Improving the Development, Monitoring and Reporting of Stroke Rehabilitation Research: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable

Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.

Download Full-text

Improving the development, monitoring and reporting of stroke rehabilitation research: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

International Journal of Stroke ◽

10.1177/1747493017711815 ◽

2017 ◽

Vol 12 (5) ◽

pp. 472-479 ◽

Cited By ~ 47

Author(s):

Marion F Walker ◽

Tammy C Hoffmann ◽

Marian C Brady ◽

Catherine M Dean ◽

Janice J Eng ◽

...

Keyword(s):

Stroke Rehabilitation ◽

Clinical Care ◽

Research Community ◽

Stroke Recovery ◽

Evidence Based ◽

Stroke Patients ◽

International Partnership ◽

Rehabilitation Research ◽

Complete Reporting

Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n = 182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.

Download Full-text

2190 Longitudinal changes in EEG power envelope connectivity are proportional to motor recovery in chronic stroke patients

Journal of Clinical and Translational Science ◽

10.1017/cts.2018.92 ◽

2018 ◽

Vol 2 (S1) ◽

pp. 17-17

Author(s):

Joseph B. Humphries ◽

David T. Bundy ◽

Eric C. Leuthardt ◽

Thy N. Huskey

Keyword(s):

Motor Cortex ◽

Motor Imagery ◽

Stroke Rehabilitation ◽

Brain Computer Interface ◽

Chronic Stroke ◽

Motor Recovery ◽

Stroke Recovery ◽

Computer Interface ◽

Beta Band ◽

Stroke Patients

OBJECTIVES/SPECIFIC AIMS: The objective of this study is to determine the degree to which the use of a contralesionally-controlled brain-computer interface for stroke rehabilitation drives change in interhemispheric motor cortical activity. METHODS/STUDY POPULATION: Ten chronic stroke patients were trained in the use of a brain-computer interface device for stroke recovery. Patients perform motor imagery to control the opening and closing of a motorized hand orthosis. This device was sent home with patients for 12 weeks, and patients were asked to use the device 1 hour per day, 5 days per week. The Action Research Arm Test (ARAT) was performed at 2-week intervals to assess motor function improvement. Before the active motor imagery task, patients were asked to quietly rest for 90 seconds before the task to calibrate recording equipment. EEG signals were acquired from 2 electrodes—one each centered over left and right primary motor cortex. Signals were preprocessed with a 60 Hz notch filter for environmental noise and referenced to the common average. Power envelopes for 1 Hz frequency bands (1–30 Hz) were calculated through Gabor wavelet convolution. Correlations between electrodes were then calculated for each frequency envelope on the first and last 5 runs, thus generating one correlation value per subject, per run. The chosen runs approximately correspond to the first and last week of device usage. These correlations were Fisher Z-transformed for comparison. The first and last 5 run correlations were averaged separately to estimate baseline and final correlation values. A difference was then calculated between these averages to determine correlation change for each frequency. The relationship between beta-band correlation changes (13–30 Hz) and the change in ARAT score was determined by calculating a Pearson correlation. RESULTS/ANTICIPATED RESULTS: Beta-band inter-electrode correlations tended to decrease more in patients achieving greater motor recovery (Pearson’s r=−0.68, p=0.031). A similar but less dramatic effect was observed with alpha-band (8–12 Hz) correlation changes (Pearson’s r=−0.42, p=0.22). DISCUSSION/SIGNIFICANCE OF IMPACT: The negative correlation between inter-electrode power envelope correlations in the beta frequency band and motor recovery indicates that activity in the motor cortex on each hemisphere may become more independent during recovery. The role of the unaffected hemisphere in stroke recovery is currently under debate; there is conflicting evidence regarding whether it supports or inhibits the lesioned hemisphere. These findings may support the notion of interhemispheric inhibition, as we observe less in common between activity in the 2 hemispheres in patients successfully achieving recovery. Future neuroimaging studies with greater spatial resolution than available with EEG will shed further light on changes in interhemispheric communication that occur during stroke rehabilitation.

Download Full-text

Adherence to Post-Acute Rehabilitation Guidelines Improves Functional Recovery in Stroke

Stroke ◽

10.1161/str.32.suppl_1.333-c ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 333-333

Author(s):

Pamela W Duncan ◽

Ronnie D Horner ◽

Dean M Reker ◽

VA Medical Ctr ◽

Kansas City ◽

...

Keyword(s):

Quality Of Care ◽

Acute Stroke ◽

Functional Recovery ◽

Stroke Rehabilitation ◽

Functional Independence ◽

Case Mix ◽

Stroke Patients ◽

Sf 36 ◽

Acute Rehabilitation

97 Purpose & Methods: To assess if compliance with post-stroke rehabilitation guidelines improves functional recovery. The design of the study was an inception cohort of stroke patients followed prospectively for 6 months. The setting was eleven Department of Veteran Affairs Medical Centers providing care to stroke patients. The subjects included 288 selected patients with stroke admitted between January 1998 - March 1999. Data were abstracted from medical records and telephone interviews. Primary outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and post-acute rehabilitation composite compliance scores (range 0–100) were derived from an algorithm. All outcomes were adjusted for case mix. Results: Average compliance scores in acute and post acute care settings were 68.2% (+ 14) and 69.5% (+ 14.4), respectively. After case-mix adjustment, level of compliance with post-acute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function scores and mortality were not affected by compliance with post-acute rehabilitation guidelines. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. Conclusion: Process of care in post-acute stroke rehabilitation affects 6-month functional recovery. Our findings support the use of guidelines as means of assessing quality of care and improving outcomes. These quality indicators are needed to ensure that quality of care is not comprised with new organizational and funding changes involving post-acute stroke care.

Download Full-text

Implementation—The Missing Link in the Research Translation Pipeline: Is It Any Wonder No One Ever Implements Evidence-Based Practice?

Neurorehabilitation and Neural Repair ◽

10.1177/1545968318777844 ◽

2018 ◽

Vol 32 (9) ◽

pp. 751-761 ◽

Cited By ~ 14

Author(s):

Elizabeth A. Lynch ◽

Brigit M. Chesworth ◽

Louise A. Connell

Keyword(s):

Clinical Practice ◽

Stroke Rehabilitation ◽

Evaluation Research ◽

Well Being ◽

Professional Associations ◽

Evidence Base ◽

Care Practice ◽

Research Translation ◽

Evidence Based ◽

Rehabilitation Research

Despite the exponential growth in the evidence base for stroke rehabilitation, there is still a paucity of knowledge about how to consistently and sustainably deliver evidence-based stroke rehabilitation therapies in clinical practice. This means that people with stroke will not consistently benefit from research breakthroughs, simply because clinicians do not always have the skills, authority, knowledge or resources to be able to translate the findings from a research trial and apply these in clinical practice. This “point of view” article by an interdisciplinary, international team illustrates the lack of available evidence to guide the translation of evidence to practice in rehabilitation, by presenting a comprehensive and systematic content analysis of articles that were published in 2016 in leading clinical stroke rehabilitation journals commonly read by clinicians. Our review confirms that only a small fraction (2.5%) of published stroke rehabilitation research in these journals evaluate the implementation of evidence-based interventions into health care practice. We argue that in order for stroke rehabilitation research to contribute to enhanced health and well-being of people with stroke, journals, funders, policy makers, researchers, clinicians, and professional associations alike need to actively support and promote (through funding, conducting, or disseminating) implementation and evaluation research.

Download Full-text

Stroke Patients’ Experiences in an Adaptive Healing Room in a Stroke Rehabilitation Unit

HERD Health Environments Research & Design Journal ◽

10.1177/1937586719879060 ◽

2019 ◽

Vol 13 (2) ◽

pp. 170-185

Author(s):

Ifah Arbel ◽

Bing Ye ◽

Alex Mihailidis

Keyword(s):

Stroke Rehabilitation ◽

Well Being ◽

Stroke Recovery ◽

Structured Interviews ◽

Stroke Patients ◽

Rehabilitation Unit ◽

Healing Environment ◽

Healthcare Settings ◽

Patient Feedback ◽

Healing Environments

Objectives: This study evaluated the user experiences (UX) of stroke patients residing in the adaptive healing room (AHR) and compared them to the UX of patients residing in standard private rooms (SPRs). Background: Healing environments in healthcare settings can promote patients’ healing processes, outcomes, and psychological well-being. The AHR was designed as a healing environment for stroke patients and has been previously evaluated in laboratory settings. This study was the first to evaluate it in its intended context—a stroke rehabilitation unit. Methods: The UX of 10 patients residing in the AHR and 15 patients residing in SPRs were collected via structured interviews with a set of open-ended questions and analyzed using quantitative and qualitative methods. Results: The AHR design features (orientation screen, skylight, and nature view) were rated positively by most patients. The skylight emerged as the least favorable. Responses to open-ended questions revealed that UX may be further improved if patients have more control over some of the settings (e.g., light intensity and nature views), and if the system allowed for more stimulation for patients at later stages of their recovery. Additionally, the results suggest that patients in the AHR have better UX than patients in the SPRs. Conclusion: The AHR has the potential to improve UX in the stroke rehabilitation unit. Patient feedback can be used to refine the AHR before carrying out clinical trials to assess the effect of the AHR on patient outcomes (e.g., sleep, mood, and length of stay) and stroke recovery.

Download Full-text

Cognition in stroke rehabilitation and recovery research: Consensus-based core recommendations from the second Stroke Recovery and Rehabilitation Roundtable

International Journal of Stroke ◽

10.1177/1747493019873600 ◽

2019 ◽

Vol 14 (8) ◽

pp. 774-782 ◽

Cited By ~ 10

Author(s):

Matthew W McDonald ◽

Sandra E Black ◽

David A Copland ◽

Dale Corbett ◽

Rick M Dijkhuizen ◽

...

Keyword(s):

Quality Of Life ◽

Cognitive Impairment ◽

Cognitive Rehabilitation ◽

Stroke Rehabilitation ◽

Stroke Recovery ◽

Future Research ◽

Insufficient Evidence ◽

Cognitive Assessments ◽

Important Target

Cognitive impairment is an important target for rehabilitation as it is common following stroke, is associated with reduced quality of life and interferes with motor and other types of recovery interventions. Cognitive function following stroke was identified as an important, but relatively neglected area during the first Stroke Recovery and Rehabilitation Roundtable (SRRR I), leading to a Cognition Working Group being convened as part of SRRR II. There is currently insufficient evidence to build consensus on specific approaches to cognitive rehabilitation. However, we present recommendations on the integration of cognitive assessments into stroke recovery studies generally and define priorities for ongoing and future research for stroke recovery and rehabilitation. A number of promising interventions are ready to be taken forward to trials to tackle the gap in evidence for cognitive rehabilitation. However, to accelerate progress requires that we coordinate efforts to tackle multiple gaps along the whole translational pathway.

Download Full-text

Technology-assisted toilets: Improving independence and hygiene in stroke rehabilitation

Journal of Rehabilitation and Assistive Technologies Engineering ◽

10.1177/2055668317725686 ◽

2017 ◽

Vol 4 ◽

pp. 205566831772568 ◽

Cited By ~ 1

Author(s):

David Yachnin ◽

Georges Gharib ◽

Jeffrey Jutai ◽

Hillel Finestone

Keyword(s):

Quality Of Life ◽

Pilot Study ◽

Stroke Rehabilitation ◽

Bowel Movement ◽

Assistive Devices ◽

Stroke Patients ◽

Rehabilitation Unit ◽

Full Protocol ◽

Perineal Region

Background and Purpose Dependence on assistance for toileting is a widespread problem for persons receiving healthcare. Technology-assisted toilets, which hygienically wash and dry the perineal region, are devices that could improve toileting independence in a variety of patients. The objective was to investigate whether technology-assisted toilets improve toileting independence, quality of life, and whether technology-assisted toilets can provide sufficient toileting hygiene in stroke rehabilitation. Methods This pilot study was carried out in a stroke rehabilitation unit. Thirty participants were recruited. Participants had a bowel movement and cleaned themselves using the technology-assisted toilet on one to three occasions. Participants rated their toileting before using the technology-assisted toilet and after each technology-assisted toilet use with the Psychosocial Impact of Assistive Devices Scale (PIADS). After each session, participants were rated for cleanliness. Results PIADS scores were analyzed from eight individual participants, five of whom completed the full protocol. PIADS scores were significantly higher with the technology-assisted toilet than with the participants’ regular toileting routine (p < 0.05). Technology-assisted toilets cleaned effectively in 73% of cases (16/22, p < 0.05). Conclusion Technology-assisted toilets improved stroke patients’ psychosocial outcomes compared to standard toileting and completely cleaned participants in the majority of cases. A larger study should confirm technology-assisted toilet’s benefit in stroke rehabilitation through improved independence and hygiene.

Download Full-text

Evidence-based implementation of normal childbirth: what are the obstacles? (qualitative study)

Journal of Health Technology Assessment in Midwifery ◽

10.31101/jhtam.1180 ◽

2020 ◽

Vol 3 (2) ◽

pp. 115-126

Author(s):

Rizki Amalia ◽

Moch. Hakimi ◽

Herlin Fitriani

Keyword(s):

Clinical Care ◽

Sampling Technique ◽

Obstetric Care ◽

Evidence Based ◽

Independent Practice ◽

Structured Interviews ◽

Delivery Assistance ◽

Quality Of Obstetric Care ◽

The Impact

Evidence-based is a very effective strategy to improve the quality of midwifery services. One of the most frequently problems faced is the gap between midwifery practices that are in accordance with the procedures (based on evidence-based) with clinical care practices that occur in the clinic. The purpose of this study was to explore in-depth the obstacles to the implementation of evidence-based normal childbirth, which are the position of delivery, monitoring and documenting delivery by using partographs in the Independent Practice of Midwives of Gunungkidul District, Yogyakarta.This research was a qualitative research with a phenomenological descriptive approach. The participants of this study were midwives who had the Independent Midwife Practice (PMB) consisting of 7 informants. Participant selection in this study used a purposive sampling technique with convenience sampling and identification of obstacles used was the Consolidated Framework for Implementation Research (CFIR). Data collection used was semi-structured interviews and observations. Data analysis used was a thematic analysis.The interview and observation of delivery assistance is done at the Independent Midwife Practice Center (PMB). The position of delivery that was often used by patients was lithotomy and left slant, and the application of evidence-based monitoring and documentation using partograph was still not optimal. This was because there were several obstacles in its application, which were obstacles from patients, families, midwives, and obstacles from the organization. The impact of these obstacles was that it can reduce the quality of obstetric care in patients according to evidence-based. The evaluation of clinical practice based on evidence-based by the organization and the existence of feedback from patients to midwives are expected to improve the quality of service to patients.

Download Full-text

Cognition in Stroke Rehabilitation and Recovery Research: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable

Neurorehabilitation and Neural Repair ◽

10.1177/1545968319886444 ◽

2019 ◽

Vol 33 (11) ◽

pp. 943-950 ◽

Cited By ~ 1

Author(s):

Matthew W. McDonald ◽

Sandra E. Black ◽

David A. Copland ◽

Dale Corbett ◽

Rick M. Dijkhuizen ◽

...

Keyword(s):

Quality Of Life ◽

Cognitive Impairment ◽

Cognitive Rehabilitation ◽

Stroke Rehabilitation ◽

Stroke Recovery ◽

Future Research ◽

Insufficient Evidence ◽

Cognitive Assessments ◽

Important Target

Download Full-text

Stroke rehabilitation and recovery

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0701 ◽

2021 ◽

Vol 82 (9) ◽

pp. 1-7

Author(s):

Alifa Isaacs-Itua ◽

Sancho Wong

Keyword(s):

Quality Of Life ◽

Stroke Rehabilitation ◽

Stroke Recovery ◽

Improve Quality ◽

Post Stroke ◽

Communication Impairments

Stroke is the UK's leading cause of disability. Stroke rehabilitation can maximise recovery and improve quality of life. This article discusses some post-stroke impairments, including hemiplegia, dysphagia, communication impairments and neglect, and how rehabilitation can address these. Developing techniques of adaptation or compensation is vital, since the extent of stroke recovery is dependent on successful neuroplasticity, with healthy neurons adapting to compensate for damaged ones.

Download Full-text