Browsing by Person "Pollock, A."

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A new taxonomy of current physiotherapy treatment approaches, developed with a stakeholder group, enables clinically relevant evidence synthesis within a Cochrane systematic review.
(Wiley, 2013-12) Baer, Gill; Campbell, P.; Morris, J.; Choo, P-L; Forster, A.; Pollock, A.
Introduction:-Clear, clinically relevant taxonomies of complex rehabilitation interventions are essential to enable objective evidence synthesis within systematic reviews. Classifications of current physiotherapy treatment approaches are generally inadequately defined, difficult to apply objectively, and lack universal international acceptance or interpretation. We aimed to determine an internationally, clinically relevant taxonomy of physiotherapy treatment approaches using language and terminology agreed by physiotherapists and stroke survivors. Method:-We systematically extracted descriptions of physiotherapy approaches from the trials currently included in the Cochrane review, and from foreign-language trials listed as 'awaiting assessment'. We convened a stakeholder group, comprising 13 purposively selected stroke survivors, carers and physiotherapists. Nominal group techniques were used to reach consensus decisions. The group debated the treatment components described within the trials of physiotherapy approaches, reached consensus on key types of intervention components, agreed descriptions of components and determined categorisation for synthesis of evidence within an update of a Cochrane review. Results:-84% of the stakeholder group agreed that the current categories were no longer clinically relevant. 27 intervention components were identified and described from the intervention components described within 31 trials. These were grouped into categories of: functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary interventions, assistive devices and modalities. 100% of the stakeholder group agreed with these intervention component descriptions and categories. Conclusion:-A clinically relevant taxonomy of physiotherapy intervention components has been agreed, and will be used to categorise evidence within a major update of a Cochrane systematic review of physiotherapy treatment approaches.
Challenges in integrating international evidence relating to stroke rehabilitation: experiences from a Cochrane systematic review
(Wiley, 2014-12) Pollock, A.; Campbell, P.; Baer, Gill; Choo, P-L; Forster, A.; Morris, J.; Pomeroy, V. M.; Langhorne, P.
There are many randomized controlled trials relating to stroke rehabilitation being carried out in China, which are often published in Chinese-language journals. A recent update to our Cochrane systematic review of physical rehabilitation to improve function and mobility after stroke included 96 trials; over half (51) were conducted in China; 37 of these included studies were published in Chinese. Analyses within this Cochrane review support the conclusion that physical rehabilitation, using a mix of components from different approaches, is effective for the recovery of function and mobility after stroke. The inclusion of the Chinese studies had a substantial impact on the volume of evidence and, consequently, the conclusions. In this paper, we explore whether it is appropriate to draw implications for clinical practice throughout the world from evidence relating to a complex rehabilitation intervention delivered within one particular geographical healthcare setting. We explore the unique challenges associated with incorporating the body of evidence from China, particularly the Chinese-language publications, and identify the ongoing debate about the quality of Chinese research publications. We conclude that the growing body of evidence from China has important implications for future systematic reviews and evidence-based stroke care, but analysis and interpretation raise challenges, and improved reporting is critical.
Content of physical Rehabilitation interventions: Can we generalise from Chinese trials to other geographical regions?
(Wiley, 2014-11) Pollock, A.; Baer, Gill; Campbell, P.; Choo, P-L; Langhorne, P.; Morris, J.; Pomeroy, V. M.; Forster, A.
Physical rehabilitation approaches for the recovery of function and mobility following stroke
(The Cochrane Collaboration, 2014-04-22) Pollock, A.; Baer, Gill; Campbell, P.; Choo, P-L; Forster, A.; Morris, J.; Pomeroy, V. M.; Langhorne, P.
Physical rehabilitation approaches for the recovery of function and mobility following stroke. A major update.
(2014-10) Pollock, A.; Baer, Gill; Campbell, P.; Choo, P-L; Forster, A.; Morris, J.; Pomeroy, V.; Langhorne, P.
Objectives We aimed to determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess whether any one physical rehabilitation approach is more effective than any other approach. Methods A stakeholder group, comprising stroke survivors, caregivers, and physiotherapists, made decisions using consensus-making techniques relating to the scope and focus of this updated review.1 We performed a comprehensive search (to December 2012),1 including randomized controlled trials of physical rehabilitation approaches in adult stroke survivors. Interventions comprised a range of philosophically different approaches to promote recovery of function or mobility. Randomized controlled trials of single specific treatments were excluded. Outcomes analyzed were independence in activities of daily living, motor function, balance, gait, and length of stay. Two reviewers independently applied selection criteria, assessed risk of bias and extracted data. We calculated standardized mean differences (SMD) using a random effects model.
Physiotherapy treatment approaches following stroke: major update of Cochrane systematic review of evidence
(Wiley, 2013-12) Pollock, A.; Campbell, P.; Morris, J.; Forster, A.; Pomeroy, V.; Langhorne, P. P.; Baer, Gill
Introduction:-Physiotherapists traditionally base stroke rehabilitation practice on global 'approaches' (e.g. Bobath and Motor Learning approaches). A 2007 Cochrane systematic review explored the effect of different physiotherapy approaches for stroke, but failed to include all foreign-language (particularly Chinese) trials. We aim to update this Cochrane review, restructuring to incorporate all current international evidence relating to effectiveness of physiotherapy treatment approaches. Method:-Our Cochrane review update is based on searches of electronic databases (including CENTRAL, MEDLINE, EMBASE, CINAHL, AMED) from 2005-December 2012. Foreign-language abstracts have been translated. Two independent reviewers applied selection criteria with disagreements resolved by a third reviewer. Two review authors will independently categorise the interventions within identified trials, document methodological quality, and extract data. Cochrane risk of bias tool will be used to assess methodological quality. Data from included studies will be pooled within meta-analyses, calculating standardised mean differences and 95% confidence intervals, using a random-effects model, for disability, motor impairment and participation outcomes. Results:-(June 2013) We considered 11,576 titles, screened 592 abstracts and included 75 new RCTs (n-=-896, plus 13 awaiting assessment). 49/75 RCTs were completed in China. 38/75 RCTs compare a physical rehabilitation approach with no rehabilitation. Our updated review synthesises evidence from 95 trials (n-=-10,048). Data extraction is ongoing and meta-analyses will be completed by October 2013. Conclusion:-This major Cochrane review update substantially increases the volume of evidence, with trials including over 10,000 participants, providing the most comprehensive, up-to-date synthesis of international evidence relating to the effect of physiotherapy treatment approaches after stroke.
Physiotherapy Treatment Approaches for Stroke
(2008) Pollock, A.; Baer, Gill; Langhorne, P.; Pomeroy, V. M.
There are several different approaches to physiotherapy treatment after stroke. These can broadly be divided into approaches that are based on neurophysiological, motor learning, or orthopaedic principles. Some physiotherapists base their treatment on a single approach, whereas others use a mixture of components from a number of different approaches. The practical application of these approaches can result in substantial differences in patient treatment. At present, the Bobath Approach, based on neurophysiological principles, probably remains the most widely used approach in the Western world.1-5 However, there is a lack of convincing evidence to support any specific physiotherapy treatment approach.3,6 This systematic review aims to assess the effects of physiotherapy treatment if it is based on orthopaedic, motor learning, or neurophysiological principles, or on a mixture of these treatment principles.
Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke
(The Cochrane Collaboration, 2003) Pollock, A.; Baer, Gill; Pomeroy, V. M.; Langhorne, P.; Pollock, A.
Background There are a number of different approaches to physiotherapy treatment following stroke that, broadly speaking, are based on neurophysiological, motor learning and orthopaedic principles. Some physiotherapists base their treatment on a single approach, while others use a mixture of components from a number of different approaches. Objectives To determine if there is a difference in the recovery of postural control and lower limb function in patients with stroke if physiotherapy treatment is based on orthopaedic or neurophysiological or motor learning principles, or on a mixture of these treatment principles. Search strategy We searched the Cochrane Stroke Group Trials Register (last searched May 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and CINAHL (1982 to May 2005). We contacted experts and researchers with an interest in stroke rehabilitation. Selection criteria Randomised or quasi-randomised controlled trials of physiotherapy treatment approaches aimed at promoting the recovery of postural control and lower limb function in adult participants with a clinical diagnosis of stroke. Outcomes included measures of disability, motor impairment or participation. Data collection and analysis Two review authors independently categorised the identified trials according to the inclusion and exclusion criteria, documented their methodological quality, and extracted the data. Main results Twenty-one trials were included in the review, five of which were included in two comparisons. Eight trials compared a neurophysiological approach with another approach; eight compared a motor learning approach with another approach; and eight compared a mixed approach with another approach. A mixed approach was significantly more effective than no treatment or placebo control for improving functional independence (standardised mean difference (SMD) 0.94, 95% confidence intervals (CI) 0.08 to 1.80). There was no significant evidence that any single approach had a better outcome than any other single approach or no treatment control. Authors' conclusions There is evidence that physiotherapy intervention, using a mix of components from different approaches, is significantly more effective than no treatment or placebo control in the recovery of functional independence following stroke. There is insufficient evidence to conclude that any one physiotherapy approach is more effective in promoting recovery of lower limb function or postural control following stroke than any other approach. We recommend that future research should concentrate on investigating the effectiveness of clearly described individual techniques and task-specific treatments, regardless of their historical or philosophical origin.
Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke (Review)
(The Cochrane Collaboration, 2007) Pollock, A.; Baer, Gill; Pomeroy, V. M.; Langhorne, P.
Background There are a number of different approaches to physiotherapy treatment following stroke that, broadly speaking, are based on neurophysiological, motor learning and orthopaedic principles. Some physiotherapists base their treatment on a single approach, while others use a mixture of components from a number of different approaches. Objectives To determine if there is a difference in the recovery of postural control and lower limb function in patients with stroke if physiotherapy treatment is based on orthopaedic or neurophysiological or motor learning principles, or on a mixture of these treatment principles. Search strategy We searched the Cochrane Stroke Group Trials Register (last searchedMay 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and CINAHL (1982 to May 2005). We contacted experts and researchers with an interest in stroke rehabilitation. Selection criteria Randomised or quasi-randomised controlled trials of physiotherapy treatment approaches aimed at promoting the recovery of postural control and lower limb function in adult participants with a clinical diagnosis of stroke. Outcomes included measures of disability, motor impairment or participation. Data collection and analysis Two review authors independently categorised the identified trials according to the inclusion and exclusion criteria, documented their methodological quality, and extracted the data. Main results Twenty-one trialswere included in the review, five ofwhichwere included in two comparisons. Eight trials compared a neurophysiological approach with another approach; eight compared a motor learning approach with another approach; and eight compared a mixed approach with another approach. Amixed approach was significantly more effective than no treatment or placebo control for improving functional independence (standardised mean difference (SMD) 0.94, 95% confidence intervals (CI) 0.08 to 1.80). There was no significant evidence that any single approach had a better outcome than any other single approach or no treatment control. Authors' conclusions There is evidence that physiotherapy intervention, using a mix of components from different approaches, is significantly more effective than no treatment or placebo control in the recovery of functional independence following stroke. There is insufficient evidence to conclude that any one physiotherapy approach is more effective in promoting recovery of lower limb function or postural control following stroke than any other approach. We recommend that future research should concentrate on investigating the effectiveness of clearly described individual techniques and task-specific treatments, regardless of their historical or philosophical origin. Plain language summary Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke Physiotherapy, using a mix of components from different treatment approaches, appears best for promoting functional independence following stroke; no single physiotherapy approach is clearly best for promoting recovery after stroke. A stroke interrupts the blood flow to the brain, often leading to damage to some brain functions. This can cause paralysis of some parts of the body or other difficulties with various physical functions. Physiotherapy is an important part of rehabilitation for people who have had a stroke. A number of physiotherapy approaches have been developed based on different ideas about how people recover after a stroke. This review of 21 trials found there is no evidence that any one approach was clearly better than another for improving leg strength, balance, walking speed or the ability to perform everyday tasks. However, physiotherapy using a mixture of components from the different approaches was better than no treatment or placebo treatment for improving aspects of function following a stroke.
Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review
(2007-05) Pollock, A.; Baer, Gill; Langhorne, P.; Pomeroy, V. M.
Objectives: To determine whether there is a difference in global dependency and functional independence in patients with stroke associated with different approaches to physiotherapy treatment. Data sources: We searched the Cochrane Stroke Group Trials Register (last searched May 2005), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2005), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and CINAHL (1982 to May 2005). We contacted experts and researchers with an interest in stroke rehabilitation. Review methods: Inclusion criteria were: (a) randomized or quasi-randomized controlled trials; (b) adults with a clinical diagnosis of stroke; (c) physiotherapy treatment approaches aimed at promoting postural control and lower limb function; (d) measures of disability, motor impairment or participation. Two independent reviewers categorized identified trials according to the inclusion/exclusion criteria, documented the methodological quality and extracted the data. Results: Twenty trials (1087 patients) were included in the review. Comparisons included: neurophysiological approach versus other approach; motor learning approach versus other approach; mixed approach versus other approach for the outcomes of global dependency and functional independence. A mixed approach was significantly more effective than no treatment control at improving functional independence (standardized mean difference (SMD) 0.94, 95% confidence interval (CI) 0.08 to 1.80). There were no significant differences found for any other comparisons. Conclusions: Physiotherapy intervention, using a 'mix' of components from different 'approaches' is more effective than no treatment control in attaining functional independence following stroke. There is insufficient evidence to conclude that any one physiotherapy 'approach' is more effective in promoting recovery of disability than any other approach.
Simultaneous bilateral training for improving arm function after stroke
(Wiley, 2009) Coupar, Fiona; van Wijck, Frederike; Morris, J.; Pollock, A.; Langhorne, P.
This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effects of simultaneous bilateral training for improving arm function after stroke compared with: (1) usual care; (2) other specific upper limb interventions or programmes; (3) placebo or no intervention. Questions to be answered (1) Is simultaneous bilateral training more effective at improving arm function than usual care, in patients with upper limb impairment after stroke? (2) Is simultaneous bilateral training more effective at improving arm function than other specific upper limb interventions or programmes, in patients with upper limb impairment after stroke? (3) Is simultaneous bilateral training more effective at improving arm function than placebo or no intervention in patients with upper limb impairment after stroke?
Using the nominal group technique to engage stakeholders with experience of stroke in a Cochrane systematic review of physiotherapy treatment approaches.
(Wiley, 2013-12) Campbell, P.; Baer, Gill; Morris, J.; Forster, A.; Pollock, A.
Introduction:-It has been recommended that people affected by a healthcare condition are actively involved in systematic reviews; ensuring completed reviews are clinically relevant. We aimed to engage stroke survivors, carers and physiotherapists in a Cochrane systematic review of physiotherapy treatment approaches for patients with stroke. Method:-We convened a stakeholder group, comprising 13 purposively selected stroke survivors, carers and physiotherapists. Nominal group techniques were used to reach consensus decisions around review aims and methods, focusing on clinical relevance. The group specifically discussed the categorisation of interventions and inclusion of evidence from a number of international trials, and voted on two key statements: A.-The current categories are appropriate and clinically relevant-; B.-These international trials should be included in our review of physiotherapy treatment approaches-. The proportion agreeing with each statement was determined. Consensus decision meetings were audio-recorded and transcribed verbatim. Qualitative data were coded and analysed using NVivo software. Results:-84% of group members disagreed with statement A. 100% agreed with statement B. Two key themes, and several sub-themes, emerged from transcribed data. Key themes were: (1) current intervention categories should be amended to enable inclusion of all international evidence; (2) there are limitations with current physiotherapy taxonomies and concerns surrounding the relevance to clinical practice in the UK. Conclusion:-Involving key stakeholders in a Cochrane systematic review of physiotherapy treatment approaches for patients with stroke has influenced decisions around the scope and format of the review, and ensured relevance and accessibility of the output.