Browsing by Person "Bulley, Catherine"

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25. Upper limb morbidity after treatment for breast cancer: A cross-sectional study of lymphedema and function
(2012-11) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Tan, Chee-Wee; Barber, Matthew; Breast Cancer Institute
Introduction: This study explored the prevalence of impaired upper limb function (ULF) and lymphoedema (LO) after breast cancer treatment, their relationships with each other, quality of life, and with patient/treatment characteristics.
A critical review of the validity of measuring stages of change in relation to exercise and moderate physical activity
(2007) Bulley, Catherine; Donaghy, Marie; Payne, A.; Mutrie, N.
Many professionals are integrally involved in the promotion of exercise and physical activity, for specific therapeutic purposes, and with the aim of improving population health and quality of life. Design and evaluation of intervention strategies are frequently underpinned by the Transtheoretical Model, a process-oriented approach to behaviour change. One component of this model is the stage of change structure, which describes a person's behaviour in the context of a change process. It is frequently used to assess current levels of exercise or physical activity participation, and as a measure of change in behaviour following intervention. This paper discusses the importance of validity in the assessment of stages of change for exercise and physical activity. Various different scales exist and have been investigated for validity using comparisons with self-reported outcome measures and physiological markers of activity. Generally, comparative data provide evidence of stage hierarchies relating to both exercise and physical activity. However, this does not establish actual levels of activity represented by stage allocation, limiting its applicability. Further appropriately designed comparisons with objective measures are required if the stage of change structure is to be applied as a meaningful, accurate and sensitive tool for the measurement of physical activity and exercise.
A mixed methods service evaluation of a pilot functional electrical stimulation clinic for the correction of dropped foot in patients with chronic stroke
(Cambridge University Press, 2011-07-29) Shiels, J.; Wilkie, K.; Bulley, Catherine; Smith, Stephen; Salisbury, Lisa
Aim To undertake a service evaluation of the pilot Lothian functional electrical stimulation (FES) clinic using both quantitative and qualitative methods and clinical practice reflection. Background Clinical guidelines recommend that FES, for the management of dropped foot after stroke, is delivered by a specialist team. However, little detail is provided about the structure and composition of the specialist team or model of service delivery. A pilot Lothian FES clinic was developed to explore the clinical value of providing such a service to stroke patients with dropped foot and identify any service modifications. Methods Mixed methods were used to evaluate the service and included quantitative, qualitative and reflective components. Phase 1: Before and after service evaluation of patients attending the FES clinic between 2003 and 2007. Outcomes of gait velocity and cadence were recorded at initial clinic appointment and 6 months after application of FES. Phase 2: Qualitative research exploring patients with stroke and carers' experiences of the FES clinic. Data were collected via semi-structured interviews. Phase 3: A reflection on the service delivery model. Participants: Phase 1: 40 consecutive out-patients with stroke; Phase 2: 13 out-patients with stroke and 9 carers; Phase 3: Three specialist physiotherapists engaged in running the FES clinic. Findings Statistically significant improvements (p < 0.001) were demonstrated in gait velocity and cadence. Qualitatively, one super-ordinate theme 'The FES clinic met my needs' emerged. Within this were four sub-themes, namely 1. 'Getting to grips with FES wasn't difficult'; 2. 'It's great to know they're there'; 3. 'Meeting up with others really helps' and 4. 'The service is great but could be better'. On reflection, minor modifications were made to the service delivery model but overall the service met user needs. This dedicated FES clinic produced positive physical outcomes and met the needs of this chronic stroke population.
A Morbidity Screening Tool for identifying fatigue, pain, upper limb dysfunction and lymphedema after breast cancer treatment: A validity study
(Elsevier, 2013-11-15) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Barber, Matthew; Tan, Chee-Wee
Purpose: This study aimed to investigate validity of a newly developed Morbidity Screening Tool (MST) to screen for fatigue, pain, swelling (lymphedema) and arm function after breast cancer treatment. Methods: A cross-sectional study included women attending reviews after completing treatment (surgery, chemotherapy and radiotherapy), without recurrence, who could read English. They completed the MST and comparator questionnaires: Disability of the Arm, Shoulder and Hand questionnaire (DASH), Chronic Pain Grade Questionnaire (CPGQ), Lymphedema and Breast Cancer Questionnaire (LBCQ) and Functional Assessment of Cancer Therapy questionnaire with subscales for fatigue (FACT F) and breast cancer (FACT B + 4). Bilateral combined shoulder ranges of motion were compared (upward reach; hand behind back) and percentage upper limb volume difference (%LVD =/>10% diagnosed as lymphedema) measured with the vertical perometer (400T). Results: 613 of 617 participants completed questionnaires (mean age 62.3 years, SD 10.0; mean time since treatment 63.0 months, SD 46.6) and 417 completed objective testing. Morbidity prevalence was estimated as 35.8%, 21.9%, 19.8% and 34.4% for fatigue, impaired upper limb function, lymphedema and pain respectively. Comparing those self-reporting the presence or absence of each type of morbidity, statistically significant differences in comparator variables supported validity of the MST. Statistically significant correlations resulted between MST scores focussing on impact of morbidity, and comparator variables that reflect function and quality of life. Conclusion: Analysis supports the validity of all four short-forms of the MST as providing indications of both presence of morbidity and impacts on participants' lives. This may facilitate early and appropriate referral for intervention. 2013 Elsevier Ltd. All rights reserved.
A needs assessment of lymphoedema services in Fife and resulting recommendations
(Wounds UK, 2007) Bulley, Catherine
Lymphoedema is a chronic condition that leads to reduced quality of life through its negative impacts on physical, psychological, and social aspects of health. Limb swelling leads to discomfort and pain, reduced movement and function, and acute inflammatory episodes. Individuals experience altered body image and self-esteem impacting on social interaction. There is evidence that specialist management of the condition leads to improved quality of life. Concern regarding the adequacy of lymphoedema services led to the commissioning of a needs assessment by the Core Cancer Review Group in Fife, Scotland. The needs assessment used a variety of methods. Current services were located through consultation of known providers and databases. Existing databases were analysed to find out the number of people requiring the service: hospital admissions and diagnoses were analysed alongside a survey of primary practices in Fife. Access to existing services was explored through a telephone survey of referrers (n _ 44), and qualitative interviews with five service providers and five clients. At the time of the study, non-palliative National Health Service (NHS) provision consisted of one part-time clinician; the service provided was under pressure from rapidly increasing referrals.However, consensus from referrers, providers, and clients indicated that there were obstacles to achieving diagnosis and referral, especially for those with non-cancer-related lymphoedema. This was primarily due to poor referrer awareness of the condition, its management, and existing services, for example, only seven per cent of those surveyed would refer to existing specialist services. Delayed referral is a significant issue, as prompt intervention leads to more positive treatment outcomes. As a result of the needs assessment, recommendations were made to increase staffing levels, promote awareness of the condition and related services, and improve geographical and multidisciplinary coordination of the service.
A project to qualitatively evaluate an exercise programme for wheelchair users with MS: an opportunity for clinically-based student research?
(2008-09-27) Galante, Claudia; Bulley, Catherine; Hooper, Julie
This presentation will describe a clinical/academic research collaboration via each team member's project 'journey'. A programme of monthly exercise classes, intended to facilitate maintenance of physical function of wheelchair-dependent people with MS, was developed and piloted by Julie Hooper at an out-patients physiotherapy gym. The MS Society Edinburgh branch part-funded the classes. Formal independent evaluation of the pilot programme was required. A focus group study to explore the six participants' experiences was proposed and registered with NHS Lothian R&D by Julie Hooper. Discussion between her and Cathy Bulley highlighted the possibility of the study being carried out as a supervised student project, both to provide necessary evaluation rigour and offer the opportunity for a student to gain qualititative research skills in a clinical environment. Claudia Galante conducted the focus group and wrote up the results for her dissertation. Key findings demonstrated the strong desire of the group to be more physically active, and multiple benefits to their quality-of-life. Dissemination of the findings is underway to help inform future service provision for this population. This project represented a very successful pilot of clinically-based dissertations that benefitted all parties; more such collaborations are now being planned.
A prospective qualitative exploration of views about attending pulmonary rehabilitation
(Wiley, 2009-02-04) Bulley, Catherine; Donaghy, Marie; Howden, Stella; Salisbury, Lisa; Whiteford, Suzanne; Mackay, Elaine
Background and Purpose. Pulmonary rehabilitation has been found to be an effective strategy for managing chronic obstructive pulmonary disease (COPD). However, attendance at such programmes is not optimal, therefore, this study aimed to develop an in-depth understanding of views regarding attendance at pulmonary rehabilitation and experiences which may have shaped these views. Methods. An inductive qualitative study was carried out within the framework of Interpretative Phenomenological Analysis. Five female and four male individuals with COPD who had been referred for pulmonary rehabilitation participated in semi-structured interviews. Interviews were conducted prior to participation in pulmonary rehabilitation. Results. Three main themes were identified that related to views about attending pulmonary rehabilitation. The first is entitled Desired benefits of attending pulmonary rehabilitation, which described realistic hopes about impact on daily life. The second theme was called Evaluating the threat of exercise, and it encompassed both positive and negative evaluations; some interviewees described fear and avoidance of exercise, while others were determined to overcome symptoms. These attitudes extended to views about pulmonary rehabilitation. The third theme was called Attributing value to pulmonary rehabilitation. Contrasting opinions about the value of attending pulmonary rehabilitation appeared to be influenced by the nature of prior interactions with health personnel and systems as well as information about the programme provided at referral. The referrer's attitude towards pulmonary rehabilitation appeared to be particularly influential. Conclusion. In summary, when considering rehabilitation attendance, potential participants are able to identify possible benefits, but previous experiences of symptoms and attitudes towards their condition can influence views both positively and negatively. Information and enthusiasm conveyed by the referring clinician, as well as previous interactions with health professionals can have powerful impact on views about attending. Referral practices should be informative and enthusiastic to increase the likelihood of uptake. Copyright 2009 John Wiley & Sons, Ltd.
A protocol for the development of professional competencies: the SPA Project
(2005) Bulley, Catherine; Donaghy, Marie
After the stroke': Patients' and carers' experiences of healthcare after stroke in Scotland
(Blackwell Publishing, 2010) Salisbury, Lisa; Wilkie, K.; Bulley, Catherine; Shiels, J.
We report findings on patients with stroke and carers experiences of the healthcare system in Scotland after stroke. These findings emerged from data collected in a primary qualitative study exploring patients with stroke and carers perception of a Functional Electrical Stimulation (FES) Clinic. Rich data emerged in relation to healthcare after stroke as experienced by both patients and carers, highlighting important clinically relevant messages and constituting an important area for dissemination. Thirteen patients with stroke and nine carers consented to participate. Data were collected using face-to-face semi-structured interviews, undertaken in April and May 2007, and analysed using the framework of Interpretative Phenomenological Analysis (IPA). IPA aims to explore in depth the participants lived experiences of a specific phenomenon. An overarching theme of 'After the stroke' was identified. Within this, six sub-themes emerged entitled, (1) 'What is wrong?'; (2) 'Help came quickly'; (3) 'Something is still wrong'; (4) 'In the hospital'; (5) 'I'm taking them home' and (6) 'Back at home'. Interestingly, patients with stroke and carers recalled similar parts of the pathway through the healthcare system after stroke, resulting in the six chronological sub-themes. The data highlighted issues surrounding recognition of stroke symptoms by both participants and professionals; expeditious admission to hospital and stroke unit; consultation during the discharge planning process and access to support and community follow up. Despite the availability of clinical guidelines to direct the management of stroke, this study suggests that the experiences of patients with stroke and carers do not always concur with guideline recommendations. These results highlight that such recommendations do not always transfer into clinical practice. Both clinicians and service managers should consider these issues when delivering care to patients after stroke.
An investigation into the minimum accelerometry wear time for reliable estimates of habitual physical activity and definition of a standard measurement day in pre-school children.
(IOP Science, 2014-11) Hislop, Jane; Law, James; Rush, Robert; Grainger, Andrew; Bulley, Catherine; Reilly, John J.; Mercer, Tom
The purpose of this study was to determine the number of hours and days of accelerometry data necessary to provide a reliable estimate of habitual physical activity in pre-school children. The impact of a weekend day on reliability estimates was also determined and standard measurement days were defined for weekend and weekdays. Accelerometry data were collected from 112 children (60 males, 52 females, mean (SD) 3.7 (0.7)yr) over 7 d. The Spearman-Brown Prophecy formula (S-B prophecy formula) was used to predict the number of days and hours of data required to achieve an intraclass correlation coefficient (ICC) of 0.7. The impact of including a weekend day was evaluated by comparing the reliability coefficient (r) for any 4 d of data with data for 4 d including one weekend day. Our observations indicate that 3 d of accelerometry monitoring, regardless of whether it includes a weekend day, for at least 7 h d-1 offers sufficient reliability to characterise total physical activity and sedentary behaviour of pre-school children. These findings offer an approach that addresses the underlying tension in epidemiologic surveillance studies between the need to maintain acceptable measurement rigour and retention of a representatively meaningful sample size.
Are physiotherapy guidelines for the management of osteoporosis being implemented? A UK-wide survey.
(Taylor & Francis Ltd, 2009-07-11) Bulley, Catherine; Donaghy, Marie; Dow, C.
The availability of increasing amounts of research has led to the development of clinical guidelines to facilitate evidence-based decisions. However, effective implementation must be evaluated. A survey was carried out to evaluate a clinical guideline for osteoporosis, endorsed by the Chartered Society of Physiotherapy (CSP). A stratified proportional sample of 588 relevant National Health Service providers was selected from Strategic Health Authorities/Health Boards throughout the UK. Random samples of 31 independent hospitals and 102 private practitioners were obtained from lists of seven UK-based service providers and the CSP website. One hundred and twenty further surveys were sent through the clinical interest group, AGILE. The survey was developed to investigate awareness and use of the clinical guideline, current implementation strategies and barriers to implementation. Of the clinical sites sampled, 25% responded, giving 243 usable surveys. While guidelines were available in 62% of responding sites, only 35% reported its use - although this was higher in services with a primary osteoporosis caseload (45%). Only 6% reported formal implementation. Barriers to guideline use frequently highlighted a lack of resources and training. Survey responses indicate a lack of guideline use; this should be facilitated through formal implementation strategies, requiring training and resources.
Being person‐centred in community and ambulatory services
(Wiley-Blackwell, 2021-02) Dickson, Caroline; Peelo‐Kilroe, Lorna; McCormack, Brendan; McCance, Tanya; Bulley, Catherine; Brown, Donna; McMillan, Ailsa; Martin, Suzanne
Carer experiences of life after stroke - a qualitative analysis.
(2010) Bulley, Catherine; Shiels, J.; Wilkie, K.; Salisbury, Lisa
Aims and objectives. Carers' experiences of caring for a stroke survivor were explored, including reactions and changes in their lives. Method. A phenomenological approach was taken to the collection and analysis of data. Semi-structured interviews lasting an average of 43 min were carried out with nine informal carers in their own homes. All were married to someone who had survived a stroke. Results. An overarching theme emerged, entitled: 'lives turned upside-down'. It took time for participants to understand the long-term impacts of stroke. Carers experienced increased caring and domestic workloads alongside reduced participation and altered expectations of life. They found emotional and cognitive changes in their partners particularly distressing, and would have valued more information and help with adjusting to the increased emotional, physical and cognitive workload of caring. Conclusions. It is important to support carers of people who have survived a stroke in adjusting to their changed lifestyles. This may affect their quality of life as well as sustainability of caring, and requires further research.
Chapter 6: Professionalism and practising professionally
(Wiley, 2020-12) Gibson, Caroline; MacDonald, Kath; Deirdre O’Donnell; McCormack, Brendan; McCance, Tanya; Bulley, Catherine; Brown, Donna; McMillan, Ailsa; Martin, Suzanne
Classifying Outcome Measures According to the International Classification of Functioning, Disability and Health: a Pilot Study.
(2009-11-25) Williamson, Julia; Bulley, Catherine; Coutts, Fiona; Macmillan, Fiona
at which level of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF) (WHO 2001) a selection of low back pain outcome tools measure. The ICF describes several categories of impact, those on body systems, activity, participation in life roles as well as environmental and personal factors. These categories can be used to relate an outcome measure to the level of the intervention. The results of a study may be compromisedif the outcome measure does not correspond to the level of intervention. For example, a treatment designed to reduce pain should be measured by a tool that measures at a body systems level while an intervention designed to improve return to work needs to measure at the participation level. In order to conduct a trial examining the effects of rehabilitation strategies after lumbar surgery it has been necessary to examine the qualities of commonly used low back pain outcome measures in light of the ICF. Confusion exists as to whether the entities of activity and participation are separate (Dahl 2002). Several attempts have been made to distinguish between the two but as yet, no consensus exists (Granlund2004). It was therefore necessary to define activity and participation and to validate this with a group of qualified health practitioners. J Williamson, C Bulley, F. Coutts, F. MacMillan
Collaborating to advocate for patients through research
(2008-03-27) Bulley, Catherine
Commencing taught post-qualifying education: barriers facing physiotherapists. Oral presentation at the World Confederation of Physical Therapy Congress, Vancouver, 2-6/06/2007
(Elsevier Science B.V. Amsterdam, 2007) Glover, Peter; Bulley, Catherine
PURPOSE: The aim of this study was to explore the personal perspectives of physiotherapists regarding their perceived barriers to commencing taught physiotherapy-related Master's level study(MLS). RELEVANCE: With rapidly increasing knowledge there is a requirement for continuing professional development to enable evidence-based practice. Taught MLS provides guidance in this development; greater understanding of barriers facing physiotherapists in undertaking MLS will enable facilitation in clinical and educational environments. PARTICIPANTS: A purposive sample of 9 volunteers (8 female, 1 male, mean age: 36 7.29) was recruited. Participants were: engaged in part-time taught MLS; registered with the United Kingdom's professional regulatory body; working within the National Health Service, and possessed a minimum of four years clinical experience. METHODS: A qualitative, interpretative, phenomenological study was undertaken with the assumption that reality is individual and all viewpoints are valid. Following ethical approval, individual, semi-structured interviews (mean time: 67 minutes) were conducted using an interview schedule. Questions were derived from a literature review and two developmental interviews with Master's graduates. ANALYSIS: Interviews were transcribed verbatim and a summary was member-checked to ensure that initial interpretations were appropriate. Data analysis was conducted using the framework of interpretative phenomenological analysis. This focuses on analysis and interpretation of the participants' words in context to gain deeper understanding of their experiences. Quotations that communicated similar meanings and ideas were grouped to form themes. Where conceptual links were identified, key themes emerged. Peer verification of this analysis was conducted to increase rigour and involved reflexive discussions with an experienced qualitative researcher. RESULTS: Three key themes emerged that described the barriers to MLS in different environments: educational, working, and social. There were several barriers associated with the educational environment; participants frequently expressed self-doubt regarding academic abilities, often related to past educational experiences. They also described negative emotions due to unfamiliarity with the environment and content of MLS. These seemed particularly strong amongst participants who were only qualified to diploma level, as they felt their previous education did not prepare them for MLS. Barriers associated with the working context included a lack of professional support, especially in relation to funding and study leave. These led to social barriers as clinicians were anxious about having insufficient time and finances to fulfil their social roles. CONCLUSIONS: The experiences of this group of post-qualifying students suggest that clinicians who have not previously studied at degree level may face greater barriers to commencing MLS than those with a degree, due to self-doubt and unfamiliarity with higher education. Prior to commencing their study participants had perceived the experience of MLS as potentially threatening, and were concerned about the time and financial resource implications. Further exploratory research into how to effectively address the barriers highlighted in this study is required. IMPLICATIONS: The perceived barriers to MLS communicated by this group of physiotherapists may be reduced by improving links between clinical and educational environments, thereby increasing familiarity and enabling discussion of the resources required for MLS. This may lead to greater professional and financial support for qualified physiotherapists who wish to commence MLS.
Comparison of Accelerometry Cut Points for Physical Activity and Sedentary Behavior in Preschool Children: A Validation Study
(Human Kinetics, 2012-11) Hislop, Jane; Bulley, Catherine; Mercer, Tom; Reilly, J. J.
This study compared accelerometry cut points for sedentary behavior, light and moderate to vigorous intensity activity (MVPA) against a criterion measure, the Children's Activity Rating Scale (CARS), in preschool children. Actigraph accelerometry data were collected from 31 children (4.4 0.8 yrs) during one hour of free-play. Video data were coded using the CARS. Cut points by Pate et al., van Cauwenberghe et al., Sirard et al. and Puyau et al. were applied to calculate time spent in sedentary, light and MVPA. Repeated-measures ANOVA and paired t tests tested differences between the cut points and the CARS. Bland and Altman plots tested agreement between the cut points and the CARS. No significant difference was found between the CARS and the Puyau et al. cut points for sedentary, light and MVPA or between the CARS and the Sirard et al. cut point for MVPA. The present study suggests that the Sirard et al. and Puyau et al. cut points provide accurate group-level estimates of MVPA in preschool children.
Comparison of breast cancer-related lymphedema (Upper Limb Swelling) prevalence estimated using objective and subjective criteria and relationship with quality of life
(Hindawi, 2013-05) Bulley, Catherine; Gaal, S.; Coutts, Fiona; Blyth, Christine; Jack, W.; Chetty, U.; Barber, M.; Tan, Chee-Wee
This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95-10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema. 2013 Catherine Bulley et al.
Comparison of epoch and uniaxial versus triaxial accelerometers in the measurement of physical activity in preschool children: a validation study
(Human Kinetics, 2012-08) Hislop, Jane; Bulley, Catherine; Mercer, Tom; Reilly, J. J.
The objectives of this study were to explore whether triaxial is more accurate than uniaxial accelerometry and whether shorter sampling periods (epochs) are more accurate than longer epochs. Physical activity data from uniaxial and triaxial (RT3) devices were collected in 1-s epochs from 31 preschool children (15 males, 16 females, 4.4 0.8 yrs) who were videoed while they engaged in 1-hr of free-play. Video data were coded using the Children's Activity Rating Scale (CARS). A significant difference (p < .001) in the number of minutes classified as moderate to vigorous physical activity (MVPA) was found between the RT3 and the CARS (p < .002) using the cut point of relaxed walk. No significant difference was found between the GT1M and the CARS or between the RT3 and the CARS using the cut point for light jog. Shorter epochs resulted in significantly greater overestimation of MVPA, with the bias increasing from 0.7 mins at 15-s to 3.2 mins at 60-s epochs for the GT1M and 0 mins to 1.7 mins for the RT3. Results suggest that there was no advantage of a triaxial accelerometer over a uniaxial model. Shorter epochs result in significantly higher number of minutes of MVPA with smaller bias relative to direct observation.