt systems to identify and adjust for the impact of inter-rater variability in abstract selection processes.
Publisher: Wiley
Date: 15-10-2020
DOI: 10.1111/ENE.14531
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2007
Publisher: SAGE Publications
Date: 09-2017
Abstract: Finding, testing and demonstrating efficacy of new treatments for stroke recovery is a multifaceted challenge. We believe that to advance the field, neurorehabilitation trials need a conceptually rigorous starting framework. An essential first step is to agree on definitions of sensorimotor recovery and on measures consistent with these definitions. Such standardization would allow pooling of participant data across studies and institutions aiding meta-analyses of completed trials, more detailed exploration of recovery profiles of our patients and the generation of new hypotheses. Here, we present the results of a consensus meeting about measurement standards and patient characteristics that we suggest should be collected in all future stroke recovery trials. Recommendations are made considering time post stroke and are aligned with the international classification of functioning and disability. A strong case is made for addition of kinematic and kinetic movement quantification. Further work is being undertaken by our group to form consensus on clinical predictors and pre-stroke clinical data that should be collected, as well as recommendations for additional outcome measurement tools. To improve stroke recovery trials, we urge the research community to consider adopting our recommendations in their trial design.
Publisher: Cambridge University Press (CUP)
Date: 30-05-2022
DOI: 10.1017/BRIMP.2022.8
Abstract: Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients. To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service. A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed. Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was −3.63 ( p = 0.11) and the LSM 4.25 ( p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service. Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI.
Publisher: Wiley
Date: 21-01-2019
Abstract: Increasing the intensity of practice is associated with improved upper limb outcomes, yet observed intensity levels during rehabilitation are low. The purpose of this study was to investigate: whether a professional development program would increase the intensity of practice undertaken in an inpatient, upper limb rehabilitation class and whether any increase would be maintained six months after the cessation of the program. A pre-post study was conducted within an existing inpatient, upper limb rehabilitation class in a metropolitan hospital. Staff received a professional development program which included: a two day theoretical, practical and clinical training workshop covering evidence-based practice for upper limb rehabilitation after stroke and three 1-hour meetings to revise evidence-based practice and discuss implementation of strategies. Intensity of practice, as measured by the proportion of practice time per class (%) and the number of repetitions per practice time (repetitions/min) observed during the 60-minute classes during one week, was recorded at baseline, end of program (12 months) and six months later (18 months). Twenty-two (100%) staff attended at least one professional development program session outcomes were measured across n = 15 classes (n = 30 patients). Between baseline and 12 months, the mean proportion of practice time per class increased by 52% (95% confidence interval (CI) 33-70 P < 0.001) and the mean number of repetitions per practice time increased by 5.1 repetitions/min (95% CI 1.7-8.4 P < 0.01). Between baseline and 18 months, the mean proportion of practice time per class increased by 53% (95% CI 36-69 P < 0.001) and the mean number of repetitions per practice time increased by 3.9 repetitions/min (95% CI 1.9-5.9 P < 0.001). Providing professional development was associated with increased intensity of practice in an inpatient, upper limb rehabilitation class. The increase was maintained six months later.
Publisher: Informa UK Limited
Date: 04-07-2022
DOI: 10.1080/10749357.2022.2095087
Abstract: People with communication disabilities post-stroke have poor quality-of-life. We aimed to explore the association of self-reported communication disabilities with different dimensions of quality-of-life between 90 and 180 days post-stroke. Cross-sectional survey data were obtained between 90 and 180 days post-stroke from registrants in the Australian Stroke Clinical Registry recruited from three hospitals in Queensland. The usual follow-up survey included the EQ5D-3L. Responses to the Hospital Anxiety and Depression Scale, and extra questions (e.g. communication disabilities) were also collected. We used χ Overall, 244/647 survivors completed the survey. Respondents with communication disabilities (n = 72) more often reported moderate to extreme problems in all EQ5D-3L dimensions, than those without communication disabilities (n = 172): anxiety or depression (74% vs 40%, p < .001), pain or discomfort (58% vs 39%, p = .006), self-care (46% vs 18%, p < .001), usual activities (77% vs 49%, p < .001), and mobility (68% vs 35%, p < .001). Respondents with communication disabilities reported less fatigue (66% vs 89%, p < .001), poorer cognitive skills (thinking) (16% vs 1%, p < .001) and lower social participation (31% vs 6%, p < .001) than those without communication disabilities. Survivors of stroke with communication disabilities are more negatively impacted across different dimensions of quality-of-life (as reported between 90 and 180 days post-stroke) compared to those without communication disabilities. This highlights the need for timely and on-going comprehensive multidisciplinary person-centered support.
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1365-2753.2008.00957.X
Abstract: If allied health professionals are to begin measuring outcomes routinely, a change in attitudes and behaviour is necessary. However, in iduals need to be ready to change and often move through several stages before practice change is observed. To develop and test the psychometric properties of a questionnaire that determines clinicians' readiness to measure outcomes. A study of instrument development, validation and reliability. Ten expert allied health professionals were involved in content validity testing. A further 396 allied health professionals completed the questionnaire to establish content and construct validity, internal consistency and temporal reliability (or stability). Of these 396 allied health professionals, 70 participated in the temporal reliability assessment. Content validity was established using the Content Validity Index (CVI). Construct validity was determined using confirmatory factor analysis (CFA) and internal consistency was ascertained using Cronbach's alpha. Temporal reliability was confirmed using intraclass correlation coefficients (ICC 3,1). A 30-item questionnaire was developed, reflecting the five stages of change from the Transtheoretical Model of Change, and commonly cited barriers to outcome measurement. Content validity was excellent (CVI = 0.96). Using CFA, a two-factor model provided best fit. Based on CFA results, four items were dropped resulting in a 26-item questionnaire (range 26-156). Internal consistency reliability was excellent (alpha = 0.94). Temporal (stability) reliability ICC (3,1) was very good (r = 0.86, P = 0.0001). The final 26-item questionnaire takes 10 minutes to complete and 5 minutes to score. The Clinician Readiness for Measuring Outcomes Scale provides educators with useful information about clinician readiness and helps identify strategies for affecting behaviour change.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
DOI: 10.1161/STROKEAHA.117.019771
Abstract: In multicultural Australia, some patients with stroke cannot fully understand, or speak, English. Language barriers may reduce quality of care and consequent outcomes after stroke, yet little has been reported empirically. An observational study of patients with stroke or transient ischemic attack (2010–2015) captured from 45 hospitals participating in the Australian Stroke Clinical Registry. The use of interpreters in hospitals, which is routinely documented, was used as a proxy for severe language barriers. Health-Related Quality of Life was assessed using the EuroQoL-5 dimension-3 level measured 90 to 180 days after stroke. Logistic regression was undertaken to assess the association between domains of EuroQoL-5 dimension and interpreter status. Among 34 562 registrants, 1461 (4.2%) required an interpreter. Compared with patients without interpreters, patients requiring an interpreter were more often women (53% versus 46% P .001), aged ≥75 years (68% versus 51% P .001), and had greater access to stroke unit care (85% versus 78% P .001). After accounting for patient characteristics and stroke severity, patients requiring interpreters had comparable discharge outcomes (eg, mortality, discharged to rehabilitation) to patients not needing interpreters. However, these patients reported poorer Health-Related Quality of Life (visual analogue scale coefficient, −9 95% CI, −12.38, −5.62), including more problems with self-care (odds ratio: 2.22 95% CI, 1.82, 2.72), pain (odds ratio: 1.84 95% CI, 1.52, 2.34), anxiety or depression (odds ratio: 1.60 95% CI, 1.33, 1.93), and usual activities (odds ratio: 1.62 95% CI, 1.32, 2.00). Patients requiring interpreters reported poorer Health Related Quality of Life after stroke/transient ischemic attack despite greater access to stroke units. These findings should be interpreted with caution because we are unable to account for prestroke Health Related Quality of Life. Further research is needed.
Publisher: Public Library of Science (PLoS)
Date: 09-02-2016
Publisher: SAGE Publications
Date: 12-07-2019
Abstract: Home assessments conducted by occupational therapists can identify hazards and prevent falls. However, they may not be conducted because of limited time or long distances between the therapist’s workplace and the person’s home. Developments in technologies may overcome such barriers and could improve the quality of the home assessment process. This scoping review synthesises the findings of studies evaluating information and communication technology use within occupational therapy home assessments. Fourteen studies were included and revealed the two main approaches to technology use: the development of new applications and the use of existing and readily available technologies. Facilitators and barriers to use were also identified. Facilitators included usefulness, ease of use and the potential for cost-effectiveness. Barriers to use included poor usability, unsuitability for some populations and perceived threat to the role of occupational therapy. The synthesis revealed that traditional in-home assessments conducted by therapists are more sensitive in identifying hazards. The availability of new technologies offers potential to improve service delivery however these technologies are underutilised in clinical practice. Technologies may offer advantages in the conduct of home assessments, especially regarding efficiency, but have not yet been shown to be superior in terms of patient outcome.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.JCLINEPI.2013.03.005
Abstract: To compare the efficiency and differential costs of telephone- vs. mail-based assessments of outcome in patients registered in a national clinical quality of care registry, the Australian Stroke Clinical Registry (AuSCR). The participants admitted to hospital with stroke or transient ischemic attack were randomly assigned to complete a health questionnaire by mail or telephone interview at 3-6 months postevent. Response rate, researcher burden, and costs of each method were compared. Compared with the participants in the mail questionnaire arm (n=277 50% female mean age: 70 years), those in the telephone arm (n=282 45% female mean age: 68 years) required a shorter time to complete the follow-up (mean difference: 24.2 days 95% confidence interval [CI]: 15.0, 33.5 days). However, the average cost of completing a telephone follow-up was greater (US$20.87 vs. US$13.86) and had a similar overall response to the mail method (absolute difference: 0.57% 95% CI: -4.8%, 6%). Posthospital stroke outcome data were slower to collect by mail, but the method achieved a similar completion rate and was significantly cheaper to conduct than follow-up telephone interview. Findings are informative for planning outcome data collection in large numbers of patients with acute stroke.
Publisher: Wiley
Date: 02-03-2018
Abstract: Approximately, 80% of traumatic brain injuries are considered mild in severity. Mild traumatic brain injury (mTBI) may cause temporary or persisting impairments that can adversely affect an in idual's ability to participate in daily occupations and life roles. This study aimed to identify symptoms, factors predicting level of symptoms and functional and psycho-social outcomes for participants with mTBI three months following injury. Patients discharged from the Emergency Department of a major metropolitan hospital with a diagnosis of mTBI were contacted by telephone three months after injury. An interview with two questionnaires was administered: The Concussion Symptom Inventory (CSI) Scale and the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ). Data obtained were used to determine the type and prevalence of post-concussion symptoms and their impact on activity change. Sixty-three people with mTBI participated in the study. The majority of participants (81%) reported that all symptoms had resolved within the three-month time frame. Of those still experiencing symptoms, workplace fatigue (22%) and an inability to maintain previous workload/standards (17%) were reported. There is a small, but clinically significant, subgroup of patients who continue to experience symptoms three-month post-mTBI. Symptoms experienced beyond the expected three-month recovery timeframe have the potential to adversely affect an in idual's ability to participate in daily occupation and return to work.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.SAPHARM.2022.01.007
Abstract: It is unclear whether survivors of stroke or transient ischemic attack (TIA) routinely receive, and understand, education about secondary prevention medications. To investigate whether survivors of stroke/TIA understand explanations about their prescribed prevention medications and associations with medication adherence, control of risk factors, and unmet needs. A survey was administered among survivors of stroke/TIA (random s le N = 1500) from the Australian Stroke Clinical Registry (Victoria and Queensland, 2016). Participants reported whether they understood explanations about each prescribed medication, as well as their unmet needs, perceived control of risk factors, and 30-day medication adherence. Linked pharmacy claims data were also used to determine medication adherence in the previous two years (proportion of days covered ≥80%). Outcomes were analyzed using multivariable logistic regression or multivariable negative binomial regression for frequency of unmet needs. Overall, 630/1455 eligible survivors completed the survey at ≈2.5 years post-admission (median age 69 years 37% female). Most participants reported using prevention medications (76% antihypertensive 84% antithrombotic 76% lipid-lowering) but only 66-75% reported they understood explanations about their medication (75% antihypertensive 66% antithrombotic 74% lipid-lowering). Participants who understood explanations about their medication more often reported 30-day adherence for antihypertensive (adjusted odds ratios [aOR]: 1.96 95% CI: 1.20-3.19), antithrombotic (aOR: 2.03 95% CI: 1.31-3.14) and lipid-lowering medications (aOR: 1.73 95% CI: 1.08-2.76). Similar associations were observed for antihypertensive and antithrombotic medications when pharmacy claims data were used to infer 2-year medication adherence. Understanding explanations about medications was also associated with perceived control of risk factors (hypertension: aOR: 11.08 95% CI: 6.04-20.34 cholesterol aOR: 8.26 95% CI: 4.72-14.47) and up to 33% fewer unmet needs related to secondary prevention. Expanded efforts are needed to improve the delivery of information about prevention medications to promote medication adherence, control of risk factors, and potentially prevent unmet needs following stroke/TIA.
Publisher: Cambridge University Press (CUP)
Date: 09-2012
Abstract: Aim: To investigate the characteristics of Australian organisations providing case management to in iduals who have acquired brain injury, and to determine the methods of case management service delivery including professional development and evaluation of outcomes. Method: An anonymous 23-item web-based survey was used. Respondents were case managers who deliver services to adults and/or children with brain injuries. A snowball s ling method was used to recruit respondents from around Australia. Findings: Fifty-one case managers completed the survey. Respondents were from a wide range of professions, the largest group being occupational therapy. The majority of respondents were based in metropolitan areas, were employed within the public health system and were based in the community. Respondents reported that the main determinant for clients receiving case management was the severity of the brain injury followed by complex family needs. Variations in practice and a lack of consistency in outcome measurement, goal setting and professional development were noted. Discussion: This study provides an overview of characteristics of case management practices for people with acquired brain injury (ABI). Identifying roles and responsibilities of case managers is the first step to developing future research designs, which determine the effectiveness of case management.
Publisher: Informa UK Limited
Date: 07-06-2021
Publisher: Wiley
Date: 19-09-2016
Abstract: Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex
Publisher: JMIR Publications Inc.
Date: 29-11-2019
Abstract: ral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. his systematic review will (1) identify relevant ABI clinical practice guidelines and (2) appraise the oral care recommendations existing in the selected guidelines. search strategy was developed based on a recent systematic review of clinical practice guidelines for ABI. The protocol includes a search of MEDLINE, EMBASE, and DynaMed Plus databases, as well as organizational and best-practice websites and reference lists of accepted guidelines. Search terms will include medical subject headings and user-defined terms. Guideline appraisal will involve the Appraisal of Guidelines for Research and Evaluation II ratings, followed by a descriptive synopsis for oral care recommendations according to the National Health and Medical Research Council evidence levels. his project started in April 2019, when we developed the search strategy. The preliminary search of databases and websites yielded 863 and 787 citations, respectively, for a total of 1650 citations. Data collection will start in August 2020 and we expect to begin disseminating the results in May 2021. ursing staff may not have detailed recommendations on how to provide oral care for neurologically impaired patients. The findings of this review will explore the evidence for oral care in existing guidelines and improve outcomes for patients with ABI. We expect to provide adequate orientations to clinicians, inform policy and guidelines for best practices, and contribute to future directions for research in the ABI realm. RR1-10.2196/17249
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
DOI: 10.1002/CHP.21263
Abstract: Abstract ranking processes for scientific conferences are essential but controversial. This study examined the validity of a structured abstract rating instrument, evaluated interrater variability, and modeled the impact of interrater variability on abstract ranking decisions. Additionally, we examined whether a more efficient rating process (abstracts rated by two rather than three raters) supported valid abstract rankings. Data were 4016 sets of abstract ratings from the 2011 and 2013 national scientific conferences for a health discipline. Many-faceted Rasch analysis procedures were used to examine validity of the abstract rating instrument and to identify and adjust for the presence of interrater variability. The two-rater simulation was created by the deletion of one set of ratings for each abstract in the 2013 data set. The abstract rating instrument demonstrated sound measurement properties. Although each rater applied the rating criteria consistently (intrarater reliability), there was significant variability between raters. Adjusting for interrater variability changed the final presentation format for approximately 10-20% of abstracts. The two-rater simulation demonstrated that abstract rankings derived through this process were valid, although the impact of interrater variability was more substantial. Interrater variability exerts a small but important influence on overall abstract acceptance outcome. The use of many-faceted Rasch analysis allows for this variability to be adjusted for. Additionally, Rasch processes allow for more efficient abstract ranking by reducing the need for multiple raters.
Publisher: AMPCo
Date: 10-12-2019
DOI: 10.5694/MJA2.12029
Abstract: To determine the feasibility of linking data from the Australian Stroke Clinical Registry (AuSCR), the National Death Index (NDI), and state-managed databases for hospital admissions and emergency presentations to evaluate data completeness and concordance between datasets for common variables. Cohort design probabilistic/deterministic data linkage of merged records for patients treated in hospital for stroke or transient ischaemic attack from New South Wales, Queensland, Victoria, and Western Australia. Descriptive statistics for data matching success concordance of demographic variables common to linked databases sensitivity and specificity of AuSCR in-hospital death data for predicting NDI registrations. Data for 16 214 patients registered in the AuSCR during 2009-2013 were linked with one or more state datasets: 15 482 matches (95%) with hospital admissions data, and 12 902 matches (80%) with emergency department presentations data were made. Concordance of AuSCR and hospital admissions data exceeded 99% for sex, age, in-hospital death (each κ = 0.99), and Indigenous status (κ = 0.83). Of 1498 registrants identified in the AuSCR as dying in hospital, 1440 (96%) were also recorded by the NDI as dying in hospital. In-hospital death in AuSCR data had 98.7% sensitivity and 99.6% specificity for predicting in-hospital death in the NDI. We report the first linkage of data from an Australian national clinical quality disease registry with routinely collected data from several national and state government health datasets. Data linkage enriches the clinical registry dataset and provides additional information beyond that for the acute care setting and quality of life at follow-up, allowing clinical outcomes for people with stroke (mortality and hospital contacts) to be more comprehensively assessed.
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/09638280600929201
Abstract: The Canadian Occupational Performance Measure (COPM) is a commonly used outcome measure in rehabilitation. In this study it was adapted for very young children by deleting paid/unpaid work and household management categories and having parents act as proxies to rate child performance and their own satisfaction. To assess the internal consistency reliability, content and construct validity, responsiveness, and impact of half scores (20 not 10-point scale) of the adapted COPM. Parent proxies of subjects aged 2 - 8 (mean 3.9) years with spastic hemiplegic cerebral palsy (n = 41) participating in a clinical trial. There was a total of 214 occupational performance problems for analysis and an additional 56 which had used half score ratings. Internal consistency reliability and construct validity were evaluated using Cronbach alpha statistic. Proxy views explored content validity. Responsiveness was evaluated using pre-post intervention scores and a comparison with Goal Attainment Scaling scores which were assumed to be a suitable benchmark measure. The effect of half scores was assessed by two-s le t-tests. The COPM adaptations did not have a negative impact on internal consistency reliability as this was acceptable for performance (0.73) and satisfaction (0.83). The high Cronbach alpha scores indicated good construct validity. Content of occupations and rating approach was considered valid by proxies. Use of half scores did not result in significantly different performance ratings, but mean satisfaction ratings were significantly higher when half scores were used (p = 0.0001). This suggests that half scores may provide more precise proxy satisfaction ratings, but at the cost of rigour as internal consistency with satisfaction half scores was lower (0.63 vs. 0.82). Responsiveness to change in clinical status was demonstrated by significant pre-post scores and moderate correlations with goal attainment scores. The adapted COPM is a psychometrically robust tool and the use of half scores is not recommended.
Publisher: AOTA Press
Date: 09-2013
Abstract: OBJECTIVE. The Western Neuro Sensory Stimulation Profile (WNSSP) presents a hierarchy of items suggestive of a sequence of recovery. The aim of this study was to understand the sequence of recovery of neurobehavioral function in patients with brain injury and determine whether this sequence was consistent with the WNSSP test item order. METHOD. We conducted a retrospective clinical chart audit of 37 adult inpatients (mean age = 29 yr 31 men, 6 women) with a diagnosis of traumatic brain injury and a minimum of two medical record entries on the WNSSP. The sequence of recovery was statistically derived from the content and structure of the WNSSP. RESULTS. Our analysis did not support the current item ordering of the WNSSP as a function of the sequence of recovery from coma, with the exception of the Arousal/Attention subscale. CONCLUSION. WNSSP item performance suggested a sequence of recovery clinicians may consider a revised item order that reflects this observed order.
Publisher: Wiley
Date: 19-08-2015
Abstract: Goal setting is a complex skill. The use of formal goal writing procedures (including the use of the SMART goal model) has been advocated. However, a standardised method of writing and evaluating SMART goals is currently lacking. This study comprised of two phases. The aims of phase one was to (i) develop the SMART Goal Evaluation Method (SMART-GEM) based on a SMART goal model and (ii) investigate the content validity of the SMART-GEM. The aim of phase two of the study was to test the inter-rater reliability of the SMART-GEM. Development of the SMART- GEM involved defining and constructing evaluation criteria suitable for auditing goal statements. A content validity assessment was conducted using an expert panel of Occupational Therapists (n = 10). Inter-rater reliability of the SMART-GEM was examined using a purposive s le of multiple raters (n = 24). The SMART- GEM was rated as having good content validity (in idual items CVI ranged from 0.90 to 1.00 total SMART- GEM CVI = 0.99, ρ = 0.05). Agreement between raters on in idual items ranged from poor (κ = 0.254) to excellent (κ = 0.965) and agreement of overall grades was fair to good (κ = 0.582). Inter-rater agreement on total scores was found to be very good (ICC = 0.895, 95% CI = 0.743 to 0.986, ρ = 0.001) with excellent internal consistency (α = 0.995). The SMART-GEM demonstrated good construct validity and very good inter-rater reliability on total score and shows promise as a standardised method to writing and evaluating clinical goals.
Publisher: MDPI AG
Date: 16-09-2021
Abstract: Background: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists (CPs), and explored factors affecting delivery and acceptability in a feasibility study. Methods: Surveys pre- (5 OTs, 2 CPs) and post-training (3 OTs, 1 CP) interviews pre- (5 OTs, 2 CPs) and post-intervention (4 trauma survivors, 4 OTs, 2 CPs). Mean survey scores for 14 theoretical domains identified telerehabilitation barriers (score ≤ 3.5) and facilitators (score ≥ 5). Interviews were transcribed and thematically analysed. Results: Surveys: pre-training, the only barrier was therapists’ intentions to use telerehabilitation (mean = 3.40 ± 0.23), post-training, 13/14 domains were facilitators. Interviews: barriers/facilitators included environmental context/resources (e.g., technology, patient engagement, privacy/disruptions, travel and access) beliefs about capabilities (e.g., building rapport, complex assessments, knowledge/confidence, third-party feedback and communication style) optimism (e.g., impossible assessments, novel working methods, perceived importance and patient/therapist reluctance) and social rofessional role/identity (e.g., therapeutic methods). Training and experience of intervention delivery addressed some barriers and increased facilitators. The intervention was acceptable to trauma survivors and therapists. Conclusion: Despite training and experience in intervention delivery, some barriers remained. Providing some face-to-face delivery where necessary may address certain barriers, but strategies are required to address other barriers.
Publisher: SAGE Publications
Date: 12-04-2021
DOI: 10.1177/17474930211006301
Abstract: Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation. The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence. Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria ( n = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS five trials) and electroacupuncture (four trials). Studies provide good-to-fair quality evidence that TENS commenced months post-stroke has a large effect on urinary continence ( SMD = −3.40, 95% CI −4.46 to −2.34) and a medium effect when commenced months after stroke ( SMD = −0.67, 95% CI −1.09 to −0.26). Electroacupuncture has a large effect when administered times a week ( SMD = −2.32, 95% CI −2.96 to −1.68) and a small effect when administered five times a week ( SMD = −0.44, 95% CI −0.69 to −0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence. Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-018791
Abstract: Rehabilitation clinical practice guidelines (CPGs) contain recommendation statements aimed at optimising care for adults with stroke and other brain injury. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation covering the acquired brain injury populations. Systematic review. Included CPGs contained recommendations for inpatient rehabilitation or community rehabilitation for adults with an acquired brain injury diagnosis (stroke, traumatic or other non-progressive acquired brain impairments). Electronic databases (n=2), guideline organisations (n=4) and websites of professional societies (n=17) were searched up to November 2017. Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. From 427 papers screened, 20 guidelines met the inclusion criteria. Only three guidelines were rated high ( %) across all domains of AGREE-II highest rated domains were ‘scope and purpose’ (85.1, SD 18.3) and ‘clarity’ (76.2%, SD 20.5). Recommendations for assessment and for motor therapies were most commonly reported, however, varied in the level of detail across guidelines. Rehabilitation CPGs were consistent in scope, suggesting little difference in rehabilitation approaches between vascular and traumatic brain injury. There was, however, variability in included studies and methodological quality. CRD42016026936 .
Publisher: Springer Science and Business Media LLC
Date: 15-10-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
DOI: 10.1161/STROKEAHA.116.015714
Abstract: Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke. Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received. There were 17 585 stroke admissions (median age 77 years, 47% female 81% managed in ASUs 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49 95% confidence interval, 0.43–0.56) and better HRQoL (coefficient, 21.34 95% confidence interval, 15.50–27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45 95% confidence interval, 0.38–0.52) compared with ASU care alone (hazard ratio, 0.64 95% confidence interval, 0.54–0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%–19%). Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.APMR.2017.06.032
Abstract: To identify the risk factors for falls in community stroke survivors. A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted. Prospective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh tool were included in the meta-analysis. Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy. Twenty-one articles met the minimum criteria for inclusion risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36 95% confidence interval [CI], 2.68-7.10) reduced balance (OR, 3.87 95% CI, 2.39-6.26) use of sedative or psychotropic medications (OR, 3.19 95% CI, 1.36-7.48) disability in self-care (OR, 2.30 95% CI, 1.51-3.49) depression (OR, 2.11 95% CI, 1.18-3.75) cognitive impairment (OR, 1.75 95% CI, 1.02-2.99) and history of fall (OR, 1.67 95% CI, 1.03-2.72). A history of fall (OR, 4.19 95% CI, 2.05-7.01) had a stronger association with recurrent fallers. This study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional.
Publisher: Informa UK Limited
Date: 07-05-2022
DOI: 10.1080/09638288.2021.1906957
Abstract: Goals are vital in rehabilitation however, how goal-setting occurs varies widely in clinical practice. This study aims to review goal-setting practices across the rehabilitation continuum within varied case mix services in Queensland, Australia. A descriptive multisite qualitative case study with medical record audits and interviews of adult rehabilitation clients was used to evaluate four propositions across three inpatient and two community rehabilitation services. The propositions evaluated the process in which goal-setting occurs, action planning and review of goals, as well as the type, specificity and client-centeredness of goals set. Goals ( Goal-setting in rehabilitation should be specific, meaningful and include the client in action planning, feedback and review. However, goal-setting in rehabilitation is often multidisciplinary and unstructured.Implications for rehabilitationBest-practice rehabilitation team goal-negotiation and goal-setting should include a common goal focus and incorporate components of staff and client action planning, coping planning, feedback and review.Rehabilitation clients prefer shared-decision making approaches to setting meaningful and personalised goals, however, require time and support to engage in the goal-setting and negotiation process.Rehabilitation clinicians need training and support to improve their goal negotiation and goal writing skills to create specific, understandable and meaningful goals with rehabilitation clients.
Publisher: Springer Science and Business Media LLC
Date: 19-11-2022
DOI: 10.1186/S40814-022-01197-8
Abstract: Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Re covery-focused C ommunity support to A void readmissions and improve P articipation after S troke (ReCAPS) trial. We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Between November 2018 and October 2019, 312 patients were screened 37/105 (35%) eligible patients provided consent (mean age 61 years 32% female) 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018) Universal Trial Number: U1111-1206-7237
Publisher: SAGE Publications
Date: 23-12-2015
Abstract: Patients with acquired brain impairments require intensive, task-specific training to maximise upper limb recovery. Current evidence suggests, however, that they rarely achieve this. The purpose of this study was to describe the amount of practice that can be achieved by patients with acquired brain impairment during intensive upper limb treatment within a public hospital, and to examine the strategies used by therapists to maximise practice. A secondary analysis was conducted using data from a previously published randomised trial. The training received by 20 people with acquired brain impairment over the 6-week trial period was recorded. The strategies used by therapists to maximise practice were also noted. Over the 6-week period, 45 hours of upper limb training was provided. The median (interquartile range) amount of actual practice achieved by patients was 59 (54–63) minutes per day, with a median (interquartile range) of 186 (50–330) repetitions of active movement. Patients’ practice was maximised through the use of task-specific feedback, practice books, counters, environmental cues and stopwatches. In addition, therapists provided coaching as well as ensuring tasks were goal-oriented, measurable and patient-driven. Described strategies enabled patients with acquired brain impairment to practise upper limb tasks at intensities greater than currently reported in the literature.
Publisher: Wiley
Date: 15-07-2010
Publisher: Springer Science and Business Media LLC
Date: 10-07-2022
DOI: 10.1007/S11136-021-02944-9
Abstract: To evaluate the psychometric properties of common health-related quality-of-life instruments used post stroke and provide recommendations for research and clinical use with this diagnostic group. A systematic review of the psychometric properties of the five most commonly used quality-of-life measurement tools (EQ-5D, SF-36, SF-6D, AQoL, SS-QOL) was conducted. Electronic searches were performed in MEDLINE, CINAHL, and EMBASE on November 27th 2019. Two authors screened papers against the inclusion criteria and where consensus was not reached, a third author was consulted. Included papers were appraised using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist and findings synthesized to make recommendations. A total of n = 50,908 papers were screened and n = 45 papers reporting on 40 separate evaluations of psychometric properties met inclusion criteria (EQ-5D = 19, SF-36 = 16, SF-6D = 4, AQoL = 2, SS-QOL = 4). Studies reported varied psychometric quality of instruments, and results show that psychometric properties of quality-of-life instruments for the stroke population have not been well established. The strongest evidence was identified for the use of the EQ-5D as a quality-of-life assessment for adult stroke survivors. This systematic evaluation of the psychometric properties of self-reported quality-of-life instruments used with adults after stroke suggests that validity across tools should not be assumed. Clinicians and researchers alike may use findings to help identify the most valid and reliable measurement instrument for understanding the impact of stroke on patient-reported quality of life.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2017.09.043
Abstract: Comprehensive discharge planning is important for successful transitions from hospital to home after stroke. The aim of this study was to describe the quality of discharge planning received by patients discharged home from acute care, identify factors associated with a positive discharge experience, and assess the influence of discharge quality on outcomes. Patients discharged to the community and registered in the Australian Stroke Clinical Registry in 2014 were invited to participate. Patient-perceived discharge quality was evaluated using the Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services questionnaire (recall at 3-9 months). Factors associated with higher discharge quality scores were identified and associations between quality scores of more than 80% and outcomes were investigated using multivariable, multilevel regression analyses. There were 200 of 434 eligible registrants who responded responders and nonresponders were similar with respect to age, sex, and type of stroke. The average overall quality score was 73% (standard deviation: 21). However, only 18% received all aspects of discharge care planning. Quality scores of more than 80% were independently associated with receiving hospital specific information (odds ratio: 5.7, 95% confidence interval [CI]: 2.7, 12.4), and referral to a local support group (odds ratio: 2.5, 95% CI: 1.1, 5.9). Discharge quality scores of more than 80% were associated with higher European Quality of Life-5 Dimensions EQ-5D scores (coefficient: .1, 95% CI: .04, .2) and a reduction in the rate of unmet needs reported at 3-9 months postdischarge (incidence rate ratio: .5, 95% CI: .3, .7). We provide new information on the quality of discharge planning from acute care after stroke. Aspects of discharge planning that correlate with quality of care may reduce unmet needs and improve quality of life outcomes.
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJOQ-2020-000954
Abstract: Hand and arm activity after stroke improves with evidence-based rehabilitation. Therapists face known barriers when providing evidence-based rehabilitation and require support to implement guidelines. The aim of this study was to investigate the feasibility of two implementation packages on guideline adherence by occupational therapists and physiotherapists, and explore effect on patient upper limb outcomes. This was a non-randomised clustered feasibility study of occupational and physiotherapy rehabilitation services (n=3 inpatient and n=3 outpatient services). Services were allocated to one of three groups: (group A) facilitator-mediated implementation package, (group B) self-directed implementation package or (group C) usual care (control) we recruited n=1 inpatient and n=1 outpatient service per group. Outcomes of feasibility, adherence to guidelines (medical file audits) and patient upper limb impairment (Fugl-Meyer Upper Extremity Assessment), activity (Box and Block Test) and practice (minutes/week) were collected at baseline and after 3 months of intervention. 29 therapists (8 in group A, 13 in groups B and 8 in group C) and 55 patients participated. Both the facilitator-mediated and the self-directed implementation packages were feasible to deliver in the rehabilitation setting. Therapists in group A improved with respect to guideline adherence (medical file audits median within-group proportion difference of 0.29 (95% CI 0.22 to 0.36, p .0001) preintervention to postintervention). No significant within-group differences from baseline to postintervention were found in group B or group C, and no between-group differences were found for upper limb outcomes. A facilitator-mediated package was acceptable to therapists working in stroke rehabilitation, and feasibility data suggest increased guideline uptake following implementation. An adequately powered study is planned to understand how to support therapists to provide evidence-based upper limb rehabilitation after stroke. Australian New Zealand Clinical Trials Registry (ACTRN12619000596101).
Publisher: Wiley
Date: 03-04-2011
DOI: 10.1111/J.1440-1630.2011.00923.X
Abstract: Handwriting is an important activity that is commonly affected by neurological and orthopaedic conditions. Handwriting research has predominantly involved children. Little is known about handwriting behaviour in healthy older adults. This study aims to describe the handwriting practices of 30 unimpaired adults aged 65 years and over. In this cross-sectional observational study, data were collected from 30 older adults using a self-report questionnaire, digital pen recordings over three days and a handwriting log. Data were analysed using descriptive statistics. The mean age of participants was 75.1 years (standard deviation=6.9). Variations in handwriting were evident in letter size, slant and spacing. Participants wrote very little--a median of 18 words per occasion (interquartile range=10.5-26.9 words). Most handwriting involved self-generated text (85%), not copied or transcribed text. Participants stood while writing for 17% of handwriting occasions. The most common reasons for handwriting were note taking (23%) and puzzles (22%). Legibility may not depend exclusively on the handwriting script that a beginning writer is taught, but may be a result of other factors as the person ages. A comprehensive adult handwriting assessment and retraining programme should be relevant to older adults, including common handwriting activities, involving self-generated text and few words.
Publisher: John Wiley & Sons, Ltd
Date: 20-01-2010
Publisher: John Wiley & Sons, Ltd
Date: 31-01-2013
Publisher: Wiley
Date: 27-01-2016
Publisher: Wiley
Date: 13-02-2007
Publisher: Elsevier BV
Date: 06-0066
DOI: 10.1016/J.JPHYS.2016.08.006
Abstract: In people receiving rehabilitation aimed at reducing activity limitations of the lower and/or upper limb after stroke, does adding extra rehabilitation (of the same content as the usual rehabilitation) improve activity? What is the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect? Systematic review with meta-analysis of randomised trials. Adults aged 18 years or older that had a diagnosis of stroke. Extra rehabilitation with the same content as usual rehabilitation aimed at reducing activity limitations of the lower and/or upper limb. Activity measured as lower or upper limb ability. A total of 14 studies, comprising 15 comparisons, met the inclusion criteria. Pooling data from all the included studies showed that extra rehabilitation improved activity immediately after the intervention period (SMD=0.39, 95% CI 0.07 to 0.71, I(2)=66%). When only studies with a large increase in rehabilitation (> 100%) were included, the effect was greater (SMD 0.59, 95% CI 0.23 to 0.94, I(2)=44%). There was a trend towards a positive relationship (r=0.53, p=0.09) between extra rehabilitation and improved activity. The turning point on the ROC curve of false versus true benefit (AUC=0.88, p=0.04) indicated that at least an extra 240% of rehabilitation was needed for significant likelihood that extra rehabilitation would improve activity. Increasing the amount of usual rehabilitation aimed at reducing activity limitations improves activity in people after stroke. The amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large. PROSPERO CRD42012003221. [Schneider EJ, Lannin NA, Ada L, Schmidt J (2016) Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.Journal of Physiotherapy62: 182-187].
Publisher: Informa UK Limited
Date: 22-09-2022
DOI: 10.1080/09638288.2020.1815873
Abstract: In search of Kipling's six honest serving men in upper limb rehabilitation after stroke, we sought to investigate clinicians' perspective of In total, 225 Australian stroke clinicians responded: 53% occupational therapists, 61% working in acute/inpatient stroke setting. Most respondents indicated they did not have a protocol/expectation regarding when (62%), how much (84%) or what (60%) therapy to provide in their setting. Respondents ranked 24-h to 7-days post-stroke as the optimal time to commence therapy, and 30- to 60-min per day as the optimal dose to provide. Within-participant experiments demonstrated that greater motor recovery as time progressed increased the odds of offering therapy, while lack of motor recovery, shoulder pain, neurological decline and sole therapist reduced the odds. We need to develop an evidence base concerning Kipling's six honest serving men and equip clinicians with clinical decision-making skills aligned with this focus.IMPLICATIONS FOR REHABILITATIONMost clinicians did not have access to a protocol / clinical pathway which defines when, how much and what upper limb therapy to provide after stroke, which may be improved by providing in idual clinicians with organisational support to make therapy decisions.To improve the personalisation of upper limb rehabilitation in clinical practice, we need to understand
Publisher: Cambridge University Press (CUP)
Date: 15-05-2017
DOI: 10.1017/BRIMP.2017.8
Abstract: Transitional living service (TLS) programmes for adults with an acquired brain injury are considered an important part of rehabilitation. However, considerable variability exists in the design and structure of these services, with limited research to guide the development of a programme based on best evidence. A scoping literature review was completed to answer the question ‘What is known about TLS programmes for adults with an acquired brain injury?’ Four electronic databases were systematically searched, followed by a grey literature search (from 1996 to 2015). 3183 articles were screened and 13 articles were included in the final review. Themes that emerged from the literature include the types of residents using TLS programmes, the subjective experience of residents and staff, intervention approaches, programme staffing, and programme outcomes. The research reviewed supports the use of TLS programmes to maximise functional independence and community integration of in iduals with an acquired brain injury. Clinical practise recommendations were developed to help support implementation of TLS programmes based on best evidence, these included: to use multiple outcome measures, implement collaborative goal setting, support generalisation of skills learnt in the TLS to the home environment and for eligibility criteria for these programmes to include in iduals across all phases of recovery.
Publisher: SAGE Publications
Date: 27-12-2012
Abstract: Background. Feedback is used in rehabilitation to improve self-awareness in people with traumatic brain injury (TBI), but there have been no comparisons of the different methods of providing feedback. Objective. To compare the effect of different methods of feedback on impaired self-awareness after TBI. Method. This was a randomized, assessor-blinded trial with concealed allocation. A total of 54 participants with TBI and impaired self-awareness (85% male) were recruited from inpatient and community rehabilitation settings. Participants performed a meal preparation task on 4 occasions and were randomly assigned to 1 of 3 feedback intervention groups: video plus verbal feedback, verbal feedback, or experiential feedback. The primary outcome was improvement in online awareness measured by the number of errors made during task completion. Secondary outcomes included level of intellectual awareness, self-perception of rehabilitation, and emotional status. Results. Receiving video plus verbal feedback reduced the number of errors more than verbal feedback alone (mean difference = 19.7 errors 95% confidence interval [CI] = 9.2-30.1) and experiential feedback alone (mean difference = 12.4 errors 95% CI = 1.8-23.0). Conclusion. The results suggest that the video plus verbal feedback approach used in this study was effective in improving self-awareness in people with TBI. The results also provide evidence that improvement in self-awareness was not accompanied by deterioration in emotional status.
Publisher: AMPCo
Date: 07-2015
DOI: 10.5694/MJA15.00021
Abstract: To assess the feasibility of linking a national clinical stroke registry with hospital admissions and emergency department data and to determine factors associated with hospital readmission after stroke or transient ischaemic attack (TIA) in Australia. Data from the Australian Stroke Clinical Registry (AuSCR) at a single Victorian hospital were linked to coded, routinely collected hospital datasets for admissions (Victorian Admitted Episodes Dataset) and emergency presentations (Victorian Emergency Minimum Dataset) in Victoria from 15 June 2009 to 31 December 2010, using stepwise deterministic data linkage techniques. Association of patient characteristics, social circumstances, processes of care and discharge outcomes with all-cause readmissions within 1 year from time of hospital discharge after an index admission for stroke or TIA. Of 788 patients registered in the AuSCR, 46% (359/781) were female, 83% (658/788) had a stroke, and the median age was 76 years. Data were successfully linked for 782 of these patients (99%). Within 1 year of their index stroke or TIA event, 42% of patients (291/685) were readmitted, with 12% (35/286) readmitted due to a stroke or TIA. Factors significantly associated with 1-year hospital readmission were two or more presentations to an emergency department before the index event (adjusted odds ratio [aOR], 1.57 95% CI, 1.02-2.43), higher Charlson comorbidity index score (aOR, 1.19 95% CI, 1.07-1.32) and diagnosis of TIA on the index admission (aOR, 2.15 95% CI, 1.30-3.56). Linking clinical registry data with routinely collected hospital data for stroke and TIA is feasible in Victoria. Using these linked data, we found that readmission to hospital is common in this patient group and is related to their comorbid conditions.
Publisher: Informa UK Limited
Date: 17-03-2021
DOI: 10.1080/10749357.2021.1895494
Abstract: Anxiety and depression are common post-stroke and impact quality-of-life (QoL). The EQ-5D three-level version (EQ-5D-3L) is increasingly used to routinely measure health-related QoL in stroke populations, but its potential value for detecting anxiety or depression is uncertain. We sought to examine the agreement and convergent validity of the EQ-5D-3L anxiety or depression domain in survivors of stroke. Cross-sectional survey data obtained from participants in the Australian Stroke Clinical Registry (AuSCR) between 90 and 180 days after stroke were used. Correlation, sensitivity, specificity, and the area under the curve were calculated for the EQ-5D-3L anxiety or depression domain against the Hospital Anxiety Depression Scale (HADS, reference standard), which has been validated as a screening measure following stroke. Data were obtained from 245 respondents (median time post-stroke 143 days), median age 74 years 42% female. Nearly 50% reported problems (43% moderate 7% extreme) in the EQ-5D-3L anxiety or depression domain. The median HADS-Anxiety score was 6 (Q1:3, Q3:9), and the median HADS-Depression score was 5 (Q1:2, Q3:9). The EQ-5D-3L anxiety or depression scores were strongly correlated (r = 0.58) with scores of the HADS-Anxiety, but moderately correlated with HADS-Depression (r = 0.37), and combined HADS-Anxiety or HADS-Depression (r = 0.46). The EQ-5D-3L anxiety or depression domain had greater sensitivity and specificity in identifying cases with anxiety than in identifying depressive symptoms in survivors of stroke. The EQ-5D-3L appears to have value as a population level indicator of anxiety or depression following stroke. Further validation against "gold standard" clinical assessment is required for clinical applications.
Publisher: SAGE Publications
Date: 17-10-2014
Abstract: Impaired self-awareness can limit rehabilitation outcomes for people with traumatic brain injury (TBI). Video feedback on occupational performance has been found to improve self-awareness after TBI when delivered according to specific principles. The purpose of this article is to describe an occupation-based video feedback intervention found to be effective in a randomized controlled trial to assist with translation into clinical practice. The intervention uses therapist-mediated video feedback on clients’ occupational performance, aiming to facilitate self-reflection on performance and improve self-awareness. This paper describes the theoretical background, intervention principles, and protocol of the intervention. Therapists can use video feedback intervention, incorporating the principles in this article, to improve people’s intellectual awareness and ability to recognize and correct errors during task performance after TBI without a negative impact on emotional status.
Publisher: Wiley
Date: 16-12-2013
Publisher: Elsevier BV
Date: 10-2016
Abstract: To describe the challenges of obtaining state and nationally held data for linkage to a non-government national clinical registry. We reviewed processes negotiated to achieve linkage between the Australian Stroke Clinical Registry (AuSCR), the National Death Index, and state held hospital data. Minutes from working group meetings, national workshop meetings, and documented communications with health department staff were reviewed and summarised. Time from first application to receipt of data was more than two years for most state data-sets. Several challenges were unique to linkages involving identifiable data from a non-government clinical registry. Concerns about consent, the re-identification of data, duality of data custodian roles and data ownership were raised. Requirements involved the development of data flow methods, separating roles and multiple governance and ethics approvals. Approval to link death data presented the fewest barriers. To our knowledge, this is the first time in Australia that person-level data from a clinical quality registry has been linked to hospital and mortality data across multiple Australian jurisdictions. Implications for Public Health: The administrative load of obtaining linked data makes projects such as this burdensome but not impossible. An improved national centralised strategy for data linkage in Australia is urgently needed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2008
Publisher: Cold Spring Harbor Laboratory
Date: 12-09-2023
Publisher: Research Square Platform LLC
Date: 12-08-2020
DOI: 10.21203/RS.3.RS-42831/V1
Abstract: Background There is a compelling rationale that effective communication between hospital allied health professionals and primary care practitioners could improve quality and continuity of patient care. It is not known which methods of communication are used, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health professionals and primary care practitioners. Method Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital allied health professionals communicating with primary care practitioners. Risk of bias in the different study designs were appraised using recognised tools and a content analysis conducted of the methodologies used. Results From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health professionals communicating in some form with primary care practitioners. There was, however, limited literature investigating the methods and/or the effectiveness of communication between hospital allied health professionals and primary care practitioners. Conclusion There is currently no 'gold standard' method or measure of communication between hospital allied health professionals and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced health information technologies to improve collaboration across healthcare settings and facilitate continuity of integrated people-centred care. Registration: www.crd.york.uk PROSPERO CRD42019120410
Publisher: SAGE Publications
Date: 16-06-2009
DOI: 10.1177/17474930221135730
Abstract: Broadening eligibility criteria has been a focus to increase the generalizability of trial findings. Using upper-limb motor trials conducted early post-stroke as the illustrative domain, we sought to (1) investigate whether the published aim and conclusion statements adequately reflect the generalizability of findings and (2) explore internal validity and feasibility as constraints to achieving generalizability. We systematically applied a conceptual model of a trial s ling process to published literature from systematic review and prospective cross-sectional data. The eligibility criteria reported and used to exclude patients were classified by consensus as related to safety, internal validity, feasibility, or a combination thereof. Categorical data were reported as counts roportions, and continuous data were reported as median (interquartile range (IQR)). Thirty trials ( n = 1638 participants) were included in the published literature and 1013 patients in the prospective data set. Thirty-seven percent of trials did not describe their target population in the aim and conclusion, and 80% did not report all trial screening data. Eligibility criteria related to internal validity were the most common type reported and applied to exclude patients across both data sets. In the prospective data set, 70% of patients were excluded for more than one reason. Key information to support the generalizability of trial findings was insufficiently reported in published upper-limb motor research conducted early post-stroke. Broadening eligibility criteria alone is unlikely to sufficiently improve trial inclusivity due to internal validity constraints. Trials could achieve inclusivity through targeting multiple sub-populations, that in combination, produce clinically relevant results that are applicable to a broader population.
Publisher: Wiley
Date: 24-04-2014
DOI: 10.1118/1.4871619
Abstract: To explore the feasibility of pulsed current annealing in reusing metal oxide semiconductor field-effect transistor (MOSFET) dosimeters for in vivo intensity modulated radiation therapy (IMRT) dosimetry. Several MOSFETs were irradiated at d(max) using a 6 MV x-ray beam with 5 V on the gate and annealed with zero bias at room temperature. The percentage recovery of threshold voltage shift during multiple irradiation-annealing cycles was evaluated. Key dosimetry characteristics of the annealed MOSFET such as the dosimeter's sensitivity, reproducibility, dose linearity, and linearity of response within the dynamic range were investigated. The initial results of using the annealed MOSFETs for IMRT dosimetry practice were also presented. More than 95% of threshold voltage shift can be recovered after 24-pulse current continuous annealing in 16 min. The mean sensitivity degradation was found to be 1.28%, ranging from 1.17% to 1.52%, during multiple annealing procedures. Other important characteristics of the annealed MOSFET remained nearly consistent before and after annealing. Our results showed there was no statistically significant difference between the annealed MOSFETs and their control s les in absolute dose measurements for IMRT QA (p = 0.99). The MOSFET measurements agreed with the ion chamber results on an average of 0.16% ± 0.64%. Pulsed current annealing provides a practical option for reusing MOSFETs to extend their operational lifetime. The current annealing circuit can be integrated into the reader, making the annealing procedure fully automatic.
Publisher: Elsevier BV
Date: 2017
Publisher: JMIR Publications Inc.
Date: 31-10-2022
DOI: 10.2196/40548
Abstract: Resuming work after stroke is a common goal of working-age adults, yet there are few vocational rehabilitation programs designed to address the unique challenges faced following stroke. The Work intervention was developed to address these gaps. This paper presents a protocol that outlines the steps that will be undertaken to pilot both the intervention and trial processes for the Work trial. The Work trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. A total of 54 adults of working age who have experienced a stroke months prior will be randomized 1:1 to either (1) an experimental group who will receive a 12-week early vocational intervention (Work intervention) plus usual clinical rehabilitation or (2) a control group who will receive only their usual clinical rehabilitation. Outcomes include study and intervention feasibility and intervention benefit. In addition to evaluating the feasibility of delivering vocational intervention early after stroke, benefit will be assessed by measuring rates of vocational participation and quality-of-life improvements at the 3- and 6-month follow-ups. Process evaluation using data collected during the study, as well as postintervention in idual interviews with participants and surveys with trial therapists, will complement quantitative data. The results of the trial will provide details on the feasibility of delivering the Work intervention embedded within the clinical rehabilitation context and inform future trial processes. Pilot data will enable a future definitive trial to determine the clinical effectiveness of vocational rehabilitation when delivered in the early subacute phase of stroke recovery. Australian New Zealand Clinical Trials Registry ACTRN12619001164189 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378112& isReview=true DERR1-10.2196/40548
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-040418
Abstract: To compare the processes and outcomes of care in patients who had a stroke treated in urban versus rural hospitals in Australia. Observational study using data from a multicentre national registry. Data from 50 acute care hospitals in Australia (25 urban, 25 rural) which participated in the Australian Stroke Clinical Registry during the period 2010–2015. Patients were ided into two groups (urban, rural) according to the Australian Standard Geographical Classification Remoteness Area classification. Data pertaining to 28 115 patients who had a stroke were analysed, of whom 8159 (29%) were admitted to hospitals located within rural areas. Regional differences in processes of care (admission to a stroke unit, thrombolysis for ischaemic stroke, discharge on antihypertensive medication and provision of a care plan), and survival analyses up to 180 days and health-related quality of life at 90–180 days. Compared with those admitted to urban hospitals, patients in rural hospitals less often received thrombolysis (urban 12.7% vs rural 7.5%, p .001) or received treatment in stroke units (urban 82.2% vs rural 76.5%, p .001), and fewer were discharged with a care plan (urban 61.3% vs rural 44.7%, p .001). No significant differences were found in terms of survival or overall self-reported quality of life. Rural access to recommended components of acute stroke care was comparatively poorer however, this did not appear to impact health outcomes at approximately 6 months.
Publisher: Informa UK Limited
Date: 2023
Publisher: OMICS Publishing Group
Date: 2014
Publisher: Wiley
Date: 24-11-2005
Publisher: Informa UK Limited
Date: 10-06-2021
Publisher: Springer Science and Business Media LLC
Date: 31-07-2018
Publisher: Informa UK Limited
Date: 2011
DOI: 10.3109/09638288.2011.553707
Abstract: To examine the validity and reliability of a modified Reintegration to Normal Living Index (mRNL Index) with a s le of community-dwelling adults with mixed diagnoses. Forty-six adults (mean 55.2 ± 20.3 years) were recruited through convenience s ling from outpatient rehabilitation services. They completed the mRNL Index, Community Integration Measure (CIM) and Life Space Assessment (LSA) and were invited to complete them again 2 weeks later. Construct validity of the mRNL Index was confirmed by good fit to the Rasch measurement model. The mRNL Index demonstrated acceptable internal consistency (Cronbach's α = 0.80), as did the Daily Functioning subscale (Cronbach's α = 0.80) and Personal Integration subscale (Cronbach's α = 0.82). Test-retest reliability was also acceptable (intraclass correlation coefficient (3,1) = 0.83, p = .0001). As hypothesised, the LSA did not correlate with the Personal Integration subscale (Spearman rho = 0.08) and moderately correlated to the Daily Functioning subscale (Spearman rho = 0.59). The CIM was moderately correlated with the Personal Integration subscales (Spearman rho = 0.54) and the Daily Functioning subscale (Spearman rho = 0.53), though higher correlation was expected with the latter. Modifications to the phrasing, rating scale and subscales improved the validity of the original RNL Index for a mixed rehabilitation, community-dwelling population.
Publisher: Wiley
Date: 27-09-2007
Publisher: Informa UK Limited
Date: 07-06-2016
DOI: 10.1080/09638288.2016.1179350
Abstract: The purpose of this study was to explore the experience of parents of children with cerebral palsy (CP) who participated in an intensive cognitive orientation to daily occupational performance (CO-OP) group program addressing child chosen goals. Participants were six parents of children with CP who participated in a CO-OP upper limb task-specific training program. Parents participated in semi-structured interviews conducted via phone. A grounded theory approach was used. Interviews were transcribed verbatim and coded to identify categories and overarching themes of the parent experience of CO-OP. The theory of CO-OP for children with CP was one of offering a unique and motivating learning experience for both the child and the parent, differing from other therapeutic approaches that families had previously been involved in. Five categories were identified: the unique benefits of CO-OP the importance of intensity the child's motivation challenging the parent role and the benefits and challenges of therapy within a group context. Parents felt that CO-OP was a worthwhile intervention that leads to achievement of goals involving upper limb function and had the capacity to be transferred to future goals. Intensity of therapy and a child's motivation were identified as important factors in improvements. Further studies using quantitative research methods are warranted to investigate the benefits of CO-OP for children with neurological conditions. Implications for rehabilitation The cognitive orientation to daily occupational performance (CO-OP) is a promising upper limb cognitive motor training intervention for children with cerebral palsy. In a small s le, parents perceived that CO-OP leads to achievement of upper limb goals. Intensity of therapy, the child's motivation and the parents' ability to "step-back" were identified as important to the success of CO-OP.
Publisher: Wiley
Date: 10-2018
Abstract: The Action Research Arm Test (ARAT) measures upper limb activity limitations in people with acquired brain injuries. Evidence relating to the use of this test in neurorehabilitation is scattered. This review identifies, rates and synthesises evidence on the original 1981 ARAT use within neurorehabilitation. Psychometric properties are reviewed, including specific examination of participants with upper limb spasticity. Systematic review of published articles describing psychometric properties and/or use of the original version of the ARAT in neurorehabilitation. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy, reporting and methodological checklist with criterion-based appraisal of quality criteria for good measurement properties were applied. A best evidence synthesis for each psychometric property was completed. In 28 included studies, participants had suffered a stroke or traumatic brain injury, with 46% >6 months post-injury. Six studies identified participants with upper limb spasticity. Methodological quality of psychometric properties ranged from poor to excellent. Best evidence synthesis determined moderate positive evidence for using the ARAT with people without limb spasticity: intra-rater reliability (ICC 0.71 (95% CI 0.53-0.89) to 0.99 (95% CI 0.98, 0.99)) responsiveness (ROC curve 0.72-0.88, SRM 0.89) and regarding construct validity, it is a valid measure of activity limitation. Limited evidence for psychometric properties of the ARAT were found when used with people with upper limb spasticity for construct validity and responsiveness (ES 0.55-0.78). Gaps in evidence were found for inter and test-retest reliability, measurement error, content validity, structural validity, floor and ceiling effects. The ARAT is an appropriate measure of activity limitation post-stroke and should be considered for use with people with TBI evidence for people with upper limb spasticity is limited. Gaps and mixed limited to moderate evidence for psychometric properties in neurorehabilitation mean further research is required.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-062483
Abstract: Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women’s Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported interventions on the use of Prep-to-Play (primary aim) and injury rates (secondary aim) will be evaluated in women and girls playing community Australian Football. This stepped-wedge, cluster randomised controlled trial will include ≥140 teams from U16, U18 or senior women’s competitions. All 10 geographically separated clusters (each containing ≥14 teams) will start in the control (unsupported) phase and be randomised to one of five dates (or ‘wedges’) during the 2021 or 2022 season to sequentially transition to the intervention (supported Prep-to-Play), until all teams receive the intervention. Prep-to-Play includes four elements: a neuromuscular training warm-up, contact-focussed football skills (eg, tackling), strength exercises and education (eg, technique cues). When transitioning to supported interventions, study physiotherapists will deliver a workshop to coaches and player leaders on how to use Prep-to-Play, attend team training at least two times and provide ongoing support. In the unsupported phase, team will continue usual routines and may freely access available Prep-to-Play resources online (eg, posters and videos about the four elements), but without additional face-to-face support. Outcomes will be evaluated throughout the 2021 and 2022 seasons (~14 weeks per season). Primary outcome: use of Prep-to-Play will be reported via a team designate (weekly) and an independent observer (five visits over the two seasons) and defined as the team completing 75% of the programme, two-thirds (67%) of the time. Secondary outcomes: injuries will be reported by the team sports trainer and/or players. Injury definition: any injury occurring during a football match or training that results in: (1) being unable to return to the field of play for that match or (2) missing ≥ one match. Outcomes in the supported and unsupported phases will be compared using a generalised linear mixed model adjusting for clustering and time. Due to the type III hybrid implementation-effectiveness design, the study is powered to detect a improvement in use of Prep-to-Play and a reduction in ACL injuries. La Trobe University Ethics Committee (HREC 20488) approved. Coaches provided informed consent to receive the supported intervention and players provided consent to be contacted if they sustained a head or knee injury. Results will be disseminated through partner organisations, peer-reviewed publications and scientific conferences. NCT04856241 .
Publisher: Springer Science and Business Media LLC
Date: 02-03-2020
DOI: 10.1186/S12877-020-1494-3
Abstract: Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of “at-risk” older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients’ characteristics. Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization ( p = 0.003) and ED presentations ( p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations ( p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles ( p = 0.019), the participation observed in HOME patients with no support was not significantly improved. Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home. The trial was registered before commencement ( ACTRN12611000615987 ).
Publisher: Informa UK Limited
Date: 12-02-2021
DOI: 10.1080/09593985.2021.1875525
Abstract: Less than half of stroke survivors will be able to use their arm at 6 months post-stroke. Guidelines recommend the use of intensive upper limb exercise programs to optimize recovery however, there has been limited research exploring experiences of participation in intensive programs. To identify factors influencing adherence to an intensive upper limb exercise program in people with stroke. Qualitative design. Semi-structured interviews were conducted with 20 stroke survivors who had participated in an intensive upper limb program. Perspectives of participation, including perceived barriers and enablers to program adherence were explored. Interviews were audio-recorded, transcribed, and imported into NVivo for analysis. Two authors mapped themes to the Capability, Opportunity, Motivation-Behavior (COM-B) behavior change model to identify barriers and enablers to adherence. Enablers influencing adherence included: 1) routine practice times (Motivation - automatic) 2) accountability to staff (Motivation - reflective) and 3) social support (Opportunity - social). Barriers to adherence included: 1) exercises being too difficult (Capability - physical) 2) reliance on others to help (Capability - physical) and 3) difficulty 'fitting it in' (Motivation - reflective). Findings will inform recommendations for the delivery of intensive upper limb exercise programs to improve adherence and assist services to provide rehabilitation in a manner that enables self-directed practice by stroke survivors.
Publisher: SAGE Publications
Date: 11-2007
Abstract: Objective: To summarize evidence on the use of upper extremity casting designed to achieve reductions in contracture, tone, pain, function, oedema or spasticity in the elbow, wrist or hand of adults and children with neurological conditions. Data sources: A search was conducted of the Cochrane Database of Systematic Reviews the electronic databases MEDLINE, EMBASE, CINAHL, PEDro, OT-Seeker Google Scholar reference lists of retrieved trial reports and review articles. Review methods: Two independent reviewers determined whether retrieved study abstracts met inclusion criteria: human subjects % of participants children or adults described as having brain injury, cerebral palsy or stroke. Methodological quality of randomized controlled trials was rated using the PEDro scale (1—10 highest). Results: Thirty-one papers were retrieved and 23 studies appraised: three were randomized controlled trials and four were systematic reviews. Over three-quarters of the studies, excluding systematic reviews, were lower level evidence (n = 4 level V n = 4 level IV n = 1 level III). Methodological quality of randomized controlled trials was high (PEDro 8, 8 and 9) and there were modest positive short-term outcomes for two trials, although they did not include no-stretch comparison conditions. Safety issues typically included pain or skin breakdown two adverse events were not cast related. Conclusion: While theoretical rationales suggest upper limb casting should be effective there is insufficient high-quality evidence regarding impact or long-term effects to either support or abandon this practice. High variability in casting protocols indicates little consistency or consensus in practice. As maximum or low-load stretch are rationales for cast application, the absence of no-stretch conditions in existing trials is a major weakness in current evidence.
Publisher: SAGE Publications
Date: 18-06-2014
Abstract: A systematic review and meta-analysis of randomized controlled trials to determine if motivational interviewing leads to increased physical activity, cardiorespiratory fitness or functional exercise capacity in people with chronic health conditions. Seven electronic databases (MEDLINE, PsychINFO, EMBASE, AMED, CINHAL, SPORTDiscus and the Cochrane Central Register of Controlled trials) were searched from inception until January 2014. Two reviewers independently examined publications for inclusion. Trials were included if participants were adults ( years), had a chronic health condition, used motivational interviewing as the intervention and examined physical activity, cardiorespiratory fitness or functional exercise capacity. Two reviewers independently extracted data. Risk of bias within trials was assessed using the Physiotherapy Evidence Database Scale. Meta-analyses were conducted with standardized mean differences and 95% confidence intervals (CIs) were calculated. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. Eleven publications (of ten trials) were included. There was moderate level evidence that motivational interviewing had a small effect in increasing physical activity levels in people with chronic health conditions relative to comparison groups (standardized mean differences = 0.19, 95% CI 0.06 to 0.32, p = 0.004). Sensitivity analysis based on trials that confirmed treatment fidelity produced a larger effect. No conclusive evidence was observed for cardiorespiratory fitness or functional exercise capacity. The addition of motivational interviewing to usual care may lead to modest improvements in physical activity for people with chronic health conditions.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.JPHYS.2017.02.014
Abstract: Is stretch effective for the treatment and prevention of contractures in people with neurological and non-neurological conditions? A Cochrane Systematic Review with meta-analyses of randomised trials. People with or at risk of contractures. Trials were considered for inclusion if they compared stretch to no stretch, or stretch plus co-intervention to co-intervention only. The stretch could be administered in any way. The outcome of interest was joint mobility. Two sets of meta-analyses were conducted with a random-effects model: one for people with neurological conditions and the other for people with non-neurological conditions. The quality of evidence supporting the results of the two sets of meta-analyses was assessed using GRADE. Eighteen studies involving 549 participants examined the effectiveness of stretch in people with neurological conditions, and provided useable data. The pooled mean difference was 2 deg (95% CI 0 to 3) favouring stretch. This was equivalent to a relative change of 2% (95% CI 0 to 3). Eighteen studies involving 865 participants examined the effectiveness of stretch in people with non-neurological conditions, and provided useable data. The pooled standardised mean difference was 0.2 SD (95% CI 0 to 0.3) favouring stretch. This translated to an absolute mean increase of 1 deg (95% CI 0 to 2) and a relative change of 1% (95% CI 0 to 2). The GRADE level of evidence was high for both sets of meta-analyses. Stretch does not have clinically important effects on joint mobility. [Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K (2017) Stretch for the treatment and prevention of contracture: an abridged republication of a Cochrane Systematic Review. Journal of Physiotherapy 63: 67-75].
Publisher: SAGE Publications
Date: 10-2019
Abstract: A major goal of the Stroke Recovery and Rehabilitation Roundtable (SRRR) is to accelerate development of effective treatments to enhance stroke recovery beyond that expected to occur spontaneously or with current approaches. In this paper, we describe key issues for the next generation of stroke recovery treatment trials and present the Stroke Recovery and Rehabilitation Roundtable Trials Development Framework (SRRR-TDF). An exemplar (an upper limb recovery trial) is presented to demonstrate the utility of this framework to guide the GO, NO-GO decision-making process in trial development.
Publisher: Elsevier BV
Date: 02-2003
Publisher: Wiley
Date: 31-07-2012
DOI: 10.1111/J.1469-8749.2012.04368.X
Abstract: The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). A total of 170 QUEST assessments from a convenience s le of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females mean age 6y 10mo, SD 2y 11mo, range 2-16y Gross Motor Function Classification System levels I-V) were reviewed. The QUEST was not unidimensional many items demonstrated poor fit when total scores were analysed goodness of fit improved when domains were considered independently and limbs separately examined. QUEST items involving elbow flexion and/or forearm in pronation were easily achieved, thus reducing test sensitivity. Postures items in the grasp domain behaved erratically, with little total score relationship. Calculating total scores is discouraged. Reporting QUEST results separately for domains and each limb is recommended. Posture items in the grasp domain had little relationship with total scores and it is recommended that they be removed from the test.
Publisher: Informa UK Limited
Date: 26-05-2016
DOI: 10.1080/11038128.2016.1187202
Abstract: The advanced hand activities item of the Motor Assessment Scale (Upper Limb items, UL-MAS) includes the 'lines' and 'dots' tasks, which require skilful pencil use. Prior Rasch analysis studies identify these two tasks as the most difficult to achieve for stroke survivors compared with the other advanced hand activities. Yet it is unknown if healthy, older adults can perform these two tasks. To describe the performance of older adults' without stroke on the 'lines' and 'dots' tasks, relationship between age and task performance, and relationship between writing speed and performance on the 'lines' task. Cross-sectional study design. A s le of healthy older Australians (n = 120) aged between 60 and 99 years completed the UL-MAS 'lines' and 'dots' tasks and wrote two sentences using pencil. Fifty-four participants (45%) failed the UL-MAS 'lines' task. Differences in line drawing performance across age groups were statistically significant (chi-square = 9.02, df = 3, p = .03). Eleven participants (9%) failed the 'dots' task, mostly from the 90 to 99 year age group. Participants who passed the 'lines' task wrote sentences faster than participants who failed (p<.001). Older adults may not pass the UL-MAS 'lines' and 'dots' tasks due to age and in idual skill level.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Informa UK Limited
Date: 02-2021
DOI: 10.2147/JMDH.S295549
Publisher: Informa UK Limited
Date: 23-04-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-09-2022
DOI: 10.1212/WNL.0000000000200794
Abstract: To examine the preferences and user experiences of people with epilepsy and caregivers regarding automated wearable seizure detection devices. We performed a mixed-methods systematic review. We searched electronic databases for original peer-reviewed publications between January 1, 2000, and May 26, 2021. Key search terms included “epilepsy,” “seizure,” “wearable,” and “non-invasive.” We performed a descriptive and qualitative thematic analysis of the studies included according to the technology acceptance model. Full texts of the discussion sections were further analyzed to identify word frequency and word mapping. Twenty-two observational studies were identified. Collectively, they comprised responses from 3,299 participants including patients with epilepsy, caregivers, and healthcare workers. Sixteen studies examined user preferences, 5 examined user experiences, and 1 examined both experiences and preferences. Important preferences for wearables included improving care, cost, accuracy, and design. Patients desired real-time detection with a latency of ≤15 minutes from seizure occurrence, along with high sensitivity (≥90%) and low false alarm rates. Device-related costs were a major factor for device acceptance, where device costs of $300 USD and a monthly subscription fee of $20 USD were preferred. Despite being a major driver of wearable-based technologies, sudden unexpected death in epilepsy was rarely discussed. Among studies evaluating user experiences, there was a greater acceptance toward wristwatches. Thematic coding analysis showed that attitudes toward device use and perceived usefulness were reported consistently. Word mapping identified “specificity,” “cost,” and “battery” as key single terms and “battery life,” “insurance coverage,” “prediction/detection quality,” and the effect of devices on “daily life” as key bigrams. User acceptance of wearable technology for seizure detection was strongly influenced by accuracy, design, comfort, and cost. Our findings emphasize the need for standardized and validated tools to comprehensively examine preferences and user experiences of wearable devices in this population using the themes identified in this study. Greater efforts to incorporate perspectives and user experiences in developing wearables for seizure detection, particularly in community-based settings, are needed. PROSPERO Registration CRD42020193565.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2023
DOI: 10.1161/STROKEAHA.123.043094
Abstract: Fractures are a serious consequence following stroke, but it is unclear how these events influence health-related quality of life (HRQoL). We aimed to compare annualized rates of fractures before and after stroke or transient ischemic attack (TIA), identify associated factors, and examine the relationship with HRQoL after stroke/TIA. Retrospective cohort study using data from the Australian Stroke Clinical Registry (2009–2013) linked with hospital administrative and mortality data. Rates of fractures were assessed in the 1-year period before and after stroke/TIA. Negative binomial regression, with censoring at death, was used to identify factors associated with fractures after stroke/TIA. Respondents provided HRQoL data once between 90 and 180 days after stroke/TIA using the EuroQoL 5-dimensional 3-level instrument. Adjusted logistic regression was used to assess differences in HRQoL at 90 to 180 days by previous fracture. Among 13 594 adult survivors of stroke/TIA (49.7% aged ≥75 years, 45.5% female, 47.9% unable to walk on admission), 618 fractures occurred in the year before stroke/TIA (45 fractures per 1000 person-years) compared with 888 fractures in the year after stroke/TIA (74 fractures per 1000 person-years). This represented a relative increase of 63% (95% CI, 47%–80%). Factors associated with poststroke fractures included being female (incidence rate ratio [IRR], 1.34 [95% CI, 1.05–1.72]), increased age (per 10-year increase, IRR, 1.35 [95% CI, 1.21–1.50]), history of prior fracture(s IRR, 2.56 [95% CI, 1.77–3.70]), and higher Charlson Comorbidity Scores (per 1-point increase, IRR, 1.18 [95% CI, 1.10–1.27]). Receipt of stroke unit care was associated with fewer poststroke fractures (IRR, 0.67 [95% CI, 0.49–0.93]). HRQoL at 90 to 180 days was worse among patients with prior fracture across the domains of mobility, self-care, usual activities, and pain/discomfort. Fracture risk increases substantially after stroke/TIA, and a history of these events is associated with poorer HRQoL at 90 to 180 days after stroke/TIA.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-044573
Abstract: After first stroke, the transition from rehabilitation to home can be confronting and fraught with challenges. Although stroke clinical practice guidelines recommend predischarge occupational therapy home visits to ensure safe discharge and provision of appropriate equipment, there is currently limited evidence to support this recommendation. The HOME Rehab trial is a national, multicentre, phase III randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis being conducted in Australia. The trial aim is to determine the effect and potential cost-effectiveness of an enhanced occupational therapy discharge planning intervention that involves pre and postdischarge home visits, goal setting and occupational therapy in the home (the HOME programme) in comparison to an in-hospital predischarge planning intervention. Stroke survivors aged ≥45 years, admitted to a rehabilitation ward, expected to return to a community (private) dwelling after discharge, with no significant prestroke disability will be randomly allocated 1:1 to receive a standardised discharge planning intervention and the HOME programme or the standardised discharge planning intervention alone. The primary outcome is participation measured using the Nottingham Extended Activities of Daily Living. Secondary outcome areas include hospital readmission, disability, performance of instrumental activities of daily living, health-related quality of life, quality of care transition and carer burden. Resources used/costs will be collected for the cost-effectiveness analysis and hospital readmission. Recruitment commenced in 2019. Allowing for potential attrition, 360 participants will be recruited to detect a clinically important treatment difference with 80% power at a two-tailed significance level of 0.05. This study is approved by the Alfred Health Human Research Ethics Committee and site-specific ethics approval has been obtained at all participating sites. Results of the main trial and the secondary endpoint of cost-effectiveness will be submitted for publication in peer-reviewed journals Trial registration number NCT12618001360202
Publisher: Wiley
Date: 12-08-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
DOI: 10.1161/STROKEAHA.121.034348
Abstract: This systematic review aimed to investigate timing, dose, and efficacy of upper limb intervention during the first 6 months poststroke. Three online databases were searched up to July 2020. Titles/abstracts/full-text were reviewed independently by 2 authors. Randomized and nonrandomized studies that enrolled people within the first 6 months poststroke, aimed to improve upper limb recovery, and completed preintervention and postintervention assessments were included. Risk of bias was assessed using Cochrane reporting tools. Studies were examined by timing (recovery epoch), dose, and intervention type. Two hundred and sixty-one studies were included, representing 228 (n=9704 participants) unique data sets. The number of studies completed increased from one (n=37 participants) between 1980 and 1984 to 91 (n=4417 participants) between 2015 and 2019. Timing of intervention start has not changed (median 38 days, interquartile range [IQR], 22–66) and study s le size remains small (median n=30, IQR 20–48). Most studies were rated high risk of bias (62%). Study participants were enrolled at different recovery epochs: 1 hyperacute ( hours), 13 acute (1–7 days), 176 early subacute (8–90 days), 34 late subacute (91–180 days), and 4 were unable to be classified to an epoch. For both the intervention and control groups, the median dose was 45 (IQR, 600–1430) min/session, 1 (IQR, 1–1) session/d, 5 (IQR, 5–5) d/wk for 4 (IQR, 3–5) weeks. The most common interventions tested were electromechanical (n=55 studies), electrical stimulation (n=38 studies), and constraint-induced movement (n=28 studies) therapies. Despite a large and growing body of research, intervention dose and s le size of included studies were often too small to detect clinically important effects. Furthermore, interventions remain focused on subacute stroke recovery with little change in recent decades. A united research agenda that establishes a clear biological understanding of timing, dose, and intervention type is needed to progress stroke recovery research. Prospective Register of Systematic Reviews ID: CRD42018019367/CRD42018111629.
No related grants have been discovered for Natasha Lannin.