Browsing by Person "Salisbury, Lisa"

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A constructivist grounded theory of staff experiences relating to early mobilisation of mechanically ventilated patients in intensive care
(SAGE, 2022-02-23) Clarissa, Catherine; Salisbury, Lisa; Rodgers, Sheila; Kean, Susanne
Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive care units were collected to understand healthcare staff experiences relating to early mobilisation in mechanical ventilation. Data included observations of mobilisation activities, individual staff interviews and two focus groups with multidisciplinary staff. Managing Risks emerged as the core category and was theorised using the concept of risk. The middle-range theory developed in this study suggests that the process of early mobilisation starts by staff defining patient status and includes a process of negotiating patient safety, which in turn enables performing accountable mobilisation within the dynamic context of an intensive care unit setting.
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 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 rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial
(2014-01-29) Ramsay, Pamela; Salisbury, Lisa; Merriweather, Judith L.; Huby, G.; Rattray, Janice; Hull, Alastair M.; Brett, Stephen J.; Mackenzie, Simon J.; Murray, Gordon D.; Forbes, John F.; Walsh, Timothy S.
Increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause ongoing disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods The intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development.
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.
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.
Determinants of Health-Related Quality of Life After ICU: Importance of Patient Demographics, Previous Comorbidity, and Severity of Illness.
(2018-04-01) Griffith, David M.; Salisbury, Lisa; Lee, Robert J.; Lone, Nazir; Merriweather, Judith L.; Walsh, Timothy S.
ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge. Nested cohort study within a previously published randomized controlled trial. Two ICUs in Edinburgh, Scotland. Adult ICU survivors (n = 240) who required more than 48 hours of mechanical ventilation. None. We prospectively collected data for age, gender, social deprivation (Scottish index of multiple deprivation), preexisting comorbidity (Functional Comorbidity Index), Acute Physiology and Chronic Health Evaluation II score, and days of mechanical ventilation. Health-related quality of life (Medical Outcomes Study Short Form version 2 Physical Component Score and Mental Component Score) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness, and breathlessness) were measured at 3, 6, and 12 months. Mean Physical Component Score and Mental Component Score were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis, increasing pre-ICU comorbidity count was strongly associated with lower health-related quality of life (Physical Component Score _ = -1.56 [-2.44 to -0.68]; p = 0.001; Mental Component Score _ = -1.45 [-2.37 to -0.53]; p = 0.002) and more severe self-reported symptoms. In contrast, Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation days were not associated with health-related quality of life. Older age (_ = 0.33 [0.19-0.47]; p < 0.001) and lower social deprivation (_ = 1.38 [0.03-2.74]; p = 0.045) were associated with better Mental Component Score health-related quality of life. Preexisting comorbidity counts, but not severity of ICU illness, are strongly associated with health-related quality of life and physical symptoms in the year following critical illness.
The development and feasibility of a ward-based physiotherapy and nutritional rehabilitation package for people experiencing critical illness
(SAGE Publications, 2010-04-21) Salisbury, Lisa; Merriweather, Judith; Walsh, Timothy
Objective: To investigate ward-based rehabilitation after critical illness and undertake a pilot study exploring the feasibility of delivering enhanced physiotherapy and nutritional rehabilitation. Design: Service evaluation (part A) and pilot feasibility randomized controlled trial (part B). Setting: Hospital inpatient wards following discharge from intensive care. Participants: Part A involved 24 people with an intensive care stay of four days or more. Part B involved 16 participants randomized into a control (n = 8) or intervention (n = 8) group. Interventions: Part A defined the current ‘standard’ physiotherapy and nutritional interventions. In part B the control group received this ‘standard’ service while the intervention group received this ‘standard’ service plus enhanced rehabilitation. Main measures: Part A collected process outcomes of current interventions and outcomes that included calorie and protein intake and the Rivermead Mobility Index. In part B process outcomes determined differences between groups. Outcomes included those undertaken in part A plus an incremental shuttle test, handgrip dynamometry and visual analogue scales. Results: Part A found low levels of ward-based physiotherapy (walking and transfer practice once per week) and dietetic input (0.8 visits per week). Part B found an increased frequency of both physiotherapy (P = 0.002) and dietetic (P = 0.001) visits in the intervention group. Physical and nutritional outcomes were suitable for use after critical illness, but no statistically significant differences were found between groups. Power calculations indicated 100 participants per group would be required for a definitive study. Conclusions: This feasibility pilot work has informed the design of a larger study to evaluate enhanced rehabilitation following critical illness.
Does treadmill training improve walking after stroke - the long-term follow-up from a phase II randomised controlled trial.
(Wiley, 2009) Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa; Smith, M.
Introduction: A recent Cochrane review has indicated that current evidence for the effectiveness of Treadmill Training (TT) following stroke is inconclusive. This paper reports the 6 month follow up of mobility outcomes from a phase II feasibility randomised-controlled trial investigating an eight week TT programme with ambulant and non-ambulant people with sub-acute stroke. Method: Sub-acute stroke patients within 3 months of stroke onset were recruited from four stroke rehabilitation units. Randomisation based on side of lesion and initial independence or dependence in walking allocated participants to receive either an eight week programme of ''usual physiotherapy'' (control) or physiotherapy including TT (experimental). Mobility outcomes taken at baseline and 6 months after randomisation included: the Modified Rivermead Mobility Index (RMI); Functional Ambulation Classification (FAC); Timed Up and Go (TUG); 10 min walk test (10 mwt); and the 6 min walk test (6 mwt). Results: Seventy-seven participants were recruited, 39 were randomised to control, and 38 to experimental. At 6 months post randomisation, while both groups had improved their mobility scores, Mann-Whitney U-tests showed no significant differences between the groups for RMI (U=481.5; p=0.421); FAC (U=488; p=0.457); TUG (U=204; p=0.678); 10 mwt (U=262; p=0.956) or 6 mwt (U=194.5; p=0.892). Conclusion: The results indicated that while both groups improved their mobility scores from baseline measures, there were no statistically significant differences between the groups at 6 months. The amount and content of ''usual physiotherapy'' and TT is being analysed to determine whether this may be one of the influencing factors.
Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers
(2015-09-15) Harrold, Meg E.; Salisbury, Lisa; Webb, Steve A.; Allison, Garry T.
Introduction: Mobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses. Methods: The objectives of the study were to (1) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs, (2) compare mobilisation practises between Australian and Scottish ICUs and (3) identify barriers to mobilisation in Australian and Scottish ICUs. We conducted a prospective, observational, cohort study with a 4-week inception period. Patients were censored for follow-up upon ICU discharge or after 28 days, whichever occurred first. Patients were included if they were >18 years of age, admitted to an ICU and received mechanical ventilation in the ICU. Results: Ten tertiary ICUs in Australia and nine in Scotland participated in the study. The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery (43.3 %), whereas the Scottish cohort had none. Therefore, comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery. In total, 60.2 % of the 347 patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay (p < 0.001). Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort (hazard ratio 1.83, 95 % confidence interval 1.38-2.42). However, the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort (41.1 % vs 16.3 %, p < 0.001). Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts. Physiological instability and the presence of an endotracheal tube were also frequently reported barriers. Conclusions: This is the first study to benchmark baseline practise of early mobilisation internationally, and it demonstrates variation in early mobilisation practises between Australia and Scotland.
Early mobilisation in mechanically ventilated patients: A systematic integrative review of definitions and activities
(BioMed Central, 2019-01-17) Clarissa, Catherine; Salisbury, Lisa; Rodgers, Sheila; Kean, Susanne
Background: Mechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature. Methods: Whittemore and Knafl’s framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and data-driven thematic analysis was undertaken on verbatim extracts of EM-MV definitions and activities in included studies. Results: Seventy-six studies were included from which four major themes were inferred: (1) non-standardised definition, (2) contextual factors, (3) negotiated process and (4) collaboration between patients and staff. The first theme indicates that EM-MV is either not fully defined in studies or when a definition is provided this is not standardised across studies. The remaining themes reflect the diversity of EM-MV activities which depends on patients’ characteristics and ICU settings; the negotiated decision-making process between patients and staff; and their interdependent relationship during the implementation. Conclusions: This review highlights the absence of an agreed definition and on what constitutes early mobilisation in mechanically ventilated patients. To advance research and practice an agreed and shared definition is a pre-requisite.
Encouraging attendance at pulmonary rehabilitation: a qualitative exploration
(Elsevier Science B.V. Amsterdam, 2007-06) Bulley, Catherine; Salisbury, Lisa; Whiteford, Suzanne
PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is a limitation of airflow that leads to reduced participation in life. Pulmonary rehabilitation uses individually-tailored exercise and multidisciplinary education to help people manage their symptoms optimally and be as independent as possible. However, not all individuals referred to pulmonary rehabilitation participate. This qualitative study aimed to analyse patient views regarding attendance at pulmonary rehabilitation to explore influences on their decisions. RELEVANCE: Better understanding of influences on attendance at pulmonary rehabilitation will enable health professionals to take actions that increase the likelihood of participation; this will increase the numbers of individuals with COPD who take the opportunity to learn better ways of managing their condition. PARTICIPANTS: Individuals with COPD who were referred to a pulmonary rehabilitation service were invited to participate in a single interview prior to joining the programme. It was emphasised that their decision would not impact on any future treatment. Purposive selection of men and women ensured a variety of experiences. Five women and four men aged 59 to 82 completed interviews. All were white Caucasians living in Glasgow, Scotland. METHODS: The study was carried out within the framework of Interpretative Phenomenological Analysis. Semi-structured interviews (50-90 minutes) were carried out in participants' homes. A topic guide was developed to focus on experiences of COPD and views regarding future attendance at pulmonary rehabilitation. Ethical approval was granted by the Multi-Region Ethics Committee in Scotland. ANALYSIS: Transcribed interviews were analysed using the QSR N6 computer package. Two researchers were involved in developing themes, iteratively developing a classification or typology of views and experiences, progressing to locate relationships between themes. Three overarching master themes emerged. RESULTS: Master themes are labelled to reflect views or needs described by interviewees. The first describes contrasting experiences and attitudes: 'Exercise will kill me' versus 'I can't let it beat me.' Some individuals developed fear and avoidance of exercise, translating into wariness about attending pulmonary rehabilitation. Others refused to dwell on negative experiences,were determined to overcome symptoms, and expressed willingness to attend rehabilitation. The second master theme is called: 'A waste of my time' versus 'Doctors know best.' Participants with previous negative experiences of management often described low expectations of pulmonary rehabilitation. Others expressed faith in health professionals as a result of positive experiences, and were willing to follow their recommendations. The last theme was labelled: 'I want to walk and breathe better.' This reflects individuals' desire for professional advice and support in coping better with their condition. CONCLUSIONS: Individuals frequently recognise that they could be helped to cope better with their COPD symptoms. However,some fear that the burden of attending pulmonary rehabilitation will outweigh the benefits. IMPLICATIONS: It is important that the aims and content of pulmonary rehabilitation are carefully explained on referral in order to motivate patients and allay any fears. Positive and informative communications about pulmonary rehabilitation are likely to lead to increased uptake and benefit to more patients.
Exercise rehabilitation following intensive care unit discharge for recovery from critical illness
(2015-06-22) Connolly, Bronwen; Salisbury, Lisa; O'Neill, Brenda; Geneen, Louise; Douiri, Abdel; Grocott, Michael PW; Hart, Nicholas; Walsh, Timothy S.; Blackwood, Bronagh
Background Skeletal muscle wasting and weakness are significant complications of critical illness, associated with degree of illness severity and periods of reduced mobility during mechanical ventilation. They contribute to the profound physical and functional deficits observed in survivors. These impairments may persist for many years following discharge from the intensive care unit (ICU) and can markedly influence health-related quality of life. Rehabilitation is a key strategy in the recovery of patients after critical illness. Exercise-based interventions are aimed at targeting this muscle wasting and weakness. Physical rehabilitation delivered during ICU admission has been systematically evaluated and shown to be beneficial. However, its effectiveness when initiated after ICU discharge has yet to be established. Objectives To assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, for functional exercise capacity and health-related quality of life in adult ICU survivors who have been mechanically ventilated longer than 24 hours
Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review
(2016-09-16) Connolly, Bronwen; Salisbury, Lisa; O'Neill, Brenda; Geneen, Louise; Douiri, Abdel; Grocott, Michael PW; Hart, Nicholas; Walsh, Timothy S.; Blackwood, Bronagh
Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and func- tional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be bene fi cial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life. We sought randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials compar- ing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or ' usual care ' programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval Sys- tem Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were per- formed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health-related quality of life and neither reported differences between intervention and control groups. Meta- analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of out- come measurements. We were unable to determine an overall effect on functional exercise capacity or health-related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis.
Exercise rehabilitation for recovery from critical illness (Protocol)
(The Cochrane Collaboration, 2010) Geneen, Louise; Mercer, Tom; Salisbury, Lisa; Walsh, Timothy S.; Thomson, Colin E.
This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this systematic review is to assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, on improving functional exercise capacity and quality of life in adult ICU survivors who have been mechanically ventilated for more than 24 hours. We will compare an exercise intervention to any other intervention or a control or 'usual care' programme. Exercise includes any structured or taught programmes. Respiratory or inspiratory muscle training is excluded due to it being initiated within the ICU environment, for example with weaning from a ventilator, and not as post-discharge rehabilitation as required for this review.
Functional electrical stimulation (FES) impacted on important aspects of my life--A qualitative exploration of chronic stroke patients' and carers' perceptions of FES in the management of dropped foot
(Informa Healthcare, 2012-01) Wilkie, K.; Shiels, Jane E.; Bulley, Catherine; Salisbury, Lisa
Our purpose was to explore the impact of functional electrical stimulation (FES), as applied in the management of dropped foot, on patients with chronic stroke and their carers. A qualitative phenomenological study was undertaken. Participants were recruited from the Lothian FES clinic. Data were collected by using semistructured face-to-face interviews and analysed by using the framework of interpretative phenomenological analysis (IPA). Thirteen patients and nine carers consented to participate in the study. The overarching theme that emerged from the data was that FES impacted on important aspects of my life. Four subthemes were identified: 1) Walking with FES is much better; 2) FES helped regain control of life; 3) Feeling good comes with using FES; and 4) FES is not perfect but it is of value. This study provides insights into the perceptions of patients and carers of the impact of FES. These results have implications for clinicians delivering an FES service for the management of dropped foot after stroke. Informa Healthcare. USA, Inc.
Functional Status and Older Age
(Springer, 2022-08-04) Lone, Nazir I.; Salisbury, Lisa; Anand, Atul
1. To understand the changes in functional status associated with normal ageing, and risk factors of change in functional status. 2. To compare instruments used to measure functional status in older people, and their specific application in the ICU setting. 3. To evaluate the literature relating to functional status and its impact on ICU triage and outcomes for older adults admitted to intensive care.
How feasible is the delivery of treadmill training early after stroke within the NHS: Findings of a Phase II randomised controlled trial
(Wiley, 2009) Smith, M.; Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa
Introduction: RCP Stroke Guidelines advocate treadmill training (TT) for gait rehabilitation post-stroke. The protocols described in previous studies were intensive, short-term and may not be feasible to deliver within a UK clinical setting. One aim of this Phase II study was to explore key elements of delivering TT in a clinical setting within the NHS. Method: As part of a randomised controlled trial over 8 weeks, participants with stroke were allocated to a control or experimental group. The protocol demanded that all participants received a minimum of three therapy sessions per week of which at least two were on the treadmill for experimental participants. A treadmill system with unweighing harness was used. The content of treadmill sessions was decided by the treating therapists and all parameters were recorded. Results: Seventy-seven participants were recruited with 39 randomised to the experimental group. Experimental participants received a median of two treadmill sessions per week, with an average total walking time on the treadmill of between 8 and 16 min/week, at a median speed of 0.6m/s. Use of a support harness by participants reduced from 49% in week 1 to 23% in week 8. Conclusion: Only the minimum number of treadmill interventions were delivered. Clinical staff cited staffing levels, number of staff required for safety and time required for harness application as some of the reasons for the limited TT. These findings suggest that it may not be feasible to deliver sufficient doses of TT within the current NHS clinical environment.
The impact on redeployed nurses of working in critical care during the COVID-19 pandemic: a cross-sectional study
(Wiley, 2025-06-25) Mccallum, Louise; Dixon, Diane; Pollard, Beth; Miller, Jordan; Hull, Alastair; Scott, Teresa; Salisbury, Lisa; Ramsay, Pam; Rattray, Janice
Background Many nurses with little critical care experience were redeployed to critical care units during the COVID-19 pandemic to assist with the increased numbers of critically ill patients. The impact of this redeployment on nurses and their employing organization merits detailed assessment. Aims To (a) measure the impact on redeployed nurses of working in critical care during the COVID-19 pandemic and identify the predictors of that impact, (b) identify any differences between redeployed and critical care nurses and (c) measure the organizational impact. Study Design A cross-sectional study of redeployed (n = 200) and critical care nurses (n = 461) within the United Kingdom's National Health Service between January 2021 and March 2022. A survey measured components of the Job Demand-Resources Model of occupational stress. Free text questions enabled nurses to describe their experiences of being redeployed to critical care during the pandemic. Results Survey data indicated high levels of health impairment; 70% of redeployed nurses met the threshold for psychological distress, 52% for burnout and 35% had clinically significant symptoms of posttraumatic stress. When job demands (emotional load, mental load, pace and amount of work and role conflict) were high, health impairment was worse and when job resources (staffing, focus on well-being and learning opportunities) were low, work engagement was reduced. Free text comments illustrated both the stress and distress experienced by redeployed nurses. Conclusion Many redeployed nurses experienced significant negative consequences and potentially enduring sequelae of working in critical care during the pandemic. These may continue to affect individual and organizational outcomes. Relevance to Clinical Practice Nurses' well-being should be monitored, and appropriate services provided. Improvements in ongoing and meaningful communications with senior management alongside prioritization of ongoing professional development are required.
Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge
(2015-04-13) Walsh, Timothy S.; Salisbury, Lisa; Merriweather, Judith L.; Boyd, Julia A.; Griffith, David M.; Huby, G.; Kean, Susanne; Mackenzie, Simon J.; Krishan, Ashma; Lewis, Stephanie C.; Murray, Gordon D.; Forbes, John F.; Smith, Joel; Rattray, Janice; Hull, Alastair M.; Ramsay, Pamela
Importance Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P-=-.71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, -0.1 [95% CI, -3.3 to 3.1; P-=-.96]; and in the Mental Component Summary score, 0.2 [95% CI, -3.4 to 3.8; P-=-.91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance Post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.