Chronic stroke survivors with upper limb spasticity: linking experience to the ICF.

PURPOSE: To identify the impact of upper limb spasticity on stroke survivors by linking their shared experience to the International Classification of Functioning, Disability, and Health (ICF). METHODS: Ten community dwelling adults with a chronic stroke and spasticity, who had completed an upper limb rehabilitation trial participated in semi-structured interviews. Data were analysed using content analysis and linked to the ICF Comprehensive Core Set for stroke using standard linking rules. RESULTS: Four hundred and thirty-nine meaningful concepts eligible for linking were identified. The majority (n = 178) linked to Body Function, n = 137 to Activities and Participation, n = 115 to Environmental Factors, and n = 9 to Body Structures. Sixty-two of the 130 Comprehensive Core Set categories were used; an additional eight were required to fully represent experience. Stroke survivors with upper limb spasticity use words and discuss topics concentrated around mental functions, functions of the joints and bones, muscles and movements, carrying, moving and handling objects, support and relationships with immediate family and health professionals, products and technology, and health services. CONCLUSIONS: Half of the Comprehensive Core Set categories for stroke were relevant, but to adequately capture experience an additional eight were needed. The ICF category profile may be unique to our participants or may suggest further research is needed to determine if additions to core set categories are required.Implications for rehabilitationOur ICF mapping demonstrated that the Brief Core Set for stroke was not sufficient to capture the range of experience for stroke survivors with upper limb spasticity, instead the Comprehensive Core Set for stroke supplemented with eight clinical-cohort specific second-level-categories should be used.Our findings suggest that rehabilitation may better reflect lived experience if it focuses on Body Function (Chapters 1, 2, 4, 7), Activity and Participation (Chapters 1-9), and Environment (Chapters 1, 2, 3, 5) because Body Structure was rarely mentioned in this or previous post-stroke ICF mapping research.

Self-reported quality of life following stroke: a systematic review of instruments with a focus on their psychometric properties.

PURPOSE: To evaluate the psychometric properties of common health-related quality-of-life instruments used post stroke and provide recommendations for research and clinical use with this diagnostic group. METHODS: A systematic review of the psychometric properties of the five most commonly used quality-of-life measurement tools (EQ-5D, SF-36, SF-6D, AQoL, SS-QOL) was conducted. Electronic searches were performed in MEDLINE, CINAHL, and EMBASE on November 27th 2019. Two authors screened papers against the inclusion criteria and where consensus was not reached, a third author was consulted. Included papers were appraised using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist and findings synthesized to make recommendations. RESULTS: A total of n = 50,908 papers were screened and n = 45 papers reporting on 40 separate evaluations of psychometric properties met inclusion criteria (EQ-5D = 19, SF-36 = 16, SF-6D = 4, AQoL = 2, SS-QOL = 4). Studies reported varied psychometric quality of instruments, and results show that psychometric properties of quality-of-life instruments for the stroke population have not been well established. The strongest evidence was identified for the use of the EQ-5D as a quality-of-life assessment for adult stroke survivors. CONCLUSIONS: This systematic evaluation of the psychometric properties of self-reported quality-of-life instruments used with adults after stroke suggests that validity across tools should not be assumed. Clinicians and researchers alike may use findings to help identify the most valid and reliable measurement instrument for understanding the impact of stroke on patient-reported quality of life.

Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation-A systematic review.

INTRODUCTION: This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. METHODS: 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. RESULTS: 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). CONCLUSIONS: The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014013190.

Stroke self-management and the role of self-efficacy.

PURPOSE: This study explored the impact of a 12-week stroke self-management program on occupational performance, the role of self-efficacy on improving occupational performance and the potential barriers and facilitators to self-efficacy as reported by clients and careers. MATERIALS AND METHODS: Participants (n = 40) were recruited to participate in a self-management program after admission to hospital with diagnosis of stroke. A pre-post study was conducted and data were obtained from participants using: the Canadian Occupational Performance Measure, Stroke Self-efficacy Questionnaire, and semi-structured interviews with five participants and two careers. Data analysis was conducted using parametric statistics and thematic analysis. RESULTS: Significant improvements were observed in occupational performance (t = 11.2; p = 0.001) and satisfaction (t = 9.7; p = 0.001). Self-efficacy was shown to be a significant mediator to improvements in occupational performance (F = 7.08; p < 0.01) and satisfaction (F = 6.52; p = 0.02). Three key barriers and facilitators emerged from the thematic analysis: "Support in making the transition home," "Getting back to normal," and "Reflecting on shared experiences." CONCLUSIONS: Engagement in a stroke-specific self-management program can improve client-perceived occupational performance and satisfaction. Self-efficacy was shown to be a mediating variable to occupational performance improvements. Future research should explore further the facilitatory strategies of self-efficacy during stroke self-management programs to maximize rehabilitation outcomes.Implications for rehabilitationMulti-modal self-management programs are recommended as effective for improving client-perceived occupational performance of people who have experienced stroke.Returning to valued occupations, goal setting, shared experiences, and local support are recommended components of a self-management program for stroke survivors.Focusing on enhancing client confidence, competence, and self-efficacy is recommended to achieve occupational performance gains through self-management.Occupational therapy coaching is recommended to guide participants through the self-management processes of goal-setting, shared problem-solving, performance evaluation, and reflection.

A systematic review of the psychometric properties of the Action Research Arm Test in neurorehabilitation.

BACKGROUND/AIM: The Action Research Arm Test (ARAT) measures upper limb activity limitations in people with acquired brain injuries. Evidence relating to the use of this test in neurorehabilitation is scattered. This review identifies, rates and synthesises evidence on the original 1981 ARAT use within neurorehabilitation. Psychometric properties are reviewed, including specific examination of participants with upper limb spasticity. METHODS: Systematic review of published articles describing psychometric properties and/or use of the original version of the ARAT in neurorehabilitation. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy, reporting and methodological checklist with criterion-based appraisal of quality criteria for good measurement properties were applied. A best evidence synthesis for each psychometric property was completed. RESULTS: In 28 included studies, participants had suffered a stroke or traumatic brain injury, with 46% >6 months post-injury. Six studies identified participants with upper limb spasticity. Methodological quality of psychometric properties ranged from poor to excellent. Best evidence synthesis determined moderate positive evidence for using the ARAT with people without limb spasticity: intra-rater reliability (ICC 0.71 (95% CI 0.53-0.89) to 0.99 (95% CI 0.98, 0.99)); responsiveness (ROC curve 0.72-0.88, SRM 0.89); and regarding construct validity, it is a valid measure of activity limitation. Limited evidence for psychometric properties of the ARAT were found when used with people with upper limb spasticity for construct validity and responsiveness (ES 0.55-0.78). Gaps in evidence were found for inter and test-retest reliability, measurement error, content validity, structural validity, floor and ceiling effects. CONCLUSIONS: The ARAT is an appropriate measure of activity limitation post-stroke and should be considered for use with people with TBI; evidence for people with upper limb spasticity is limited. Gaps and mixed limited to moderate evidence for psychometric properties in neurorehabilitation mean further research is required.

A systematic review protocol to evaluate the psychometric properties of measures of function within adult neuro-rehabilitation.

BACKGROUND: Spasticity in the upper limb is common after acquired brain impairment and may have a significant impact on the ability to perform meaningful daily activities. Traditionally, outcome measurement in spasticity rehabilitation has focused on impairment, however, improvements in impairments do not necessarily translate to improvements in an individual's ability to perform activities or engage in life roles. There is an increasing need for outcome measures that capture change in activity performance and life participation. METHODS/DESIGN: We will conduct a systematic review of the psychometric properties of instruments used to measure upper limb functional outcomes (activity performance and participation) in patients with spasticity. Assessments (n = 27) will be identified from a recently published systematic review of assessments that measure upper limb function in neurological rehabilitation for adults with focal spasticity, and a systematic review of each assessment will then be conducted. The databases MEDLINE, CINAHL and EMBASE will be searched from inception. Search strategies will include the name of the assessment and the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) published search strategy for identifying studies of measurement properties. The methodological rigour of the testing of the psychometric quality of instruments will be undertaken using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. International Classification of Functioning, Disability and Health (ICF) definitions of impairment, activity and participation will be used for content analysis of items to determine the extent to which assessments are valid measures of activity performance and life participation. We will present a narrative synthesis on the psychometric properties and utility of all instruments and make recommendations for assessment selection in practice. DISCUSSION: This systematic review will present a narrative synthesis on the psychometric properties and utility of assessments used to evaluate function in adults with upper limb focal spasticity. Recommendations for assessment selection in practice will be made which will aid clinicians, managers and funding bodies to select an instrument fit for purpose. Importantly, appropriate assessment selection will provide a mechanism for capturing how applicable to everyday life the outcomes from individualised rehabilitation programs for the upper limb really are. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014013190.

The effectiveness of psychosocial interventions for cognitive dysfunction in cancer patients who have received chemotherapy: a systematic review.

BACKGROUND: Chemotherapy-related cognitive dysfunction (CRCD) refers to problems with memory, attention span, or concentration, experienced by patients with cancer who have had chemotherapy. CRCD can have a significant negative effect on a patient's quality of life. The exact cause of CRCD is unknown but is presumed to be multifactorial. OBJECTIVE: To conduct a systematic review of the effectiveness of psychosocial interventions designed to treat CRCD. METHODS: Participants of interest to the review were over 18 years of age, diagnosed with cancer, and receiving chemotherapy or had received chemotherapy in the past. Interventions of interest were methods to improve cognitive function. Included study designs were randomized controlled trials, quasi-experimental trials, and quantitative observational studies. The primary outcome of interest was level of cognitive function. A three-step search strategy was utilized to identify studies published from 1985 to 2011 from a wide range of databases. Joanna Briggs Institute systematic review methods were used but findings were analyzed using the Cochrane Collaboration Review Manager 5.1 program. Weighted mean differences with 95% confidence intervals were calculated from the continuous data. RESULTS: Searching identified 3,109 potentially relevant articles and 120 full-text articles were retrieved. Two further papers were sourced from reference lists of retrieved articles. From 122 papers, six were suitable for critical appraisal and six were included in the analysis. Meta-analysis was conducted on two cognitive behavioral therapy (CBT) trials for the outcome of inability to concentrate. Significant effect was seen for one CBT intervention at 20 weeks (p = .004). Significant effect from CBT on quality of life was seen at 6-month follow-up (p < .05). CONCLUSIONS: Despite some evidence of an effect, there is insufficient evidence at this stage to strongly recommend any of the interventions to assist in decreasing the effects of CRCD, except in terms of improving quality of life.

Effectiveness of psychosocial interventions for cognitive dysfunction in cancer patients who have received chemotherapy: a systematic review.

BACKGROUND: Chemotherapy related cognitive dysfunction is a condition experienced by patients with cancer who have had chemotherapy. It may cause problems with memory, attention span and/or concentration, which can have a significant negative effect on the patient's quality of life. The exact cause of chemotherapy related cognitive dysfunction is unknown but is presumed to be multifactorial. To date, there is limited research available testing the effectiveness of non-pharmacological treatments for chemotherapy related cognitive dysfunction, despite widespread acceptance that the phenomenon exists, and as yet no meta-analysis has been conducted. OBJECTIVES: To assess the effectiveness of psychosocial interventions designed to treat chemotherapy related cognitive dysfunction. INCLUSION CRITERIA: Participants were over 18, diagnosed with cancer and either currently receiving chemotherapy or had received chemotherapy as part of their treatment.The interventions of interest were methods to improve cognitive function and included cognitive behavioural therapy, psychological counselling and/or education on compensatory mechanisms for managing chemotherapy related cognitive dysfunction.Randomised controlled trials, clinical trials, quasi-experimental and other quantitative research designs were considered for inclusion.The primary outcome of interest was level of cognitive dysfunction, as measured by any reliable and validated scale. Secondary outcome was quality of life, again measured by a valid and reliable tool. SEARCH STRATEGY: A three-step search strategy was utilised to identify published and non-published studies, dated between January 1985 to May, 2011. METHODOLOGICAL QUALITY: All studies meeting the criteria were retrieved. Two reviewers critically appraised the studies using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. DATA EXTRACTION: Data was extracted from the included papers using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument data extraction form. Two authors were contacted to provide further data. DATA SYNTHESIS: Findings were analysed using the Cochrane Collaboration Review Manager 5.1 program. RESULTS: The search process identified 3109 potentially relevant articles. From this, 120 full articles were retrieved. Two further papers were identified from the reference lists of retrieved articles. From 122 papers, 6 were suitable for critical appraisal. Meta-analysis was conducted on two trials for the outcome of inability to concentrate. CONCLUSIONS: The available evidence on psychosocial interventions for chemotherapy related cognitive dysfunction is incomplete. There is some weak evidence to suggest some of the tested interventions may reduce memory and attention problems for some people. A significant positive effect on some Quality of Life measures was shown. IMPLICATIONS FOR PRACTICE: Symptoms of chemotherapy related cognitive dysfunction can be distressing and limiting to patients and must therefore be acknowledged and validated in a clinical context. There is insufficient strong evidence at this stage to recommend any of the interventions for use in clinical practice. IMPLICATIONS FOR RESEARCH: There is abundant research identifying that the phenomena of chemotherapy related cognitive dysfunction exists, but little research on interventions to improve symptoms. Further good quality research is required to target specific non-pharmacological interventions which will improve patients' quality of life and functional ability.

The Tobacco Addiction Recovery Program: initial outcome findings.

Tobacco addiction is a major cause of excess mortality among individuals with severe mental illness (SMI). This study examined the impact of a brief group intervention developed for individuals with SMI that integrates evidence-based and recovery-oriented strategies to address tobacco addiction. The intervention was found to significantly decrease tobacco use and dependence and increase participants' sense of self-efficacy with respect to resisting the urge to smoke. These preliminary findings indicate that the Tobacco Addiction Recovery Program intervention is an effective, recovery-oriented intervention for tobacco addiction.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review.

BACKGROUND: The admission and assessment of patients for elective procedures is a task faced by all healthcare organisations that provide elective surgical services. Several different strategies have been used to facilitate the management of these tasks. Nurse-led preadmission clinics or services have been implemented in many health services as one of these management strategies; however their effectiveness has not been established. OBJECTIVES: The objective of this review was to examine the available research on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes. INCLUSION CRITERIA: Types of participants The review considered studies that included adult or paediatric patients who were undergoing any type of elective surgical procedure, either as a day-only case or as an inpatient.Types of interventions The review considered studies that evaluated the effect of attending or receiving the services of a nurse-led elective surgery outpatient preadmission or preoperative assessment clinic.Types of outcomes This review considered studies that included the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, preoperative preparation, recognition and fulfilment of postoperative care needs, patient anxiety and reducing the number of overnight stays for day or ambulatory surgery patients.Types of studies The review considered any randomised controlled trials published after 1999; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence regarding the effectiveness of nurse-led preoperative assessment services. EXCLUSION CRITERIA: This review excluded studies of preoperative education as this has been the subject of a previous review. We also excluded studies of emergency admissions. Additionally, studies comparing nurse-led with physician-led preadmission assessments were excluded as that has also been the subject of a previous systematic review. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilised in each component of this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed by two independent reviewers for congruence to the review's inclusion criteria, using a tool developed for the purpose. Methodological validity was assessed by two reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA COLLECTION/EXTRACTION: Data were extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI. DATA SYNTHESIS: Due to the methodological heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. RESULTS: Of the 19 included articles, there were 10 audits of patient and hospital data, 3 surveys or questionnaires, 3 descriptive studies, 1 action research design, 1 prospective observational study and 1 RCT. Five of ten studies reporting data on cancellations rates found that nurse-led preadmission services reduced the number of day-of-surgery cancellations. Non-attendance for surgery was also reduced, with nine studies reporting decreases in the number of patients failing to attend. Eight studies reporting data on patient or parent satisfaction found high levels of satisfaction with nurse-led preadmission services. Three of four studies investigating the effect of the nurse-led preadmission service on patient anxiety found a reduction in reported anxiety levels. Three studies found that preoperative preparation was enhanced by the use of a nurse-led preadmission service. CONCLUSIONS: While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low, and further research is needed. IMPLICATIONS FOR PRACTICE: Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety, however currently the evidence level is low. IMPLICATIONS FOR RESEARCH: Currently the overall level of evidence regarding nurse-led preadmission services is low and further more rigorous studies are required for all the examined outcomes. There is little evidence regarding the effect of this intervention on length of stay, mortality rates and morbidity, and therefore more research is needed on the effect of nurse-led preadmission services on these important outcomes.

Effect of a vocationally-focused brief cognitive behavioural intervention on employment-related outcomes for individuals with mood and anxiety disorders.

Despite an increasing emphasis on the importance of vocational success to the quality of life of individuals with mental illness (Bond, Drake, & Becker, 2008), minimal work has examined the impact of cognitive behavioural interventions that focus on vocational stressors. Vocational stressors commonly faced by persons with mental illness include difficulties with work task completion, obtaining employment, and coping with interpersonal stressors (Becker et al., 1998). The purpose of this pilot study was to examine the effectiveness of a brief cognitive behavioural therapy group intervention that targets vocational stressors for individuals whose vocational functioning had been significantly impacted by mental illness. Participants included 16 individuals with mood and anxiety disorder diagnoses. After this intervention, it was found that employed persons reported an improved sense of mastery in the completion of work tasks, improved satisfaction with work supervision, and decreased satisfaction with advancement and job security. Unemployed participants reported improved expectancy for employment success.