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Background: Many areas of healthcare are impacted by a paucity of research that is translatable to clinical practice. Research utilising real-world data, such as routinely collected patient data, may be one option to efficiently create evidence to inform practice and service delivery. Such studies are also valuable for exploring (in)equity of services and outcomes, and benefit from using non-selected samples representing the diversity of the populations served in the 'real world'. This scoping review aims to identify and map the published research which utilises routinely collected clinical healthcare data. A secondary aim is to explore the extent to which this literature supports the pursuit of social justice in health, including health inequities and intersectional approaches. Method: This review utilises Arksey and O'Malley's methodological framework for scoping reviews and draws on the recommended enhancements of this framework to promote a team-based and mixed methods approach. This includes searching electronic databases and screening papers based on a pre-specified inclusion and exclusion criteria. Data relevant to the research aims will be extracted from included papers, including the clinical/professional area of the topic, the source of data that was used, and whether it addresses elements of social justice. All screening and reviewing will be collaborative and iterative, drawing on strengths of the research team and responsive changes to challenges will be made. Quantitative data will be analysed descriptively, and conceptual content analysis will be utilised to understand qualitative data. These will be collectively synthesised in alignment to the research aims. Conclusion: Our findings will highlight the extent to which such research is being conducted and published, including gaps and make recommendations for future endeavours for real-world data studies. The findings from this scoping review will be relevant for practitioners and researchers, as well as health service managers, commissioners, and research funders. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThe Therapy Outcome Measure (TOM) comprises many profession and client group-specific adapted scales based on the International Classification of Functioning Model, used by different Health Care Professionals (HCPs). A new Multidisciplinary stroke TOM scale (MDT Stroke TOMs) was developed by amalgamating the relevant scales. This study aimed to develop a scale to describe patients’ abilities and improve communication and collaboration within the stroke Multidisciplinary Team (MDT). The present study investigated the inter-rater and intra-rater reliability of this adaptation.The MDT Stroke TOM Scale was developed by combining and rewording four profession-specific adapted TOM scales following iterative trials and discussions leading to an agreed version. 150 stroke Allied Health Professional (AHPs) and nurses were trained virtually in TOM and the MDT Stroke TOM Scale. Ten AHP and nursing raters from five professions evaluated ten composite stroke case studies for inter-rater reliability. Six participated in the intra-rater reliability review of the same three case studies at different time points. Reliability was quantified using intraclass correlation coefficients and measurement error using the smallest detectable change.There was good to excellent concordance between the raters in terms of scoring. Raters’ scores were also consistent. The MDT Stroke TOMs is being used consistently across the South West London Stroke Network.The Stroke MDT TOMs is psychometrically robust and should assist with improving team work in the rehabilitation of stroke patients and their carers. Future research may use MDT Stroke TOM to promote interprofessional team working and facilitate communication in Stroke Rehabilitation. The introduction of a new Multidisciplinary Team (MDT) Stroke Therapy Outcome measure to encourage interdisciplinary working and collaboration.One measure to complete and document for busy MDTs, which has good - excellent reliability.Early and timely MDT discussions regarding patient care and needs.Using this reliable outcome measure facilitates audit and benchmarking of services.The introduction of a new Multidisciplinary Team (MDT) Stroke Therapy Outcome measure to encourage interdisciplinary working and collaboration.One measure to complete and document for busy MDTs, which has good - excellent reliability.Early and timely MDT discussions regarding patient care and needs.Using this reliable outcome measure facilitates audit and benchmarking of services. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is common after stroke, affecting up to 50% of patients initially. It can lead to post-stroke pneumonia, which causes 30% of stroke-related deaths, a longer hospital stay and poorer health outcomes. Dysphagia care post-stroke generally focuses on the management of symptoms, via modified oral intake textures and adapted posture, rather than direct physical rehabilitation of the swallowing function. Transcutaneous neuromuscular electrical stimulation (NMES) is a promising rehabilitation technology that can be used to stimulate swallowing; however, findings regarding efficacy have been conflicting. Aims: This pilot randomized controlled study involving three UK sites compared the efficacy of the Ampcare Effective Swallowing Protocol (ESP), combining NMES with swallow-strengthening exercises, with usual care in order to clarify evidence on NMES in the treatment of dysphagia post-stroke. A further objective was to pilot recruitment procedures and outcome measures in order to inform the design of a full-scale trial. Methods & Procedures: Thirty patients were recruited and randomized into either (1) usual speech and language therapy dysphagia care; or (2) Ampcare ESP, receiving treatment 5 days/week for 4 weeks. Outcome measures included: the Functional Oral Intake Scale (FOIS), the Rosenbek Penetration-Aspiration Scale (PAS) and patient-reported outcomes (Swallow Related Quality of Life--SWAL-QOL). Outcomes & Results: Thirty patients were recruited; 15 were randomized to the Ampcare ESP intervention arm and 15 to usual care. A greater proportion (75%, or 9/12) of patients receiving Ampcare ESP improved compared with 57% (or 8/14) of the usual-care group. Patients receiving Ampcare ESP also made clinically meaningful change (a comparative benefit of 1.5 on the FOIS, and on the PAS: 1.35 for diet and 0.3 for fluids) compared with usual care. The intervention group also reported much better outcome satisfaction. Conclusions & Implications: The pilot demonstrated successful recruitment, treatment safety and tolerability and clinically meaningful outcome improvements, justifying progression to a fully powered study. It also showed clinically meaningful treatment trends for the Ampcare ESP intervention.

Byline: Pam. Enderby, Laura. Sutton Objective: To provide a brief review of research literature relating to the current state of knowledge regarding speech and language therapy for people with aphasia [...]

Background: Speech and language therapy (SLT) for aphasia can be difficult to access in the later stages of stroke recovery, despite evidence of continued improvement with sufficient therapeutic intensity. Computerized aphasia therapy has been reported to be useful for independent language practice, providing new opportunities for continued rehabilitation. The success of this option depends on its acceptability to patients and carers. Aims: To investigate factors that affect the acceptability of independent home computerized aphasia therapy practice. Methods & Procedures: An acceptability study of computerized therapy was carried out alongside a pilot randomized controlled trial of computer aphasia therapy versus usual care for people more than 6 months post-stroke. Following language assessment and computer exercise prescription by a speech and language therapist, participants practised three times a week for 5 months at home with monthly volunteer support. Semi-structured interviews were conducted with 14 participants who received the intervention and ten carers (n = 24). Questions from a topic guide were presented and answered using picture, gesture and written support. Interviews were audio recorded, transcribed verbatim and analysed thematically. Three research SLTs identified and cross-checked themes and subthemes emerging from the data. Outcomes & Results: The key themes that emerged were benefits and disadvantages of computerized aphasia therapy, need for help and support, and comparisons with face-to-face therapy. The independence, flexibility and repetition afforded by the computer was viewed as beneficial and the personalized exercises motivated participants to practise. Participants and carers perceived improvements in word-finding and confidence-talking. Computer practice could cause fatigue and interference with other commitments. Support from carers or volunteers for motivation and technical assistance was seen as important. Although some participants preferred face-to-face therapy, using a computer for independent language practice was perceived to be an acceptable alternative. Conclusions & Implications: Independent computerized aphasia therapy is acceptable to stroke survivors. Acceptability can be maximized by tailoring exercises to personal interests of the individual, ensuring access to support and giving consideration to fatigue and life style when recommending practice schedules.

Background: There has been a rapid growth in recent years of available technologies for individuals with communication difficulties. Research in the area is currently underdeveloped with practitioners having a limited body of work on which to draw to guide the process of intervention. Concerns have been raised that this newly developed technology may have limited functional usage. Aims: This review aims to investigate the potential barriers and facilitators to high-technology AAC provision and its ongoing use. The aim of the analysis is to explore factors underpinning use rather than effectiveness, thus it synthesized data from predominantly qualitative and survey studies reporting the views and perceptions of AAC users or staff providing the devices. Main Contribution: The review highlights the range of factors that can impact on provision and use of high-technology AAC, which practitioners should consider and address as appropriate in the intervention process. These include: ease of use of the device; reliability; availability of technical support; voice/language of the device; decision-making process; time taken to generate a message; family perceptions and support; communication partner responses; service provision; and knowledge and skills of staff. The work outlines how qualitative synthesis review methods may be applied to the consideration of published material that is not reporting outcomes data, and how this may provide valuable information to inform future studies. Conclusions: Practitioners should be aware of barriers and facilitators to successful use when making recommendations, and consider how barriers where present might be overcome. Aspects of service delivery such as ongoing technical support and staff training may require further consideration. The synthesis of evidence describing views of users and providers, and the implementation of high-technology AAC systems, can provide valuable data to inform intervention studies and functional outcome measures. (Contains 3 tables and 1 figure.)

Background: In clinical practice, it is common for speech and language therapists to discontinue dysarthria treatment when a plateau in spontaneous recovery is reached. However, there is some evidence from single-case research studies that people with chronic dysarthria can improve their speech with intervention several years after the onset of the disorder. If this is so, it can be argued that speech treatment should still be an option available to them. Motor learning principles suggest that in order to be effective, treatment needs to involve frequent, consistent practice with feedback. Aims: To compare the effects of both traditional treatment for clients with longstanding, stable dysarthria with computerized speech therapy, which allows independent practice with feedback. Development of the Computer Program: A new computer program was developed through a European Union-funded, quality of life and management of human resources programme. The program was designed for use with people with speech disorders and was based on motor learning principles. Speech recognition technology was exploited to provide feedback on practice attempts. Methods & Procedures: Seven clients with longstanding, stable dysarthria completed a within-participant ABAC/ACAB case series design to compare 6-week blocks of weekly traditional treatment with 6-week blocks of computer-based treatment over a 6-month period. Outcomes & Results: The findings suggest that the participants improved their speech with treatment. The computerized therapy was as effective as traditional treatment. The participants spent more time (37%) with the computerized therapy than with traditional practice techniques. Conclusions: The participants with longstanding dysarthria in this study made improvements to their speech with treatment using both traditional and computer-based techniques. Computers could provide a method of delivering an effective dysarthria treatment service without placing high demands on therapy resources. (Contains 11 tables and 1 figure.)

The STARDUST project developed robust computer speech recognizers for use by eight people with severe dysarthria and concomitant physical disability to access assistive technologies. Independent computer speech recognizers trained with normal speech are of limited functional use by those with severe dysarthria due to limited and inconsistent proximity to "normal" articulatory patterns. Severe dysarthric output may also be characterized by a small mass of distinguishable phonetic tokens making the acoustic differentiation of target words difficult. Speaker dependent computer speech recognition using Hidden Markov Models was achieved by the identification of robust phonetic elements within the individual speaker output patterns. A new system of speech training using computer generated visual and auditory feedback reduced the inconsistent production of key phonetic tokens over time.

This article describes the development of a new service for people with dementia and their carers in a large post-industrial city in the north of England, UK. The service arose in response to the perceived inadequacies of existing respite care provision and has proved very successful in meeting the needs of people with dementia and their family carers, and in providing high levels of job satisfaction for staff. The success of the initiative can be understood using the Senses Framework and relationship-centred care as an analytic lens to identify key attributes of the service. The article also discusses implications for the development of support services more generally., Keywords: relationship-centred care; respite care 71 ArticleUsing the Senses Framework to achieve relationship-centred dementia care servicesA case example SAGE Publications, Inc.200810.1177/1471301207085368 TonyRyan Sheffield Hallam University, UK, a.w.ryan@shu.ac.uk MikeNolan University of [...]

This study investigated whether it is possible for people with chronic dysarthria to adjust their articulation in three practice conditions. A speaker dependent, speech recognition system was used to compare [...]