Browsing by Person "Mead, Gillian"

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A qualitative theory guided analysis of stroke survivors' perceived barriers and facilitators to physical activity
(2014-10) Nicholson, Sarah L.; Donaghy, Marie; Johnston, Marie; Sniehotta, Falko F.; van Wijck, Frederike; Johnston, Derek; Greig, Carolyn; McMurdo, Marion E. T.; Mead, Gillian
Purpose: After stroke, physical activity and physical fitness levels are low, impacting on health, activity and participation. It is unclear how best to support stroke survivors to increase physical activity. Little is known about the barriers and facilitators to physical activity after stroke. Thus, our aim was to explore stroke survivors' perceived barriers and facilitators to physical activity. Methods: Semi-structured interviews with 13 ambulatory stroke survivors exploring perceived barriers and facilitators to physical activity post stroke were conducted in participants' homes, audio-recorded and transcribed verbatim. The Theoretical Domains Framework (TDF) informed content analysis of the interview transcripts. Results: Data saturation was reached after interviews with 13 participants (median age of 76 years (inter-quartile range (IQR) = 69-83 years). The median time since stroke was 345 d (IQR = 316-366 d). The most commonly reported TDF domains were "beliefs about capabilities", "environmental context and resources" and "social influence". The most commonly reported perceived motivators were: social interaction, beliefs of benefits of exercise, high self-efficacy and the necessity of routine behaviours. The most commonly reported perceived barriers were: lack of professional support on discharge from hospital and follow-up, transport issues to structured classes/interventions, lack of control and negative affect. Conclusions: Stroke survivors perceive several different barriers and facilitators to physical activity. Stroke services need to address barriers to physical activity and to build on facilitators to promote physical activity after stroke.
Delirium in acute stroke: A survey of screening and diagnostic practice in Scotland
(Hindawi Publishing Corporation, 2013-07-13) Carin-Levy, Gail; Nicol, Kath; van Wijck, Frederike; Mead, Gillian
Aims to survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland, and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data and content analysis was used to interpret free text responses. Results Sixty five responses were logged (30% return rate). 48% of respondents reported they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium and 32% stated they combined clinical judgment with a standardised tool. 28% of clinicians reported they used The Confusion Assessment Method however, only 13.5% felt it was suitable for stroke patients. Conclusions Screening for delirium is inconsistent in Scottish stroke services and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.
Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review.
(springer verlag, 2012-08) Carin-Levy, Gail; Mead, Gillian; Nicol, Kath; Rush, Robert; van Wijck, Frederike
Delirium is a common complication in acute stroke yet there is uncertainty regarding how best to screen for and diagnose delirium after stroke. We sought to establish how delirium after stroke is identified, its incidence rates and factors predicting its development. We conducted a systematic review of studies investigating delirium in acute stroke. We searched The Cochrane Collaboration, MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, British Nursing Index, PEDro and OT Seeker in October 2010. A total of 3,127 citations were screened, full text of 60 titles and abstracts were read, of which 20 studies published between 1984 and 2010 were included in this review. The methods most commonly used to identify delirium were generic assessment tools such as the Delirium Rating Scale (n = 5) or the Confusion Assessment Method (n = 2) or both (n = 2). The incidence of delirium in acute stroke ranged from 2.3-66%, with our meta-analysis random effects approach placing the rate at 26% (95% CI 19-33%). Of the 11 studies reporting risk factors for delirium, increased age, aphasia, neglect or dysphagia, visual disturbance and elevated cortisol levels were associated with the development of delirium in at least one study. The outcomes associated with the condition are increased morbidity and mortality. Delirium is found in around 26% of stroke patients. Difference in diagnostic and screening procedures could explain the wide variation in frequency of delirium. There are a number of factors that may predict the development of the condition.
Identifying and responding to delirium in acute stroke: Clinical team members’ understandings
(Sage, 2020-09-24) Carin-Levy, Gail; Nicol, Kath; van Wijck, Frederike; Mead, Gillian; McVittie, Chris; Funder: Chest Heart and Stroke Scotland; FundRef: 10.13039/501100007919
Delirium is associated with increased mortality, morbidity and length of hospital stay. In the acute stroke setting, delirium identification is challenging due to the complexity of cognitive screening in this patient group. The aim of this study was to explore how members of interprofessional stroke unit teams identified and responded to a potential delirium in a patient. Online focus groups and interviews utilizing case vignettes were conducted with 15 participants: nurses, occupational therapists, speech and language therapists, and physiotherapists working in acute stroke services. Participants’ understandings of delirium varied, most participants did not identify the symptoms of a possible hypoactive delirium, and nearly all participants discussed delirium symptoms in tentative terms. Aspects of interprofessional working were discussed through the expression of distinct roles around delirium identification. Although participants demonstrated an ethos of person-focused care, there are ongoing challenges involved in early identification and management of delirium in stroke survivors.
Incidence, types and nature of post-stroke pain: Systematic review of literature and meta-analysis [Protocol]
(University of York, 2019-08-27) Ioannou, Antreas; Carin-Levy, Gail; Cheyne, Joshua David; Clarke, David; Cowey, Eileen; Fallon, Marie; Morton, Sarah; Klinkhamer, Laura; Kyriakou, Georgios; Fleetwood-Walker, Susan; Quinn, Terence; Rush, Robert; Sande, Tonje; Smith, Mark; Whalley-Sibley, Heather; Woodfield, Rebecca; Mead, Gillian
To determine the type and nature of post stroke pain, along with frequency and time–to-onset of pain after stroke. Searches Initially a broad systematic search of published literature will be implemented using a comprehensive search strategy developed by the Cochrane Stroke Group Information Specialist. A search filter for identifying observational studies (cross-sectional studies, cohort studies, case-control studies, longitudinal studies) has been adapted from the Observational Studies search filter used by the Scottish Intercollegiate Guidelines Network (SIGN) (https://www.sign.ac.uk/search-filters.html).
Longitudinal changes in muscle strength and mass after acute stroke.
(2006-02) Carin-Levy, Gail; Greig, Carolyn; Young, Archie; Lewis, Susan; Hannan, Jim; Mead, Gillian; The Stroke Association
BACKGROUND: Reduced mobility after stroke may cause a loss of muscle mass which may, in theory, contribute to disability. We investigated longitudinal changes in muscle strength, lean cross-sectional area and muscle mass in all limbs after acute stroke. METHODS: We recruited 17 patients within 72 h of hospital admission and measured (a) hand grip strength, (b) knee extensor strength and (c) arm and leg lean cross-sectional area on 6 occasions over 6 months. Appendicular and total muscle mass (dual-energy X-ray absorptiometry) were measured at 3 weeks and 6 months. RESULTS: There was no significant change over time in the strength, lean cross-sectional area and muscle mass of the arms or legs. We noted that muscle strength was substantially lower in all limbs compared with population norms. CONCLUSION: We found no evidence of a decline in muscle strength or mass in any limb after the stroke, which could have been attributed to reduced mobility. The observed muscle weakness in the ipsilateral side may have pre-dated the stroke.
Properties of pain assessment tools for use in people living with stroke: Systematic review
(2020-08-11) Edwards, Sophie A.; Ioannou, Antreas; Carin-Levy, Gail; Cowey, Eileen; Brady, Marian; Morton, Sarah; Sande, Tonje; Mead, Gillian; Quinn, Terence J.
Background: Pain is a common problem after stroke and is associated with poor outcomes. There is no consensus on the optimal method of pain assessment in stroke. A review of the properties of tools should allow an evidence based approach to assessment. Objectives: We aimed to systematically review published data on pain assessment tools used in stroke, with particular focus on classical test properties of: validity, reliability, feasibility, responsiveness. Methods: We searched multiple, cross-disciplinary databases for studies evaluating properties of pain assessment tools used in stroke. We assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. We used a modified harvest plot to visually represent psychometric properties across tests. Results: The search yielded 12 relevant articles, describing 10 different tools (n=1106 participants). There was substantial heterogeneity and an overall high risk of bias. The most commonly assessed property was validity (eight studies) and responsiveness the least (one study). There were no studies with a neuropathic or headache focus. Included tools were either scales or questionnaires. The most commonly assessed tool was the Faces Pain Scale (FPS) (6 studies). The limited number of papers precluded meaningful meta-analysis at level of pain assessment tool or pain syndrome. Even where common data were available across papers, results were conflicting e.g. two papers described FPS as feasible and two described the scale as having feasibility issues. Conclusion: Robust data on the properties of pain assessment tools for stroke are limited. Our review highlights specific areas where evidence is lacking and could guide further research to identify the best tool(s) for assessing post-stroke pain. Improving feasibility of assessment in stroke survivors should be a future research target.
Staff response to delirium in acute stroke: Knowledge, awareness and barriers to early identication
(Wiley, 2015-10-23) Carin-Levy, Gail; Nicol, Kath; van Wijck, Frederike; Mead, Gillian; McVittie, Chris
Introduction: Delirium is a serious medical complication, which can have adverse effects on patients. Identifying delirium following a stroke can be challenging due to the complexity of cognitive screening. This study explored how multidisciplinary team (MDT) members understand delirium following a stroke and what actions are taken when working with a patient exhibiting delirium symptoms. Method: A grounded theory exploration utilising two online focus groups and email exchanges with nurses, physiotherapists, speech and language and occupational therapists working in acute stroke across Scotland. 2 case vignettes were used to elicit responses: 1 described a stroke patient with hypoactive delirium, the other, a hyperactive delirium. Results: 15 participants from various professional groups were recruited. A minority of participants who received delirium training in the past were able to identify symptoms and suggest relevant screening tools. Most participants struggled to identify a hypoactive delirium, mistaking it for dementia or depression and using more tentative language to discuss delirium symptoms. Participants placed an emphasis on the roles of MDT members as instrumental in working out the clinical picture: nurses saw their role as identifying the biomarkers as well as using a delirium screening tool. Allied health staff tended to defer to nurses and medical staff to take these actions. Discussion: MDT members can struggle to identify delirium in acute stroke, particularly the hypoactive subtype. Education and raising awareness of all MDT members working in stroke units has the potential to increase identication rates and possibly lead to more favourable outcomes for these patients.
The effect of different body positions on anthropometric measurements and derived estimates of body composition
(Smith-Gordon, 2008) Carin-Levy, Gail; Greig, Carolyn; Lewis, Susan; Stewart, A.; Young, Archie; Mead, Gillian
Purpose: Measurement of cross-sectional lean limb area using physical anthropometry is usually performed in the standing position, but sometimes this may be impractical. Our aim was to determine the effect of different positions on cross-sectional lean area of the upper arm, calf and thigh derived from girth and skin-fold measurements. Methods: Twenty healthy volunteers participated. Girth and skin-fold thickness of the upper arm, calf and thigh were measured in the standing, sitting and supine positions. We derived lean cross-sectional area (cm2), and calculated the mean difference, its 95% confidence intervals (CI), and the 95% limits of agreement (LOA) between standing and the other two positions. Results: For the upper arm, mean differences in lean cross-sectional area for the supine-standing and sitting-standing positions were 0.7cm2, (95% CI -0.6 to 2.0) and -0.6cm2, (95% CI -1.4 to 0.3) respectively. Mean differences for thigh were 3.9cm2 (95% CI -2.3 to 10.1) and -4.3cm2 (95% CI -8.6 to 0.0) for supine-standing and sitting-standing respectively. For the calf, mean difference for supine-standing was -3.1cm2 (95% CI -5.3 to -0.9), while for sitting-standing it was 0.3cm2 (95% CI -1.8 to 2.4). The range of values expected to cover agreement for 95% of subjects (LOA) was widest for the thigh and narrowest for the upper arm. Conclusion: In young healthy subjects, lean cross-sectional area differs according to measurement position, particularly for the lower limb. The same measurement method should be used in any one individual when monitoring change.
The psychosocial effects of exercise and relaxation classes for persons surviving a stroke
(Canadian Association of Occupational Therapists, 2009-04) Carin-Levy, Gail; Kendall, Marilyn; Young, Archie; Mead, Gillian
Background. This study was set up to explore unexpected findings emergent from a randomized controlled trial of exercise versus relaxation post-stroke. Purpose. Stroke survivors' experiences of taking part in exercise and relaxation classes were explored. Methods. In-depth, semi-structured interviews carried out with 14 community-dwelling stroke survivors in Edinburgh. The informants previously participated in a randomized exploratory trial of exercise versus relaxation. Findings. The classes motivated participants to take part in other purposeful activities, to continue to practice what they had learned, and/or to attend another class in the community. Class participation also led to an improvement of self-perceived quality of life, specifically, improved confidence, physical ability, psychosocial functioning, and a sense of empowerment. Implications. Taking part in either exercise or relaxation classes after stroke can contribute to improved self-perceived quality of life, improved psychosocial functioning, and improved motivation to take an active role in the recovery process. Rsum Description. Cette tude a t mene en vue d'examiner les rsultats imprvus d'un essai contrl alatoire comportant des sances d'exercice et des sances de relaxation chez des patients ayant subi un accident vasculaire crbral (AVC). But. Les expriences vcues par des survivants d'un AVC ayant particip des sances d'exercice ou des sances de relaxation ont t tudies. Mthodologie. Des entrevues en profondeur semi-structures ont t menes auprs de 14 survivants d'un AVC vivant dans la collectivit Edinburgh. Les informateurs avaient particip auparavant un essai exploratoire alatoire comportant des sances d'exercice et des sances de relaxation. Rsultats. Les sances motivaient les participants participer d'autres activits significatives, continuer de mettre en pratique ce qu'ils avaient appris ou assister d'autres cours dans la communaut. La participation ces sances a galement permis aux participants d'amliorer leur perception face leur qualit de vie, en particulier d'amliorer leur confiance, leurs habilets physiques et leur fonctionnement psychosocial et d'avoir un sentiment de pouvoir sur leur vie. Consquences. La participation des sances d'exercice ou de relaxation la suite d'un AVC peut contribuer l'amlioration de la perception de la qualit de vie, du fonctionnement psychosocial et de la motivation participer activement au processus de rtablissement.