How does mentoring occupational therapists improve intervention fidelity in a randomised controlled trial? A realist evaluation.

BACKGROUND: Integrating complex interventions within healthcare settings can be challenging. Mentoring can be embedded within a randomised controlled trial (RCT) to upskill and support those delivering the intervention. This study aimed to understand, from a realist perspective, how mentoring worked to support implementation fidelity for occupational therapists (OTs) delivering a vocational rehabilitation (VR) intervention within the context of an RCT. METHODS: A realist evaluation using secondary data (emails, mentoring record forms, interviews) collected as part of an RCT. Three researchers coded the data following content analysis, focused on refining or refuting an initial programme theory by exploring the interactions between context, mechanisms, and outcomes. The research team met to further refine the programme theories. RESULTS: Data from 584 emails, 184 mentoring record forms, and 25 interviews were analysed following a realist approach. We developed a programme theory consisting of two contexts (trial set-up, ongoing mentoring), nine mechanisms (collective understanding, monitoring, timely support, positive reinforcement, reflective practice, support data completeness, facilitation strategy, shared learning experience, management of research and clinical duties), and three outcomes (improved confidence, improved fidelity, reduced contamination). CONCLUSIONS: Offering mentoring support to OTs delivering a VR intervention as part of an RCT improves intervention fidelity and reduces the risk of contamination. It improves OTs' understanding of the differences between their clinical and research roles and increases their confidence and competence in trial paperwork completion and identification of potential contamination issues.

The Breakfast and Dressing Conflict Task: Preliminary Evidence of Its Validity to Measure Online Self-Awareness After Acquired Brain Injury.

IMPORTANCE: Impaired self-awareness (SA) of deficits after an acquired brain injury (ABI) severely affects patients' independence in activities of daily living (ADLs). However, any assessment tool permits an exhaustive evaluation of SA in the context of ADLs. OBJECTIVE: To study the validity of the Breakfast and Dressing Conflict Task (BD Conflict Task) to assess online SA (awareness of performance in the context of a given task) in patients with ABI; to study its interactions with offline SA (general awareness); and to test the validity of a simplified measure of performance monitoring, the ADL Conflict-Monitoring Index. DESIGN: Convergent validity and correlational study. SETTING: Research laboratory, hospitals, and homes. PARTICIPANTS: Thirty patients with ABI and 28 neurologically healthy controls. OUTCOMES AND MEASURES: Using the BD Conflict Task, measures of emergent awareness, self-regulation, anticipatory awareness, and self-evaluation were assessed and their convergent validity and relationship with offline SA were analyzed. The ADL Conflict-Monitoring Index was calculated, and its convergent validity was tested. RESULTS: The online SA variables of the BD Conflict Task showed convergent validity with traditional online SA measures. Offline SA correlated with emergent and anticipatory awareness in the Breakfast Task. The ADL Conflict-Monitoring Index proved to be a valid measure of patients' performance monitoring. CONCLUSIONS AND RELEVANCE: These preliminary findings suggest that the BD Conflict Task is a valid tool to assess online SA in patients with ABI and provide further understanding of the online SA-offline SA interaction. Furthermore, the ADL Conflict-Monitoring Index may be a valid and easy-to-use monitoring measure in clinical settings. Plain-Language Summary: Patients with acquired brain injury (ABI) and reduced awareness of their cognitive deficits face problems performing activities of daily living (ADLs) and may show signs of unsafe behaviors. Being aware of one's own abilities involves anticipating problems before starting a task, detecting and correcting errors during the task, and evaluating performance afterward. This study provides preliminary validity for the Breakfast and Dressing Conflict Task, a new tool that assesses aspects of self-awareness simultaneously in the context of familiar and significant ADLs. Furthermore, the tool simplifies the assessment of detecting and correcting errors with an easy-to-use index, making it suitable for use in clinical settings.

Co-created Technological Solutions for Caregivers in Health Care: Systematic Review.

BACKGROUND: Support interventions for caregivers can reduce their stress, possibly improving the quality of patients' care while reducing care costs. Technological solutions have been designed to cover their needs, but there are some challenges in making them truly functional for end users. Co-design approaches present important opportunities for engaging diverse populations to help ensure that technological solutions are inclusive and accessible. OBJECTIVE: This study aimed to identify co-created technological solutions, as well as the process followed for their co-creation, in the field of health for caregivers. METHODS: The literature review was conducted in the Medline, Web of Science, Scopus, Science Direct, Scielo, and IEEE Xplore databases. The inclusion criteria were studies written in English or Spanish and with a publication date until May 2021. The content had to specify that the caregivers actively participated in the co-creation process, which covered until the development phase of the technological solution (prototype). The level of evidence and the methodological quality were analyzed when possible, using the Scottish Intercollegiate Guidelines Network criteria and the Mixed Methods Appraisal Tool, version 2018, respectively. RESULTS: In total, 410 papers were identified, and 11 met the eligibility criteria. The most predominant articles were mixed methods studies and qualitative studies. The technology used in the analyzed articles were mobile or web applications (9 studies) and specific devices such as sensors, cameras, or alarm systems (2 studies) to support the health and social aspects of caregivers and improve their education in care. The most common patient profile was older people (7 studies); 6 studies used co-creation in the requirements phase, 6 studies detailed the design phase. In 9 studies, the prototype was iteratively refined in the development phase, and the validation phase was performed in 5 of the reviewed studies. CONCLUSIONS: This systematic review suggests that existing co-created technological solutions in the field of health for caregivers are mostly mobile or web applications to support caregivers' social health and well-being and improve their health knowledge when delivering care to patients, especially older people. As for the co-creation process, caregivers are particularly involved during development and in the design. The scarce literature found indicates that further research with higher methodological quality is needed.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults.

BACKGROUND: The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health. AIM: To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular. METHODS: A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates. RESULTS: Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (ß = -.33). Loss of meaningful activities was strongly related to mental health (ß = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables. CONCLUSIONS: The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.

Using Smartphones to Collect Quantitative Data on Lower Limb Functionality in People Who Have Suffered a Stroke.

GOAL: The main objective was to use the inertial sensor integrated into a smartphone to collect quantitative data on lower limb functioning during execution of the timed up and go test and sit to stand test by people in the acute stage of stroke. The secondary objective was to analyze whether smartphones provide reliable quantitative data on performance of these functional tests. MATERIAL AND METHODS: Cross-sectional analytical study involving 8 elderly people (M age = 67.50 years). Both tests were performed to parametrize and analyze the functionality, balance, and strength of lower limbs using an inbuilt inertial sensor of the smartphone. Time, difference in trunk position, angular displacement, angular velocity, and angular acceleration were measured and calculated for each stage at which both functional tests were divided. RESULTS: The obtained results highlight the similarity in the angular displacement during the 2 stages into which the sitting-standing (flexion: 38.85° and extension: 38.10°) and the standing-sitting (flexion: 36.42° and extension: 36.45°) phases were divided. Mean velocities of .59 m/s and .61 m/s were registered during outward and return walking phases. The intra- and interobserver reliability of variables recorded with the inbuilt inertial sensor ranged from .860 to .897. CONCLUSIONS: Balance and muscle strength problems of stroke patients gave rise to the use of compensatory mechanisms when getting up from or sitting down in a chair and resulted in a reduction in walking speed that is sufficient to make walking in community contexts difficult. Smartphones has excellent reliability when used to quantify lower limb functioning in stroke patients.

Experimental Validation of Depth Cameras for the Parameterization of Functional Balance of Patients in Clinical Tests.

In clinical practice, patients' balance can be assessed using standard scales. Two of the most validated clinical tests for measuring balance are the Timed Up and Go (TUG) test and the MultiDirectional Reach Test (MDRT). Nowadays, inertial sensors (IS) are employed for kinematic analysis of functional tests in the clinical setting, and have become an alternative to expensive, 3D optical motion capture systems. In daily clinical practice, however, IS-based setups are yet cumbersome and inconvenient to apply. Current depth cameras have the potential for such application, presenting many advantages as, for instance, being portable, low-cost and minimally-invasive. This paper aims at experimentally validating to what extent this technology can substitute IS for the parameterization and kinematic analysis of the TUG and the MDRT tests. Twenty healthy young adults were recruited as participants to perform five different balance tests while kinematic data from their movements were measured by both a depth camera and an inertial sensor placed on their trunk. The reliability of the camera's measurements is examined through the Interclass Correlation Coefficient (ICC), whilst the Pearson Correlation Coefficient (r) is computed to evaluate the correlation between both sensor's measurements, revealing excellent reliability and strong correlations in most cases.

Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors.

BACKGROUND/AIM: Stroke is a leading cause of disability in developed countries. One of the most widespread techniques in clinical practice is mirror therapy (MT). To determine the effectiveness of MT over other methods of intervention in the recovery of upper limb function in people who have had a stroke. METHODS: A systematic review was conducted. The search string was established based on the last systematic review about MT that dated from 2009: "upper extremity" OR "upper limb "AND "mirror therapy" AND stroke. For this search Pubmed, Scopus and SciELO databases were used. RESULTS: Fifteen studies were included in the systematic review. Recovery of the upper limb, upper limb function and gross manual dexterity were frequently measured in these studies. CONCLUSIONS: In the primary variables in promoting recovery, MT alone showed better results in acute and chronic stroke patients in upper limb functioning than either conventional rehabilitation (CR) or CR plus MT. PROSPERO registration number: CRD42015026869.

Comparison of kinematic variables obtained by inertial sensors among stroke survivors and healthy older adults in the Functional Reach Test: cross-sectional study.

BACKGROUND: Balance dysfunction is one of the most common problems in people who suffer stroke. To parameterize functional tests standardized by inertial sensors have been promoted in applied medicine. The aim of this study was to compare the kinematic variables of the Functional Reach Test (FRT) obtained by two inertial sensors placed on the trunk and lumbar region between stroke survivors (SS) and healthy older adults (HOA) and to analyze the reliability of the kinematic measurements obtained. METHODS: Cross-sectional study. Five SS and five HOA over 65. A descriptive analysis of the average range as well as all kinematic variables recorded was developed. The intrasubject and intersubject reliability of the measured variables was directly calculated. RESULTS: In the same intervals, the angular displacement was greater in the HOA group; however, they were completed at similar times for both groups, and HOA conducted the test at a higher speed and greater acceleration in each of the intervals. The SS values were higher than HOA values in the maximum and minimum acceleration in the trunk and in the lumbar region. CONCLUSIONS: The SS show less functional reach, a narrower, slower and less accelerated movement during the FRT execution, but with higher peaks of acceleration and speed when they are compared with HOA.

The effectiveness of graded motor imagery and its components on phantom limb pain in amputated patients: A systematic review.

BACKGROUND: Phantom limb pain (PLP) can be defined as pain in a missing part of the limb. It is reported in 50%-80% of people with amputation. OBJECTIVES: To provide an overview of the effectiveness of graded motor imagery (GMI) and the techniques which form it on PLP in amputees. STUDY DESIGN: Systematic review. METHODS: Two authors independently selected relevant studies, screened the articles for methodological validity and risk of bias, and extracted the data. Inclusion criteria used were clinical studies, written in English or Spanish, using GMI, laterality recognition, motor imagery, mirror therapy, or a combination of some of them as an intervention in amputated patients, and one of the outcomes was PLP, and it was assessed using a validated scale. The databases used were PubMed, Scopus, Web of Science, CINAHL, and PEDro. RESULTS: Fifteen studies were included in the review. After the intervention, all the groups in which the GMI or one of the techniques that comprise it was used showed decrease in PLP. CONCLUSION: The 3 GMI techniques showed effectiveness in decreasing PLP in amputees, although it should be noted that the application of the GMI showed better results.

Effectiveness of an occupational self-analysis intervention through a mobile application (OcupApp) in people with anxiety or depression: a randomised controlled trial protocol.

The main objective of this protocol is to understand the effectiveness of the use of a mobile application (OcupApp) to generate a personal self-analysis about meaningful activities in a population of adults aged between 50 and 70 years with low or moderate depression/anxiety. A randomised study will be carried out comparing the effects of the use of the OcupApp application with a control intervention on health-related quality of life, mental health, frequency of participation on meaningful activities, and perceived occupational balance. This is the first study to use occupational self-analysis in m-health to improve occupational balance, mental health, frequency of participation in meaningful activities and health-related quality of life. The app was co-created with a population whose characteristics are similar to those of the target users, and it was tested in both the intervention itself and the presentation, thus it is expected to be effective.Trial Registration Number: Clinical Trial B1-2020_25.

This is the first study to evaluate the impact of an app on occupational participation in people older than 50 years with mild-moderate anxiety and/or depressionIntroducing an occupational self-analysis app that helps people become aware of their occupations can improve health-related quality of life, mental health, frequency of participation on meaningful activities, and perceived occupational balance.OcupApp will allow people to go under occupational self-analysis process from home or any other place, maintaining the principles of the original programme.

Feasibility study of a home-based graded motor imagery intervention (GraMI protocol) for amputees with phantom limb pain.

INTRODUCTION: Phantom limb pain affects 64% of amputees. Graded Motor Imagery comprises three consecutive application techniques designed to reorganize maladaptive changes that have occurred after the amputation. OBJECTIVE: To assess the feasibility of a home-based Graded Motor Imagery intervention, the GraMI protocol, for amputee people with phantom limb pain. METHODS: Twenty individuals over 18 years of age with upper or lower limb amputation, experiencing phantom limb pain, who were pharmacologically stable, and had been discharged from the hospital were recruited. The experimental group followed the GraMI protocol. Primary outcomes included study processes, such as recruitment time and rate, adherence, compliance, and the acceptability of digital technologies as a treatment tool. Secondary outcomes assessed the impact on phantom limb pain, quality of life, functionality, and depressive symptoms. RESULTS: On average, seven participants were recruited monthly over a three-month period. No losses were recorded throughout the nine weeks of intervention. Treatment adherence averaged 89.32%, and all participants demonstrated familiarity with the usability of digital technologies. No significant differences were observed between groups (p = .054). However, within the experimental group, intragroup analysis revealed a significant (p = .005) and clinically relevant reduction (>2 points) with a large effect size (0.89) in phantom limb pain. CONCLUSION: Conducting a multicenter study with a home-based intervention using the GraMI protocol is feasible. Future clinical trials are needed to verify its effectiveness in managing phantom limb pain.

Translation, cross-cultural adaptation and validation of the 10-item Weekly Calendar Planning Activity in Spanish-speaking ABI patients: a multicenter study.

We present the process of translation, adaptation, and validation in the Spanish context of the 10-item version of the Weekly Calendar Planning Activity (WCPA-10), a performance-based measure of cognitive instrumental activities of daily living (C-IADL). The study consisted of two phases: I) translation/cultural adaptation of the WCPA, conducted by professional bilingual translators, a panel of experts, and a pilot study, and II) validation in a sample of 42 acquired brain injury patients (ABI) and 42 healthy participants (HC). WCPA primary outcomes showed expected convergent/discriminant validity patterns with socio-demographical and clinical variables and cognitive processes identifying those WCPA outcomes that best predicted executive and memory deficits measured with a battery of traditional neuropsychological tests. In addition, performance on the WCPA was a significant predictor of everyday functioning over variables such as socio-demographics or global cognition when measured with traditional tests. External validity was established by the WCPA's ability to identify everyday cognitive deficits in ABI patients compared to HC, even in those with subtle cognitive impairment based on neuropsychological tests. The Spanish WCPA-10 seems an appropriate and sensitive assessment tool to identify cognitive-functional impairment in ABI-patients, even those with subtle cognitive impairment. The results also highlight the relevance of this kind of test, as they indicate a better prediction of patients' real-world functioning than traditional neuropsychological tests.

Client-centred practice in occupational therapy after stroke: A systematic review.

Background: Client-centred practice aims to involve the person in making decisions during the therapeutic intervention process, giving him or her a central and active role.Objectives: To analyze the effects of client-centred practice in occupational therapy on issues related to occupational performance and participation among people with stroke and traumatic brain injury.Material and methods: A systematic review of randomized clinical trials examining the effects of a client-centred practice carried out by occupational therapists in patients with stroke or traumatic brain injury aged over 18 years was conducted. PubMed, Web of Science, Scopus, OT Seeker, PsycINFO and EBSCO were used to retrieve potentially eligible publications.Results: Eight studies, from 294 identified, were included. The extracted data showed that the application of client-centred practice in occupational therapy improved satisfaction with occupational performance compared to conventional interventions. However, client-centred practice and conventional intervention had similar effects on functionality (Activities of Daily Living), life satisfaction and burden on caregivers.Conclusions and significance: Client-centred practice has the effect of achieving greater satisfaction with occupational performance. This suggests that client-centred practice in occupational therapy helps patients to accept the new limitations on their occupational performance. Further studies are needed to determine the effects of client-centred practice on other aspects.

Effectiveness of graded motor imagery protocol in phantom limb pain in amputed patient: Protocol of a randomized clinical trial.

OBJECTIVE: The aim of this study is to analyse the effectiveness of the Graded Motor Imagery (GraMI) protocol in phantom limb pain in amputee patients. MATERIALS AND METHODS: A randomised clinical trial will be conducted, with two parallel groups and simple blinding, and a phenomenological study with semi-structured interviews. People over the age of 18, with amputation of one limb, with a minimum score of 3 on the visual analogue scale of pain, who are pharmacologically stable and have been discharged from hospital, will be recruited. An initial assessment, a post-intervention assessment (9 weeks) and a follow-up assessment (12 weeks post-intervention) will be performed, in which pain, quality of life, functionality and psychological aspects will be assessed. The aim of the qualitative study is to find out about the experience of living with phantom limb pain and to identify the satisfaction with the intervention. A descriptive, univariate and bivariate quantitative statistical analysis will be performed using the SPSS program, with a 95% confidence level and a statistical significance level of p < 0.05. The qualitative analysis will be carried out using the Atlas.ti 8.0 program, where the different interviews will be analysed, coded and categorised. DISCUSSION: The GraMI protocol allows the patient to work on motor learning through brain reorganisation, analytical movements, sensory stimulation, and functional activities. In addition, it can help to standardise the use of graded motor imagery in future studies and in clinical practice with this patient profile. TRIAL REGISTRATION: NCT05083611.

Developing a method to assess fidelity to a complex vocational rehabilitation intervention in the FRESH trial: a feasibility study.

BACKGROUND: Determining whether complex rehabilitation interventions are delivered with fidelity is important. Implementation fidelity can differ between sites, therapists delivering interventions and, over time, threatening trial outcomes and increasing the risk of type II and III errors. This study aimed to develop a method of assessing occupational therapists' fidelity to deliver a complex, individually tailored vocational rehabilitation (VR) intervention to people with traumatic brain injury (TBI) and assess the feasibility of its use in a randomised controlled trial. METHODS: Using mixed methods and drawing on the intervention logic model, we developed data collection tools to measure fidelity to early specialist TBI VR (ESTVR). Fidelity was measured quantitatively using intervention case report forms (CRF), fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with intervention therapists, participants with TBI, employers and NHS staff at trial sites explored moderators of implementation fidelity. The conceptual framework of implementation fidelity (CFIF) guided measurement and analysis of and factors affecting fidelity. Data were triangulated and benchmarked against an earlier cohort study. RESULTS: Fidelity to a complex individually tailored VR intervention could be measured. Overall, OTs delivered ESTVR with fidelity. Different fidelity measures answered different questions, offering unique insights into fidelity. Fidelity was best assessed using a fidelity checklist, intervention CRFs and clinical notes. The OT clinical notes and mentoring records were best at identifying fidelity moderating factors. Interviews added little insight into fidelity moderating factors over and above mentoring or clinical records. Data triangulation offered a comprehensive assessment of fidelity, highlighting limitations of measurement methods and learning for future trials but was resource intensive. Interviews, fidelity visits and analysing clinical notes were also resource intense. Comparing fidelity data to a benchmark and using CFIF as a framework for organising the fidelity assessment helped. CONCLUSIONS: OTs delivered the VR intervention with fidelity. A fidelity checklist and benchmark plus mentoring may offer a practical and effective way of measuring fidelity and identifying fidelity moderating factors in trials of complex individually-tailored rehabilitation interventions. Mentoring provided real-time indicators of and reasons for fidelity deviations. These methods require further evaluation. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN38581822 (Registered: 02/01/2014).

Spanish cross-cultural adaptation and validation of the Australian Pelvic Floor Questionnaire in running women.

Pelvic floor dysfunctions are a wide range of disorders in the gynaecological, lower urinary and gastrointestinal tracts that affect the structure and/or function of the pelvic organs. The objective of this study was to carry out a cross-cultural adaptation and a psychometric analysis of the Spanish version of the Australian Pelvic Floor Questionnaire. Observational study divided into two main phases: (1) translation and cross-cultural adaptation and (2) psychometric tests. Women runners from all over the Spanish territory, from different federations, clubs and levels were recruited. Participants: 424 female runners, native Spanish, over 18 years of age and who had been practicing running for more than 6 months. The instruments used in this study were the Australian Pelvic Floor Questionnaire, Female Sexual Function Index, King Health Questionnaire, Quality of Life SF-12 and EuroQoL 5-D. The Spanish version of Australian Pelvic Floor Questionnaire has proven to be an understandable and easy-to-use tool. The general internal consistency of the questionnaire was 0.972 and the intraclass correlation coefficient ranged between ICC 0.596-0.960. The Spanish version of Australian Pelvic Floor Questionnaire is a valid and reliable measure that can be used clinically to assess pelvic floor dysfunctions among the female Spanish population.

Study protocol for a non-randomised controlled trial: Community-based occupational therapy intervention on mental health for people with acquired brain injury (COT-MHABI).

INTRODUCTION: The sequelae of moderate-severe acquired brain injury (ABI) encompass motor, cognitive, sensory, emotional and behavioural areas that affect meaningful occupational participation and quality of life, with a high prevalence of associated mental disorders. When the patient returns to community life after discharge from the hospital, specialised care is generally insufficient due to the lack of consideration of the dual condition of mental disorder and ABI. Since there is a negative impact on competence and thus on occupational participation, occupational therapy represents a convenient way of intervention. On these assumptions, a community-based occupational therapy protocol on mental health for people with moderate/severe acquired brain injury (COT-MHABI) is presented. It is focused on meaningful occupational participation and looks for improvement in the quality of life. METHODS AND ANALYSIS: This study aims: (i) to design a protocol to evaluate the effectiveness of a community occupational therapy intervention based on MOHO for patients with a dual (mental health/ABI) for improving quality of life and self-perceived occupational performance; (ii) to analyse the outcomes of occupational and social variables (occupational balance, participation level, satisfaction with occupation and performed roles and community integration) after the COT-MHABI process; (iii) to analyse the impact of quality of life on satisfaction with occupations performed by this population. A non-randomised controlled clinical trial will be performed. Patients assigned to the experimental group will receive over one year of on-site and telematic occupational therapy sessions, 16 sessions on average. Variables such as quality of life, community integration or satisfaction with occupational performance will be collected at baseline, 6, and 12 months. DISCUSSION: The needs for the dual mental/ABI population in their reintegration into the community are related to the associated deficits and to the absence of specialised services for the complexity of this patient profile. Few studies consider the coexistence of mental health and ABI issues. The COT-MHABI protocol is proposed to provide continuity to the community needs of this population, conceptualised from occupational participation, person-centred and focused on meaningful activities. CLINICAL TRIAL REGISTRATION: Trial identifier and registry name ClinicalTrials.gov ID: NCT04586842 https://clinicaltrials.gov/ct2/show/NCT04586842?term=252136&draw=2&rank=1; Pre-results; Community-based Occupational Therapy Intervention on Mental Health for People With Acquired Brain Injury (COT-MHABI).

Effect of Blood Flow Restriction on Functional, Physiological and Structural Variables of Muscle in Patients with Chronic Pathologies: A Systematic Review.

The main objective of this systematic review of the current literature is to analyze the changes that blood flow restriction (BFR) causes in subjects with neuro-musculoskeletal and/or systemic pathologies focusing on the following variables: strength, physiological changes, structural changes and cardiocirculatory variables. The search was carried out in seven databases, including randomized clinical trials in which therapeutic exercise was combined with the blood flow restriction tool in populations with musculoskeletal pathologies. Outcome variables are strength, structural changes, physiological changes and cardiocirculatory variables. Twenty studies were included in the present study. Although there is a lot of heterogeneity between the interventions and evaluation instruments, we observed how the restriction of blood flow presents significant differences in the vast majority of the variables analyzed. In addition, we observed how BFR can become a supplement that provides benefits when performed with low intensity, similar to those obtained through high-intensity muscular efforts. The application of the BFR technique can provide benefits in the short and medium term to increase strength, muscle thickness and cardiovascular endurance, even improving the physiological level of the cardiovascular system. In addition, BFR combined with low-load exercises also achieves benefits comparable to high-intensity exercises without the application of BFR, benefiting patients who are unable to lift high loads.

Development and Validation of a Graded Motor Imagery Intervention for Phantom Limb Pain in Patients with Amputations (GraMI Protocol): A Delphi Study.

BACKGROUND: Phantom limb pain can be defined as discomfort or pain in a missing part of the limb. The aims of this study were to develop and validate, through a Delphi methodology, a graded motor imagery protocol in order to reduce phantom limb pain. METHOD: Physiotherapists and/or occupational therapists with experience in research and a minimum clinical experience of five years in the field of neurorehabilitation and/or pain were recruited by part of a group of experts to assess the intervention. The study was conducted through an online questionnaire, where experts assessed each aspect of the intervention through a Likert scale. As many rounds as necessary were carried out until consensus was reached among experts. RESULTS: A total of two rounds were required to fully validate the intervention. During the second round, the relative interquartile range of all aspects to be assessed was less than 15%, thus showing a consensus among experts and with good concordance (Kappa index of 0.76). CONCLUSION: Experts validated a graded motor imagery intervention of phantom limb pain in patients with amputations (GraMi protocol). This intervention can help to homogenize the use of graded motor imagery in future studies and in clinical practice.