scholarly journals Outcome measures in post-stroke arm rehabilitation trials: do existing measures capture outcomes that are important to stroke survivors, carers, and clinicians?

2019 ◽  
Vol 33 (4) ◽  
pp. 737-749 ◽  
Author(s):  
Julie Duncan Millar ◽  
Frederike van Wijck ◽  
Alex Pollock ◽  
Myzoon Ali
Keyword(s):  
Outcome Measures ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Post Stroke ◽  
Arm Rehabilitation ◽  
Modified Ashworth Scale ◽  
Research Outcome ◽  
Ashworth Scale

Objective: We sought to (1) identify the outcome measures currently used across stroke arm rehabilitation randomized trials, (2) identify and compare outcomes important to stroke survivors, carers and clinicians and (3) describe where existing research outcome measures capture outcomes that matter the most to stroke survivors, carers and clinicians and where there may be discrepancies. Methods: First, we systematically identified and extracted data on outcome measures used in trials within a Cochrane overview of arm rehabilitation interventions. Second, we conducted 16 focus groups with stroke survivors, carers and clinicians using nominal group technique, supplemented with eight semi-structured interviews, to identify these stakeholders’ most important outcomes following post-stroke arm impairment. Finally, we described the constructs of each outcome measure and indicated where stakeholders’ important outcomes were captured by each measure. Results: We extracted 144 outcome measures from 243 post-stroke arm rehabilitation trials. The Fugl-Meyer Assessment Upper Extremity section (used in 79/243 trials; 33%), Action Research Arm Test (56/243; 23%), and modified Ashworth Scale (53/243; 22%) were most frequently used. Stroke survivors ( n = 43), carers ( n = 10) and clinicians ( n = 58) identified 66 unique, important outcomes related to arm impairment following stroke. Between one and three outcomes considered important by the stakeholders were captured by the three most commonly used assessments in research. Conclusion: Post-stroke arm rehabilitation research would benefit from a reduction in the number of outcome measures currently used, and better alignment between what is measured and what is important to stroke survivors, carers and clinicians.

scholarly journals Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ingrid Johansen Skogestad ◽  
Marit Kirkevold ◽  
Petra Larsson ◽  
Christine Råheim Borge ◽  
Bent Indredavik ◽  
...  
Keyword(s):  
Future Development ◽  
Health Professionals ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Post Stroke ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity

2009 ◽  
Vol 24 (3) ◽  
pp. 225-229 ◽  
Author(s):  
Noureddin Nakhostin Ansari ◽  
Soofia Naghdi ◽  
Scott Hasson ◽  
Atefeh Mousakhani ◽  
Azam Nouriyan ◽  
...  
Keyword(s):  
Elbow Flexor ◽  
Clinical Tool ◽  
Rater Reliability ◽  
Post Stroke ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

scholarly journals Experiences of augmented arm rehabilitation including supported self-management after stroke: a qualitative investigation

2020 ◽  
pp. 026921552095638
Author(s):  
Stefanie Schnabel ◽  
Frederike van Wijck ◽  
Brenda Bain ◽  
Mark Barber ◽  
Philippa Dall ◽  
...  
Keyword(s):  
Feasibility Trial ◽  
Self Management ◽  
Daily Routine ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Daily Lives ◽  
Daily Routines ◽  
Arm Rehabilitation ◽  
Normalization Process

Objective: To explore the experiences of stroke survivors and their carers of augmented arm rehabilitation including supported self-management in terms of its acceptability, appropriateness and relevance. Design: A qualitative design, nested within a larger, multi-centre randomized controlled feasibility trial that compared augmented arm rehabilitation starting at three or nine weeks after stroke, with usual care. Semi-structured interviews were conducted with participants in both augmented arm rehabilitation groups. Normalization Process Theory was used to inform the topic guide and map the findings. Framework analysis was applied. Setting: Interviews were conducted in stroke survivors’ homes, at Glasgow Caledonian University and in hospital. Participants: 17 stroke survivors and five carers were interviewed after completion of augmented arm rehabilitation. Intervention: Evidence-based augmented arm rehabilitation (27 additional hours over six weeks), including therapist-led sessions and supported self-management. Results: Three main themes were identified: (1) acceptability of the intervention (2) supported self-management and (3) coping with the intervention. All stroke survivors coped well with the intensity of the augmented arm rehabilitation programme. The majority of stroke survivors engaged in supported self-management and implemented activities into their daily routine. However, the findings suggest that some stroke survivors (male >70 years) had difficulties with self-management, needing a higher level of support. Conclusion: Augmented arm rehabilitation commencing within nine weeks post stroke was reported to be well tolerated. The findings suggested that supported self-management seemed acceptable and appropriate to those who saw the relevance of the rehabilitation activities for their daily lives, and embedded them into their daily routines.

Achieving Consensus on Leadership Competencies and Outcome Measures

2005 ◽  
Vol 28 (4) ◽  
pp. 428-446 ◽  
Author(s):  
Julie A. Mcdougal ◽  
C. Michael Brooks ◽  
Mark Albanese
Keyword(s):  
Outcome Measures ◽  
Leadership Training ◽  
Phase 1 ◽  
Nominal Group Technique ◽  
Leadership Competencies ◽  
Nominal Group ◽  
Evaluation Instrument ◽  
Modified Delphi ◽  
Formal Program ◽  
Modified Delphi Technique

Pediatric Pulmonary Centers (PPCs) are federally funded interdisciplinary leadership training programs aiming to improve the health of families and children. This article describes the process PPCs used to efficiently and effectively achieve consensus on leadership training competencies and outcome measures among a large and diverse group of health professionals. Phase 1 used a modified Delphi technique to develop an initial set of competencies and outcome measures. Phase 2 used the nominal group technique and modified focus group strategies to refine and prioritize the competencies and outcomes measures. Participants reported being highly satisfied with the process and outcomes. In Phase 3, a formal program evaluation instrument was implemented, designed to measure the competency and describe the career paths and leadership accomplishments of previous trainees. The consensus process adopted can serve as a model for academic and public health entities seeking to achieve consensus on program goals, strategies, methods, priorities, and outcomes.

scholarly journals Effects of Robot-Aided Rehabilitation on Improving Ankle and Balance Performance of Stroke Survivors: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Xiaoxue Zhai ◽  
Qiong Wu ◽  
Quan Xu ◽  
Xin Li ◽  
Yanlin Zhang ◽  
...  
Keyword(s):  
Biomechanical Properties ◽  
Control Group ◽  
Study Group ◽  
Stroke Survivors ◽  
Balance Test ◽  
Average Speed ◽  
Modified Ashworth Scale ◽  
Ankle Rehabilitation ◽  
Eyes Open ◽  
Ashworth Scale

Abstract Background: Stroke survivors often experience abnormal posture control, which affects balance and locomotion. The ankle strategy is important in maintaining static balance. Prolonged spasticity may result in biomechanical changes at the ankle joint, which may cause balance disorders. The intelligent stretching device may decrease the stiffness of the ankle and improve balance. The purpose of this study was to investigate the effects of robot-aided ankle rehabilitation of stroke survivors with ankle spasticity and the correlations between biomechanical properties and balance in these patients. Methods: Twenty inpatients post stroke with ankle spasticity performed 20 minutes of stretching treatment for 2 weeks. The study group used a rehabilitation robot to stretch the spastic ankle plantar flexors under intelligent control and the control group received manual stretching. Outcome measures included biomechanical, clinical evaluations and Pro-Kin balance test. Results: After training, significant improvements were found in both groups in the active range of motion, muscle strength, Berg Balance Scale, Fugl-Meyer Motor Assessment of Lower Extremity, Postural Assessment Scale for Stroke Patients, 6-minute walk test, and Modified Barthel Index (P<0.05); significant decreases were found in the study group in dorsiflexion stiffness, Modified Ashworth Scale, trajectory lengths, elliptical trajectory, standard deviation medial/lateral, average speed forward/backward with eyes closed, and standard deviation forward/backward with eyes open (P=0.001, P=0.037, P=0.028, P=0.019, P=0.016, P=0.001, and P=0.033, respectively); dorsiflexion stiffness was positively correlated with the Pro-Kin balance test outcomes: ellipse area, trajectory length, average speed forward/backward, average speed medial/lateral with eyes open ( =0.352, P=0.026; =0.522, P=0.001; =0.045, P=0.004; =0.433, P=0.005, respectively); dorsiflexion stiffness was correlated with the Modified Ashworth Scale ( =0.265, P=0.041); the study group improved significantly more than the control group in the activities of daily living after training (P =0 .017). Conclusions: The results suggested that robot-aided ankle rehabilitation had a positive effect on the biomechanical properties of the spastic ankle, and it may be feasible to improve balance post-stroke. Ankle dorsiflexion stiffness affected balance poststroke significantly; it may be a sensitive indicator for evaluating balance. Trial registration: www.chictr.org.cn ChiCTR1900022128. Registered 21 February 2020. Retrospectively registered.

Research Priorities in Forensic Occupational Therapy

2003 ◽  
Vol 66 (2) ◽  
pp. 55-64 ◽  
Author(s):  
Edward A S Duncan ◽  
Karen Munro ◽  
Margaret M Nicol
Keyword(s):  
Occupational Therapy ◽  
Outcome Measures ◽  
Group Work ◽  
Nominal Group Technique ◽  
Research Priorities ◽  
Occupational Therapists ◽  
Assessment Tools ◽  
Nominal Group ◽  
Specific Research ◽  
Effective Group

National research priorities have been developed and published by the College of Occupational Therapists (Ilott and White 2001). Such an exercise, however, cannot provide the specific research priorities of a particular area of practice. A questionnaire survey was undertaken to ascertain the specific research priorities of forensic occupational therapists. The survey had three parts: determining research priorities, examining outcome measures and exploring the use of protocol-driven group work. Three specific research priorities were clearly defined by part one of the survey: the development of appropriate outcome measures, the development of rigorous and effective group-work programmes and the development of effective risk assessment tools. The nominal group technique was used in order to triangulate the data. The survey also examined the participants' use of outcome measures: a high number of the participants (62%, 44/71) stated that they used outcome measures in practice. The participants' responses to the third aspect of the survey, regarding the use of protocol-driven groups, were more varied. The majority of the groups reported by the participants were ‘home grown’, with little research base underpinning their implementation. The methodological weaknesses of undertaking such a survey are examined. The paper concludes that having identified clinicians' priorities in forensic occupational therapy research, the challenge is how best to gather robust evidence for practice.

scholarly journals Proposal for a definition for response to treatment, inactive disease and damage for JIA associated uveitis based on the validation of a uveitis related JIA outcome measures from the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC)

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Ivan Foeldvari ◽  
Jens Klotsche ◽  
Gabriele Simonini ◽  
Clive Edelsten ◽  
Sheila T. Angeles-Han ◽  
...  
Keyword(s):  
Disease Activity ◽  
Outcome Measures ◽  
School Attendance ◽  
Nominal Group Technique ◽  
Initial Step ◽  
Nominal Group ◽  
Response To Treatment ◽  
Inactive Disease ◽  
Single Measure ◽  
Patient Reported

Abstract Background JIA-associated uveitis (JIAU) is a serious, sight-threatening disease with significant long-term complications and risk of blindness, even with improved contemporary treatments. The MIWGUC was set up in order to propose specific JIAU activity and response items and to validate their applicability for clinical outcome studies. Methods The group consists of 8 paediatric rheumatologists and 7 ophthalmologists. A consensus meeting took place on November 2015 in Barcelona (Spain) with the objective of validating the previously proposed measures. The validation process was based on the results of a prospective open, international, multi-centre, cohort study designed to validate the outcome measures proposed by the initial MIWGUC group meeting in 2012. The meeting used the same Delphi and nominal group technique as previously described in the first paper from the MIWGUC group (Arthritis Care Res 64:1365–72, 2012). Patients were included with a diagnosis of JIA, aged less than 18 years, and with active uveitis or an uveitis flare which required treatment with a disease-modifying anti-rheumatic drug. The proposed outcome measures for uveitis were collected by an ophthalmologist and for arthritis by a paediatric rheumatologist. Patient reported outcome measures were also measured. Results A total of 82 patients were enrolled into the validation cohort. Fifty four percent (n = 44) had persistent oligoarthritis followed by rheumatoid factor negative polyarthritis (n = 15, 18%). The mean uveitis disease duration was 3.3 years (SD 3.0). Bilateral eye involvement was reported in 65 (79.3%) patients. The main findings are that the most significant changes, from baseline to 6 months, are found in the AC activity measures of cells and flare. These measures correlate with the presence of pre-existing structural complications and this has implications for the reporting of trials using a single measure as a primary outcome. We also found that visual analogue scales of disease activity showed significant change when reported by the ophthalmologist, rheumatologist and families. The measures formed three relatively distinct groups. The first group of measures comprised uveitis activity, ocular damage and the ophthalmologists’ VAS. The second comprised patient reported outcomes including disruption to school attendance. The third group consisted of the rheumatologists’ VAS and the joint score. Conclusions We propose distinctive and clinically significant measures of disease activity, severity and damage for JIAU. This effort is the initial step for developing a comprehensive outcome measures for JIAU, which incorporates the perspectives of rheumatologists, ophthalmologists, patients and families.

Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: a prospective multicenter randomized controlled trial

2016 ◽  
Vol 31 (7) ◽  
pp. 904-912 ◽  
Author(s):  
Yu-jie Yang ◽  
Jun Zhang ◽  
Ying Hou ◽  
Bao-yin Jiang ◽  
Hua-fei Pan ◽  
...  
Keyword(s):  
Barthel Index ◽  
Therapy Group ◽  
Massage Therapy ◽  
Control Group ◽  
Post Stroke ◽  
Modified Ashworth Scale ◽  
Significant Difference ◽  
Multicenter Randomized Controlled Trial ◽  
Muscle Groups ◽  
Ashworth Scale

Objective: To evaluate the effectiveness and safety of Chinese massage therapy (Tui Na) for patients with post-stroke spasticity. Design: A prospective, multicenter, blinded, randomized, placebo-controlled intervention trial. Subject: A total of 90 patients with post-stroke spasticity were randomly assigned to the experimental (Tui Na therapy) group ( n = 45) or control (placebo Tui Na therapy) group ( n = 45). Intervention: Participants in the experimental group received Tui Na therapy, while those in the control group received placebo-Tai Na (gentle rubbing) for 20–25 minutes per limb, once per day, five days per week for a total of four weeks. All participants in both groups received conventional rehabilitation. Main measure: The Modified Ashworth Scale, the Fugl-Meyer Assessment and the Modified Barthel Index were used to assess the severity of spasticity, motor function of limbs and activities of daily living, respectively. Assessments were performed at baseline, at four weeks and at three months. Results: Tui Na group had a significantly greater reduction in Modified Ashworth Scale in only four muscle groups than the control did (elbow flexors, P = 0.026; wrist flexors, P = 0.005; knee flexors, P = 0.023; knee extensors, P = 0.017). Improvements were sustained at three months follow-up. There was no significant difference between the two groups in Fugl-Meyer Assessment ( P = 0.503) and Modified Barthel Index ( P = 0.544). No adverse reaction was recorded in any of the cases mentioned at all study sites. Conclusions: Tui Na might be a safe and effective treatment to reduce post-stroke spasticity of several muscle groups.

Prevalence and predictors of return to work among stroke survivors in Jordan

Work ◽  
2020 ◽  
Vol 67 (4) ◽  
pp. 817-827
Author(s):  
Huda A. Yousef ◽  
Hanan W. Khalil ◽  
Mohammad S. Nazzal ◽  
Khalid I. El-Salem ◽  
Ziad M. Hawamdeh ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Rehabilitation Programs ◽  
Rehabilitation Centers ◽  
Occupational Therapy Practice Framework ◽  
Client Factors ◽  
Returning To Work ◽  
Practice Framework ◽  
Low Prevalence

BACKGROUND: Returning to work (RTW) is an essential goal for many stroke survivors. Currently, the prevalence of RTW post stroke in developing countries such as Jordan is unknown. Additionally, more research is required to identify factors that contribute to RTW post stroke. OBJECTIVES: This study aims to (1) determine the prevalence of RTW among stroke survivors in Jordan, and (2) determine the predictors of RTW from a holistic perspective using the Occupational Therapy Practice Framework (OTPF) 3rd edition. METHODS: Recruitment was carried out from different Jordanian hospitals and rehabilitation centers. A complete battery of outcome measures was used to reflect OTPF domains. These included outcome measures of occupations, client factors, performance skills, and context and environment. Logistic regression was used to determine factors that predicted RTW. RESULTS: 69 participants were enrolled; 45 Males, 24 females; mean age±SD, 52.2±11.07 years. Only 29% succeeded in RTW during the first year after stroke onset. The highest percentage of RTW was among craft workers (40% ), and those who were self-employed (60% ). Of those who resumed work, 35% returned to their previous work, while 65% needed to make work modifications, or change positions or jobs. Factors that predicted higher rates of RTW were walking speed (Odds ratio (OR)=0.004, 95% confidence interval (CI)=0.00–0.55, P < 0.02), as well as absence of environmental restrictions (OR = 21.16, 95% CI = 1.91–233.5, P < 0.013). CONCLUSIONS: The alarming low prevalence of RTW among stroke survivors in Jordan emphasizes the essential need to develop vocational rehabilitation programs. Clinicians should pay attention to enhancing walking abilities and reducing environmental restrictions post stroke, in order to improve the occurrence of RTW.

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