Browsing by Person "van Wijck, Frederike"

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A Comparison of Bilateral and Unilateral Upper-Limb Task Training in Early Poststroke Rehabilitation: A Randomized Controlled Trial
(2008-07) Morris, J.; van Wijck, Frederike; Joice, S.; Ogston, S. A.; Cole, I.; MacWalter, R. S.
Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation. Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, postintervention (6wk), and follow-up (18wk). Setting: Inpatient acute and rehabilitation hospitals. Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset. Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program. Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor. Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P>.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95% CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P<.05), but this was irrespective of the treatment group. Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation. 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.
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.
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?
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.
Study design and methods of the BoTULS trial: a randomised controlled trial to evaluate the clinical effect and cost effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A
(BioMed Central, 2008-10) Rodgers, Helen; Shaw, Lisa; Price, Christopher; van Wijck, Frederike; Barnes, Michael; Graham, Laura; Ford, Gary; Shackley, Phil; Steen, Nick; BoTULS investigators, On behalf of
Background Following a stroke, 55-75% of patients experience upper limb problems in the longer term. Upper limb spasticity may cause pain, deformity and reduced function, affecting mood and independence. Botulinum toxin is used increasingly to treat focal spasticity, but its impact on upper limb function after stroke is unclear. The aim of this study is to evaluate the clinical and cost effectiveness of botulinum toxin type A plus an upper limb therapy programme in the treatment of post stroke upper limb spasticity. Methods Trial design : A multi-centre open label parallel group randomised controlled trial and economic evaluation. Participants : Adults with upper limb spasticity at the shoulder, elbow, wrist or hand and reduced upper limb function due to stroke more than 1 month previously. Interventions : Botulinum toxin type A plus upper limb therapy (intervention group) or upper limb therapy alone (control group). Outcomes : Outcome assessments are undertaken at 1, 3 and 12 months. The primary outcome is upper limb function one month after study entry measured by the Action Research Arm Test (ARAT). Secondary outcomes include: spasticity (Modified Ashworth Scale); grip strength; dexterity (Nine Hole Peg Test); disability (Barthel Activities of Daily Living Index); quality of life (Stroke Impact Scale, Euroqol EQ-5D) and attainment of patient-selected goals (Canadian Occupational Performance Measure). Health and social services resource use, adverse events, use of other antispasticity treatments and patient views on the treatment will be compared. Participants are clinically reassessed at 3, 6 and 9 months to determine the need for repeat botulinum toxin type A and/or therapy. Randomisation : A web based central independent randomisation service. Blinding : Outcome assessments are undertaken by an assessor who is blinded to the randomisation group. Sample size : 332 participants provide 80% power to detect a 15% difference in treatment successes between intervention and control groups. Treatment success is defined as improvement of 3 points for those with a baseline ARAT of 0-3 and 6 points for those with ARAT of 4-56.
The construct validity of a spasticity measurement device for clinical practice: An alternative to the Ashworth scales
(Taylor & Francis, 2006-05) Pandyan, Anand; van Wijck, Frederike; Stark, Sandra; Vuadens, Philippe; Johnson, Garth; Barnes, Michael
Introduction. Spasticity is a significant cause of disability in people with an upper motor neurone lesion, but there is a paucity of appropriate outcome measures to evaluate this phenomenon. The aim was to test the construct validity of a clinically relevant, non-invasive measure of spasticity. Methods. A cross-section study design in which participants with elbow flexor spasticity and capable of providing written informed consent were recruited. Results. Fourteen stroke patients participated (six female and eight male). Median age was 61 years and the median time post stroke was 48 months. Six patients had a MAS grading of '1+', three a grade of '2' and five a grade of '3'. The velocity of the brisk stretch was significantly higher than that of the slow stretch (p < 0.05: median difference, 34/s: IQR, 20 - 46). Flexor muscle activity during the brisk stretch was significantly higher than that of the slow stretch (p < 0.05: median difference, 2.0 _V; IQR, 0.4 - 8.4). In contrast the RPE was not significantly different between the slow and the fast stretches (p > 0.1: median difference, 0.07 N/deg; IQR, - 0.09 - 0.16). There were no patterns of association between the MAS, elbow flexor muscle activity and RPE. Other important observations, in some patients, were: continuous background muscle activation consistent with descriptions of spastic dystonia; muscle activity at the slow velocity stretch; muscle activation patterns consistent with the clasp-knife phenomenon. Conclusions. The measurement system was capable of measuring spasticity as defined by Lance (1980; In: Lance et al., editors. Spasticity: disordered motor control. Chicago, IL: Year Book. p 185 - 204). In addition, it enabled various other clinical phenomena associated with spasticity to be measured. Assessing spasticity by measuring changes in resistance to passive movement only may not be sufficient, as the latter is influenced by many factors of which spasticity may only be one. Further work is now required to investigate repeatability and sensitivity.
The effects and experiences of goal setting in stroke rehabilitation - a systematic review
(Taylor & Francis Ltd, 2013-02) Sugavanam, Thavapriya; Mead, G.; Bulley, Catherine; Donaghy, Marie; van Wijck, Frederike
Objective: To systematically integrate and appraise the evidence for effects and experiences of goal setting in stroke rehabilitation. Design: Systematic review of quantitative and qualitative studies. Methods: Relevant databases were searched from start of database to 30 April 2011. Studies of any design employing goal setting, reporting stroke-specific data and evaluating its effects and/ or experiences were included. Results: From a total of 53998 hits, 112 full texts were analysed and 17 studies were included, of which seven evaluated effects while ten explored experiences of goal setting. No eligible randomized controlled trials were identified. Most of the included studies had weak to moderate methodological strengths. The design, methods of goal setting and outcome measures differed, making pooling of results difficult. Goal setting appeared to improve recovery, performance and goal achievement, and positively influenced patients' perceptions of self-care ability and engagement in rehabilitation. However, the actual extent of patient involvement in the goal setting process was not made clear. Patients were often unclear about their role in this process. Professionals reported higher levels of collaboration during goal setting than patients. Patients and professionals differed on how they set goals, types of goals set, and on how they perceived goal attainment. Barriers to goal setting outnumbered the facilitators. Conclusion: Due to the heterogeneity and quality of included studies, no firm conclusions could be made on the effectiveness, feasibility and acceptability of goal setting in stroke rehabilitation. Further rigorous research is required to strengthen the evidence base. Better collaboration and communication between patients and professionals and relevant education are recommended for best practice. Implications for Rehabilitation- Communication is key to collaborative goal setting. - Education and training of professionals regarding goal setting is recommended, especially in relation to methods of involving people with communication and cognitive impairments. - Educating patients about stroke and goal setting could enhance their participation in goal