scholarly journals Implementation and evaluation of the virtual Graded Repetitive Arm Supplementary Program (GRASP) for individuals with stroke during the COVID-19 pandemic and beyond

2021 ◽  
Author(s):  
Chieh-ling Yang ◽  
Seonaid Waterson ◽  
Janice J Eng
Keyword(s):  
Patient Outcomes ◽  
Rehabilitation Program ◽  
Small Sample ◽  
Rehabilitation Services ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Post Test ◽  
Practice Time ◽  
Videoconferencing Technology ◽  
Movement Test

Abstract Objective Given the uncertainty with the COVID-19 pandemic, implementing telerehabilitation that enables the remote delivery of rehabilitation services is needed to mitigate the spread of COVID-19. We studied the implementation and the effectiveness of the virtual Graded Repetitive Arm Supplementary (GRASP) Program delivered and evaluated via videoconferencing in individuals with stroke. Methods The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods was used to evaluate the implementation of the two iterations of the program delivered by a nonprofit organization during the pandemic. Results REACH: Seventeen people were screened, 13 people were eligible, and 11 consented to participate in the study. EFFECTIVENESS: Between baseline and post-test, participants with stroke demonstrated significant improvement in upper extremity function (Arm Capacity and Movement Test) and self-perceived UE function (Stroke Impact Scale). ADOPTION: Factors that facilitate program uptake by the staff were well-planned implementation, appropriate screening procedure, and helpful feedback from the audits. All staff felt comfortable using videoconferencing technology to deliver the program despite some technical difficulties. Factors contributing to ongoing participation included that the participants liked the group, they perceived improvements, and the instructor was encouraging. Only one participant with stroke was not comfortable using videoconferencing technology. IMPLEMENTAION: The program was implemented as intended as evaluated by a fidelity checklist. Participants’ adherence was high, as verified by the average attendance and practice time. MAINTENANCE: The organization continued to offer the program. Conclusion The virtual GRASP program was successfully implemented. Although the program was effective in improving both measured and perceived UE function in a small sample of individuals with stroke, caution should be taken in generalizing the results. Impact Implementing telerehabilitation is crucial to optimize patient outcomes and reduce the spread of COVID-19. Our findings provide guidance on the process of delivering a UE rehabilitation program remotely via videoconferencing for stroke. Moreover, insights that arise from this study also inform the implementation of other telerehabilitation services.

scholarly journals Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

2021 ◽  
pp. 154596832110329
Author(s):  
Margaret J. Moore ◽  
Kathleen Vancleef ◽  
M. Jane Riddoch ◽  
Celine R. Gillebert ◽  
Nele Demeyere
Keyword(s):  
Functional Outcomes ◽  
Stroke Severity ◽  
Visuospatial Neglect ◽  
Recovery Pattern ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Significant Difference ◽  
Initial Severity

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

scholarly journals Psychometric properties of the short form of the Stroke Impact Scale in German-speaking stroke survivors

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Anna Coppers ◽  
Jens Carsten Möller ◽  
Detlef Marks
Keyword(s):  
Factor Analysis ◽  
Psychometric Properties ◽  
Short Form ◽  
Trial Registration ◽  
Cognitive Domain ◽  
Retest Reliability ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
German Speaking ◽  
Test Retest Reliability

Abstract Background The short form of the Stroke Impact Scale (SF-SIS) consists of eight questions and provides an overall index of health-related quality of life after stroke. The goal of the study was the evaluation of construct validity, reliability and responsiveness of the SF-SIS for the use in German-speaking stroke patients in rehabilitation. Methods The SF-SIS, the Stroke Impact Scale 2.0 (SIS 2.0), EQ-5D-5L, National Institutes of Health Stroke Scale (NIHSS) and de Morton Mobility Index were assessed in 150 inpatients after stroke, with a second measurement two weeks later for the analyses of responsiveness. In 55 participants, the test–retest-reliability was assessed one week after the first measurement. The study was designed following the recommendations of the COSMIN initiative. Results The correlations of the SF-SIS with the SIS 2.0 (ρ = 0.90), as well as the EQ-5D-5L (ρ = 0.79) were high, as expected. There was adequate discriminatory ability of the SF-SIS index between patients who were less and more severely affected by stroke, as assessed by the NIHSS. Exploratory factor analysis indicated a two-factor structure of the SF-SIS explaining 59.9% of the total variance, providing better model fit in the confirmatory factor analysis than the one-factorial structure. Analyses of test–retest-reliability showed an intraclass correlation coefficient of 0.88 (95% CI 0.75–0.94). Hypotheses concerning responsiveness were not confirmed due to lower correlations between the assessments change scores. Conclusion Results of this analysis of the SF-SIS’s psychometric properties are matching with the validity analysis of the English original version, confirming the high correlations with the Stroke Impact Scale and the EQ-5D-5L. Examination of structural validity did not confirm the presumed unidimensionality of the scale and found evidence of an underlying two-factor solution with a physical and cognitive domain. Sufficient test–retest reliability and internal consistency were found. In addition, this study provides first results for the responsiveness of the German version. Trial registration The study was registered at the German Clinical Trials Register. Trial registration number: DRKS00011933, date of registration: 07.04.2017

How Much Change in the Stroke Impact Scale-16 Is Important to People Who Have Experienced a Stroke?

2010 ◽  
Vol 17 (6) ◽  
pp. 477-483 ◽  
Author(s):  
George D. Fulk ◽  
Miriam Ludwig ◽  
Kari Dunning ◽  
Sue Golden ◽  
Pierce Boyne ◽  
...  
Keyword(s):  
Stroke Impact Scale ◽  
Impact Scale

scholarly journals Perioperative Outcomes Following Kidney-Pancreas Transplantation in Alberta, Canada: Research Letter

2021 ◽  
Vol 8 ◽  
pp. 205435812110293
Author(s):  
Danielle E. Fox ◽  
Robert R. Quinn ◽  
Paul E. Ronksley ◽  
Tyrone G. Harrison ◽  
Hude Quan ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Postoperative Care ◽  
Pancreas Transplantation ◽  
Type I Diabetes ◽  
Small Sample Size ◽  
Small Sample ◽  
Perioperative Outcomes ◽  
Type I ◽  
Patient Safety Indicators ◽  
Significant Difference

Background: Simultaneous kidney-pancreas transplantation (SPK) has benefits for patients with kidney failure and type I diabetes mellitus, but is associated with greater perioperative risk compared with kidney-alone transplantation. Postoperative care settings for SPK recipients vary across Canada and may have implications for patient outcomes and hospital resource use. Objective: To compare outcomes following SPK transplantation between patients receiving postoperative care in the intensive care unit (ICU) compared with the ward. Design: Retrospective cohort study using administrative health data. Setting: In Alberta, the 2 transplant centers (Calgary and Edmonton) have different protocols for routine postoperative care of SPK recipients. In Edmonton, SPK recipients are routinely transferred to the ICU, whereas in Calgary, SPK recipients are transferred to the ward. Patients: 129 adult SPK recipients (2002-2019). Measurements: Data from the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) were used to identify SPK recipients (procedure codes) and the outcomes of inpatient mortality, length of initial hospital stay (LOS), and the occurrence of 16 different patient safety indicators (PSIs). Methods: We followed SPK recipients from the admission date of their transplant hospitalization until the first of hospital discharge or death. Unadjusted quantile regression was used to determine differences in LOS, and age- and sex-adjusted marginal probabilities were used to determine differences in PSIs between centers. Results: There were no perioperative deaths and no major differences in the demographic characteristics between the centers. The majority of the SPK transplants were performed in Edmonton (n = 82, 64%). All SPK recipients in Edmonton were admitted to the ICU postoperatively, compared with only 11% in Calgary. There was no statistically significant difference in the LOS or probability of a PSI between the 2 centers (LOS for Edmonton vs Calgary:16 vs 13 days, P = .12; PSIs for Edmonton vs Calgary: 60%, 95% confidence interval [CI] = 0.50-0.71 vs 44%, 95% CI = 0.29-0.59, P = .08). Limitations: This study was conducted using administrative data and is limited by variable availability. The small sample size limited precision of estimated differences between type of postoperative care. Conclusions: Following SPK transplantation, we found no difference in inpatient outcomes for recipients who received routine postoperative ICU care compared with ward care. Further research using larger data sets and interventional study designs is needed to better understand the implications of postoperative care settings on patient outcomes and health care resource utilization.

scholarly journals Outcome after Stroke upon Awakening

2005 ◽  
Vol 32 (2) ◽  
pp. 232-236 ◽  
Author(s):  
Janel O. Nadeau ◽  
Jiming Fang ◽  
Moira K. Kapral ◽  
Frank L. Silver ◽  
Michael D. Hill
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Stroke Severity ◽  
Linear Modeling ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Level Of Consciousness ◽  
Using Data ◽  
Poor Outcomes ◽  
Ischemic Attack

ABSTRACT:Background:An estimated 20-25% of all strokes occur during sleep and these patients wake up with their deficits. This study evaluated outcomes among patients who woke up with stroke compared to those who were awake at stroke onset.Methods:Using data from the Registry of the Canadian Stroke Network Phases 1 and 2, we compared demographics, clinical data and six-month outcomes between patients with stroke-on-awakening versus stroke-while-awake. Strokes of all types (ischemic stroke, transient ischemic attack, intracerebral hemorrhage and subarachnoid hemorrhage) were included. Standard descriptive statistics, multivariable logistic regression and general linear modeling were applied to the data to compare variables.Results:Among 2,585 stroke patients, 349 (13.5%) woke up with stroke and 2,236 (86.5%) did not. Patients with stroke-on-awakening were more likely to have higher blood pressure and to suffer ischemic stroke, but stroke severity, measured by level of consciousness, did not differ. Mortality both at discharge and at six-month follow-up did not differ between the two cohorts. However, patients with stroke-on-awakening were less likely to return home, and their median Stroke Impact Scale-16 scores were 7.0 points lower compared to those with stroke-while-awake.Conclusions:There are minor demographic and clinical differences between patients with stroke-on-awakening and stroke-while-awake. Functional outcomes are slightly worse among patients with stroke-on-awakening, an effect which was driven by poor outcomes among patients with subarachnoid hemorrhage.

scholarly journals Psychometric Evaluation of the Stroke Impact Scale 3.0

2015 ◽  
Vol 30 (3) ◽  
pp. 229-241 ◽  
Author(s):  
Ercole Vellone ◽  
Serenella Savini ◽  
Roberta Fida ◽  
Victoria Vaughan Dickson ◽  
Gail D’Eramo Melkus ◽  
...  
Keyword(s):  
Psychometric Evaluation ◽  
Stroke Impact Scale ◽  
Impact Scale

scholarly journals Cost-effectiveness of adding psychomotor therapy to a multidisciplinary rehabilitation program for chronic pain

2020 ◽  
Vol 7 (1) ◽  
pp. 124-130
Author(s):  
Lia Van der Maas ◽  
Judith E. Bosmans ◽  
Maurits W. Van Tulder ◽  
Thomas W.J. Janssen
Keyword(s):  
Chronic Pain ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Rehabilitation Program ◽  
Small Sample ◽  
Mean Difference ◽  
Data Uncertainty ◽  
Life Years ◽  
Chronic Pain Patients ◽  
Pain Patients

Introduction: This study assesses the cost-effectiveness (CE) of a multidisciplinary pain rehabilitation program (treatment as usual [TAU]) with and without psychomotor therapy (PMT) for chronic pain patients. Methods: Chronic pain patients were assigned to TAU + PMT or TAU using cluster randomization. Clinical outcomes measured were health-related quality of life (HRQOL), pain-related disability, and quality-adjusted life years (QALYs). Costs were measured from a societal perspective. Multiple imputation was used for missing data. Uncertainty surrounding incremental CE ratios was estimated using bootstrapping and presented in CE planes and CE acceptability curves. Results: Ninety-four chronic pain patients (n = 49 TAU + PMT and n = 45 TAU) were included. There were no significant differences in HRQOL, Pain Disability Index, and QALYs between TAU + PMT and TAU. Direct costs in TAU + PMT were significantly higher than in TAU (mean difference €3327, 95% confidence interval [CI] 1329; 5506). However, total societal costs in TAU + PMT were not significantly higher than in TAU (mean difference €642, 95% CI −3323; 4373). CE analyses showed that TAU + PMT was not cost-effective in comparison with TAU. Conclusions: Adding PMT to a multidisciplinary pain rehabilitation program is not considered cost-effective in comparison with a multidisciplinary pain rehabilitation program alone. The results of this study should be interpreted with caution because of the small sample size and high drop-out rate.

Correlates of vocational outcomes of youth with co-occurring mental illness and substance use disorders: Evidence from a vocational rehabilitation program

2021 ◽  
pp. 1-12
Author(s):  
Olayemi A. Akinola ◽  
Euchay Ngozi Horsman ◽  
Lisa Dunkley
Keyword(s):  
Mental Illness ◽  
Substance Use ◽  
Vocational Rehabilitation ◽  
Substance Use Disorders ◽  
The United States ◽  
Rehabilitation Program ◽  
Rehabilitation Services ◽  
Competitive Employment ◽  
Personal Factors ◽  
Vocational Outcomes

Abstract Youth with co-occurring mental illness and substance use disorders are at higher risk for vocational rehabilitation exclusion. This study aimed to (a) explore the personal factors associated with vocational outcomes of youth with co-occurring mental illness and substance use disorders and (b) highlight services that have shown the greatest promise for this population in the state-federal rehabilitation program in the United States. Our analytic sample was extracted from the Rehabilitation Services Administration’s Case Service Report data set for 2013, 2014, and 2015 fiscal years. Multiple regression analyses results identified personal factors such as gender, race/ethnicity, level of education, and severity of disability as predictors of the achievement of competitive employment, hours worked, and income. The receipt of vocational rehabilitation services such as job search support, job placement assistance, vocational training, and on-the-job support are significantly associated with the achievement of competitive employment, higher work hours, and income. These finding have implications for vocational rehabilitation practice as they highlight who is at higher risk for poor outcomes, effective services, and additional factors to consider when working with youth with co-occurring mental illness and substance use disorders.

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