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1.
Brain Inj ; 38(4): 316-329, 2024 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-38318794

RESUMO

INTRODUCTION: Over 100 million people worldwide live with disabilities resulting from an acquired brain injury (ABI). ABI survivors experience cognitive and physical problems and require support to resume an active life. They can benefit from support from someone who has been through the same issues (i.e. peer mentor). This review investigated the effectiveness of peer mentoring for ABI survivors. METHOD: Eleven databases, two trial registers, and PROSPERO were searched for published studies. Two reviewers independently screened all titles, abstracts, and full texts, extracted data, and assessed quality. The PRISMA 2020 guidelines were followed to improve transparency in the reporting of the review. RESULTS: The search returned 4,094 results; 2,557 records remained after the removal of duplicates and 2,419 were excluded based on titles and abstracts. Of the remaining 138, 12 studies met the inclusion criteria. Five were conducted in the United States, three in Canada, three in the UK, and one in New Zealand. Meta-analysis was inappropriate due to the heterogeneity of study designs. Therefore, a narrative synthesis of the data was undertaken. CONCLUSION: Although peer mentoring has the potential to positively influence activity and participation among ABI survivors, further research is needed to understand the extent of the benefits.


Assuntos
Lesões Encefálicas , Tutoria , Humanos , Mentores , Grupo Associado , Sobreviventes
2.
JASA Express Lett ; 4(2)2024 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-38341684

RESUMO

This study examines the lateral biases in tongue movements during speech production. It builds on previous research on asymmetry in various aspects of human biology and behavior, focusing on the tongue's asymmetric behavior during speech. The findings reveal that speakers have a pronounced preference toward one side of the tongue during lateral releases with a majority displaying the left-side bias. This lateral bias in tongue speech movements is referred to as tonguedness. This research contributes to our understanding of the articulatory mechanisms involved in tongue movements and underscores the importance of considering lateral biases in speech production research.


Assuntos
Fala , Língua , Humanos , Medida da Produção da Fala , Testes de Articulação da Fala
3.
Disabil Rehabil ; : 1-8, 2023 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-37395345

RESUMO

PURPOSE: Returning to work is an important goal after stroke, not only as a recovery indicator but also for facilitating independent living and improved social identity. The aim of this study was to explore the lived experiences of vocational rehabilitation and the return to work pathway after stroke. METHOD: Qualitative data were collected through semi-structured interviews with purposively selected participants who had participated in a vocational rehabilitation trial. All participants were employed at the time of their stroke and were community-living. Interviews were undertaken by occupational therapists and were transcribed verbatim before data were thematically analysed using a framework approach. RESULTS: Sixteen participants were interviewed, seven received specialist vocational rehabilitation and nine received usual clinical rehabilitation. Three major themes were identified which highlighted the importance of tailored vocational rehabilitation to address the challenges that arise when returning to the workplace. Stroke survivors perceived the most beneficial components of the specialist vocational rehabilitation intervention to be employer liaison support, fatigue management, and support for cognition and executive processing skills. CONCLUSIONS: Vocational rehabilitation was perceived to provide an opportunity to influence working after stroke, although areas of unmet need were highlighted. Findings provide direction for the development of future stroke-specific vocational rehabilitation programs.


Psychosocial (emotional) and cognitive (memory and planning) changes along with post-stroke fatigue were perceived to be the greatest barriers faced on returning to work and should be key areas for intervention within a vocational rehabilitation program.Vocational rehabilitation interventions should be tailored to each participant, incorporating elements perceived to be important to stroke survivors, including workplace liaison, employer communication and psychological support.Workplaces may benefit from access to information about the range of physical, cognitive and language deficits associated with stroke, and the potential impact these may have on work skills.

4.
Artigo em Inglês | MEDLINE | ID: mdl-36901017

RESUMO

BACKGROUND: Dementia-friendly communities (DFCs) are seen as key to the inclusion and participation of people with dementia and carers. Dementia-friendly initiatives (DFIs) are important building blocks for the growth of DFCs. The collaboration between different stakeholders is a central aspect in developing and sustaining DFIs. AIM: This study tests and refines an initial theory about collaborating for DFIs with special attention for the involvement of people with dementia and their carers during the collaboration for DFIs. The realist approach is used for deepening contextual aspects, mechanisms, outcomes, and its explanatory power. METHODS: A participatory case study design using qualitative data (focus groups, observations, reflections, minutes from meetings, and exit interviews) was executed in four Dutch municipalities that have ambitions to become dementia- friendly communities. RESULTS: The refined theory on the collaboration for DFIs incorporates contextual aspects such as diversity, shared insights, and clarity. It draws attention to the importance of mechanisms such as the recognition of efforts and progress, informal distributed leadership, interdependency, belonging, significance, and commitment. These mechanisms resonate with feeling useful and feeling collectively powerful in the collaboration. The outcomes of collaboration were activation, getting new ideas, and fun. Our findings address how stakeholders' routines and perspectives impact the involvement of people with dementia and their carers during collaboration. CONCLUSION: This study provides detailed information about collaboration for DFIs. The collaboration for DFIs is largely influenced by feeling useful and collectively powerful. Further research is needed to understand how these mechanisms can be triggered with the involvement of people with dementia and their carers in the heart of the collaboration.


Assuntos
Demência , Humanos , Cuidadores , Grupos Focais , Emoções , Projetos de Pesquisa
5.
Artigo em Inglês | MEDLINE | ID: mdl-36498277

RESUMO

BACKGROUND: Following traumatic injury, an informal carer is often required to support recovery. Understanding the impact of caregiving is important to inform intervention design. AIM: to explore the impact of caring on family and caregiver finances, employment, social life, and psychological wellbeing. METHOD: Semi-structured interviews conducted with carers of traumatic injury survivors. Interviews were audio recorded, transcribed and thematically analysed, informed by the Roy Adaptation Model (RAM) and International Classification of Functioning, Disability and Health (ICF). RESULTS: Ten participants were interviewed. Key themes included (1) financial impact/employment issues, (2) relationships and support and (3) psychological impact. Most carers did not receive professional support with daily care post-discharge. Carers' employers responded positively, supporting them even after extensive leave. Carers received inconsistent communication whilst visiting trauma survivors in hospital; carers with healthcare experience were favoured. Navigating and receiving benefits was complex. Some carers found it difficult to accept the trauma survivor's injury, whilst others focused on achieving goals. CONCLUSIONS: Support from professional services is limited outside hospital settings for non-brain injuries. Future interventions and healthcare services should acknowledge the lack of psychological support for carers. Researchers should consider using the ICF/RAM when designing interventions to ensure the full impact on carers is addressed.


Assuntos
Assistência ao Convalescente , Alta do Paciente , Humanos , Cuidadores/psicologia , Sobreviventes , Pesquisa Qualitativa
6.
J Rehabil Assist Technol Eng ; 9: 20556683221117759, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36105910

RESUMO

Introduction: Individuals with acquired brain injury may find it difficult to self-manage and live independently. Brain-in-Hand is a smartphone app designed to support psychological problems and encourage behaviour change, comprised of a structured diary, reminders, agreed solutions, and traffic light monitoring system. Aim: To evaluate the potential use and effectiveness of Brain-in-Hand for self-management in adults with acquired brain injury. Methods: A-B mixed-methods case-study design. Individuals with acquired brain injury (n = 10) received Brain-in-Hand for up to 12 months. Measures of mood, independence, quality of life, cognition, fatigue, goal attainment, participation administered at baseline, 6 and 12 months. Semi-structured interviews conducted with acquired brain injury participants (n = 9) and healthcare workers (n = 3) at 6 months. Results: Significant increase in goal attainment after 6 months use (t(7) = 4.20, p = .004). No significant improvement in other outcomes. Qualitative data suggested improvement in anxiety management. Contextual (personal/environmental) factors were key in influencing the use and effectiveness of Brain-in-Hand. Having sufficient insight, appropriate support and motivation facilitated use. Conclusions: Brain-in-Hand shows potential to support acquired brain injury, but further work is required to determine its effectiveness. Context played a pivotal role in the effectiveness and sustained use of Brain-in-Hand, and needs to be explored to support implementation.

7.
BMJ Open ; 12(3): e060294, 2022 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-35361654

RESUMO

OBJECTIVES: This study aimed to: (1) understand the context for delivering a trauma vocational rehabilitation (VR) intervention; (2) identify potential barriers and enablers to the implementation of a VR intervention post-trauma. DESIGN: Qualitative study. Data were collected in person or via phone using different methods: 38 semistructured interviews, 11 informal 'walk-through care pathways' interviews, 5 focus groups (n=25), 5 codesign workshops (n=43). Data were thematically analysed using the framework approach, informed by the Consolidated Framework for Implementation Research. SETTING: Stakeholders recruited across five UK major trauma networks. PARTICIPANTS: A variety of stakeholders were recruited (n=117) including trauma survivors, rehabilitation physicians, therapists, psychologists, trauma coordinators and general practitioners. We recruited 32 service users (trauma survivors or carers) and 85 service providers. RESULTS: There were several issues associated with implementing a trauma VR intervention including: culture within healthcare/employing organisations; extent to which healthcare systems were networked with other organisations; poor transition between different organisations; failure to recognise VR as a priority; external policies and funding. Some barriers were typical implementation issues (eg, funding, policies, openness to change). This study further highlighted the challenges associated with implementing a complex intervention like VR (eg, inadequate networking/communication, poor service provision, perceived VR priority). Our intervention was developed to overcome these barriers through adapting a therapist training package, and by providing early contact with patient/employer, a psychological component alongside occupational therapy, case coordination/central point of contact, and support crossing sector boundaries (eg, between health/employment/welfare). CONCLUSIONS: Findings informed the implementation of our VR intervention within the complex trauma pathway. Although we understand how to embed it within this context, the success of its implementation needs to be measured as part of a process evaluation in a future trial.


Assuntos
Atenção à Saúde , Reabilitação Vocacional , Grupos Focais , Humanos , Pesquisa Qualitativa , Reino Unido
8.
Work ; 72(1): 303-313, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35431210

RESUMO

BACKGROUND: Supporting people with multiple sclerosis (MS) at work can be challenging due to the unpredictable nature and myriad of disease-related symptoms, and issues related to the work environment. OBJECTIVE: To explore, amongst people with MS in employment, their experiences of and need for vocational rehabilitation (VR), and perceived barriers and facilitators to implementing VR. METHODS: We conducted 20 semi-structured interviews with people with MS, employers, and healthcare professionals. Interviews were audio-recorded, transcribed, and analysed using the framework method. RESULTS: We identified nine themes reflecting the main MS symptoms (e.g. cognition, fatigue), and environmental factors such as support provided at work (e.g. change of working hours) and workplace characteristics. Providing support tailored to the individual's needs and early intervention were seen as important attributes for the intervention. The barriers identified referred to lack of resources and confidentiality issues; however, having flexibility in the content and delivery of the intervention were seen as facilitators. CONCLUSION: The impact of environmental factors (e.g. attitudes towards disability) on employment difficulties is equal to or greater than disease-related factors. Environmental changes in the attitudes of co-workers and workplace flexibility can enable people with MS to remain in work for longer.


Assuntos
Pessoas com Deficiência , Esclerose Múltipla , Pessoas com Deficiência/reabilitação , Emprego , Humanos , Esclerose Múltipla/complicações , Reabilitação Vocacional , Local de Trabalho
9.
Artigo em Inglês | MEDLINE | ID: mdl-34574670

RESUMO

BACKGROUND: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists (CPs), and explored factors affecting delivery and acceptability in a feasibility study. METHODS: Surveys pre- (5 OTs, 2 CPs) and post-training (3 OTs, 1 CP); interviews pre- (5 OTs, 2 CPs) and post-intervention (4 trauma survivors, 4 OTs, 2 CPs). Mean survey scores for 14 theoretical domains identified telerehabilitation barriers (score ≤ 3.5) and facilitators (score ≥ 5). Interviews were transcribed and thematically analysed. RESULTS: Surveys: pre-training, the only barrier was therapists' intentions to use telerehabilitation (mean = 3.40 ± 0.23), post-training, 13/14 domains were facilitators. Interviews: barriers/facilitators included environmental context/resources (e.g., technology, patient engagement, privacy/disruptions, travel and access); beliefs about capabilities (e.g., building rapport, complex assessments, knowledge/confidence, third-party feedback and communication style); optimism (e.g., impossible assessments, novel working methods, perceived importance and patient/therapist reluctance) and social/professional role/identity (e.g., therapeutic methods). Training and experience of intervention delivery addressed some barriers and increased facilitators. The intervention was acceptable to trauma survivors and therapists. CONCLUSION: Despite training and experience in intervention delivery, some barriers remained. Providing some face-to-face delivery where necessary may address certain barriers, but strategies are required to address other barriers.


Assuntos
Reabilitação Vocacional , Telerreabilitação , Humanos , Terapeutas Ocupacionais , Inquéritos e Questionários , Sobreviventes
10.
Artigo em Inglês | MEDLINE | ID: mdl-33669750

RESUMO

Returning to work after traumatic injury can have a range of benefits, but there is currently little research that incorporates patient perspectives to identify outcomes of vocational rehabilitation interventions that are important to survivors. Trauma survivors (n = 17) participated in in-depth semi-structured interviews or focus groups exploring outcomes that were important to them for recovery and return to work. Data were analysed using thematic analysis. Participants identified a range of outcomes that they considered important and necessary to facilitate a successful and sustainable return to work: physical and psychological recovery, purposeful life engagement, managing expectations of recovery, managing expectations about return to work, and employers' expectations. Our participants advocated for a multifaceted and biopsychosocial understanding of recovery and outcomes that need to be captured for vocational rehabilitation interventions. Implications for practice and research are discussed, and recommendations are given based on the findings.


Assuntos
Reabilitação Vocacional , Retorno ao Trabalho , Grupos Focais , Humanos , Sobreviventes
11.
Clin Rehabil ; 35(5): 750-764, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33222497

RESUMO

OBJECTIVE: To identify where and how trauma survivors' rehabilitation needs are met after trauma, to map rehabilitation across five UK major trauma networks, and to compare with recommended pathways. DESIGN: Qualitative study (interviews, focus groups, workshops) using soft-systems methodology to map usual care across trauma networks and explore service gaps. Publicly available documents were consulted. CATWOE (Customers, Actors, Transformation, Worldview, Owners, Environment) was used as an analytic framework to explore the relationship between stakeholders in the pathway. SETTING: Five major trauma networks across the UK. SUBJECTS: 106 key rehabilitation stakeholders (service providers, trauma survivors) were recruited to interviews (n = 46), focus groups (n = 4 groups, 17 participants) and workshops (n = 5 workshops, 43 participants). INTERVENTIONS: None. RESULTS: Mapping of rehabilitation pathways identified several issues: (1) lack of vocational/psychological support particularly for musculoskeletal injuries; (2) inconsistent service provision in areas located further from major trauma centres; (3) lack of communication between acute and community care; (4) long waiting lists (up to 12 months) for community rehabilitation; (5) most well-established pathways were neurologically focused. CONCLUSIONS: The trauma rehabilitation pathway is complex and varies across the UK with few, if any patients following the recommended pathway. Services have developed piecemeal to address specific issues, but rarely meet the needs of individuals with multiple impairments post-trauma, with a lack of vocational rehabilitation and psychological support for this population.


Assuntos
Procedimentos Clínicos , Necessidades e Demandas de Serviços de Saúde , Reabilitação Vocacional , Apoio Social , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/reabilitação , Grupos Focais , Humanos , Pesquisa Qualitativa , Centros de Traumatologia , Reino Unido
12.
BMC Musculoskelet Disord ; 21(1): 607, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912199

RESUMO

BACKGROUND: Work problems are common in people with inflammatory arthritis. Up to 50% stop work within 10 years due to their condition and up to 67% report presenteeism (i.e. reduced work productivity), even amongst those with low disease activity. Job retention vocational rehabilitation (JRVR) may help prevent or postpone job loss and reduce presenteeism through work assessment, work-related rehabilitation and enabling job accommodations. This aims to create a better match between the person's abilities and their job demands. The objectives of the Workwell trial are to test the overall effectiveness and cost-effectiveness of JRVR (WORKWELL) provided by additionally trained National Health Service (NHS) occupational therapists compared to a control group who receive self-help information both in addition to usual care. METHODS: Based on the learning from a feasibility trial (the WORK-IA trial: ISRCTN76777720 ), the WORKWELL trial is a multi-centre, pragmatic, individually-randomised parallel group superiority trial, including economic evaluation, contextual factors analysis and process evaluation. Two hundred forty employed adults with rheumatoid arthritis, undifferentiated inflammatory arthritis or psoriatic arthritis (in secondary care), aged 18 years or older with work instability will be randomised to one of two groups: a self-help written work advice pack plus usual care (control intervention); or WORKWELL JRVR plus a self-help written work advice pack and usual care. WORKWELL will be delivered by occupational therapists provided with additional JRVR training from the research team. The primary outcome is presenteeism as measured using the Work Limitations Questionnaire-25. A comprehensive range of secondary outcomes of work, health, contextual factors and health resource use are included. Outcomes are measured at 6- and 12- months (with 12-months as the primary end-point). A multi-perspective within-trial cost-effectiveness analyses will also be conducted. DISCUSSION: This trial will contribute to the evidence base for provision of JRVR to people with inflammatory arthritis. If JRVR is found to be effective in enabling people to keep working, the findings will support decision-making about provision of JRVR by rheumatology teams, therapy services and healthcare commissioners, and providing evidence of the effectiveness of JRVR and the economic impact of its implementation. TRIAL REGISTRATION: Clinical Trials.Gov: NCT03942783 . Registered 08/05/2019 ( https://clinicaltrials.gov/ct2/show/NCT03942783 ); ISRCTN Registry: ISRCTN61762297 . Registered:13/05/2019 ( http://www.isrctn.com/ISRCTN61762297 ). Retrospectively registered.


Assuntos
Artrite Psoriásica , Artrite Reumatoide , Adolescente , Adulto , Análise Custo-Benefício , Humanos , Estudos Multicêntricos como Assunto , Presenteísmo , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação Vocacional , Medicina Estatal
13.
Disabil Rehabil ; 42(10): 1359-1372, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-30508491

RESUMO

Purpose: Rebuilding one's life after stroke is a key priority persistently identified by patients yet professionally led interventions have little impact. This co-design study constructs and tests a novel peer-led coaching intervention to improve post-stroke leisure and general social participation.Methods: This study followed the principles of co-design by actively engaging and harnessing the knowledge of stroke survivors in order to develop and test a peer-lead coaching intervention. Phase 1 assessed function, mood, and involvement in leisure and social activities 6 months following stroke (n = 79). Phase 2 involved semi-structured, in-depth interviews with 18 stroke survivors, and 10 family carers to explore experiences related to social and leisure participation. Phase 3 tested the co-designed peer-led coaching intervention. Data collected also included co-design feedback sessions and a training workshop with selected peer coaches and in addition, interviews with stroke survivors and their peer coaches at two time-points: following the training program (n = 5) and delivery of the intervention (n = 2).Results: A peer-coaching intervention was successfully co-designed and tested combining the use of lay knowledge sociocognitive and self-regulatory theories with principles of transformational leadership theory. Both peers and stroke survivors reported having benefited at a personal level.Conclusions: This study reports on an innovative community-based and peer-led intervention and its results have generated new evidence on how stroke survivors engage with and respond to peer coaching support. It further provides a theoretical platform for designing and implementing peer interventions. Hence, these results have the potential to inform the development of future peer coaching intervention not only for stroke rehabilitation but also for a wide range of chronic conditions.Implications for rehabilitationThe results of this co-design study, if replicated and extended, provide a theoretical framework to guide rehabilitation professionals about the optimal timing of peer-coaching interventions and contextual factors that need to be taken into account.Applying transformational leadership theory principles to the training of peers may prove useful at the time of the implementation of a coaching intervention.Peer-led coaching interventions, which are community-based and tailored to stroke survivors at the time of discharge, may help support re-engagement in social and leisure activities.


Assuntos
Tutoria , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Cuidadores , Humanos , Sobreviventes
14.
Clin Rehabil ; 33(11): 1705-1712, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31353940

RESUMO

OBJECTIVE: This review aimed to determine the effectiveness of personal smart technologies on outcomes in adults with acquired brain injury. DATA SOURCES: A systematic literature search was conducted on 30 May 2019. Twelve electronic databases, grey literature databases, PROSPERO, reference list and author citations were searched. METHODS: Randomised controlled trials were included if personal smart technology was used to improve independence, goal attainment/function, fatigue or quality of life in adults with acquired brain injury. Data were extracted using a bespoke form and the TIDieR checklist. Studies were graded using the PEDro scale to assess quality of reporting. Meta-analysis was conducted across four studies. RESULTS: Six studies met the inclusion criteria, generating a total of 244 participants. All studies were of high quality (PEDro ⩾ 6). Interventions included personal digital assistant, smartphone app, mobile phone messaging, Neuropage and an iPad. Reporting of intervention tailoring for individual needs was inconsistent. All studies measured goal attainment/function but none measured independence or fatigue. One study (n = 42) reported a significant increase in memory-specific goal attainment (p = 0.0001) and retrospective memory function (p = 0.042) in favour of the intervention. Another study (n = 8) reported a significant increase in social participation in favour of the intervention (p = 0.01). However, our meta-analyses found no significant effect of personal smart technology on goal attainment, cognitive or psychological function. CONCLUSION: At present, there is insufficient evidence to support the clinical benefit of personal smart technologies to improve outcomes in acquired brain injury. Researchers need to conduct more randomised studies to evaluate these interventions and measure their potential effects/harms.


Assuntos
Lesões Encefálicas/reabilitação , Computadores de Mão , Aplicativos Móveis , Objetivos , Humanos , Memória , Participação Social
15.
Birth Defects Res ; 111(2): 41-52, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30537250

RESUMO

The aerodigestive and communicative behaviors of anencephalic and hydranencephalic patients are assessed from literature sources and are compared with documented neural structures present in the brainstem, subcortical, and cortical regions of the brain. Much of the data analyzed corroborate previous neurological studies, which focus on central pattern generators and development in model organisms. However, findings suggest that further research is necessary to determine which components of these systems support these behaviors. A low reporting rate of behavior in tandem with pathology is observed throughout the literature. More data pairing behavior and pathology is recommended, both in the interest of understanding the relationship between neural structures and functions, and to provide clinicians with more information about a patient's signs and symptoms. Potential clinical practices are recommended to increase documentation about patients within this population.


Assuntos
Anencefalia/patologia , Hidranencefalia/patologia , Encéfalo/patologia , Comunicação , Deglutição/fisiologia , Ingestão de Alimentos/fisiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neuroimagem/métodos
16.
BMC Med Inform Decis Mak ; 18(1): 33, 2018 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-29848312

RESUMO

BACKGROUND: Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement. METHODS: We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire responses. RESULTS: We engaged with 20 ABI survivors, 5 carers, 25 professionals, 41 questionnaires were completed by stakeholders. Comments made during group discussions were supported by questionnaire results. Enablers included smartphone competency (capability), personalisation of app (opportunity), and identifying perceived need (motivation). Barriers included a physical and cognitive inability to use smartphone (capability), potential cost and reliability of technology (opportunity), and no desire to use technology or change from existing strategies (motivation). The stakeholders identified potential uses and changes to the app, which were not easily mapped onto the behaviour change wheel, e.g. monitoring fatigue levels, method of logging task completion, and editing the diary on their smartphone. CONCLUSIONS: The study identified that both ABI survivors and therapists could see a use for Brain in Hand, but wanted users to be able to personalise it themselves to address individual user needs, e.g. monitoring activity levels. The behaviour change wheel is a useful tool when designing and evaluating engagement activities as it addresses most aspects of implementation, however additional categories may be needed to explore the specific features of assistive technology interventions, e.g. technical functions.


Assuntos
Sintomas Comportamentais/diagnóstico , Lesões Encefálicas/diagnóstico , Aplicativos Móveis , Participação dos Interessados , Telemedicina/métodos , Adolescente , Adulto , Sintomas Comportamentais/etiologia , Lesões Encefálicas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Smartphone , Adulto Jovem
17.
Health Technol Assess ; 22(33): 1-124, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29863459

RESUMO

BACKGROUND: Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. OBJECTIVE: To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. DESIGN: A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. SETTING: Three NHS major trauma centres (MTCs) in England. PARTICIPANTS: Adults with TBI admitted for > 48 hours and working or studying prior to injury. INTERVENTIONS: Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. MAIN OUTCOME MEASURES: Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. RESULTS: Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. LIMITATIONS: Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. CONCLUSIONS: This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. TRIAL REGISTRATION: Current Controlled Trials ISRCTN38581822. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Terapia Ocupacional/organização & administração , Reabilitação Vocacional/economia , Reabilitação Vocacional/métodos , Retorno ao Trabalho , Atividades Cotidianas , Adolescente , Adulto , Análise Custo-Benefício , Inglaterra , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Terapia Ocupacional/economia , Qualidade de Vida , Projetos de Pesquisa , Autoeficácia , Participação Social , Fatores de Tempo , Centros de Traumatologia , Índices de Gravidade do Trauma , Adulto Jovem
18.
Clin Rehabil ; 32(3): 410-418, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28929802

RESUMO

OBJECTIVE: To assess return to work outcomes of major trauma patients treated at a level 1 UK major trauma centre and evaluate factors associated with improved outcomes. DESIGN: Cross-sectional cohort design. SUBJECTS: In total, 99 patients at one, two or three years post-discharge from a Major Trauma Centre with an injury severity score above 9, in full-time work or education prior to injury, aged 18-70 and discharged between April 2012 and June 2015. MAIN MEASURES: Self-report questionnaire including the Trauma Outcome Profile, the Multiple Sclerosis Neuropsychological Screening questionnaire and questions pertaining to work and education. RESULTS: Of the 99 patients in full-time work pre-injury, 65 made a complete return to work, 15 made an incomplete return to work and 19 did not return to work, where incomplete return to work was defined as working below 80% of previous working hours. In all, 25 participants scored below the cut-off point on physical disabilities, 46 below the cut-off point on mental functioning and 38 below the cut-off point on social interaction. Reduced anxiety and higher mental functioning were consistently associated with complete return to work. CONCLUSION: In all, 66% of patients with moderate to severe injuries made a complete return to work. A range of psycho-social, physical and functional health issues were persistent at long-term follow-up.


Assuntos
Avaliação da Deficiência , Modalidades de Fisioterapia , Retorno ao Trabalho/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/reabilitação , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Seguimentos , Nível de Saúde , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Pessoa de Meia-Idade , Fatores de Tempo , Centros de Traumatologia/organização & administração , Resultado do Tratamento , Reino Unido , Adulto Jovem
19.
BMC Musculoskelet Disord ; 18(1): 315, 2017 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-28732491

RESUMO

BACKGROUND: Inflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working. The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written advice about managing work problems. To help plan a randomized controlled trial, we tested screening, recruitment, intervention delivery, response rates, applicability of the control intervention and identified the relevant primary outcome. METHODS: A feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support services, assistive technology, work modifications, psychological and disclosure support, workplace visits and employer liaison. RESULTS: Fifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = -12.4 (SD 13.2); control = -2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status, indicating proof of concept. The preferred primary outcome measure was the WLQ, a presenteeism measure. CONCLUSIONS: This brief job retention VR is a credible and acceptable intervention for people with inflammatory arthritis with concerns about continuing to work due to arthritis. TRIAL REGISTRATION: ISRCTN 76777720 . Registered 21.9.12.


Assuntos
Absenteísmo , Artrite/epidemiologia , Artrite/reabilitação , Presenteísmo , Reabilitação Vocacional/métodos , Adulto , Artrite/diagnóstico , Emprego/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Presenteísmo/métodos , Reino Unido/epidemiologia
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