333 results on '"Lannin, NA"'
Search Results
2. Development of an electronic health message system to support recovery after stroke: Inspiring Virtual Enabled Resources following Vascular Events (iVERVE)
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Cadilhac DA, Busingye D, Li JC, Andrew NE, Kilkenny MF, Thrift AG, Thijs V, Hackett ML, Kneebone I, Lannin NA, Stewart A, Dempsey I, and Cameron J
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stroke ,e-health ,self-management ,Medicine (General) ,R5-920 - Abstract
Dominique A Cadilhac,1,2 Doreen Busingye,1 Jonathan C Li,3 Nadine E Andrew,1,4 Monique F Kilkenny,1,2 Amanda G Thrift,1 Vincent Thijs,2,5 Maree L Hackett,6,7 Ian Kneebone,8 Natasha A Lannin,9,10 Alana Stewart,11 Ida Dempsey,12 Jan Cameron,1,13 1Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; 2Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia; 3Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia; 4Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia; 5Department of Neurology, Austin Health, Melbourne, VIC, Australia; 6The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; 7Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK; 8Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia; 9College of Science, Health and Engineering, School of Allied Health, La Trobe University, Melbourne, VIC, Australia; 10Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia; 11Stroke Foundation, Melbourne, VIC, Australia; 12Consumer Representative, Melbourne, VIC, Australia; 13Australian Centre for Heart Health, Royal Melbourne Hospital, Melbourne, VIC, Australia Purpose: Worldwide, stroke is a leading cause of disease burden. Many survivors have unmet needs after discharge from hospital. Electronic communication technology to support post-discharge care has not been used for patients with stroke. In this paper, we describe the development of a novel electronic messaging system designed for survivors of stroke to support their goals of recovery and secondary prevention after hospital discharge. Participants and methods: This was a formative evaluation study. The design was informed by a literature search, existing data from survivors of stroke, and behavior change theories. We established two working groups; one for developing the electronic infrastructure and the other (comprising researchers, clinical experts and consumer representatives) for establishing the patient-centered program. Following agreement on the categories for the goal-setting menu, we drafted relevant messages to support and educate patients. These messages were then independently reviewed by multiple topic experts. Concurrently, we established an online database to capture participant characteristics and then integrated this database with a purpose-built messaging system. We conducted alpha testing of the approach using the first 60 messages. Results: The initial goal-setting menu comprised 26 subcategories. Following expert review, another 8 goal subcategories were added to the secondary prevention category: managing cholesterol; smoking; physical activity; alcohol consumption; weight management; medication management; access to health professionals, and self-care. Initially, 455 health messages were created by members of working group 2. Following refinement and mapping to different goals by the project team, 980 health messages across the health goals and 69 general motivational messages were formulated. Seventeen independent reviewers assessed the messages and suggested adding 73 messages and removing 16 (2%). Overall, 1,233 messages (18 administrative, 69 general motivation and 1,146 health-related) were created. Conclusion: This novel electronic self-management support system is ready to be pilot tested in a randomized controlled trial in patients with stroke. Keywords: stroke, e-health, self-management, health promotion, secondary prevention
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- 2018
3. Cardiac structural and functional abnormalities in epilepsy: A systematic review and meta-analysis
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Liu, Z, Thergarajan, P, Antonic-Baker, A, Chen, Z, Sparks, PB, Lannin, NA, Kwan, P, Jones, NC, Casillas-Espinosa, PM, Perucca, P, O'Brien, TJ, Sivathamboo, S, Liu, Z, Thergarajan, P, Antonic-Baker, A, Chen, Z, Sparks, PB, Lannin, NA, Kwan, P, Jones, NC, Casillas-Espinosa, PM, Perucca, P, O'Brien, TJ, and Sivathamboo, S
- Abstract
OBJECTIVE: Epilepsy is associated with an increased risk of cardiovascular disease and mortality. Whether cardiac structure and function are altered in epilepsy remains unclear. To address this, we conducted a systematic review and meta-analysis of studies evaluating cardiac structure and function in patients with epilepsy. METHODS: We searched the electronic databases MEDLINE, PubMed, COCHRANE, and Web of Science from inception to 31 December 2021. Primary outcomes of interest included left ventricular ejection fraction (LVEF) for studies reporting echocardiogram findings and cardiac weight and fibrosis for postmortem investigations. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tools. RESULTS: Among the 10 case-control studies with epilepsy patients (n = 515) and healthy controls (n = 445), LVEF was significantly decreased in epilepsy group compared with controls (MD: -1.80; 95% confidence interval [CI]: -3.56 to -0.04; P = 0.045), whereas A-wave velocity (MD: 4.73; 95% CI: 1.87-7.60; P = 0.001), E/e' ratio (MD: 0.39; 95% CI: 0.06-0.71; P = 0.019), and isovolumic relaxation time (MD: 10.18; 95% CI: 2.05-18.32; P = 0.014) were increased in epilepsy, compared with controls. A pooled analysis was performed in sudden unexpected death in epilepsy (SUDEP) cases with autopsy data (n = 714). Among SUDEP cases, the prevalence of cardiac hypertrophy was 16% (95% CI: 9%-23%); cardiac fibrosis was 20% (95% CI: 15%-26%). We found no marked differences in cardiac hypertrophy, heart weight, or cardiac fibrosis between SUDEP cases and epilepsy controls. SIGNIFICANCE: Our findings suggest that epilepsy is associated with altered diastolic and systolic echocardiogram parameters compared with healthy controls. Notably, SUDEP does not appear to be associated with a higher incidence of structural cardiac abnormalities, compared with non-SUDEP epilepsy controls. Longitudinal studies are needed to understand the prognostic significance
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- 2023
4. Examining Dose Frameworks to Improve Aphasia Rehabilitation Research
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Harvey, S, Rose, ML, Brogan, E, Pierce, JE, Godecke, E, Brownsett, SLE, Churilov, L, Copland, D, Dickey, MW, Dignam, J, Lannin, NA, Nickels, L, Bernhardt, J, Hayward, KS, Harvey, S, Rose, ML, Brogan, E, Pierce, JE, Godecke, E, Brownsett, SLE, Churilov, L, Copland, D, Dickey, MW, Dignam, J, Lannin, NA, Nickels, L, Bernhardt, J, and Hayward, KS
- Abstract
The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research-the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.
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- 2023
5. Receipt of Mental Health Treatment in People Living With Stroke: Associated Factors and Long-Term Outcomes.
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Tjokrowijoto, P, Stolwyk, RJ, Ung, D, Kneebone, I, Kilkenny, MF, Kim, J, Olaiya, MT, Dalli, LL, Cadilhac, DA, Nelson, MR, Lannin, NA, Andrew, NE, PRECISE Investigators, Tjokrowijoto, P, Stolwyk, RJ, Ung, D, Kneebone, I, Kilkenny, MF, Kim, J, Olaiya, MT, Dalli, LL, Cadilhac, DA, Nelson, MR, Lannin, NA, Andrew, NE, and PRECISE Investigators
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BACKGROUND: Untreated poststroke mood problems may influence long-term outcomes. We aimed to investigate factors associated with receiving mental health treatment following stroke and impacts on long-term outcomes. METHODS: Observational cohort study derived from the Australian Stroke Clinical Registry (AuSCR; Queensland and Victorian registrants: 2012-2016) linked with hospital, primary care billing and pharmaceutical dispensing claims data. Data from registrants who completed the AuSCR 3 to 6 month follow-up survey containing a question on anxiety/depression were analyzed. We assessed exposures at 6 to 18 months and outcomes at 18 to 30 months. Factors associated with receiving treatment were determined using staged multivariable multilevel logistic regression models. Cox proportional hazards regression models were used to assess the impact of treatment on outcomes. RESULTS: Among 7214 eligible individuals, 39% reported anxiety/depression at 3 to 6 months following stroke. Of these, 54% received treatment (88% antidepressant medication). Notable factors associated with any mental health treatment receipt included prestroke psychological support (odds ratio [OR], 1.80 [95% CI, 1.37-2.38]) or medication (OR, 17.58 [95% CI, 15.05-20.55]), self-reported anxiety/depression (OR, 2.55 [95% CI, 2.24-2.90]), younger age (OR, 0.98 [95% CI, 0.97-0.98]), and being female (OR, 1.30 [95% CI, 1.13-1.48]). Those who required interpreter services (OR, 0.49 [95% CI, 0.25-0.95]) used a health benefits card (OR, 0.73 [95% CI, 0.59-0.92]) or had continuity of primary care visits (ie, with a consistent physician; OR, 0.78 [95% CI, 0.62-0.99]) were less likely to access mental health services. Among those who reported anxiety/depression, those who received mental health treatment had an increased risk of presenting to hospital (hazard ratio, 1.06 [95% CI, 1.01-1.11]) but no difference in survival (hazard ratio, 1.04 [95% CI, 0.58-1.27]). CONCLUSIONS: Nearly half of the people living wit
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- 2023
6. Exploring dimensions of quality-of-life in survivors of stroke with communication disabilities – a brief report.
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Thayabaranathan, T, Baker, C, Andrew, NE, Stolwyk, R, Thrift, AG, Carter, H, Moss, K, Kim, J, Wallace, SJ, Brogan, E, Grimley, R, Lannin, NA, Rose, ML, and Cadilhac, DA
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HOSPITALS ,STROKE ,PAIN ,SELF-evaluation ,CROSS-sectional method ,INTERVIEWING ,COMMUNICATIVE disorders ,SURVEYS ,QUALITY of life ,RESEARCH funding ,CHI-squared test ,MENTAL depression ,DESCRIPTIVE statistics ,ANXIETY ,DATA analysis software ,HEALTH self-care ,DISEASE complications - Abstract
People with communication disabilities post-stroke have poor quality-of-life. We aimed to explore the association of self-reported communication disabilities with different dimensions of quality-of-life between 90 and 180 days post-stroke. Cross-sectional survey data were obtained between 90 and 180 days post-stroke from registrants in the Australian Stroke Clinical Registry recruited from three hospitals in Queensland. The usual follow-up survey included the EQ5D-3L. Responses to the Hospital Anxiety and Depression Scale, and extra questions (e.g. communication disabilities) were also collected. We used χ
2 statistics to determine differences. Overall, 244/647 survivors completed the survey. Respondents with communication disabilities (n = 72) more often reported moderate to extreme problems in all EQ5D-3L dimensions, than those without communication disabilities (n = 172): anxiety or depression (74% vs 40%, p <.001), pain or discomfort (58% vs 39%, p =.006), self-care (46% vs 18%, p <.001), usual activities (77% vs 49%, p <.001), and mobility (68% vs 35%, p <.001). Respondents with communication disabilities reported less fatigue (66% vs 89%, p <.001), poorer cognitive skills (thinking) (16% vs 1%, p <.001) and lower social participation (31% vs 6%, p <.001) than those without communication disabilities. Survivors of stroke with communication disabilities are more negatively impacted across different dimensions of quality-of-life (as reported between 90 and 180 days post-stroke) compared to those without communication disabilities. This highlights the need for timely and on-going comprehensive multidisciplinary person-centered support. [ABSTRACT FROM AUTHOR]- Published
- 2023
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7. A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention
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Cameron, J, Lannin, NA, Harris, D, Andrew, NE, Kilkenny, MF, Purvis, T, Thrift, AG, Thayabaranathan, T, Ellery, F, Sookram, G, Hackett, M, Kneebone, I, Drummond, A, Cadilhac, DA, and Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) Investigators
- Abstract
BACKGROUND: Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. METHODS: We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0-4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7-14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. RESULTS: Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. CONCLUSION: The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-7237.
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- 2022
8. Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: A Systematic Narrative Review
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Sheehan J, Laver K, Bhopti A, Rahja M, Usherwood T, Clemson L, and Lannin NA
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lcsh:R5-920 ,continuity of care ,lcsh:Medicine (General) ,discharge plan ,multidisciplinary ,collaboration - Abstract
Jacinta Sheehan,1 Kate Laver,2 Anoo Bhopti,1 Miia Rahja,2 Tim Usherwood,3,4 Lindy Clemson,5 Natasha A Lannin1,6,7 1Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia; 2Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia; 3Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; 4The George Institute for Global Health, Sydney, Australia; 5School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia; 6Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; 7Alfred Health (Allied Health), Melbourne, AustraliaCorrespondence: Natasha A LanninDepartment of Neurosciences, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, AustraliaTel +61 3 9903 0304Email natasha.lannin@monash.eduBackground: There is a compelling rationale that effective communication between hospital allied health and primary care practitioners may improve the quality and continuity of patient care. It is not known which methods of communication to use, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health and primary care practitioners.Methods: Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital-based allied health professionals communicating with community-based primary care practitioners. Risk of bias in the different study designs was appraised using recognized tools and a content analysis conducted of the methodologies used.Results: From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health communicating in some form with primary care practitioners. While none of the included studies specifically investigated the methods or effectiveness of communication between hospital allied health and primary care practitioners, 12 of the 24 studies described processes that addressed components of their discharge communication. Four enablers to effective communication between hospital allied health and primary care practitioners were identified: multidisciplinary care plans, patient and caregiver involvement, health information technology and a designated person for follow up/care management.Conclusion: There is currently no “gold standard” method or measure of communication between hospital allied health and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced information technologies to improve collaboration across care settings and facilitate the continuity of integrated people-centered care.Keywords: multidisciplinary, collaboration, discharge plan, continuity of care
- Published
- 2021
9. Exploring dimensions of quality-of-life in survivors of stroke with communication disabilities – a brief report
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Thayabaranathan, T, primary, Baker, C, additional, Andrew, NE, additional, Stolwyk, R, additional, Thrift, AG, additional, Carter, H, additional, Moss, K, additional, Kim, J, additional, Wallace, SJ, additional, Brogan, E, additional, Grimley, R, additional, Lannin, NA, additional, Rose, ML, additional, and Cadilhac, DA, additional
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- 2022
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10. Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial
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Holland, AE, Jones, AW, Mahal, A, Lannin, NA, Cox, N, Hepworth, G, O'Halloran, P, McDonald, CF, Holland, AE, Jones, AW, Mahal, A, Lannin, NA, Cox, N, Hepworth, G, O'Halloran, P, and McDonald, CF
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INTRODUCTION: There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model. METHOD AND ANALYSIS: This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is imple
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- 2022
11. Living clinical guidelines for stroke: updates, challenges and opportunities
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English, C, Hill, K, Cadilhac, DA, Hackett, ML, Lannin, NA, Middleton, S, Ranta, A, Stocks, NP, Davey, J, Faux, SG, Godecke, E, Campbell, BCV, English, C, Hill, K, Cadilhac, DA, Hackett, ML, Lannin, NA, Middleton, S, Ranta, A, Stocks, NP, Davey, J, Faux, SG, Godecke, E, and Campbell, BCV
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- 2022
12. Effect of the Coronavirus Disease 2019 Pandemic on the Quality of Stroke Care in Stroke Units and Alternative Wards: A National Comparative Analysis
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Cadilhac, DA, Kim, J, Cloud, G, Anderson, CS, Tod, EK, Breen, SJ, Faux, S, Kleinig, T, Castley, H, Lindley, R, Middleton, S, Yan, B, Hill, K, Jones, B, Shah, D, Jaques, K, Clissold, B, Campbell, B, Lannin, NA, Cadilhac, DA, Kim, J, Cloud, G, Anderson, CS, Tod, EK, Breen, SJ, Faux, S, Kleinig, T, Castley, H, Lindley, R, Middleton, S, Yan, B, Hill, K, Jones, B, Shah, D, Jaques, K, Clissold, B, Campbell, B, and Lannin, NA
- Abstract
BACKGROUND AND PURPOSE: Changes to hospital systems were implemented from March 2020 in Australia in response to the coronavirus disease 2019 pandemic, including decreased resources allocated to stroke units. We investigate changes in the quality of acute care for patients with stroke or transient ischemic attack during the pandemic according to patients' treatment setting (stroke unit or alternate ward). METHODS: We conducted a retrospective cohort study of patients admitted with stroke or transient ischemic attack between January 2019 and June 2020 in the Australian Stroke Clinical Registry (AuSCR). The AuSCR monitors patients' treatment setting, provision of allied health and nursing interventions, prescription of secondary prevention medications, and discharge destination. Weekly trends in the quality of care before and during the pandemic period were assessed using interrupted time series analyses. RESULTS: In total, 18,662 patients in 2019 and 8,850 patients in 2020 were included. Overall, 75% were treated in stroke units. Before the pandemic, treatment in a stroke unit was superior to alternate wards for the provision of all evidence-based therapies assessed. During the pandemic period, the proportion of patients receiving a swallow screen or assessment, being discharged to rehabilitation, and being prescribed secondary prevention medications decreased by 0.58% to 1.08% per week in patients treated in other ward settings relative to patients treated in stroke units. This change represented a 9% to 17% increase in the care gap between these treatment settings during the period of the pandemic that was evaluated (16 weeks). CONCLUSIONS: During the first 6 months of the pandemic, widening care disparities between stroke units and alternate wards have occurred.
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- 2022
13. Factors Associated with Receiving a Discharge Care Plan After Stroke in Australia: A Linked Registry Study
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Polhill, E, Kilkenny, MF, Cadilhac, DA, Lannin, NA, Dalli, LL, Purvis, T, Andrew, NE, Thrift, AG, Sundararajan, V, Olaiya, MT, Polhill, E, Kilkenny, MF, Cadilhac, DA, Lannin, NA, Dalli, LL, Purvis, T, Andrew, NE, Thrift, AG, Sundararajan, V, and Olaiya, MT
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- 2022
14. Are Medicare Funded Multidisciplinary Care Policies Being Claimed in accordance to Rehabilitation Needs in Patients with Stroke?
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Snowdon, DA, Ung, D, Collyer, TA, Lannin, NA, Kilkenny, MF, Thrift, AG, Sundararajan, V, Cadilhac, DA, Andrew, NE, Snowdon, DA, Ung, D, Collyer, TA, Lannin, NA, Kilkenny, MF, Thrift, AG, Sundararajan, V, Cadilhac, DA, and Andrew, NE
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- 2022
15. Evaluation of an injury prevention programme (Prep-to-Play) in women and girls playing Australian Football: design of a pragmatic, type III, hybrid implementation-effectiveness, stepped-wedge, cluster randomised controlled trial
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Patterson, BE, Donaldson, A, Cowan, SM, King, MG, Barton, CG, McPhail, SM, Hagglund, M, White, NM, Lannin, NA, Ackerman, IN, Dowsey, MM, Hemming, K, Makdissi, M, Culvenor, AG, Mosler, AB, Bruder, AM, Choong, J, Livingstone, N, Elliott, RK, Nikolic, A, Fitzpatrick, J, Crain, J, Haberfield, MJ, Roughead, EA, Birch, E, Lampard, SJ, Bonello, C, Chilman, KL, Crossley, KM, Patterson, BE, Donaldson, A, Cowan, SM, King, MG, Barton, CG, McPhail, SM, Hagglund, M, White, NM, Lannin, NA, Ackerman, IN, Dowsey, MM, Hemming, K, Makdissi, M, Culvenor, AG, Mosler, AB, Bruder, AM, Choong, J, Livingstone, N, Elliott, RK, Nikolic, A, Fitzpatrick, J, Crain, J, Haberfield, MJ, Roughead, EA, Birch, E, Lampard, SJ, Bonello, C, Chilman, KL, and Crossley, KM
- Abstract
INTRODUCTION: Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women's Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported interventions on the use of Prep-to-Play (primary aim) and injury rates (secondary aim) will be evaluated in women and girls playing community Australian Football. METHODS AND ANALYSIS: This stepped-wedge, cluster randomised controlled trial will include ≥140 teams from U16, U18 or senior women's competitions. All 10 geographically separated clusters (each containing ≥14 teams) will start in the control (unsupported) phase and be randomised to one of five dates (or 'wedges') during the 2021 or 2022 season to sequentially transition to the intervention (supported Prep-to-Play), until all teams receive the intervention. Prep-to-Play includes four elements: a neuromuscular training warm-up, contact-focussed football skills (eg, tackling), strength exercises and education (eg, technique cues). When transitioning to supported interventions, study physiotherapists will deliver a workshop to coaches and player leaders on how to use Prep-to-Play, attend team training at least two times and provide ongoing support. In the unsupported phase, team will continue usual routines and may freely access available Prep-to-Play resources online (eg, posters and videos about the four elements), but without additional face-to-face support. Outcomes will be evaluated throughout the 2021 and 2022 seasons (~14 weeks per season). PRIMARY OUTCOME: use of Prep-to-Play will be reported via a team designate (weekly) and an independent observer (five visits over the two seasons) and defined as the team completing 75% of the programme, two-thirds (67%) of the time. SECONDARY OUTCOMES: injuries will be reported by the team sports trainer and/or players. Inju
- Published
- 2022
16. Remote constraint induced therapy of the upper extremity (ReCITE): A feasibility study protocol
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Christie, LJ, Fearn, N, McCluskey, A, Lannin, NA, Shiner, CT, Kilkenny, A, Boydell, J, Meharg, A, Howes, E, Churilov, L, Faux, S, Doussoulin, A, Middleton, S, Christie, LJ, Fearn, N, McCluskey, A, Lannin, NA, Shiner, CT, Kilkenny, A, Boydell, J, Meharg, A, Howes, E, Churilov, L, Faux, S, Doussoulin, A, and Middleton, S
- Abstract
BACKGROUND: Difficulty using the upper extremity in everyday activities is common after stroke. Constraint-induced movement therapy (CIMT) has been shown to be effective in both sub-acute and chronic phases of stroke recovery and is recommended in clinical practice guidelines for stroke internationally. Despite reports of equivalence of outcome when stroke rehabilitation interventions are delivered using telehealth, there has been limited evaluation of CIMT when using this mode of delivery. ReCITE will (a) evaluate the feasibility and acceptability of CIMT when delivered via telehealth to stroke survivors (TeleCIMT) and (b) explore therapists' experiences and use of an online support package inclusive of training, mentoring and resources to support TeleCIMT delivery in clinical practice. METHODS: A prospective single-group, single blinded, study design with embedded process evaluation will be conducted. The study will be conducted at three outpatient services in Sydney, Australia. A multi-faceted therapist support package, informed by the Capabilities, Opportunity, Motivation- Behaviour model (COM-B), will be used to support occupational therapists to implement TeleCIMT as part of routine care to stroke survivors. Each service will recruit 10 stroke survivor participants (n = 30) with mild to moderate upper extremity impairment. Upper extremity and quality of life outcomes of stroke survivor participants will be collected at baseline, post-intervention and at a 4 week follow-up appointment. Feasibility of TeleCIMT will be evaluated by assessing the number of stroke participants who complete 80% of intensive arm practice prescribed during their 3 week program (i.e., at least 24 h of intensive arm practice). Acceptability will be investigated through qualitative interviews and surveys with stroke survivors, supporter surveys and therapist focus groups. Qualitative interviews with therapists will provide additional data to explore their experiences and use of the onlin
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- 2022
17. Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self-management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE)
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Purvis, T, Busingye, D, Andrew, NE, Kilkenny, MF, Thrift, AG, Li, JC, Cameron, J, Thijs, V, Hackett, ML, Kneebone, I, Lannin, NA, Cadilhac, DA, Purvis, T, Busingye, D, Andrew, NE, Kilkenny, MF, Thrift, AG, Li, JC, Cameron, J, Thijs, V, Hackett, ML, Kneebone, I, Lannin, NA, and Cadilhac, DA
- Abstract
INTRODUCTION: Despite digital health tools being popular for supporting self-management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self-management after stroke. The 4-week trial incorporated facilitated person-centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. METHODS: Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open-text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. RESULTS: Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting: The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person-centred goals. Electronic messages (intervention): Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the
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- 2022
18. EXPRESS: Protocol of a randomised controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS)
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Cadilhac, D, Cameron, J, Kilkenny, MF, Andrew, NE, Harris, D, Ellery, F, Thrift, AG, Purvis, T, Kneebone, I, Dewey, H, Drummond, A, Hackett, ML, Grimley, R, Middleton, S, Thijs, V, Cloud, G, Carey, ML, Butler, E, Ma, H, Churilov, L, Hankey, GJ, English, CK, and Lannin, NA
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Neurology & Neurosurgery ,1103 Clinical Sciences, 1109 Neurosciences - Abstract
RationaleTo address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited.HypothesisCompared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization.Methods and designMulticenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization.OutcomesPrimary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum sample capped at 1100.DiscussionWe will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
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- 2021
19. Developing person-centred goal setting resources with and for people with aphasia: a multi-phase qualitative study
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Elston, A, Barnden, R, Hersh, D, Godecke, E, Cadilhac, DA, Lannin, NA, Kneebone, I, and Andrew, NE
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Speech-Language Pathology & Audiology ,behavioral disciplines and activities ,1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Sciences - Abstract
Introduction: Stroke patients with aphasia are often excluded from person-centred goal setting as part of their clinical care, despite a recommendation for person-centred goal setting in national clinical guidelines. Aim: To develop and field test an aphasia supplement to a person-centred goal setting package for stroke to better meet the needs of patients with aphasia. Methods: A multi-phase, qualitative study design was employed building on prior work in a non-aphasia stroke population. Initial materials, including clinician training, were developed into an aphasia goal setting supplement with input from an expert working group. In phase one, feedback was sought from consumers with aphasia (n=5) on the layout and format of the patient-facing components. In phase two, six clinicians from one Australian healthcare network (occupational therapy: n=2, physiotherapy: n=1 and speech pathology: n=3) were observed using the goal setting package with eight inpatients with aphasia (2 mild, 3 moderate, 3 severe). In phase three, post field testing feedback was sought from clinicians (n=5) and patients with aphasia (n=3). Content analysis of interview data was carried out. Results: The consumer feedback session in phase one indicated that the supplement layout was helpful for including people with aphasia to participate actively in person-centred goal setting. Adaptations were made for the aphasia supplement including language, graphic, and format changes based on the feedback. During the field testing in phase two, 18 person-centred goals were set with eight patients with aphasia (median two goals) and included: secondary prevention (8%), functional recovery (31%), community participation (28%), everyday activities (28%), and environment (6%). Based on observations by members of the research team during field testing, clinicians across the multidisciplinary team were able to facilitate goal setting effectively. In phase three, clinicians and patients reported the supplement was useful to facilitate person-centred goal setting for people with aphasia. Conclusion: The aphasia supplement for the goal setting package was appropriate in meeting the needs of patients with aphasia after stroke and encouraged person-centred goal setting across multiple recovery areas. Conclusion: The aphasia supplement for the goal setting package was appropriate in meeting the needs of patients with aphasia after stroke and encouraged person-centred goal setting across multiple recovery areas.
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- 2021
20. Protocol of a randomized controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS)
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Cadilhac, DA, Cameron, J, Kilkenny, MF, Andrew, NE, Harris, D, Ellery, F, Thrift, AG, Purvis, T, Kneebone, I, Dewey, H, Drummond, A, Hackett, M, Grimley, R, Middleton, S, Thijs, V, Cloud, G, Carey, M, Butler, E, Ma, H, Churilov, L, Hankey, GJ, English, C, Lannin, NA, Cadilhac, DA, Cameron, J, Kilkenny, MF, Andrew, NE, Harris, D, Ellery, F, Thrift, AG, Purvis, T, Kneebone, I, Dewey, H, Drummond, A, Hackett, M, Grimley, R, Middleton, S, Thijs, V, Cloud, G, Carey, M, Butler, E, Ma, H, Churilov, L, Hankey, GJ, English, C, and Lannin, NA
- Abstract
Rationale: To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. Hypothesis: Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. Methods and design: Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. Outcomes: Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum sample capped at 1100. Discussion: We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
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- 2021
21. COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry
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Cadilhac, DA, Kim, J, Tod, EK, Morrison, JL, Breen, SJ, Jaques, K, Grimley, R, Jones, B, Cloud, GC, Kleinig, T, Hillier, S, Castley, H, Lindley, RI, Lannin, NA, Middleton, S, Yan, B, Hill, K, Clissold, BB, Mitchell, PJ, Anderson, CS, Faux, SG, Campbell, BCV, Cadilhac, DA, Kim, J, Tod, EK, Morrison, JL, Breen, SJ, Jaques, K, Grimley, R, Jones, B, Cloud, GC, Kleinig, T, Hillier, S, Castley, H, Lindley, RI, Lannin, NA, Middleton, S, Yan, B, Hill, K, Clissold, BB, Mitchell, PJ, Anderson, CS, Faux, SG, and Campbell, BCV
- Abstract
We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke clinicians were obtained from 53/72 (74%) hospitals participating in the AuSCR (80% nurses) via a voluntary, electronic feedback survey. Survey data were summarized to provide contextual information for the registry-based analysis. Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020. For the historical-control period, 9,308 episodes of care were compared with the pandemic period (8,992 episodes). Patient characteristics were similar for each cohort (median age: 75 years; 56% male; ischemic stroke 69%). Treatment in stroke units decreased progressively during the pandemic period (control: 76% pandemic: 70%, p < 0.001). Clinical staff reported fewer resources available for stroke including 10% reporting reduced stroke unit beds. Several time-based metrics were unchanged whereas door-to-needle times were longer during the peak pandemic period (March-April, 2020; 82 min, control: 74 min, p = 0.012). Our data emphasize the need to maintain appropriate acute stroke care during times of national emergency such as pandemic management.
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- 2021
22. Greater Adherence to Secondary Prevention Medications Improves Survival After Stroke or Transient Ischemic Attack: A Linked Registry Study.
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Dalli, LL, Kim, J, Cadilhac, DA, Greenland, M, Sanfilippo, FM, Andrew, NE, Thrift, AG, Grimley, R, Lindley, RI, Sundararajan, V, Crompton, DE, Lannin, NA, Anderson, CS, Whiley, L, Kilkenny, MF, Dalli, LL, Kim, J, Cadilhac, DA, Greenland, M, Sanfilippo, FM, Andrew, NE, Thrift, AG, Grimley, R, Lindley, RI, Sundararajan, V, Crompton, DE, Lannin, NA, Anderson, CS, Whiley, L, and Kilkenny, MF
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BACKGROUND AND PURPOSE: Although a target of 80% medication adherence is commonly cited, it is unclear whether greater adherence improves survival after stroke or transient ischemic attack (TIA). We investigated associations between medication adherence during the first year postdischarge, and mortality up to 3 years, to provide evidence-based targets for medication adherence. METHODS: Retrospective cohort study of 1-year survivors of first-ever stroke or TIA, aged ≥18 years, from the Australian Stroke Clinical Registry (July 2010-June 2014) linked with nationwide prescription refill and mortality data (until August 2017). Adherence to antihypertensive agents, statins, and nonaspirin antithrombotic medications was based on the proportion of days covered from discharge until 1 year. Cox regression with restricted cubic splines was used to investigate nonlinear relationships between medication adherence and all-cause mortality (to 3 years postdischarge). Models were adjusted for age, sex, socioeconomic position, stroke factors, primary care factors, and concomitant medication use. RESULTS: Among 8363 one-year survivors of first-ever stroke or TIA (44% aged ≥75 years, 44% female, 18% TIA), 75% were supplied antihypertensive agents. In patients without intracerebral hemorrhage (N=7446), 84% were supplied statins, and 65% were supplied nonaspirin antithrombotic medications. Median adherence was ≈90% for each medication group. Between 1% and 100% adherence, greater adherence to statins or antihypertensive agents, but not nonaspirin antithrombotic agents, was associated with improved survival. When restricted to linear regions above 60% adherence, each 10% increase in adherence was associated with a reduction in all-cause mortality of 13% for antihypertensive agents (hazard ratio, 0.87 [95% CI, 0.81-0.95]), 13% for statins (hazard ratio, 0.87 [95% CI, 0.80-0.95]), and 15% for nonaspirin antithrombotic agents (hazard ratio, 0.85 [95% CI, 0.79-0.93]). CONCLUSIONS: Greater le
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- 2021
23. Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke
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Dalli, LL, Kim, J, Thrift, AG, Andrew, NE, Sanfilippo, FM, Lopez, D, Grimley, R, Lannin, NA, Wong, L, Lindley, RI, Campbell, BCV, Anderson, CS, Cadilhac, DA, Kilkenny, MF, Dalli, LL, Kim, J, Thrift, AG, Andrew, NE, Sanfilippo, FM, Lopez, D, Grimley, R, Lannin, NA, Wong, L, Lindley, RI, Campbell, BCV, Anderson, CS, Cadilhac, DA, and Kilkenny, MF
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OBJECTIVE: To investigate whether certain patient, acute care, or primary care factors are associated with medication initiation and discontinuation in the community after stroke or TIA. METHODS: This is a retrospective cohort study using prospective data on adult patients with first-ever acute stroke/TIA from the Australian Stroke Clinical Registry (April 2010 to June 2014), linked with nationwide medication dispensing and Medicare claims data. Medication users were those with ≥1 dispensing in the year postdischarge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year postdischarge. Multivariable competing risks regression, accounting for death during the observation period, was conducted to investigate factors associated with time to medication discontinuation. RESULTS: Among 17,980 registry patients with stroke/TIA, 91.4% were linked to administrative datasets. Of these, 9,817 adults with first-ever stroke/TIA were included (45.4% female, 47.6% aged ≥75 years, and 11.4% intracerebral hemorrhage). While most patients received secondary prevention medications (79.3% antihypertensive, 81.8% antithrombotic, and 82.7% lipid-lowering medication), between one-fifth and one-third discontinued treatment over the subsequent year postdischarge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub-hazard ratio [SHR] 0.70; 95% confidence interval [CI] 0.62-0.79), quarterly contact with a primary care physician (SHR 0.62; 95% CI 0.57-0.67), and prescription by a specialist physician (SHR 0.87; 95% CI 0.77-0.98) were all inversely associated with antihypertensive discontinuation. CONCLUSIONS: Patterns of use of secondary prevention medications after stroke/TIA are not optimal, with many survivors discontinuing treatment within 1 year postdischarge. Improving postdischarge care for patients with stroke/TIA is needed to minimize unwarranted d
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- 2021
24. Sex differences in causes of death after stroke: Evidence from a national, prospective registry
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Phan, HT, Gall, S, Blizzard, CL, Lannin, NA, Thrift, AG, Anderson, CS, Kim, J, Grimley, R, Castley, HC, Kilkenny, MF, Cadilhac, DA, Phan, HT, Gall, S, Blizzard, CL, Lannin, NA, Thrift, AG, Anderson, CS, Kim, J, Grimley, R, Castley, HC, Kilkenny, MF, and Cadilhac, DA
- Abstract
Background: We examined sex differences in cause of death and cause-specific excess mortality after stroke. Materials and Methods: First-ever strokes (2010-2013; 35 hospitals) participating in the Australian Stroke Clinical Registry were linked to national death registrations and other administrative datasets. One-year cause-specific mortality was categorized as stroke, ischemic heart disease, other cardiovascular disease (CVD; e.g., hypertension), cancer, and other. Specific hazard ratios (sHRs) of death for women compared to men were estimated using competing risk models, with adjustment for factors differing by sex (e.g., age and stroke severity). Age- and sex-specific mortality rates expected in the general population were derived from national data. Standardized mortality ratios (SMRs; observed/expected deaths) were estimated for cause-specific mortality by sex after age standardization. Results: Among 9,441 cases (46% women), women were 7 years older than men, had more severe strokes, and received similar patterns of suboptimal secondary prevention medications at discharge. Women had greater mortality associated with stroke (sHRunadjusted 1.65) and other CVD (sHRunadjusted 1.65), which was related to age and stroke severity rather than other factors. Compared to population norms, those surviving to 30 days had eight-fold increased mortality from stroke (primary/recurrent) events irrespective of sex (SMRage-standardised women 8.8; men 8.3). Excess mortality from other CVD was greater in women (SMRage-standardised 3.6 vs. men 2.8; p = 0.026). Conclusions: Cause-specific mortality after first-ever stroke differs by sex. The greater death rate attributed to stroke/other CVD in women was mostly explained by age and stroke severity. Greater implementation of secondary stroke prevention is relevant to both sexes.
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- 2021
25. Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry
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Phan, HT, Gall, SL, Blizzard, CL, Lannin, NA, Thrift, AG, Anderson, CS, Kim, J, Grimley, RS, Castley, HC, Kilkenny, MF, Cadilhac, DA, Phan, HT, Gall, SL, Blizzard, CL, Lannin, NA, Thrift, AG, Anderson, CS, Kim, J, Grimley, RS, Castley, HC, Kilkenny, MF, and Cadilhac, DA
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Background and purpose: Women may receive stroke care less often than men. We examined the contribution of clinical care on sex differences and health-related quality of life (HRQoL) after stroke. Methods: We included first-ever strokes registered in the Australian Stroke Clinical Registry (2010–2014) with HRQoL assessed between 90 and 180 days after onset (EQ-5D-3L instrument) that were linked to hospital administrative data (up to 2013). Study factors included sociodemographics, comorbidities, walking ability on admission (stroke severity proxy) and clinical care (e.g. stroke unit care). Responses to the EQ-5D-3L were transformed into a total utility value (−0.516 ‘worse than death’ to 1 ‘best’ health). Quantile regression models, adjusted for confounding factors, were used to determine median differences (MD) in utility scores by sex. Results: Approximately 60% (6852/11 418) of stroke survivors had an EQ-5D-3L assessment (median 139 days; 44% female). Compared with men, women were older (median age 77.1 years vs. men 71.2 years) and fewer could walk on admission (37.9% vs. men 46.1%, P < 0.001). Women had lower utility values than men, and the difference was explained by age and stroke severity, but not clinical care [MDadjusted = −0.039, 95% confidence interval: −0.056, −0.021]. Poorer HRQoL was observed in younger men (aged <65 years), particularly those with more comorbidities, and in older women (aged ≥75 years). Conclusions: Stroke severity and comorbidities contribute to the poorer HRQoL in young men and older women. Further studies are needed to understand age–sex interaction to better inform treatments for different subgroups and ensure evidence-based treatments to reduce the severity of stroke are prioritized.
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- 2021
26. Linking Australian Stroke Clinical Registry data with Australian government Medicare and medication dispensing claims data and the potential for bias
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Andrew, NE, Cadilhac, DA, Sundararajan, V, Thrift, AG, Anderson, P, Lannin, NA, Kilkenny, MF, Andrew, NE, Cadilhac, DA, Sundararajan, V, Thrift, AG, Anderson, P, Lannin, NA, and Kilkenny, MF
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OBJECTIVE: We aim to report the accuracy of linking data from a non-government-held clinical quality registry to national claims data and identify associated sources of systematic bias. METHODS: Patients with stroke or transient ischaemic attack admitted to hospitals participating in the Australian Stroke Clinical Registry (AuSCR) were linked with Medicare and medication dispensings through the Australian Medicare enrolment file (MEF). The proportion of registrants in the datasets was calculated and factors associated with a non-merge assessed using multivariable analyses. RESULTS: A total of 17,980 AuSCR registrants (January 2010 - July 2014) were submitted for linkage (median age 76 years; 46% female; 67% ischaemic stroke); the proportion merged was 97% MEF, 93% Medicare and 95% medication dispensings. Data from registrants born in Asia were less likely to link with the MEF (adjusted Odds Ratio [aOR]: 0.20; 95%Confidence Interval [CI]: 0.15, 0.27). Data for those aged 85-plus compared to those under 65 years were less likely to merge with Medicare (aOR 0.25; 95%CI:0.21, 0.30) but more likely to merge with dispensing claims data (aOR: 2.15 (95%CI:1.71, 2.69). Implications for public health: Linkage between the AuSCR, a national clinical quality registry and Commonwealth datasets was achieved and potential sources of bias were identified.
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- 2021
27. Program evaluation of GLA:D® Australia: Physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis.
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Barton, CJ, Kemp, JL, Roos, EM, Skou, ST, Dundules, K, Pazzinatto, MF, Francis, M, Lannin, NA, Wallis, JA, Crossley, KM, Barton, CJ, Kemp, JL, Roos, EM, Skou, ST, Dundules, K, Pazzinatto, MF, Francis, M, Lannin, NA, Wallis, JA, and Crossley, KM
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OBJECTIVE: Evaluate the implementation of Good Life with osteoArthritis from Denmark (GLA:D®) for knee osteoarthritis in Australia using the RE-AIM QuEST (Reach, Effectiveness, Adoption, Implementation, Maintenance Qualitative Evaluation for Systematic Translation) framework. DESIGN: Physiotherapists completed surveys before and after GLA:D® training (2017-2020) to assess practices, and barriers and enablers to implementation. Patients completed online baseline, 3-month (post-treatment) and 12-month patient reported outcomes. Effective implementation was defined as within-participant moderate effect size (ES, ≥0.50) for average pain (100 mm VAS) and Knee Injury and Osteoarthritis Outcome Score quality of life scores (KOOS-QoL), and small effect size (≥0.20) for health-related quality of life (EQ-5D-5L). RESULTS: Reach : 1064 physiotherapists and 1945 patients from all states and territories participated. Key barriers included out-of-pocket cost to patients, and program suitability for culturally and linguistically diverse communities. Effectiveness: Following training, more physiotherapists reported discussing treatment goals and weight management, and prescribing supervised, neuromuscular exercise. Patient outcomes at 3- and 12-months (n = 1044 [54%] and 927 [48%]) reflected effective implementation, including reduced pain (ES, 95%CI = 0.72, 0.62-0.84; and 0.65, 0.54-0.77) and improved KOOS-QoL (0.79, 0.69-0.90; and 0.93, 0.81-1.04) and EQ-5D-5L (0.43, 0.31-0.54; and 0.46, 0.35-0.58) scores. Adoption: 297 sites (264 private, 33 public) implemented GLA:D®. Implementation: Most patients completed at least one education (90%), and 10 exercise-therapy (78%) sessions. Adequate staffing to support program delivery was a key enabler. Maintenance: 99% of sites (293/297) continued offering the program in July 2020. CONCLUSION: Training changed practice and was associated with effective widespread implementation of GLA:D® in Australia.
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- 2021
28. Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists.
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Barton, CJ, Pazzinatto, MF, Crossley, KM, Dundules, K, Lannin, NA, Francis, M, Wallis, J, Kemp, JL, Barton, CJ, Pazzinatto, MF, Crossley, KM, Dundules, K, Lannin, NA, Francis, M, Wallis, J, and Kemp, JL
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BACKGROUND: Physical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy. OBJECTIVES: Describe Australian physical therapists' awareness of guidelines; reported practices; and beliefs about capability, opportunity, motivation, and evidence. METHODS: An online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework. RESULTS: 1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23-24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so. CONCLUSION: Australian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.
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- 2021
29. Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR)
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Dwyer, M, Francis, K, Peterson, GM, Ford, K, Gall, S, Hoang, P, Castley, H, Wong, L, White, R, Ryan, F, Arthurson, L, Kim, J, Cadilhac, DA, Lannin, NA, Dwyer, M, Francis, K, Peterson, GM, Ford, K, Gall, S, Hoang, P, Castley, H, Wong, L, White, R, Ryan, F, Arthurson, L, Kim, J, Cadilhac, DA, and Lannin, NA
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OBJECTIVE: To compare the processes and outcomes of care in patients who had a stroke treated in urban versus rural hospitals in Australia. DESIGN: Observational study using data from a multicentre national registry. SETTING: Data from 50 acute care hospitals in Australia (25 urban, 25 rural) which participated in the Australian Stroke Clinical Registry during the period 2010-2015. PARTICIPANTS: Patients were divided into two groups (urban, rural) according to the Australian Standard Geographical Classification Remoteness Area classification. Data pertaining to 28 115 patients who had a stroke were analysed, of whom 8159 (29%) were admitted to hospitals located within rural areas. PRIMARY AND SECONDARY OUTCOME MEASURES: Regional differences in processes of care (admission to a stroke unit, thrombolysis for ischaemic stroke, discharge on antihypertensive medication and provision of a care plan), and survival analyses up to 180 days and health-related quality of life at 90-180 days. RESULTS: Compared with those admitted to urban hospitals, patients in rural hospitals less often received thrombolysis (urban 12.7% vs rural 7.5%, p<0.001) or received treatment in stroke units (urban 82.2% vs rural 76.5%, p<0.001), and fewer were discharged with a care plan (urban 61.3% vs rural 44.7%, p<0.001). No significant differences were found in terms of survival or overall self-reported quality of life. CONCLUSIONS: Rural access to recommended components of acute stroke care was comparatively poorer; however, this did not appear to impact health outcomes at approximately 6 months.
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- 2021
30. Effect of occupational therapy home visit discharge planning on participation after stroke: protocol for the HOME Rehab trial
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Lannin, NA, Clemson, L, Drummond, A, Stanley, M, Churilov, L, Laver, K, O'Keefe, S, Cameron, I, Crotty, M, Usherwood, T, Andrew, NE, Jolliffe, L, Cadilhac, DA, Lannin, NA, Clemson, L, Drummond, A, Stanley, M, Churilov, L, Laver, K, O'Keefe, S, Cameron, I, Crotty, M, Usherwood, T, Andrew, NE, Jolliffe, L, and Cadilhac, DA
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INTRODUCTION: After first stroke, the transition from rehabilitation to home can be confronting and fraught with challenges. Although stroke clinical practice guidelines recommend predischarge occupational therapy home visits to ensure safe discharge and provision of appropriate equipment, there is currently limited evidence to support this recommendation. METHODS AND ANALYSIS: The HOME Rehab trial is a national, multicentre, phase III randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis being conducted in Australia. The trial aim is to determine the effect and potential cost-effectiveness of an enhanced occupational therapy discharge planning intervention that involves pre and postdischarge home visits, goal setting and occupational therapy in the home (the HOME programme) in comparison to an in-hospital predischarge planning intervention. Stroke survivors aged ≥45 years, admitted to a rehabilitation ward, expected to return to a community (private) dwelling after discharge, with no significant prestroke disability will be randomly allocated 1:1 to receive a standardised discharge planning intervention and the HOME programme or the standardised discharge planning intervention alone. The primary outcome is participation measured using the Nottingham Extended Activities of Daily Living. Secondary outcome areas include hospital readmission, disability, performance of instrumental activities of daily living, health-related quality of life, quality of care transition and carer burden. Resources used/costs will be collected for the cost-effectiveness analysis and hospital readmission. Recruitment commenced in 2019. Allowing for potential attrition, 360 participants will be recruited to detect a clinically important treatment difference with 80% power at a two-tailed significance level of 0.05. ETHICS AND DISSEMINATION: This study is approved by the Alfred Health Human Research Ethics Committee and site-specific ethics
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- 2021
31. Factors influencing allied health professionals' implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation
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Cahill, LS, Carey, LM, Mak-Yuen, Y, McCluskey, A, Neilson, C, O'Connor, DA, Lannin, NA, Cahill, LS, Carey, LM, Mak-Yuen, Y, McCluskey, A, Neilson, C, O'Connor, DA, and Lannin, NA
- Abstract
OBJECTIVES: Somatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke. DESIGN: Qualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory). SETTING: Eight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia. PARTICIPANTS: Eighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018. RESULTS: Three types of factors influenced therapists' delivery of upper limb somatosensory rehabilitation: individual ('The uncertain, unskilled therapist'), patient ('Patient understanding and priorities') and organisational ('System pressures and resources'). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach. CONCLUSIONS: Occupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the 'frontline'. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists' perceived legitimacy in usi
- Published
- 2021
32. Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke
- Author
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Barnden, R, Cadilhac, DA, Lannin, NA, Kneebone, I, Hersh, D, Godecke, E, Stolwyk, R, Purvis, T, Nicks, R, Farquhar, M, Gleeson, S, Gore, C, Herrmann, K, Andrew, NE, Barnden, R, Cadilhac, DA, Lannin, NA, Kneebone, I, Hersh, D, Godecke, E, Stolwyk, R, Purvis, T, Nicks, R, Farquhar, M, Gleeson, S, Gore, C, Herrmann, K, and Andrew, NE
- Published
- 2021
33. Hospital Presentations in Long-Term Survivors of Stroke: Causes and Associated Factors in a Linked Data Study
- Author
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Andrew, NE, Kilkenny, MF, Sundararajan, V, Kim, J, Faux, SG, Thrift, AG, Johnston, T, Grimley, R, Gattellari, M, Katzenellenbogen, JM, Dewey, HM, Lannin, NA, Anderson, CS, Cadilhac, DA, Andrew, NE, Kilkenny, MF, Sundararajan, V, Kim, J, Faux, SG, Thrift, AG, Johnston, T, Grimley, R, Gattellari, M, Katzenellenbogen, JM, Dewey, HM, Lannin, NA, Anderson, CS, and Cadilhac, DA
- Abstract
Background and Purpose: A comprehensive understanding of the long-term impact of stroke assists in health care planning. We aimed to determine changes in rates, causes, and associated factors for hospital presentations among long-term survivors of stroke. Methods: Person-level data from the AuSCR (Australian Stroke Clinical Registry) during 2009 to 2013 were linked with state-based health department emergency department and hospital admission data. The study cohort included adults with first-ever stroke who survived the first 6 months after discharge from hospital. Annualized rates of hospital presentations (nonadmitted emergency department or admission)/person/year were calculated for 1 to 12 months prior, and 7 to 12 months (inclusive) after hospitalization. Multilevel, negative binomial regression was used to identify associated factors after adjustment for prestroke hospital presentations and stratification for perceived impairment status. Perceived impairments to health were defined according to the subscales and visual analog health status scores on the 5-Dimension European Quality of Life Scale. Results: There were 7183 adults with acute stroke, 7-month survivors (median age 72 years; 56% male; 81% ischemic, and 42% with impairment at 90-180 days) from 39 hospitals included in this landmark analysis. Annualized presentations/person increased from 0.88 (95% CI, 0.86-0.91) to 1.25 (95% CI, 1.22-1.29) between the prestroke and poststroke periods, with greater rate increases in those with than without perceived impairment (55% versus 26%). Higher presentation rates were most strongly associated with older age (≥85 versus 65 years, incidence rate ratio, 1.52 [95% CI, 1.27-1.82]) and greater comorbidity score (incidence rate ratio, 1.06 [95% CI, 1.02-1.10]), whereas reduced rates were associated with greater social advantage (incidence rate ratio, 0.71 [95% CI, 0.60-0.84]). Poststroke hospital presentations (7-12 months) were most frequently related to recurrent ca
- Published
- 2020
34. Pilot randomised clinical trial of an eHealth, self-management support intervention (iVERVE) for stroke: feasibility assessment in survivors 12–24 months post-event
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Cadilhac, DA, Andrew, NE, Busingye, D, Cameron, J, Thrift, AG, Purvis, T, Li, JC, Kneebone, I, Thijs, V, Hackett, ML, Lannin, NA, Kilkenny, MF, Cadilhac, DA, Andrew, NE, Busingye, D, Cameron, J, Thrift, AG, Purvis, T, Li, JC, Kneebone, I, Thijs, V, Hackett, ML, Lannin, NA, and Kilkenny, MF
- Abstract
Background: Electronic communication is used in various populations to achieve health goals, but evidence in stroke is lacking. We pilot tested the feasibility and potential effectiveness of a novel personalised electronic self-management intervention to support person-centred goal attainment and secondary prevention after stroke. Methods: A phase I, prospective, randomised controlled pilot trial (1:1 allocation) with assessor blinding, intention-to-treat analysis, and a process evaluation. Community-based survivors of stroke were recruited from participants in the Australian Stroke Clinical Registry (AuSCR) who had indicated their willingness to be contacted for research studies. Inclusion criteria include 1–2 years following hospital admission for stroke and living within 50 km of Monash University (Melbourne). Person-centred goals were set with facilitation by a clinician using a standardised template. The intervention group received electronic support messages aligned to their goals over 4 weeks. The control group received only 2–3 electronic administrative messages. Primary outcomes were study retention, goal attainment (assessed using Goal Attainment Scaling method) and satisfaction. Secondary outcomes were self-management (Health Education Impact Questionnaire: 8 domains), quality of life, mood and acceptability. Results: Of 340 invitations sent from AuSCR, 73 responded, 68 were eligible and 57 (84%) completed the baseline assessment. At the goal-setting stage, 54/68 (79%) were randomised (median 16 months after stroke): 25 to intervention (median age 69 years; 40% female) and 29 to control (median age 68 years; 38% female). Forty-five (83%) participants completed the outcome follow-up assessment. At follow-up, goal attainment (mean GAS-T score ≥ 50) in the intervention group was achieved for goals related to function, participation and environment (control: environment only). Most intervention participants provided positive feedback and reported that the iVE
- Published
- 2020
35. Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke The InTENSE Trial
- Author
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Lannin, NA, Ada, L, English, C, Ratcliffe, J, Faux, SG, Palit, M, Gonzalez, S, Olver, J, Cameron, I, Crotty, M, Lannin, NA, Ada, L, English, C, Ratcliffe, J, Faux, SG, Palit, M, Gonzalez, S, Olver, J, Cameron, I, and Crotty, M
- Abstract
Background and Purpose- The aim of this trial was to determine the effect of additional upper limb rehabilitation following botulinum toxin-A for upper limb activity in chronic stroke. Methods- We conducted a multicenter phase III randomized trial with concealed allocation, blinded measurement, and intention-to-treat analysis. One hundred forty stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke >3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scaling) and upper limb activity (Box and Block Test) at 3 months (end of intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. Results- In terms of goal attainment, the experimental group scored the same (mean difference, 2 T-score [95% CI, -2 to 7]) as the control group on the Goal Attainment Scale. In terms of upper limb activity, by 3 months the experimental group moved blocks at the same speed (mean difference, 0.00 blocks/s [95% CI, -0.02 to 0.01]) as the control group on the Box and Block Test. There were no differences between groups on any secondary outcome except strength, in favor of the experimental group (mean difference, 1.4 kg [95% CI, 0.2-2.7]). Conclusions- Findings suggest that additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not effective. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: ACTRN12615000616572.
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- 2020
36. Linking Registry Data with Australian Medicare And Medication Dispensing Claims Data: Feasibility, Benefits and Limitations
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Andrew, NE, Cadilhac, DA, Sundararajan, V, Thrift, AG, Anderson, P, Lannin, NA, Shehata, S, Kilkenny, MF, Andrew, NE, Cadilhac, DA, Sundararajan, V, Thrift, AG, Anderson, P, Lannin, NA, Shehata, S, and Kilkenny, MF
- Abstract
IntroductionRecent advances in Australia mean that it is possible to link national clinical registries with government held administrative datasets. However, formal evaluations of such activities and the potential impact for research are lacking. Objectives and ApproachWe aimed to assess the feasibility and accuracy of linking registrants from the Australian Stroke Clinical Registry (AuSCR) with the Medicare enrolment file. Following data custodian and ethics approvals, personal linkage identifiers were submitted to the Australian Institute of Health and Welfare (AIHW). De-identified data from AuSCR and the AIHW were submitted into the Secure Unified Research Environment and merged using project specific person-based IDs. We calculated the proportion of patients linked with the Medicare enrolment file that were present in the associated Medicare and medication dispensing datasets and the proportion with claims after their date of death. Logistic regression was used to identify factors associated with a non-merged patient. Results17,980 AuSCR registrants (January 2010-July 2014) were submitted for linkage (median age 76 years; 46% female; 67% ischaemic stroke; 16% TIA). Of these, 93% were merged with Medicare (N=16,648) and 95% with subsidised medication dispensing claims data (N=17,079). In those who died, 127 (0.8%) had one or more Medicare claim and 411 (2.4%) had one or more medications dispensed after their death date. Asian born registrants were less likely to be merged with Medicare (adjusted Odds Ratio [aOR]: 0.54; 95% Confidence Interval [CI]: 0.40, 0.72) than Australian born registrants. Those aged ≥85 years were less likely to be merged with Medicare data than those aged <65 years (aOR 0.24; 95% CI: 0.19, 0.29) but were more likely to be merged with dispensing data (aOR: 2.22 (95% CI: 1.73, 2.84). Conclusion/ImplicationsLinkage between a national clinical quality registry and the Medicare spine is feasible. These linkages will provide
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- 2020
37. What is the feasibility and observed effect of two implementation packages for stroke rehabilitation therapists implementing upper limb guidelines? A cluster controlled feasibility study
- Author
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Jolliffe, L, Hoffmann, T, Churilov, L, Lannin, NA, Jolliffe, L, Hoffmann, T, Churilov, L, and Lannin, NA
- Abstract
BACKGROUND: Hand and arm activity after stroke improves with evidence-based rehabilitation. Therapists face known barriers when providing evidence-based rehabilitation and require support to implement guidelines. The aim of this study was to investigate the feasibility of two implementation packages on guideline adherence by occupational therapists and physiotherapists, and explore effect on patient upper limb outcomes. METHOD: This was a non-randomised clustered feasibility study of occupational and physiotherapy rehabilitation services (n=3 inpatient and n=3 outpatient services). Services were allocated to one of three groups: (group A) facilitator-mediated implementation package, (group B) self-directed implementation package or (group C) usual care (control); we recruited n=1 inpatient and n=1 outpatient service per group. Outcomes of feasibility, adherence to guidelines (medical file audits) and patient upper limb impairment (Fugl-Meyer Upper Extremity Assessment), activity (Box and Block Test) and practice (minutes/week) were collected at baseline and after 3 months of intervention. RESULTS: 29 therapists (8 in group A, 13 in groups B and 8 in group C) and 55 patients participated. Both the facilitator-mediated and the self-directed implementation packages were feasible to deliver in the rehabilitation setting. Therapists in group A improved with respect to guideline adherence (medical file audits; median within-group proportion difference of 0.29 (95% CI 0.22 to 0.36, p<0.0001) preintervention to postintervention). No significant within-group differences from baseline to postintervention were found in group B or group C, and no between-group differences were found for upper limb outcomes. CONCLUSION: A facilitator-mediated package was acceptable to therapists working in stroke rehabilitation, and feasibility data suggest increased guideline uptake following implementation. An adequately powered study is planned to understand how to support therapists to provi
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- 2020
38. Correction: Hospital organizational context and delivery of evidence-based stroke care: A cross-sectional study (Implementation Science (2019) 14 (6) DOI: 10.1186/s13012-018-0849-z)
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Andrew, NE, Middleton, S, Grimley, R, Anderson, CS, Donnan, GA, Lannin, NA, Stroil-Salama, E, Grabsch, B, Kilkenny, MF, Squires, JE, Cadilhac, DA, Andrew, NE, Middleton, S, Grimley, R, Anderson, CS, Donnan, GA, Lannin, NA, Stroil-Salama, E, Grabsch, B, Kilkenny, MF, Squires, JE, and Cadilhac, DA
- Abstract
Following publication of the original article [1], the authors reported an error in one of the authors' names. In this Correction the incorrect and correct author name are shown. The original article has been corrected. Originally the author name was published as: - Enna Striol-Salama The correct author name is: - Enna Stroil-Salama.
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- 2019
39. Hospital organizational context and delivery of evidence-based stroke care: A cross-sectional study
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Andrew, NE, Middleton, S, Grimley, R, Anderson, CS, Donnan, GA, Lannin, NA, Striol-Salama, E, Grabsch, B, Kilkenny, MF, Squires, JE, Cadilhac, DA, Andrew, NE, Middleton, S, Grimley, R, Anderson, CS, Donnan, GA, Lannin, NA, Striol-Salama, E, Grabsch, B, Kilkenny, MF, Squires, JE, and Cadilhac, DA
- Abstract
Background: Organizational context is one factor influencing the translation of evidence into practice, but data pertaining to patients with acute stroke are limited. We aimed to determine the associations of organizational context in relation to four important evidence-based stroke care processes. Methods: This was a mixed methods cross-sectional study. Among 19 hospitals in Queensland, Australia, a survey was conducted of the perceptions of stroke clinicians about their work using the Alberta Context Tool (ACT), a validated measure covering 10 concepts of organizational context, and with additional stroke-specific contextual questions. These data were linked to the Australian Stroke Clinical Registry (AuSCR) to determine the relationship with receipt of evidence-based acute stroke care (acute stroke unit admission, use of thrombolysis for those with acute ischemic stroke, receipt of a written care plan on discharge, and prescription of antihypertensive medications on discharge) using quantile regression. Exploratory cluster analysis was used to categorize hospitals into high and low context groups based on all of the 10 ACT concepts. Differences in adherence to care processes between the two groups were examined. Results: A total of 215 clinicians completed the survey (50% nurses, 37% allied health staff, 10% medical practitioners), with 81% being in their current role for at least 1 year. There was good reliability (∞ 0.83) within the cohort to allow pooling of professional groups. Greater ACT scores, especially for social capital (μ 9.00, 95% confidence interval [CI] 4.86 to 13.14) and culture (μ 7.33, 95% CI 2.05 to 12.62), were associated with more patients receiving stroke unit care. There was no correlation between ACT concepts and other care processes. Working within higher compared to lower context environments was associated with greater proportions of patients receiving stroke unit care (88.5% vs. 69.0%) and being prescribed antihypertensive medication a
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- 2019
40. A systematic review protocol of timing, efficacy and cost effectiveness of upper limb therapy for motor recovery post-stroke
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Hayward, KS, Kramer, Sharon, Thijs, V, Ratcliffe, J, Ward, NS, Churilov, L, Jolliffe, L, Corbett, D, Cloud, G, Kaffenberger, T, Brodtmann, A, Bernhardt, J, Lannin, NA, Hayward, KS, Kramer, Sharon, Thijs, V, Ratcliffe, J, Ward, NS, Churilov, L, Jolliffe, L, Corbett, D, Cloud, G, Kaffenberger, T, Brodtmann, A, Bernhardt, J, and Lannin, NA
- Published
- 2019
41. Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study (vol 14, 6, 2019)
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Andrew, NE, Middleton, S, Grimley, R, Anderson, CS, Donnan, GA, Lannin, NA, Stroil-Salama, E, Grabsch, B, Kilkenny, MF, Squires, JE, Cadilhac, DA, Andrew, NE, Middleton, S, Grimley, R, Anderson, CS, Donnan, GA, Lannin, NA, Stroil-Salama, E, Grabsch, B, Kilkenny, MF, Squires, JE, and Cadilhac, DA
- Abstract
Following publication of the original article [1], the authors reported an error in one of the authors' names. In this Correction the incorrect and correct author name are shown. The original article has been corrected.
- Published
- 2019
42. Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study.
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Andrew, NE, Kim, J, Cadilhac, DA, Sundararajan, V, Thrift, AG, Churilov, L, Lannin, NA, Nelson, M, Srikanth, V, Kilkenny, MF, Andrew, NE, Kim, J, Cadilhac, DA, Sundararajan, V, Thrift, AG, Churilov, L, Lannin, NA, Nelson, M, Srikanth, V, and Kilkenny, MF
- Abstract
INTRODUCTION: The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking. AIM: To outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study. METHODS: Person-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to obtain patient experience information. In Australia, unique identifiers are unavailable. Therefore, personal-identifiers will be submitted to government data linkage units. Researchers will merge the de-identified datasets for analysis using a project identifier. An economic evaluation will also be undertaken. ANALYSIS: The index event will be the first stroke recorded in the AuSCR. Multivariable competing risks Poisson regression for multiple events, adjusted by a propensity score, will be used to test for differences in the rates of hospital presentations and medication adherence for different care (policy) types. Our estimated sample size of 25,000 patients will provide 80% estimated power (ɑ>0.05) to detect a 6-8% difference in rates. The incremental costs per Quality-adjusted life years gained of community-based care following the acute event will be estimated from a health sector perspective. CONCLUSION: Completion of this study will provide a novel and comprehensive evaluatio
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- 2019
43. A stroke recovery trial development framework: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable
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Bernhardt, J, Hayward, KS, Dancause, N, Lannin, NA, Ward, NS, Nudo, RJ, Farrin, A, Churilov, L, Boyd, LA, Jones, TA, Carmichael, ST, Corbett, D, Cramer, SC, Bernhardt, J, Hayward, KS, Dancause, N, Lannin, NA, Ward, NS, Nudo, RJ, Farrin, A, Churilov, L, Boyd, LA, Jones, TA, Carmichael, ST, Corbett, D, and Cramer, SC
- Abstract
A major goal of the Stroke Recovery and Rehabilitation Roundtable (SRRR) is to accelerate development of effective treatments to enhance stroke recovery beyond that expected to occur spontaneously or with current approaches. In this paper, we describe key issues for the next generation of stroke recovery treatment trials and present the Stroke Recovery and Rehabilitation Roundtable Trials Development Framework (SRRR-TDF). An exemplar (an upper limb recovery trial) is presented to demonstrate the utility of this framework to guide the GO, NO-GO decision-making process in trial development.
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- 2019
44. Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care
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Cadilhac, DA, Grimley, R, Kilkenny, MF, Andrew, NE, Lannin, NA, Hill, K, Grabsch, B, Levi, CR, Thrift, AG, Faux, SG, Wakefield, J, Cadigan, G, Donnan, GA, Middleton, S, Anderson, CS, Cadilhac, DA, Grimley, R, Kilkenny, MF, Andrew, NE, Lannin, NA, Hill, K, Grabsch, B, Levi, CR, Thrift, AG, Faux, SG, Wakefield, J, Cadigan, G, Donnan, GA, Middleton, S, and Anderson, CS
- Abstract
Background and Purpose- Hospital uptake of evidence-based stroke care is variable. We aimed to determine the impact of a multicomponent program involving financial incentives and quality improvement interventions, on stroke care processes. Methods- A prospective study of interventions to improve clinical care quality indicators at 19 hospitals in Queensland, Australia, during 2010 to 2015, compared with historical controls and 23 other Australian hospitals. After baseline routine audit and feedback (control phase, 30 months), interventions involving financial incentives (21 months) and then addition of externally facilitated quality improvement workshops with action plan development (9 months) were implemented. Postintervention phase was 13 months. Data were obtained for the analysis from a previous continuous audit in Queensland and subsequently the Australian Stroke Clinical Registry. Primary outcome: change in median composite score for adherence to ≤8 indicators. Secondary outcomes: change in adherence to self-selected indicators addressed in action plans and 4 national indicators compared with other Australian hospitals. Multivariable analyses with adjustment for clustered data. Results- There were 17 502 patients from the intervention sites (median age, 74 years; 46% women) and 20 484 patients from other Australian hospitals. Patient characteristics were similar between groups. There was an 18% improvement in the primary outcome across the study periods (95% CI, 12%-24%). The largest improvement was following introduction of financial incentives (14%; 95% CI, 8%-20%), while indicators addressed in action plans provided an 8% improvement (95% CI, 1%-17%). The national score (4 indicators) improved by 17% (95% CI, 13%-20%) versus 0% change in other Australian hospitals (95% CI, -0.03 to 0.03). Access to stroke units improved more in Queensland than in other Australian hospitals ( P<0.001). Conclusions- The quality improvement interventions significantly improved
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- 2019
45. Systematic review of clinical practice guidelines to identify recommendations for rehabilitation after stroke and other acquired brain injuries
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Jolliffe, L, Lannin, NA, Cadilhac, DA, Hoffmann, T, Jolliffe, L, Lannin, NA, Cadilhac, DA, and Hoffmann, T
- Abstract
OBJECTIVES: Rehabilitation clinical practice guidelines (CPGs) contain recommendation statements aimed at optimising care for adults with stroke and other brain injury. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation covering the acquired brain injury populations. DESIGN: Systematic review. INTERVENTIONS: Included CPGs contained recommendations for inpatient rehabilitation or community rehabilitation for adults with an acquired brain injury diagnosis (stroke, traumatic or other non-progressive acquired brain impairments). Electronic databases (n=2), guideline organisations (n=4) and websites of professional societies (n=17) were searched up to November 2017. Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. RESULTS: From 427 papers screened, 20 guidelines met the inclusion criteria. Only three guidelines were rated high (>75%) across all domains of AGREE-II; highest rated domains were 'scope and purpose' (85.1, SD 18.3) and 'clarity' (76.2%, SD 20.5). Recommendations for assessment and for motor therapies were most commonly reported, however, varied in the level of detail across guidelines. CONCLUSION: Rehabilitation CPGs were consistent in scope, suggesting little difference in rehabilitation approaches between vascular and traumatic brain injury. There was, however, variability in included studies and methodological quality. PROSPERO REGISTRATION NUMBER: CRD42016026936.
- Published
- 2018
46. Development of an electronic health message system to support recovery after stroke: Inspiring Virtual Enabled Resources following following Vascular Events (iVERVE)
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Cadilhac, DA, Busingye, D, Li, JC, Andrew, NE, Kilkenny, MF, Thrift, AG, Thijs, V, Hackett, ML, Kneebone, I, Lannin, NA, Stewart, A, Dempsey, I, Cameron, J, Cadilhac, DA, Busingye, D, Li, JC, Andrew, NE, Kilkenny, MF, Thrift, AG, Thijs, V, Hackett, ML, Kneebone, I, Lannin, NA, Stewart, A, Dempsey, I, and Cameron, J
- Abstract
PURPOSE: Worldwide, stroke is a leading cause of disease burden. Many survivors have unmet needs after discharge from hospital. Electronic communication technology to support post-discharge care has not been used for patients with stroke. In this paper, we describe the development of a novel electronic messaging system designed for survivors of stroke to support their goals of recovery and secondary prevention after hospital discharge. PARTICIPANTS AND METHODS: This was a formative evaluation study. The design was informed by a literature search, existing data from survivors of stroke, and behavior change theories. We established two working groups; one for developing the electronic infrastructure and the other (comprising researchers, clinical experts and consumer representatives) for establishing the patient-centered program. Following agreement on the categories for the goal-setting menu, we drafted relevant messages to support and educate patients. These messages were then independently reviewed by multiple topic experts. Concurrently, we established an online database to capture participant characteristics and then integrated this database with a purpose-built messaging system. We conducted alpha testing of the approach using the first 60 messages. RESULTS: The initial goal-setting menu comprised 26 subcategories. Following expert review, another 8 goal subcategories were added to the secondary prevention category: managing cholesterol; smoking; physical activity; alcohol consumption; weight management; medication management; access to health professionals, and self-care. Initially, 455 health messages were created by members of working group 2. Following refinement and mapping to different goals by the project team, 980 health messages across the health goals and 69 general motivational messages were formulated. Seventeen independent reviewers assessed the messages and suggested adding 73 messages and removing 16 (2%). Overall, 1,233 messages (18 administrativ
- Published
- 2018
47. Changing practice in the assessment and treatment of somatosensory loss in stroke survivors: protocol for a knowledge translation study
- Author
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Cahill, LS, Lannin, NA, Mak-Yuen, YYK, Turville, ML, Carey, LM, Cahill, LS, Lannin, NA, Mak-Yuen, YYK, Turville, ML, and Carey, LM
- Abstract
BACKGROUND: The treatment of somatosensory loss in the upper limb after stroke has been historically overshadowed by therapy focused on motor recovery. A double-blind randomized controlled trial has demonstrated the effectiveness of SENSe (Study of the Effectiveness of Neurorehabilitation on Sensation) therapy to retrain somatosensory discrimination after stroke. Given the acknowledged prevalence of upper limb sensory loss after stroke and the evidence-practice gap that exists in this area, effort is required to translate the published research to clinical practice. The aim of this study is to determine whether evidence-based knowledge translation strategies change the practice of occupational therapists and physiotherapists in the assessment and treatment of sensory loss of the upper limb after stroke to improve patient outcomes. METHOD/DESIGN: A pragmatic, before-after study design involving eight (n = 8) Australian health organizations, specifically sub-acute and community rehabilitation facilities. Stroke survivors (n = 144) and occupational therapists and physiotherapists (~10 per site, ~n = 80) will be involved in the study. Stroke survivors will be provided with SENSe therapy or usual care. Occupational therapists and physiotherapists will be provided with a multi-component approach to knowledge translation including i) tailoring of the implementation intervention to site-specific barriers and enablers, ii) interactive group training workshops, iii) establishing and fostering champion therapists and iv) provision of written educational materials and online resources. Outcome measures for occupational therapists and physiotherapists will be pre- and post-implementation questionnaires and audits of medical records. The primary outcome for stroke survivors will be change in upper limb somatosensory function, measured using a standardized composite measure. DISCUSSION: This study will provide evidence and a template for knowledge translation in clinical, organiza
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- 2018
48. Development of an electronic health message system to support recovery after stroke: Inspiring virtual enabled resources following vascular events (iVERVE)
- Author
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Cadilhac, DA, Busingye, D, Li, JC, Andrew, NE, Kilkenny, MF, Thrift, AG, Thijs, V, Hackett, ML, Kneebone, I, Lannin, NA, Stewart, A, Dempsey, I, Cameron, J, Cadilhac, DA, Busingye, D, Li, JC, Andrew, NE, Kilkenny, MF, Thrift, AG, Thijs, V, Hackett, ML, Kneebone, I, Lannin, NA, Stewart, A, Dempsey, I, and Cameron, J
- Abstract
© 2018 Cadilhac et al. Purpose: Worldwide, stroke is a leading cause of disease burden. Many survivors have unmet needs after discharge from hospital. Electronic communication technology to support post-discharge care has not been used for patients with stroke. In this paper, we describe the development of a novel electronic messaging system designed for survivors of stroke to support their goals of recovery and secondary prevention after hospital discharge. Participants and methods: This was a formative evaluation study. The design was informed by a literature search, existing data from survivors of stroke, and behavior change theories. We established two working groups; one for developing the electronic infrastructure and the other (comprising researchers, clinical experts and consumer representatives) for establishing the patient-centered program. Following agreement on the categories for the goal-setting menu, we drafted relevant messages to support and educate patients. These messages were then independently reviewed by multiple topic experts. Concurrently, we established an online database to capture participant characteristics and then integrated this database with a purpose-built messaging system. We conducted alpha testing of the approach using the first 60 messages. Results: The initial goal-setting menu comprised 26 subcategories. Following expert review, another 8 goal subcategories were added to the secondary prevention category: managing cholesterol; smoking; physical activity; alcohol consumption; weight management; medication management; access to health professionals, and self-care. Initially, 455 health messages were created by members of working group 2. Following refinement and mapping to different goals by the project team, 980 health messages across the health goals and 69 general motivational messages were formulated. Seventeen independent reviewers assessed the messages and suggested adding 73 messages and removing 16 (2%). Overall, 1,233 mes
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- 2018
49. Stretch for the treatment and prevention of contractures (Review)
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Harvey, LA, Katalinic, OM, Herbert, RD, Moseley, AN, Lannin, NA, and Schurr, K
- Subjects
stretch - Abstract
Background Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review. Objectives The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events. Search methods In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials registries. Selection criteria We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures. Data collection and analysis Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model. We assessed the quality of the body of evidence for the main outcomes using GRADE.Main results Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases. The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD 2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with 925 participants). In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with 247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising, blisters and pain but it was not possible to statistically analyse these data. In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term effects on pain (SMD-0.2, 95%CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported 41 adverse events including numbness, pain, Raynauds’ phenomenon, venous thrombosis, need for manipulation under anaesthesia, wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data. Authors’ conclusions There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods longer than sevenmonths have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain.
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- 2017
50. Stretch for the treatment and prevention of contracture: an abridged republication of a Cochrane Systematic Review
- Author
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Harvey, LA, Katalinic, OM, Herbert, RD, Moseley, AM, Lannin, NA, Schurr, K, Harvey, LA, Katalinic, OM, Herbert, RD, Moseley, AM, Lannin, NA, and Schurr, K
- Abstract
Question Is stretch effective for the treatment and prevention of contractures in people with neurological and non-neurological conditions? Design A Cochrane Systematic Review with meta-analyses of randomised trials. Participants People with or at risk of contractures. Intervention Trials were considered for inclusion if they compared stretch to no stretch, or stretch plus co-intervention to co-intervention only. The stretch could be administered in any way. Outcome measures The outcome of interest was joint mobility. Two sets of meta-analyses were conducted with a random-effects model: one for people with neurological conditions and the other for people with non-neurological conditions. The quality of evidence supporting the results of the two sets of meta-analyses was assessed using GRADE. Results Eighteen studies involving 549 participants examined the effectiveness of stretch in people with neurological conditions, and provided useable data. The pooled mean difference was 2 deg (95% CI 0 to 3) favouring stretch. This was equivalent to a relative change of 2% (95% CI 0 to 3). Eighteen studies involving 865 participants examined the effectiveness of stretch in people with non-neurological conditions, and provided useable data. The pooled standardised mean difference was 0.2 SD (95% CI 0 to 0.3) favouring stretch. This translated to an absolute mean increase of 1 deg (95% CI 0 to 2) and a relative change of 1% (95% CI 0 to 2). The GRADE level of evidence was high for both sets of meta-analyses. Conclusion Stretch does not have clinically important effects on joint mobility. [Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K (2017) Stretch for the treatment and prevention of contracture: an abridged republication of a Cochrane Systematic Review. Journal of Physiotherapy 63: 67–75]
- Published
- 2017
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