39 results on '"Watkins, Caroline"'
Search Results
2. The accuracy of pulse oximetry in measuring oxygen saturation by levels of skin pigmentation: a systematic review and meta-analysis
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Shi, Chunhu, Goodall, Mark, Dumville, Jo, Hill, James, Norman, Gill, Hamer, Oliver, Clegg, Andrew, Watkins, Caroline Leigh, Georgiou, George, Hodkinson, Alexander, Lightbody, Catherine Elizabeth, Dark, Paul, and Cullum, Nicky
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- 2022
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3. Oral care practices in stroke: findings from the UK and Australia
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Bangee, Munirah, Martinez-Garduno, Cintia Mayel, Brady, Marian C., Cadilhac, Dominique A., Dale, Simeon, Hurley, Margaret A., McInnes, Elizabeth, Middleton, Sandy, Patel, Tahera, Watkins, Caroline L., and Lightbody, Elizabeth
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- 2021
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4. The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review
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Lowther, Hayley J., Harrison, Joanna, Hill, James E., Gaskins, Nicola J., Lazo, Kimberly C., Clegg, Andrew J., Connell, Louise A., Garrett, Hilary, Gibson, Josephine M. E., Lightbody, Catherine E., and Watkins, Caroline L.
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- 2021
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5. Predictors of recognition of out of hospital cardiac arrest by emergency medical services call handlers in England: a mixed methods diagnostic accuracy study
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Watkins, Caroline L., Jones, Stephanie P., Hurley, Margaret A., Benedetto, Valerio, Price, Christopher I., Sutton, Christopher J., Quinn, Tom, Bangee, Munirah, Chesworth, Brigit, Miller, Colette, Doran, Dawn, Siriwardena, Aloysius Niroshan, and Gibson, Josephine M. E.
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- 2021
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6. An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial
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Radford, Kathryn A., Craven, Kristelle, McLellan, Vicki, Sach, Tracey H., Brindle, Richard, Holloway, Ivana, Hartley, Suzanne, Bowen, Audrey, O’Connor, Rory, Stevens, Judith, Philips, Julie, Walker, Marion, Holmes, Jain, McKevitt, Christopher, Murray, John, Watkins, Caroline, Powers, Katie, Shone, Angela, and Farrin, Amanda
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- 2020
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7. Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines
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Bray, Emma P., McMahon, Naoimh E., Bangee, Munirah, Al-Khalidi, A. Hakam, Benedetto, Valerio, Chauhan, Umesh, Clegg, Andrew J., Georgiou, Rachel F., Gibson, Josephine, Lane, Deirdre A., Lip, Gregory Y. H., Lightbody, Elizabeth, Sekhar, Alakendu, Chatterjee, Kausik, and Watkins, Caroline L.
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- 2019
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8. PULSE-I - Is rePetitive Upper Limb SEnsory stimulation early after stroke feasible and acceptable? A stratified single-blinded randomised controlled feasibility study
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Chatterjee, Kausik, Stockley, Rachel C., Lane, Steven, Watkins, Caroline, Cottrell, Katy, Ankers, Brenda, Davies, Sioned, Morris, Mary Fisher, Fallon, Nick, and Nurmikko, Turo
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- 2019
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9. Motivational interviewing for low mood and adjustment early after stroke: a feasibility randomised trial
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Patel, Kulsum, Watkins, Caroline L, Sutton, Chris J, Holland, Emma-Joy, Benedetto, Valerio, Auton, Malcolm F, Barer, David, Chatterjee, Kausik, and Lightbody, Catherine E
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- 2018
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10. Predictors of recognition of out of hospital cardiac arrest by emergency medical services call handlers in England: a mixed methods diagnostic accuracy study
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Watkins, Caroline Leigh, Jones, Stephanie, Hurley, Margaret Anne, Benedetto, Valerio, Price, Christopher I., Sutton, Christopher J., Quinn, Tom, Bangee, Munirah, Chesworth, Brigit, Miller, Colette, Doran, Dawn, Siriwardena, Aloysius Niroshan, Gibson, Josephine, Watkins, Caroline Leigh, Jones, Stephanie, Hurley, Margaret Anne, Benedetto, Valerio, Price, Christopher I., Sutton, Christopher J., Quinn, Tom, Bangee, Munirah, Chesworth, Brigit, Miller, Colette, Doran, Dawn, Siriwardena, Aloysius Niroshan, and Gibson, Josephine
- Abstract
Background: The aim of this study was to identify key indicator symptoms and patient factors associated with correct out of hospital cardiac arrest (OHCA) dispatch allocation. In previous studies, from 3% to 62% of OHCAs are not recognised by Emergency Medical Service call handlers, resulting in delayed arrival at scene. Methods: Retrospective, mixed methods study including all suspected or confirmed OHCA patients transferred to one acute hospital from its associated regional Emergency Medical Service in England from 1/7/2013 to 30/6/2014. Emergency Medical Service and hospital data, including voice recordings of EMS calls, were analysed to identify predictors of recognition of OHCA by call handlers. Logistic regression was used to explore the role of the most frequently occurring (key) indicator symptoms and characteristics in predicting a correct dispatch for patients with OHCA. Results: A total of 39,136 dispatches were made which resulted in transfer to the hospital within the study period, including 184 patients with OHCA. The use of the term ‘Unconscious’ plus one or more of symptoms ‘Not breathing/Ineffective breathing/Noisy breathing’ occurred in 79.8% of all OHCAs, but only 72.8% of OHCAs were correctly dispatched as such. ‘Not breathing’ was associated with recognition of OHCA by call handlers (Odds Ratio (OR) 3.76). The presence of key indicator symptoms ‘Breathing’ (OR 0.29), ‘Reduced or fluctuating level of consciousness’ (OR 0.24), abnormal pulse/heart rate (OR 0.26) and the characteristic ‘Female patient’ (OR 0.40) were associated with lack of recognition of OHCA by call handlers (p-values < 0.05). Conclusions: There is a small proportion of calls in which cardiac arrest indicators are described but the call is not dispatched as such. Stricter adherence to dispatch protocols may improve call handlers’ OHCA recognition. The existing dispatch protocol would not be improved by the addition of further terms as this would be at the expense of dis
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- 2021
11. Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines
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Bray, Emma, Mcmahon, Naoimh, Bangee, Munirah, Al-Khalidi, A Hakam, Benedetto, Valerio, Chauhan, Umesh, Clegg, Andrew, Georgiou, Rachel, Gibson, Josephine, Lane, Deirdre, Lip, Gregory, Lightbody, Catherine Elizabeth, Sekhar, Alakendu, Chatterjee, Kausik, Watkins, Caroline Leigh, Bray, Emma, Mcmahon, Naoimh, Bangee, Munirah, Al-Khalidi, A Hakam, Benedetto, Valerio, Chauhan, Umesh, Clegg, Andrew, Georgiou, Rachel, Gibson, Josephine, Lane, Deirdre, Lip, Gregory, Lightbody, Catherine Elizabeth, Sekhar, Alakendu, Chatterjee, Kausik, and Watkins, Caroline Leigh
- Abstract
Background Stroke is a leading cause of death and disability worldwide. Identifying the aetiology of ischaemic stroke is essential in order to initiate appropriate and timely secondary prevention measures to reduce the risk of recurrence. For the majority of ischaemic strokes, the aetiology can be readily identified, but in at least 30% of cases the exact aetiology cannot be determined using existing investigative protocols. Such strokes are classed as ‘cryptogenic’ or as a stroke of unknown origin. However, there exists substantial variation in clinical practice when investigating cases of seemingly cryptogenic stroke, often reflecting local service availability and the preferences of treating clinicians. This variation in practice is compounded by the lack of international consensus as to the optimum level and timing of investigations required following a stroke. To address this gap, we aim to systematically review and compare recommendations in evidence-based clinical practice guidelines (CPGs) that relate to the assessment and investigation of the aetiology of ischaemic stroke, and any subsequent diagnosis of cryptogenic stroke. Method We will search for CPGs using electronic databases (MEDLINE, Health Management Information Consortium (HMIC), EMBASE, and CINAHL); relevant websites and search engines (e.g. guideline specific websites, governmental, charitable, professional practice organisations); and hand-searching of bibliographies and reference lists. Two reviewers will independently screen titles, abstracts and CPGs using a pre-defined relevance criteria form. From each included CPG we will extract definitions and terms for cryptogenic stroke; recommendations related to assessment and investigation of the aetiology of stroke, including grade of recommendations and underpinning evidence. Quality of the included CPGs will be assessed using the AGREE II (Appraisal of Guidelines for Research & Evaluation) tool. Recommendations across the CPGs will be summarised
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- 2019
12. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom
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Bagot, Kathleen L., Cadilhac, Dominique A, Bladin, Christopher F, Watkins, Caroline Leigh, Vu, Michelle, Donnan, Geoffrey A, Dewey, Helen M, Emsley, Hedley C A, Davies, D Paul, Day, Elaine, Ford, Gary A, Price, Christopher I, May, Carl R, Mcloughlin, Alison Sarah rachel, Gibson, Josephine, Lightbody, Catherine Elizabeth, Bagot, Kathleen L., Cadilhac, Dominique A, Bladin, Christopher F, Watkins, Caroline Leigh, Vu, Michelle, Donnan, Geoffrey A, Dewey, Helen M, Emsley, Hedley C A, Davies, D Paul, Day, Elaine, Ford, Gary A, Price, Christopher I, May, Carl R, Mcloughlin, Alison Sarah rachel, Gibson, Josephine, and Lightbody, Catherine Elizabeth
- Abstract
Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.
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- 2017
13. Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial
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Thomas, Lois H., Watkins, Caroline Leigh, Sutton, Christopher J., Forshaw, Denise, Leathley, Michael J., French, Beverley, Burton, Christopher R., Cheater, Francine, Roe, Brenda, Britt, David, Booth, Jo, McColl, Elaine, Carter, Bernadette, Rodgers, Helen, Brittain, Katie, Walker, Andrew, Barrett, James, Whiteley, Gemma, Brand, Pat, Griffiths, May, Helvin, Philip, James, Brian, Pearl, Gill, Whitewood, Jane, Vella, Jacqui, Childs, Audrey, Childs, Richard, Crosby, Sean, Hall, Steve, Lewin, Anj, Royle, Liz, Scott, Carole, and Wright, Jean
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Urinary Bladder ,Psychological intervention ,Medicine (miscellaneous) ,Urinary incontinence ,B700 ,law.invention ,Cognition ,Randomized controlled trial ,Quality of life ,law ,Odds Ratio ,Medicine ,Humans ,Pharmacology (medical) ,Functional ability ,Cluster randomised controlled trial ,Stroke ,Aged ,Aged, 80 and over ,Wales ,urinary incontinence ,Cognitive Behavioral Therapy ,business.industry ,Patient Selection ,Research ,Odds ratio ,Recovery of Function ,medicine.disease ,stroke ,Urodynamics ,Treatment Outcome ,England ,Sample Size ,Physical therapy ,Quality of Life ,Feasibility Studies ,Female ,medicine.symptom ,business ,cluster randomised controlled trial ,feasibility - Abstract
Background Urinary incontinence (UI) affects half of patients hospitalised after stroke and is often poorly managed. Cochrane systematic reviews have shown some positive impact of conservative interventions (such as bladder training) in reducing UI, but their effectiveness has not been demonstrated with stroke patients. Methods We conducted a cluster randomised controlled feasibility trial of a systematic voiding programme (SVP) for the management of UI after stroke. Stroke services were randomised to receive SVP (n = 4), SVP plus supported implementation (SVP+, n = 4), or usual care (UC, n = 4). Feasibility outcomes were participant recruitment and retention. The main effectiveness outcome was presence or absence of UI at six and 12 weeks post-stroke. Additional effectiveness outcomes included were the effect of the intervention on different types of UI, continence status at discharge, UI severity, functional ability, quality of life, and death. Results It was possible to recruit patients (413; 164 SVP, 125 SVP+, and 124 UC) and participant retention was acceptable (85% and 88% at six and 12 weeks, respectively). There was no suggestion of a beneficial effect on the main outcome at six (SVP versus UC: odds ratio (OR) 0.94, 95% CI: 0.46 to 1.94; SVP+ versus UC: OR: 0.62, 95% CI: 0.28 to 1.37) or 12 weeks (SVP versus UC: OR: 1.02, 95% CI: 0.54 to 1.93; SVP+ versus UC: OR: 1.06, 95% CI: 0.54 to 2.09). No secondary outcomes showed a strong suggestion of clinically meaningful improvement in SVP and/or SVP+ arms relative to UC at six or 12 weeks. However, at 12 weeks both intervention arms had higher estimated odds of continence than UC for patients with urge incontinence. Conclusions The trial has met feasibility outcomes of participant recruitment and retention. It was not powered to demonstrate effectiveness, but there is some evidence of a potential reduction in the odds of specific types of incontinence. A full trial should now be considered. Trial registration ISRCTN Registry, ISRCTN08609907, date of registration: 7 July 2010. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-509) contains supplementary material, which is available to authorized users.
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- 2014
14. Repetitive arm functional tasks after stroke (RAFTAS): a pilot randomised controlled trial
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Brkic, L, Shaw, L, van Wijck, F, Francis, R, Price, C, Forster, A, Langhorne, P, Watkins, Caroline Leigh, Rodgers, H, Brkic, L, Shaw, L, van Wijck, F, Francis, R, Price, C, Forster, A, Langhorne, P, Watkins, Caroline Leigh, and Rodgers, H
- Abstract
Background Repetitive functional task practise (RFTP) is a promising treatment to improve upper limb recovery following stroke. We report the findings of a study to determine the feasibility of a multi-centre randomised controlled trial to evaluate this intervention. Methods A pilot randomised controlled trial was conducted. Patients with new reduced upper limb function were recruited within 14 days of acute stroke from three stroke units in North East England. Participants were randomised to receive a four week upper limb RFTP therapy programme consisting of goal setting, independent activity practise, and twice weekly therapy reviews in addition to usual post stroke rehabilitation, or usual post stroke rehabilitation. The recruitment rate; adherence to the RFTP therapy programme; usual post stroke rehabilitation received; attrition rate; data quality; success of outcome assessor blinding; adverse events; and the views of study participants and therapists about the intervention were recorded. Results Fifty five eligible patients were identified, 4-6% of patients screened at each site. Twenty four patients participated in the pilot study. Two of the three study sites met the recruitment target of 1-2 participants per month. The median number of face to face therapy sessions received was 6 [IQR 3-8]. The median number of daily repetitions of activities recorded was 80 [IQR 39-80]. Data about usual post stroke rehabilitation were available for 18/24 (75%). Outcome data were available for 22/24 (92%) at one month and 20/24 (83%) at three months. Outcome assessors were unblinded to participant group allocation for 11/22 (50%) at one month and 6/20 (30%) at three months. Four adverse events were considered serious as they resulted in hospitalisation. None were related to study treatment. Feedback from patients and local NHS therapists about the RFTP programme was mainly positive. Conclusions A multi-centre randomised controlled trial to evaluate an upper limb RFTP therap
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- 2016
15. Mechanisms of action of an implementation intervention in stroke rehabilitation: a qualitative interview study
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Connell, Louise, Mcmahon, Naoimh, Tyson, Sarah, Watkins, Caroline Leigh, Eng, Janice, Connell, Louise, Mcmahon, Naoimh, Tyson, Sarah, Watkins, Caroline Leigh, and Eng, Janice
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Background: Despite best evidence demonstrating the effectiveness of increased intensity of exercise after stroke, current levels of therapy continue to be below those required to optimise motor recovery. We developed and tested an implementation intervention that aims to increase arm exercise in stroke rehabilitation. The aim of this study was to illustrate the use of a behaviour change framework, the Behaviour Change Wheel, to identify the mechanisms of action that explain how the intervention produced change. Methods: We implemented the intervention at three stroke rehabilitation units in the United Kingdom. A purposive sample of therapy team members were recruited to participate in semi-structured interviews to explore their perceptions of how the intervention produced change at their work place. Audio recordings were transcribed and imported into NVivo 10 for content analysis. Two coders separately analysed the transcripts and coded emergent mechanisms. Mechanisms were categorised using the Theoretical Domains Framework (TDF) (an extension of the Capability, Opportunity, Motivation and Behaviour model (COM-B) at the hub of the Behaviour Change Wheel). Results: We identified five main mechanisms of action: ‘social/professional role and identity’, ‘intentions’, ‘reinforcement’, ‘behavioural regulation’ and ‘beliefs about consequences’. At the outset, participants viewed the research team as an external influence for whom they endeavoured to complete the study activities. The study design, with a focus on implementation in real world settings, influenced participants’ intentions to implement the intervention components. Monthly meetings between the research and therapy teams were central to the intervention and acted as prompt or reminder to sustain implementation. The phased approach to introducing and implementing intervention components influenced participants’ beliefs about the feasibility of implementation. Conclusions: The Behaviour Change Wheel, and in part
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- 2016
16. Head Position in Stroke Trial (HeadPoST)- sitting-up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomised controlled trial
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Munoz-Venturelli, Paula, Arima, Hisatomi, Lavados, Pablo, Brunser, Alejandro, Peng, Bin, Cui, Liying, Song, Lily, Billot, Laurent, Boaden, Elizabeth, Hackett, Maree, Olavarria, Veronica, Lim, Joyce, Lindley, Richard, Heeley, Emma, Robinson, Thompson, Pontes-Neto, Octavio, Natsagdorj, Lkhamtsoo, Lin, Ruey-Tay, Watkins, Caroline Leigh, Anderson, Craig, Munoz-Venturelli, Paula, Arima, Hisatomi, Lavados, Pablo, Brunser, Alejandro, Peng, Bin, Cui, Liying, Song, Lily, Billot, Laurent, Boaden, Elizabeth, Hackett, Maree, Olavarria, Veronica, Lim, Joyce, Lindley, Richard, Heeley, Emma, Robinson, Thompson, Pontes-Neto, Octavio, Natsagdorj, Lkhamtsoo, Lin, Ruey-Tay, Watkins, Caroline Leigh, and Anderson, Craig
- Abstract
Background Positioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0°) compared with sitting-up (≥30°) head positioning in the first 24 hours of hospital admission for patients with acute stroke. Methods/Design We plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0°) or sitting-up (≥30°) head position as a ‘business as usual’ stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (α 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period. Discussion HeadPoST is a large intern
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- 2015
17. Assessing fidelity to treatment delivery in the ICONS (Identifying Continence OptioNs after Stroke) cluster randomised feasibility trial
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Chesworth, Brigit, Leathley, Michael John, Thomas, Lois Helene, Sutton, Chris J, Forshaw, Denise, Watkins, Caroline Leigh, Chesworth, Brigit, Leathley, Michael John, Thomas, Lois Helene, Sutton, Chris J, Forshaw, Denise, and Watkins, Caroline Leigh
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Background The implementation of strategies to monitor and enhance treatment fidelity is of paramount importance in trials of complex interventions. A recent framework published by the National Institutes of Health Behavior Change Consortium recommends addressing five areas of treatment fidelity, one of which is delivery of treatment. This study aimed to explore fidelity to treatment delivery of the ICONS intervention (a systematic voiding programme [SVP]). This included exploring the feasibility of a method to assess fidelity to treatment delivery and collecting preliminary evidence of the level of fidelity to SVP delivery in order to inform strategies for improving fidelity in a future trial. Methods Delivery of treatment was recorded by nurses through completion of daily clinical logs, which included: a voiding interval, proposed voiding times and actual voiding times. The a priori method for assessment of fidelity – comparing actual voiding times with proposed voiding times – was trialled on a small amount of data. Due to errors in documentation of the voiding intervals and proposed voiding times it was not possible to assess fidelity directly as planned. A new method was devised, which included identification of ‘key quality indicators’. Results This new approach to assessing fidelity used key quality indicators based upon presence of the data needed to make the comparison between proposed and actual voiding times. The proportion of clinical logs with correct documentation of voiding intervals and proposed voiding times was less than 40 %. For clinical logs with correct documentation, an actual voiding time within 30 min of the proposed voiding time was identified on approximately 55 % of occasions. Conclusions Lessons learnt from this study have implications for the future ICONS definitive trial and for other trials of complex interventions. Implementation of a complex intervention may often deviate from what is intended. While careful consideration should be
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- 2015
18. Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial
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Radford, Kathryn A, Phillips, Julie, Jones, Trevor, Gibson, Ali, Sutton, Chris J, Watkins, Caroline Leigh, Sach, Tracey, Duley, Lelia, Walker, Marian, Drummond, Avril, Hoffman, Karen, O'Connor, Rory, Forshaw, Denise, Shakespeare, David, Radford, Kathryn A, Phillips, Julie, Jones, Trevor, Gibson, Ali, Sutton, Chris J, Watkins, Caroline Leigh, Sach, Tracey, Duley, Lelia, Walker, Marian, Drummond, Avril, Hoffman, Karen, O'Connor, Rory, Forshaw, Denise, and Shakespeare, David
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Background Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determin
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- 2015
19. Development of a behaviour change intervention to increase upper limb exercise in stroke rehabilitation
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Connell, Louise, McMahon, Naoimh, Redfern, Judith, Watkins, Caroline Leigh, Eng, JJ, Connell, Louise, McMahon, Naoimh, Redfern, Judith, Watkins, Caroline Leigh, and Eng, JJ
- Abstract
Background Two thirds of survivors will achieve independent ambulation after a stroke, but less than half will recover upper limb function. There is strong evidence to support intensive repetitive task-oriented training for recovery after stroke. The number of repetitions needed is suggested to be in the order of hundreds, but this is not currently being achieved in clinical practice. In an effort to bridge this evidence-practice gap, we have developed a behaviour change intervention that aims to increase provision of upper limb repetitive task-oriented training in stroke rehabilitation. This paper aims to describe the systematic processes that took place in collaboratively developing the behaviour change intervention. Methods The methods used in this study were not defined a priori but were guided by the Behaviour Change Wheel. The process was collaborative and iterative with four stages of development emerging (i) establishing an intervention development group; (ii) structured discussions to understand the problem, prioritise target behaviours and analyse target behaviours; (iii) collaborative design of theoretically underpinned intervention components and (iv) piloting and refining of intervention components. Results The intervention development group consisted of the research team and stroke therapy team at a local stroke rehabilitation unit. The group prioritised four target behaviours at the therapist level: (i) identifying suitable patients for exercises, (ii) provision of exercises, (iii) communicating exercises to family/visitors and (iv) monitoring and reviewing exercises. It also provides a method for self-monitoring performance in order to measure fidelity. The developed intervention, PRACTISE (Promoting Recovery of the Arm: Clinical Tools for Intensive Stroke Exercise), consists of team meetings and the PRACTISE Toolkit (screening tool and upper limb exercise plan, PRACTISE exercise pack and an audit tool). Conclusions This paper provides an example of
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- 2015
20. Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial
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Thomas, Lois Helene, Watkins, Caroline Leigh, Sutton, Chris J, Forshaw, Denise, Leathley, Michael John, French, Beverley, Burton, CR, Cheater, F, Roe, B, Britt, D, Booth, J, McColl, E, Thomas, Lois Helene, Watkins, Caroline Leigh, Sutton, Chris J, Forshaw, Denise, Leathley, Michael John, French, Beverley, Burton, CR, Cheater, F, Roe, B, Britt, D, Booth, J, and McColl, E
- Abstract
Background Urinary incontinence (UI) affects half of patients hospitalised after stroke and is often poorly managed. Cochrane systematic reviews have shown some positive impact of conservative interventions (such as bladder training) in reducing UI, but their effectiveness has not been demonstrated with stroke patients. Methods We conducted a cluster randomised controlled feasibility trial of a systematic voiding programme (SVP) for the management of UI after stroke. Stroke services were randomised to receive SVP (n = 4), SVP plus supported implementation (SVP+, n = 4), or usual care (UC, n = 4). Feasibility outcomes were participant recruitment and retention. The main effectiveness outcome was presence or absence of UI at six and 12 weeks post-stroke. Additional effectiveness outcomes included were the effect of the intervention on different types of UI, continence status at discharge, UI severity, functional ability, quality of life, and death. Results It was possible to recruit patients (413; 164 SVP, 125 SVP+, and 124 UC) and participant retention was acceptable (85% and 88% at six and 12 weeks, respectively). There was no suggestion of a beneficial effect on the main outcome at six (SVP versus UC: odds ratio (OR) 0.94, 95% CI: 0.46 to 1.94; SVP+ versus UC: OR: 0.62, 95% CI: 0.28 to 1.37) or 12 weeks (SVP versus UC: OR: 1.02, 95% CI: 0.54 to 1.93; SVP+ versus UC: OR: 1.06, 95% CI: 0.54 to 2.09). No secondary outcomes showed a strong suggestion of clinically meaningful improvement in SVP and/or SVP+ arms relative to UC at six or 12 weeks. However, at 12 weeks both intervention arms had higher estimated odds of continence than UC for patients with urge incontinence. Conclusions The trial has met feasibility outcomes of participant recruitment and retention. It was not powered to demonstrate effectiveness, but there is some evidence of a potential reduction in the odds of specific types of incontinence. A full trial should now be considered.
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- 2014
21. A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study
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Connell, Louise, McMahon, Naoimh, Harris, Jocelyn E, Watkins, Caroline Leigh, Eng, Janice J, Connell, Louise, McMahon, Naoimh, Harris, Jocelyn E, Watkins, Caroline Leigh, and Eng, Janice J
- Abstract
Background: The Graded Repetitive Arm Supplementary Program (GRASP) is a hand and arm exercise programme designed to increase the intensity of exercise achieved in inpatient stroke rehabilitation. GRASP was shown to be effective in a randomised controlled trial in 2009 and has since experienced unusually rapid uptake into clinical practice. The aim of this study was to conduct a formative evaluation of the implementation of GRASP to inform the development and implementation of a similar intervention in the United Kingdom. Methods: Semi-structured interviews were conducted with therapists who were involved in implementing GRASP at their work site, or who had experience of using GRASP. Normalisation Process Theory (NPT), a sociological theory used to explore the processes of embedding innovations in practice, was used to develop an interview guide. Intervention components outlined within the GRASP Guideline Manual were used to develop prompts to explore how therapists use GRASP in practice. Interview transcripts were analysed using a coding frame based on implementation theory. Results: Twenty interviews were conducted across eight sites in British Columbia Canada. Therapists identified informal networks and the free online availability of GRASP as key factors in finding out about the intervention. All therapists reported positive opinions about the value of GRASP. At all sites, therapists identified individuals who advocated for the use of GRASP, and in six of the eight sites this was the practice leader or senior therapist. Rehabilitation assistants were identified as instrumental in delivering GRASP in almost all sites as they were responsible for organising the GRASP equipment and assisting patients using GRASP. Almost all intervention components were found to be adapted to some degree when used in clinical practice; coverage was wider, the content adapted, and the dose, when monitored, was less. Conclusions: Although GRASP has translated into clinical practice, i
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- 2014
22. Icons: identifying continence options after stroke trial: utility of a logic model in the design and implementation of a process evaluation
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Thomas, Lois Helene, Burton, Christopher, French, Beverley, Leathley, Michael John, Forshaw, Denise, Sutton, Chris J, Roe, Brenda, Chesworth, Brigit, Watkins, Caroline Leigh, Thomas, Lois Helene, Burton, Christopher, French, Beverley, Leathley, Michael John, Forshaw, Denise, Sutton, Chris J, Roe, Brenda, Chesworth, Brigit, and Watkins, Caroline Leigh
- Published
- 2013
23. Training emergency services’ dispatchers to recognise stroke: an interrupted time-series analysis
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Watkins, Caroline Leigh, Leathley, Michael John, Jones, Stephanie, Ford, Gary, Quinn, Tom, Sutton, Chris J, Watkins, Caroline Leigh, Leathley, Michael John, Jones, Stephanie, Ford, Gary, Quinn, Tom, and Sutton, Chris J
- Abstract
Background: Stroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services (EMS). Identifying ‘true stroke’ from an EMS call is challenging, with over 50% of strokes being misclassified. The aim of this study was to evaluate the impact of the training package on the recognition of stroke by Emergency Medical Dispatchers (EMDs). Methods: This study took place in an ambulance service and a hospital in England using an interrupted time-series design. Suspected stroke patients were identified in one week blocks, every three weeks over an 18 month period, during which time the training was implemented. Patients were included if they had a diagnosis of stroke (EMS or hospital). The effect of the intervention on the accuracy of dispatch diagnosis was investigated using binomial (grouped) logistic regression. Results: In the Pre-implementation period EMDs correctly identified 63% of stroke patients; this increased to 80% Post-implementation. This change was significant (p=0.003), reflecting an improvement in identifying stroke patients relative to the Pre-implementation period both the During-implementation (OR=4.10 [95% CI 1.58 to 10.66]) and Post-implementation (OR=2.30 [95% CI 1.07 to 4.92]) periods. For patients with a final diagnosis of stroke who had been dispatched as stroke there was a marginally non-significant 2.8 minutes (95% CI −0.2 to 5.9 minutes, p=0.068)reduction between Pre- and Post-implementation periods from call to arrival of the ambulance at scene. Conclusions: This is the first study to develop, implement and evaluate the impact of a training package for EMDs with the aim of improving the recognition of stroke. Training led to a significant increase in the proportion of stroke patients dispatched as such by EMDs; a small reduction in time from call to arrival at scene by the ambulance also appeared
- Published
- 2013
24. The challenges of implementing a telestroke network: a systematic review and case study
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French, Beverley, Day, Elaine, Watkins, Caroline Leigh, Mcloughlin, Alison Sarah rachel, Fitzgerald, Jane, Leathley, Michael John, Davies, Paul, Emsley, Hedley, Ford, Gary, Jenkinson, Damian, May, Carl, O’Donnell, Mark, Price, Christopher, Sutton, Chris J, Lightbody, Catherine Elizabeth, French, Beverley, Day, Elaine, Watkins, Caroline Leigh, Mcloughlin, Alison Sarah rachel, Fitzgerald, Jane, Leathley, Michael John, Davies, Paul, Emsley, Hedley, Ford, Gary, Jenkinson, Damian, May, Carl, O’Donnell, Mark, Price, Christopher, Sutton, Chris J, and Lightbody, Catherine Elizabeth
- Published
- 2013
25. Study protocol: ICONS: identifying continence options after stroke: a randomised trial
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Thomas, Lois H, Watkins, Caroline L, French, Beverley, Sutton, Chris J, Forshaw, Denise, Cheater, Francine, Roe, B, Leathley, Michael J, Burton, C, McColl, E, Booth, Jo, Thomas, Lois H, Watkins, Caroline L, French, Beverley, Sutton, Chris J, Forshaw, Denise, Cheater, Francine, Roe, B, Leathley, Michael J, Burton, C, McColl, E, and Booth, Jo
- Abstract
Background: Urinary incontinence following acute stroke is common, affecting between 40%-60% of people in hospital after a stroke. Despite the availability of clinical guidelines for urinary incontinence and urinary incontinence after stroke, national audit data suggest incontinence is often poorly managed. Conservative interventions (e.g. bladder training, pelvic floor muscle training and prompted voiding) have been shown to have some effect with participants in Cochrane systematic reviews, but have not had their effectiveness demonstrated with stroke patients. Methods/Design: A cluster randomised controlled pilot trial designed to assess the feasibility of a full-scale cluster randomised trial and to provide preliminary evidence of the effectiveness and cost-effectiveness of a systematic voiding programme for the management of continence after stroke. Stroke services will be randomised to receive the systematic voiding programme, the systematic voiding programme plus supported implementation, or usual care. The trial aims to recruit at least 780 participants in 12 stroke services (4 per arm). The primary outcome is presence/absence of incontinence at six weeks post-stroke. Secondary outcomes include frequency and severity of incontinence, quality of life and cost-utility. Outcomes will be measured at six weeks, three months and (for participants recruited in the first three months) twelve months after stroke. Process data will include rates of recruitment and retention and fidelity of intervention delivery. An integrated qualitative evaluation will be conducted in order to describe implementation and assist in explaining the potential mediators and modifiers of the process.
- Published
- 2011
26. Mechanisms of action of an implementation intervention in stroke rehabilitation: a qualitative interview study.
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Connell, Louise A., McMahon, Naoimh E., Tyson, Sarah F., Watkins, Caroline L., and Eng, Janice J.
- Subjects
STROKE treatment ,ARM exercises ,EXERCISE therapy ,BEHAVIOR modification ,QUALITATIVE research - Abstract
Background: Despite best evidence demonstrating the effectiveness of increased intensity of exercise after stroke, current levels of therapy continue to be below those required to optimise motor recovery. We developed and tested an implementation intervention that aims to increase arm exercise in stroke rehabilitation. The aim of this study was to illustrate the use of a behaviour change framework, the Behaviour Change Wheel, to identify the mechanisms of action that explain how the intervention produced change. Methods: We implemented the intervention at three stroke rehabilitation units in the United Kingdom. A purposive sample of therapy team members were recruited to participate in semi-structured interviews to explore their perceptions of how the intervention produced change at their work place. Audio recordings were transcribed and imported into NVivo 10 for content analysis. Two coders separately analysed the transcripts and coded emergent mechanisms. Mechanisms were categorised using the Theoretical Domains Framework (TDF) (an extension of the Capability, Opportunity, Motivation and Behaviour model (COM-B) at the hub of the Behaviour Change Wheel). Results: We identified five main mechanisms of action: 'social/professional role and identity', 'intentions', 'reinforcement', 'behavioural regulation' and 'beliefs about consequences'. At the outset, participants viewed the research team as an external influence for whom they endeavoured to complete the study activities. The study design, with a focus on implementation in real world settings, influenced participants' intentions to implement the intervention components. Monthly meetings between the research and therapy teams were central to the intervention and acted as prompt or reminder to sustain implementation. The phased approach to introducing and implementing intervention components influenced participants' beliefs about the feasibility of implementation. Conclusions: The Behaviour Change Wheel, and in particular the Theoretical Domains Framework, were used to investigate mechanisms of action of an implementation intervention. This approach allowed for consideration of a range of possible mechanisms, and allowed us to categorise these mechanisms using an established behaviour change framework. Identification of the mechanisms of action, following testing of the intervention in a number of settings, has resulted in a refined and more robust intervention programme theory for future testing. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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27. Assessing fidelity to treatment delivery in the ICONS (Identifying Continence OptioNs after Stroke) cluster randomised feasibility trial.
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Chesworth, Brigit M., Leathley, Michael J., Thomas, Lois H., Sutton, Christopher J., Forshaw, Denise, and Watkins, Caroline L.
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MULTI-infarct dementia ,STROKE patients ,STROKE treatment ,MELAS syndrome ,BRAIN disease treatment ,CEREBROVASCULAR disease - Abstract
Background: The implementation of strategies to monitor and enhance treatment fidelity is of paramount importance in trials of complex interventions. A recent framework published by the National Institutes of Health Behavior Change Consortium recommends addressing five areas of treatment fidelity, one of which is delivery of treatment. This study aimed to explore fidelity to treatment delivery of the ICONS intervention (a systematic voiding programme [SVP]). This included exploring the feasibility of a method to assess fidelity to treatment delivery and collecting preliminary evidence of the level of fidelity to SVP delivery in order to inform strategies for improving fidelity in a future trial. Methods: Delivery of treatment was recorded by nurses through completion of daily clinical logs, which included: a voiding interval, proposed voiding times and actual voiding times. The a priori method for assessment of fidelity - comparing actual voiding times with proposed voiding times - was trialled on a small amount of data. Due to errors in documentation of the voiding intervals and proposed voiding times it was not possible to assess fidelity directly as planned. A new method was devised, which included identification of 'key quality indicators'. Results: This new approach to assessing fidelity used key quality indicators based upon presence of the data needed to make the comparison between proposed and actual voiding times. The proportion of clinical logs with correct documentation of voiding intervals and proposed voiding times was less than 40 %. For clinical logs with correct documentation, an actual voiding time within 30 min of the proposed voiding time was identified on approximately 55 % of occasions. Conclusions: Lessons learnt from this study have implications for the future ICONS definitive trial and for other trials of complex interventions. Implementation of a complex intervention may often deviate from what is intended. While careful consideration should be given to the best method of fidelity assessment, an iterative approach allowing flexibility to adapt pre-planned methods is recommended within feasibility trials. As fidelity to treatment delivery in the ICONS feasibility trial appeared to be relatively low, more attention to implementation strategies will be required in the definitive trial. Trial registration: Identifier: ISRCTN08609907; date registered: 07/07/2010. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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28. Development of a behaviour change intervention to increase upper limb exercise in stroke rehabilitation.
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Connell, Louise A., McMahon, Naoimh E., Redfern, Judith, Watkins, Caroline L., and Eng, Janice J.
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ARM exercises ,STROKE treatment ,BEHAVIOR modification ,PATIENT self-monitoring ,CEREBROVASCULAR disease - Abstract
Background: Two thirds of survivors will achieve independent ambulation after a stroke, but less than half will recover upper limb function. There is strong evidence to support intensive repetitive task-oriented training for recovery after stroke. The number of repetitions needed is suggested to be in the order of hundreds, but this is not currently being achieved in clinical practice. In an effort to bridge this evidence-practice gap, we have developed a behaviour change intervention that aims to increase provision of upper limb repetitive task-oriented training in stroke rehabilitation. This paper aims to describe the systematic processes that took place in collaboratively developing the behaviour change intervention. Methods: The methods used in this study were not defined a priori but were guided by the Behaviour Change Wheel. The process was collaborative and iterative with four stages of development emerging (i) establishing an intervention development group; (ii) structured discussions to understand the problem, prioritise target behaviours and analyse target behaviours; (iii) collaborative design of theoretically underpinned intervention components and (iv) piloting and refining of intervention components. Results: The intervention development group consisted of the research team and stroke therapy team at a local stroke rehabilitation unit. The group prioritised four target behaviours at the therapist level: (i) identifying suitable patients for exercises, (ii) provision of exercises, (iii) communicating exercises to family/visitors and (iv) monitoring and reviewing exercises. It also provides a method for self-monitoring performance in order to measure fidelity. The developed intervention, PRACTISE (Promoting Recovery of the Arm: Clinical Tools for Intensive Stroke Exercise), consists of team meetings and the PRACTISE Toolkit (screening tool and upper limb exercise plan, PRACTISE exercise pack and an audit tool). Conclusions: This paper provides an example of how the Behaviour Change Wheel may be applied in the collaborative development of a behaviour change intervention for health professionals. The process involved was resource-intensive, and the iterative process was difficult to capture. The use of a published behaviour change framework and taxonomy will assist replication in future research and clinical use. The feasibility and acceptability of PRACTISE is currently being explored in two other stroke rehabilitation units. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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29. A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: A qualitative interview study.
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Connell, Louise A., McMahon, Naoimh E., Harris, Jocelyn E., Watkins, Caroline L., and Eng, Janice J.
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ARM ,STROKE ,REHABILITATION ,PHYSICIAN practice patterns ,MELAS syndrome - Abstract
Background The Graded Repetitive Arm Supplementary Program (GRASP) is a hand and arm exercise programme designed to increase the intensity of exercise achieved in inpatient stroke rehabilitation. GRASP was shown to be effective in a randomised controlled trial in 2009 and has since experienced unusually rapid uptake into clinical practice. The aim of this study was to conduct a formative evaluation of the implementation of GRASP to inform the development and implementation of a similar intervention in the United Kingdom. Methods Semi-structured interviews were conducted with therapists who were involved in implementing GRASP at their work site, or who had experience of using GRASP. Normalisation Process Theory (NPT), a sociological theory used to explore the processes of embedding innovations in practice, was used to develop an interview guide. Intervention components outlined within the GRASP Guideline Manual were used to develop prompts to explore how therapists use GRASP in practice. Interview transcripts were analysed using a coding frame based on implementation theory. Results Twenty interviews were conducted across eight sites in British Columbia Canada. Therapists identified informal networks and the free online availability of GRASP as key factors in finding out about the intervention. All therapists reported positive opinions about the value of GRASP. At all sites, therapists identified individuals who advocated for the use of GRASP, and in six of the eight sites this was the practice leader or senior therapist. Rehabilitation assistants were identified as instrumental in delivering GRASP in almost all sites as they were responsible for organising the GRASP equipment and assisting patients using GRASP. Almost all intervention components were found to be adapted to some degree when used in clinical practice; coverage was wider, the content adapted, and the dose, when monitored, was less. Conclusions Although GRASP has translated into clinical practice, it is not always used in the way in which it was shown to be effective. This formative evaluation has informed the development of a novel intervention which aims to bridge this evidence-practice gap in upper limb rehabilitation after stroke. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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30. Training emergency services' dispatchers to recognise stroke: an interrupted time-series analysis.
- Author
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Watkins, Caroline L., Leathley, Michael J., Jones, Stephanie P., Ford, Gary A., Quinn, Tom, Sutton, Chris J., and Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) Group
- Subjects
- *
EMERGENCY medical services , *EMERGENCY medical personnel , *STROKE diagnosis , *TIME series analysis , *AMBULANCE service , *TRAINING - Abstract
Background: Stroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services (EMS). Identifying 'true stroke' from an EMS call is challenging, with over 50% of strokes being misclassified. The aim of this study was to evaluate the impact of the training package on the recognition of stroke by Emergency Medical Dispatchers (EMDs).Methods: This study took place in an ambulance service and a hospital in England using an interrupted time-series design. Suspected stroke patients were identified in one week blocks, every three weeks over an 18 month period, during which time the training was implemented. Patients were included if they had a diagnosis of stroke (EMS or hospital). The effect of the intervention on the accuracy of dispatch diagnosis was investigated using binomial (grouped) logistic regression.Results: In the Pre-implementation period EMDs correctly identified 63% of stroke patients; this increased to 80% Post-implementation. This change was significant (p=0.003), reflecting an improvement in identifying stroke patients relative to the Pre-implementation period both the During-implementation (OR=4.10 [95% CI 1.58 to 10.66]) and Post-implementation (OR=2.30 [95% CI 1.07 to 4.92]) periods. For patients with a final diagnosis of stroke who had been dispatched as stroke there was a marginally non-significant 2.8 minutes (95% CI -0.2 to 5.9 minutes, p=0.068) reduction between Pre- and Post-implementation periods from call to arrival of the ambulance at scene.Conclusions: This is the first study to develop, implement and evaluate the impact of a training package for EMDs with the aim of improving the recognition of stroke. Training led to a significant increase in the proportion of stroke patients dispatched as such by EMDs; a small reduction in time from call to arrival at scene by the ambulance also appeared likely. The training package has been endorsed by the UK Stroke Forum Education and Training, and is free to access on-line. [ABSTRACT FROM AUTHOR]- Published
- 2013
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31. A cluster randomised controlled trial of an occupational therapy intervention for residents with stroke living in UK care homes (OTCH): study protocol.
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Sackley, Cath M., Burton, Chris R., Herron-Marx, Sandy, Lett, Karen, Mant, Jonathan, Roalfe, Andrea K., Sharp, Leslie J., Sheehan, Bart, Stant, Katie E., Walker, Marion F., Watkins, Caroline L., Wheatley, Keith, Williams, Jane, Yao, Guiqing L., and Feltham, Max G.
- Subjects
STROKE ,CLINICAL trials ,ISCHEMIA - Abstract
Background: The occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care. Methods/Design: A cluster randomised controlled trial of United Kingdom (UK) care homes (n = 90) with residents (n = 900) who have suffered a stroke or transient ischaemic attack (TIA), and who are not receiving end-of-life care. Homes will be stratified by centre and by type of care provided and randomised (50:50) using computer generated blocked randomisation within strata to receive either the OT intervention (3 months intervention from an occupational therapist) or control (usual care). Staff training on facilitating independence and mobility and the use of adaptive equipment, will be delivered to every home, with control homes receiving this after the 12 month follow-up. Allocation will be concealed from the independent assessors, but the treating therapists, and residents will not be masked to the intervention. Measurements are taken at baseline prior to randomisation and at 3, 6 and 12 months post randomisation. The primary outcome measure is independence in self-care activities of daily living (Barthel Activities of Daily Living Index). Secondary outcome measures are mobility (Rivermead Mobility Index), mood (Geriatric Depression Scale), preference based quality of life measured from EQ-5D and costs associated with each intervention group. Quality adjusted life years (QALYs) will be derived based on the EQ-5D scores. Cost effectiveness analysis will be estimated and measured by incremental cost effectiveness ratio. Adverse events will be recorded. Discussion: This study will be the largest cluster randomised controlled trial of OT in care homes to date and will clarify the currently inconclusive literature on the efficacy of OT for stroke and TIA survivors residing in care homes. Trial registration: ISRCTN00757750 [ABSTRACT FROM AUTHOR]
- Published
- 2012
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- View/download PDF
32. Practical and methodological challenges in the design and implementation of a clusterrandomised feasibility trial of the management of urinary incontinence after stroke.
- Author
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Sutton, Chris J., Thomas, Lois, Forshaw, Denise, and Watkins, Caroline L.
- Subjects
RANDOMIZED controlled trials ,URINARY incontinence - Abstract
An abstract of the article "Practical and methodological challenges in the design and implementation of a clusterrandomised feasibility trial of the management of urinary incontinence after stroke," by Chris J. Sutton and colleagues, is presented.
- Published
- 2011
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33. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom.
- Author
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Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, Dewey HM, Emsley HCA, Davies DP, Day E, Ford GA, Price CI, May CR, McLoughlin ASR, Gibson JME, and Lightbody CE
- Subjects
- Adult, Delivery of Health Care methods, Dissent and Disputes, England, Female, Humans, Male, Perception, Pilot Projects, Referral and Consultation, Social Support, Stroke diagnosis, Telemedicine methods, Victoria, Practice Patterns, Physicians', Remote Consultation, Specialization, Stroke therapy
- Abstract
Background: Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations., Methods: Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70., Results: Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures., Conclusion: Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.
- Published
- 2017
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34. Repetitive arm functional tasks after stroke (RAFTAS): a pilot randomised controlled trial.
- Author
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Brkic L, Shaw L, van Wijck F, Francis R, Price C, Forster A, Langhorne P, Watkins C, and Rodgers H
- Abstract
Background: Repetitive functional task practise (RFTP) is a promising treatment to improve upper limb recovery following stroke. We report the findings of a study to determine the feasibility of a multi-centre randomised controlled trial to evaluate this intervention., Methods: A pilot randomised controlled trial recruited patients with new reduced upper limb function within 14 days of acute stroke from three stroke units. Participants were randomised to receive a four week upper limb RFTP therapy programme consisting of goal setting, independent activity practise, and twice weekly therapy reviews in addition to usual post stroke rehabilitation, or usual post stroke rehabilitation. The recruitment rate; adherence to the RFTP therapy programme; usual post stroke rehabilitation received; attrition rate; data quality; success of outcome assessor blinding; adverse events; and the views of study participants and therapists about the intervention were recorded., Results: Fifty five eligible patients were identified, 4-6 % of patients screened at each site. Twenty four patients participated in the pilot study. Two study sites met the recruitment target of 1-2 participants per month. The median number of face to face therapy sessions received was 6 [IQR 3-8]. The median number of daily repetitions of activities recorded was 80 [IQR 39-80]. Data about usual post stroke rehabilitation were available for 18/24 (75 %). Outcome data were available for 22/24 (92 %) at one month and 20/24 (83 %) at three months. Outcome assessors were unblinded to participant group allocation for 11/22 (50 %) at one month and 6/20 (30 %) at three months. Four adverse events were considered serious as they resulted in hospitalisation. None were related to study treatment. Feedback from patients and therapists about the RFTP programme was mainly positive., Conclusions: A multi-centre randomised controlled trial to evaluate an upper limb RFTP therapy programme provided early after stroke is feasible and acceptable to patients and therapists, but there are issues which need to be addressed when designing a Phase III study. A Phase III study will need to monitor and report not only recruitment and attrition but also adherence to the intervention, usual post stroke rehabilitation received, and outcome assessor blinding., Trial Registration: International Standard Randomised Controlled Trials Number (ISRCTN) 58527251.
- Published
- 2016
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35. Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial.
- Author
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Radford KA, Phillips J, Jones T, Gibson A, Sutton C, Watkins C, Sach T, Duley L, Walker M, Drummond A, Hoffman K, O'Connor R, Forshaw D, and Shakespeare D
- Abstract
Background: Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial., Methods/design: Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face V s postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial., Discussion: To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial., Trial Registration: The trial is registered ISRCTN Number 38581822.
- Published
- 2015
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36. Head Position in Stroke Trial (HeadPoST)--sitting-up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomised controlled trial.
- Author
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Muñoz-Venturelli P, Arima H, Lavados P, Brunser A, Peng B, Cui L, Song L, Billot L, Boaden E, Hackett ML, Heritier S, Jan S, Middleton S, Olavarría VV, Lim JY, Lindley RI, Heeley E, Robinson T, Pontes-Neto O, Natsagdorj L, Lin RT, Watkins C, and Anderson CS
- Subjects
- Asia, Australia, Brazil, Cerebral Hemorrhage diagnosis, Cerebral Hemorrhage mortality, Cerebral Hemorrhage physiopathology, Chile, Clinical Protocols, Cross-Over Studies, Disability Evaluation, Humans, Logistic Models, Patient Positioning adverse effects, Predictive Value of Tests, Prospective Studies, Risk Factors, Sample Size, Stroke diagnosis, Stroke mortality, Stroke physiopathology, Time Factors, Treatment Outcome, United Kingdom, Cerebral Hemorrhage therapy, Cerebrovascular Circulation, Head blood supply, Patient Positioning methods, Stroke therapy, Supine Position
- Abstract
Background: Positioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0°) compared with sitting-up (≥ 30°) head positioning in the first 24 hours of hospital admission for patients with acute stroke., Methods/design: We plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0°) or sitting-up (≥ 30°) head position as a 'business as usual' stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (α 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period., Discussion: HeadPoST is a large international clinical trial in which we will rigorously evaluate the effects of different head positioning in patients with acute stroke., Trial Registration: ClinicalTrials.gov identifier: NCT02162017 (date of registration: 27 April 2014); ANZCTR identifier: ACTRN12614000483651 (date of registration: 9 May 2014). Protocol version and date: version 2.2, 19 June 2014.
- Published
- 2015
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37. Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial.
- Author
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Thomas LH, Watkins CL, Sutton CJ, Forshaw D, Leathley MJ, French B, Burton CR, Cheater F, Roe B, Britt D, Booth J, and McColl E
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- Aged, Aged, 80 and over, Cognition, England, Feasibility Studies, Female, Humans, Male, Odds Ratio, Patient Selection, Quality of Life, Recovery of Function, Sample Size, Stroke complications, Stroke diagnosis, Stroke mortality, Stroke physiopathology, Stroke psychology, Time Factors, Treatment Outcome, Urinary Incontinence diagnosis, Urinary Incontinence etiology, Urinary Incontinence mortality, Urinary Incontinence physiopathology, Urinary Incontinence psychology, Urodynamics, Wales, Cognitive Behavioral Therapy, Stroke therapy, Urinary Bladder physiopathology, Urinary Incontinence therapy
- Abstract
Background: Urinary incontinence (UI) affects half of patients hospitalised after stroke and is often poorly managed. Cochrane systematic reviews have shown some positive impact of conservative interventions (such as bladder training) in reducing UI, but their effectiveness has not been demonstrated with stroke patients., Methods: We conducted a cluster randomised controlled feasibility trial of a systematic voiding programme (SVP) for the management of UI after stroke. Stroke services were randomised to receive SVP (n = 4), SVP plus supported implementation (SVP+, n = 4), or usual care (UC, n = 4).Feasibility outcomes were participant recruitment and retention. The main effectiveness outcome was presence or absence of UI at six and 12 weeks post-stroke. Additional effectiveness outcomes included were the effect of the intervention on different types of UI, continence status at discharge, UI severity, functional ability, quality of life, and death., Results: It was possible to recruit patients (413; 164 SVP, 125 SVP+, and 124 UC) and participant retention was acceptable (85% and 88% at six and 12 weeks, respectively). There was no suggestion of a beneficial effect on the main outcome at six (SVP versus UC: odds ratio (OR) 0.94, 95% CI: 0.46 to 1.94; SVP+ versus UC: OR: 0.62, 95% CI: 0.28 to 1.37) or 12 weeks (SVP versus UC: OR: 1.02, 95% CI: 0.54 to 1.93; SVP+ versus UC: OR: 1.06, 95% CI: 0.54 to 2.09).No secondary outcomes showed a strong suggestion of clinically meaningful improvement in SVP and/or SVP+ arms relative to UC at six or 12 weeks. However, at 12 weeks both intervention arms had higher estimated odds of continence than UC for patients with urge incontinence., Conclusions: The trial has met feasibility outcomes of participant recruitment and retention. It was not powered to demonstrate effectiveness, but there is some evidence of a potential reduction in the odds of specific types of incontinence. A full trial should now be considered., Trial Registration: ISRCTN Registry, ISRCTN08609907, date of registration: 7 July 2010.
- Published
- 2014
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38. The challenges of implementing a telestroke network: a systematic review and case study.
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French B, Day E, Watkins C, McLoughlin A, Fitzgerald J, Leathley M, Davies P, Emsley H, Ford G, Jenkinson D, May C, O'Donnell M, Price C, Sutton C, and Lightbody C
- Subjects
- Consensus, Humans, Longitudinal Studies, United Kingdom, Stroke diagnosis, Stroke therapy, Telemedicine standards
- Abstract
Background: The use of telemedicine in acute stroke care can facilitate rapid access to treatment, but the work required to embed any new technology into routine practice is often hidden, and can be challenging. We aimed to collate recommendations and resources to support telestroke implementation., Methods: Systematic search of healthcare databases and the Internet to identify descriptions of the implementation of telestroke projects; interviews with key stakeholders during the development of one UK telestroke network. Supporting documentation from existing projects was analysed to construct a framework of implementation stages and tasks, and a toolkit of documents. Interviews and literature were analysed with other data sources using Normalisation Process Theory as described in the e-Health Implementation Toolkit., Results: 61 telestroke projects were identified and contacted. Twenty projects provided documents, 13 with published research detailing four stages of telestroke system development, implementation, use, and evaluation. Interviewees identified four main challenges: engaging and maintaining the commitment of a wide range of stakeholders across multiple organisations; addressing clinicians perceptions of evidence, workload, and payback; managing clinical and technical workability across diverse settings; and monitoring how the system is used and reconfigured by users., Conclusions: Information to guide telestroke implementation is sparse, but available. By using multiple sources of data, sufficient information was collated to construct a web-based toolkit detailing implementation tasks, resources and challenges in the development of a telestroke system for assessment and thrombolysis delivery in acute care. The toolkit is freely available online.
- Published
- 2013
- Full Text
- View/download PDF
39. Study protocol: ICONS: identifying continence options after stroke: a randomised trial.
- Author
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Thomas LH, Watkins CL, French B, Sutton C, Forshaw D, Cheater F, Roe B, Leathley MJ, Burton C, McColl E, and Booth J
- Subjects
- Feasibility Studies, Health Knowledge, Attitudes, Practice, Humans, Patient Education as Topic, Quality of Life, Stroke complications, Stroke physiopathology, Surveys and Questionnaires, Time Factors, Treatment Outcome, United Kingdom, Urinary Incontinence etiology, Urinary Incontinence physiopathology, Pelvic Floor physiopathology, Physical Therapy Modalities, Research Design, Stroke Rehabilitation, Urinary Bladder physiopathology, Urinary Incontinence rehabilitation
- Abstract
Background: Urinary incontinence following acute stroke is common, affecting between 40%-60% of people in hospital after a stroke. Despite the availability of clinical guidelines for urinary incontinence and urinary incontinence after stroke, national audit data suggest incontinence is often poorly managed. Conservative interventions (e.g. bladder training, pelvic floor muscle training and prompted voiding) have been shown to have some effect with participants in Cochrane systematic reviews, but have not had their effectiveness demonstrated with stroke patients., Methods/design: A cluster randomised controlled pilot trial designed to assess the feasibility of a full-scale cluster randomised trial and to provide preliminary evidence of the effectiveness and cost-effectiveness of a systematic voiding programme for the management of continence after stroke. Stroke services will be randomised to receive the systematic voiding programme, the systematic voiding programme plus supported implementation, or usual care. The trial aims to recruit at least 780 participants in 12 stroke services (4 per arm). The primary outcome is presence/absence of incontinence at six weeks post-stroke. Secondary outcomes include frequency and severity of incontinence, quality of life and cost-utility. Outcomes will be measured at six weeks, three months and (for participants recruited in the first three months) twelve months after stroke. Process data will include rates of recruitment and retention and fidelity of intervention delivery. An integrated qualitative evaluation will be conducted in order to describe implementation and assist in explaining the potential mediators and modifiers of the process., Trial Registration: ISRCTN: ISRCTN08609907
- Published
- 2011
- Full Text
- View/download PDF
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