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5. Skill acquisition in people with chronic upper limb spasticity after stroke

Author

Van Wijck, Frederike Marlijn Jeanneke

Subjects
616.81062, Physiotherapy
Abstract

Background: After a stroke, a considerable proportion of people experience upper limb (UL) impairments, which may affect their activities of daily living. Focal spasticity is common, for which botulinum toxin-type A (BTX-A) is used increasingly. However, published randomised controlled trials have not used valid outcome measures to assess the effects of BTX-A on spasticity and have hardly explored its impact on UL function. The primary aim of this thesis was to investigate whether task-specific UL practice in the form of an evidence-based, functional skill acquisition programme, administered after BTX-A, would have any differential effects on upper limb spasticity or functional UL activity in people more than six months after stroke. The prerequisites were to: 1) clarify the definition of "spasticity", 2) pilot a novel biomechanical spasticity measurement device, 3) standardise the assessment of arm function, 4) systematically review the literature on the effects of BTX-A and 5) compile an evidence- and theory-based skill acquisition programme. Methods: Design: randomised controlled feasibility study with four repeated measures and a blinded assessor. Fourteen participants (time after stroke: range 1.4 -11.0 years) gave informed consent and were randomised into either the experimental group (EG: BTX-A plus skill acquisition) or the placebo control group (CG: BTX-A plus inflatable arm splint). Outcome measures were: Action Research Arm Test, Canadian Occupational Performance Measure, grip force of the affected hand, Stroke Impact Scale, EMG of the elbow flexors, biomechanically measured resistance to passive movement and Ashworth scale. Outcomes were assessed at baseline and weeks 4, 7 and 13 following BTX-A injection. Differences in change between the two groups were analysed using the Mann-Whitney U-test. Applying the Bonferroni correction for three repeated measures yielded a critical p-value of 0.017. Results: At baseline, there were no significant differences between the two groups in any of the dependent variables. Compared to the CG, the EG improved in self-reported hand function between baseline and week 4 (median change 25%, range 0 to 30% vs. CG: median change 0%, range -10 to 0%; p=0.04). The EG also improved in arm function between baseline and week 7 (median ARA T change 4 points, range 1 to 8 points vs. CG: median change -1 point, range -3 to 0 points; p=0.003) as well as in self-reported ADL between baseline and week 13 (median change 11.3%, range 5 to 20% vs. CG: median change 0%, range -2.5 to 5%; p=0.02). Only the differential improvement in ARAT by the EG reached statistical significance. There were no significant differences between the two groups in any of the other outcome measures. Although the programme was perceived as intensive, most participants in the experimental group had found the intervention to be enjoyable. Conclusion: The main finding of this study was that people with severe and chronic upper limb spasticity may still improve in functional activity involving their affected arm, using a combination of BTX-A and a functional skill acquisition programme - without exacerbating spasticity. BTX-A alone did not improve upper limb activity in this study. Implications for clinical practice and research were discussed.

Published
2006

21. sj-pdf-1-eso-10.1177_23969873211036586 - Supplemental material for SaeboGlove therapy for upper limb disability and severe hand impairment after stroke (SUSHI): Study protocol for a randomised controlled trial

Author

Alexander, Jen, Langhorne, Peter, Kidd, Lisa, Wu, Olivia, McConnachie, Alex, van Wijck, Frederike, and Dawson, Jesse

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-eso-10.1177_23969873211036586 for SaeboGlove therapy for upper limb disability and severe hand impairment after stroke (SUSHI): Study protocol for a randomised controlled trial by Jen Alexander, Peter Langhorne, Lisa Kidd, Olivia Wu, Alex McConnachie, Frederike van Wijck and Jesse Dawson in European Stroke Journal

Published
2021
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22. Interventions for reducing sedentary behavior in people with stroke

Author

Revalidatiegeneeskunde Onderzoek, Brain, Child Health, Fysiotherapiewetenschap, Saunders, David H., Mead, Gillian E., Fitzsimons, Claire, Kelly, Paul, van Wijck, Frederike, Verschuren, Olaf, Backx, Karianne, English, Coralie, Revalidatiegeneeskunde Onderzoek, Brain, Child Health, Fysiotherapiewetenschap, Saunders, David H., Mead, Gillian E., Fitzsimons, Claire, Kelly, Paul, van Wijck, Frederike, Verschuren, Olaf, Backx, Karianne, and English, Coralie

Published
2021

24. Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: results from the RATULS randomised controlled trial

Author

Fernandez-Garcia, Cristina, primary, Ternent, Laura, additional, Homer, Tara Marie, additional, Rodgers, Helen, additional, Bosomworth, Helen, additional, Shaw, Lisa, additional, Aird, Lydia, additional, Andole, Sreeman, additional, Cohen, David, additional, Dawson, Jesse, additional, Finch, Tracy, additional, Ford, Gary, additional, Francis, Richard, additional, Hogg, Steven, additional, Hughes, Niall, additional, Krebs, H I, additional, Price, Christopher, additional, Turner, Duncan, additional, Van Wijck, Frederike, additional, Wilkes, Scott, additional, Wilson, Nina, additional, and Vale, Luke, additional

Published
2021
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30. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT

Author

Rodgers, Helen, primary, Bosomworth, Helen, additional, Krebs, Hermano I, additional, van Wijck, Frederike, additional, Howel, Denise, additional, Wilson, Nina, additional, Finch, Tracy, additional, Alvarado, Natasha, additional, Ternent, Laura, additional, Fernandez-Garcia, Cristina, additional, Aird, Lydia, additional, Andole, Sreeman, additional, Cohen, David L, additional, Dawson, Jesse, additional, Ford, Gary A, additional, Francis, Richard, additional, Hogg, Steven, additional, Hughes, Niall, additional, Price, Christopher I, additional, Turner, Duncan L, additional, Vale, Luke, additional, Wilkes, Scott, additional, and Shaw, Lisa, additional

Published
2020
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32. Evaluation of the enhanced upper limb therapy programme within the Robot-Assisted Training for the Upper Limb after Stroke trial: descriptive analysis of intervention fidelity, goal selection and goal achievement

Author

Bosomworth, Helen, primary, Rodgers, Helen, additional, Shaw, Lisa, additional, Smith, Leanne, additional, Aird, Lydia, additional, Howel, Denise, additional, Wilson, Nina, additional, Alvarado, Natasha, additional, Andole, Sreeman, additional, Cohen, David L, additional, Dawson, Jesse, additional, Fernandez-Garcia, Cristina, additional, Finch, Tracy, additional, Ford, Gary A, additional, Francis, Richard, additional, Hogg, Steven, additional, Hughes, Niall, additional, Price, Christopher I, additional, Ternent, Laura, additional, Turner, Duncan L, additional, Vale, Luke, additional, Wilkes, Scott, additional, Krebs, Hermano I, additional, and van Wijck, Frederike, additional

Published
2020
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33. Experiences of augmented arm rehabilitation including supported self-management after stroke: a qualitative investigation

Author

Schnabel, Stefanie, primary, van Wijck, Frederike, additional, Bain, Brenda, additional, Barber, Mark, additional, Dall, Philippa, additional, Fleming, Alexander, additional, Kerr, Andrew, additional, Langhorne, Peter, additional, McConnachie, Alex, additional, Molloy, Kathleen, additional, Stanley, Bethany, additional, Young, Heather Jane, additional, and Kidd, Lisa, additional

Published
2020
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38. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS) : a pragmatic, double-blind, randomised, controlled trial

Author

Dennis, Martin, Forbes, John, Graham, Catriona, Hackett, Maree, Hankey, Graeme J., House, Allan, Lewis, Stephanie, Lundström, Erik, Sandercock, Peter, Mead, Gillian, Anderson, Rosemary, Buchanan, David, Deary, Ann, Drever, Jonathan, Fraser, Ruth, Innes, Karen, McGill, Connor, McGrath, Aileen, Perry, David, Walker, Pauli, Williams, Carol, Chun, Yvonne, Dinsmore, Lynn, Maschauer, Emma, Fraser, Greig, Lawrence, Katherine, Shaw, Alison, Barugh, Amanda, Mikhail, Shadia, Blair, Gordon, Hoeritzauer, Ingrid, Scott, Maggie, Lewis, Steff, Williamson, Judith, Murray, Veronica, French, Ray, Stott, David, Burgess, David, Emberson, Jonathan, Ellis, Graham, Tyrrell, Pippa, Brady, Marian, MacLeod, Malcolm, Milligan, Hazel, Sullivan, Frank, van Wijck, Frederike, Watkins, Caroline, Anderson, Craig, Morales, D., Langhorne, Peter, Reid, Fiona, Rodgers, Helen, Dennis, Martin, Forbes, John, Graham, Catriona, Hackett, Maree, Hankey, Graeme J., House, Allan, Lewis, Stephanie, Lundström, Erik, Sandercock, Peter, Mead, Gillian, Anderson, Rosemary, Buchanan, David, Deary, Ann, Drever, Jonathan, Fraser, Ruth, Innes, Karen, McGill, Connor, McGrath, Aileen, Perry, David, Walker, Pauli, Williams, Carol, Chun, Yvonne, Dinsmore, Lynn, Maschauer, Emma, Fraser, Greig, Lawrence, Katherine, Shaw, Alison, Barugh, Amanda, Mikhail, Shadia, Blair, Gordon, Hoeritzauer, Ingrid, Scott, Maggie, Lewis, Steff, Williamson, Judith, Murray, Veronica, French, Ray, Stott, David, Burgess, David, Emberson, Jonathan, Ellis, Graham, Tyrrell, Pippa, Brady, Marian, MacLeod, Malcolm, Milligan, Hazel, Sullivan, Frank, van Wijck, Frederike, Watkins, Caroline, Anderson, Craig, Morales, D., Langhorne, Peter, Reid, Fiona, and Rodgers, Helen

Abstract

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10,2012, and March 31,2017,3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99.3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0.951 [95% CI 0.839-1.079]; p=0.439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13.43%] patients vs 269 [17.21%]; difference 3.78% [95% CI 1.26-6.30]; p=0.0033), but they had more bone fractures (45 [2.88%] vs 23 [1.47%]; difference 1.41% [95% CI 0.38-2.43]; p=0.0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not se

Published
2019
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41. Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial

Author

Thikey Heather, Grealy Madeleine, van Wijck Frederike, Barber Mark, and Rowe Philip

Subjects
Stroke, Gait, Rehabilitation, Visual feedback, Biomechanics, Medicine (General), R5-920
Abstract

Abstract Background Increasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation. In current clinical practice, visual feedback of movement performance is often limited to the use of mirrors or video. However, neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints. Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment. However, such data are currently presented in numerical or graphical format, which is often impractical in a clinical setting. Our hypothesis is that presenting this kinematic data using bespoke visualisation software, which is tailored for gait rehabilitation after stroke, will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients. This will result in increased patient understanding of their rehabilitation and will enable progress to be tracked in a more accessible way. Methods The hypothesis will be assessed using an exploratory (phase II) randomised controlled trial. Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability (Functional Ambulation Classification of 1 or more). Participants (n = 45) will be randomised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group. The primary outcome measure will be walking speed. Secondary measures will be Functional Ambulation Category, Timed Up and Go, Rivermead Visual Gait Assessment, Stroke Impact Scale-16 and spatiotemporal parameters associated with walking. Additional qualitative measures will be used to assess the participant’s experience of the visual feedback provided in the study. Discussion Results from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient understanding of their rehabilitation. Trial registration Current Controlled Trials ISRCTN79005974

Published
2012
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42. Standardized Measurement of Quality of Upper Limb Movement After Stroke: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable

Author

Kwakkel, G., primary, van Wegen, E. E. H., additional, Burridge, J. H., additional, Winstein, C. J., additional, van Dokkum, L. E. H., additional, Alt Murphy, M., additional, Levin, M. F., additional, Krakauer, J. W., additional, Lang, Catherine E, additional, Keller, Thierry, additional, Kitago, Tomoko, additional, Nordin, Nurdiana, additional, Pomeroy, Valery, additional, Veerbeek, Janne M., additional, and van Wijck, Frederike, additional

Published
2019
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43. Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial

Author

Rodgers, Helen, primary, Bosomworth, Helen, additional, Krebs, Hermano I, additional, van Wijck, Frederike, additional, Howel, Denise, additional, Wilson, Nina, additional, Aird, Lydia, additional, Alvarado, Natasha, additional, Andole, Sreeman, additional, Cohen, David L, additional, Dawson, Jesse, additional, Fernandez-Garcia, Cristina, additional, Finch, Tracy, additional, Ford, Gary A, additional, Francis, Richard, additional, Hogg, Steven, additional, Hughes, Niall, additional, Price, Christopher I, additional, Ternent, Laura, additional, Turner, Duncan L, additional, Vale, Luke, additional, Wilkes, Scott, additional, and Shaw, Lisa, additional

Published
2019
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45. Improving life after stroke needs global efforts to implement evidence-based physical activity pathways

Author

van Wijck, Frederike, primary, Bernhardt, Julie, additional, Billinger, Sandra A, additional, Bird, Marie-Louise, additional, Eng, Janice, additional, English, Coralie, additional, Teixeira-Salmela, Luci Fuscaldi, additional, MacKay-Lyons, Marilyn, additional, Melifonwu, Rita, additional, Sunnerhagen, Katharina S, additional, Solomon, John M, additional, Thilarajah, Shamala, additional, and Mead, Gillian, additional

Published
2019
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48. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Author

Dennis, Martin, primary, Mead, Gillian, additional, Forbes, John, additional, Graham, Catriona, additional, Hackett, Maree, additional, Hankey, Graeme J, additional, House, Allan, additional, Lewis, Stephanie, additional, Lundström, Erik, additional, Sandercock, Peter, additional, Innes, Karen, additional, Williams, Carol, additional, Drever, Jonathan, additional, Mcgrath, Aileen, additional, Deary, Ann, additional, Fraser, Ruth, additional, Anderson, Rosemary, additional, Walker, Pauli, additional, Perry, David, additional, Mcgill, Connor, additional, Buchanan, David, additional, Chun, Yvonne, additional, Dinsmore, Lynn, additional, Maschauer, Emma, additional, Barugh, Amanda, additional, Mikhail, Shadia, additional, Blair, Gordon, additional, Hoeritzauer, Ingrid, additional, Scott, Maggie, additional, Fraser, Greig, additional, Lawrence, Katherine, additional, Shaw, Alison, additional, Williamson, Judith, additional, Burgess, David, additional, Macleod, Malcolm, additional, Morales, Dan, additional, Sullivan, Frank, additional, Brady, Marian, additional, French, Ray, additional, Van Wijck, Frederike, additional, Watkins, Caroline, additional, Proudfoot, Fiona, additional, Skwarski, Joanna, additional, Mcgowan, Diane, additional, Murphy, Rachael, additional, Burgess, Seona, additional, Rutherford, William, additional, Mccormick, Katrina, additional, Buchan, Ruaridh, additional, Macraild, Allan, additional, Paulton, Ruth, additional, Fazal, Adnan, additional, Taylor, Pat, additional, Parakramawansha, Ruwan, additional, Hunter, Neil, additional, Perry, Jack, additional, Bamford, John, additional, Waugh, Dean, additional, Veraque, Emelda, additional, Bedford, Caroline, additional, Kambafwile, Mary, additional, Idrovo, Luis, additional, Makawa, Linetty, additional, Smalley, Paula, additional, Randall, Marc, additional, Thirugnana-Chandran, Tharani, additional, Hassan, Ahamad, additional, Vowden, Richard, additional, Jackson, Joanne, additional, Bhalla, Ajay, additional, Rudd, Anthony, additional, Tam, Chi Kai, additional, Birns, Jonathan, additional, Gibbs, Charlotte, additional, Lee Carbon, Leonie, additional, Cattermole, Elizabeth, additional, Marks, Katherine, additional, Cape, Angela, additional, Hurley, Lisa, additional, Kullane, Sagal, additional, Smyth, Nigel, additional, Eglinton, Charlotte, additional, Wilson, Jennifer, additional, Giallombardo, Elio, additional, Frith, Angela, additional, Reidy, Paul, additional, Pitt, Matthew, additional, Sykes, Lucy, additional, Dellafera, Deborah, additional, Croome, Victoria, additional, Kerwood, Lauriane, additional, Hancevic, Mirea, additional, Narh, Christina, additional, Merritt, Carley, additional, Duffy, John, additional, Cooke, Duncan, additional, Willson, Juliet, additional, Ali, Ali, additional, Naqvi, Aaizza, additional, Kamara, Christine, additional, Bowler, Helen, additional, Bell, Simon, additional, Jackson, Tracy, additional, Harkness, Kirsty, additional, Stocks, Kathy, additional, Duty, Suzanna, additional, Doyle, Clare, additional, Dunn, Geoffrey, additional, Endean, Keith, additional, Claydon, Fiona, additional, Richards, Emma, additional, Howe, Jo, additional, Lindert, Ralf, additional, Majid, Arshad, additional, Dakin, Katy, additional, Maatouk, Ahmad, additional, Barron, Luke, additional, Meegada, Madana, additional, Rana, Pratap, additional, Nair, Anand, additional, Brighouse-Johnson, Christine, additional, Greig, Jill, additional, Kyu, Myint, additional, Prasad, Sanjeev, additional, Robinson, Matthew, additional, Alam, Irfan, additional, Mclean, Belinda, additional, Greenhalgh, Lindsay, additional, Ahmed, Zenab, additional, Roffe, Christine, additional, Brammer, Susan, additional, Beardmore, Carole, additional, Finney, Kay, additional, Barry, Adrian, additional, Hollinshead, Paul, additional, Grocott, Jeanette, additional, Maguire, Holly, additional, Natarajan, Indira, additional, Chembala, Jayan, additional, Sanyal, Ranjan, additional, Lijko, Sue, additional, Abano, Nenette, additional, Remegoso, Alda, additional, Ferdinand, Phillip, additional, Stevens, Stephanie, additional, Varquez, Resti, additional, Causley, Chelsea, additional, Butler, Adrian, additional, Whitmore, Philip, additional, Stephen, Caroline, additional, Carpio, Racquel, additional, Hiden, Joanne, additional, Muddegowda, Girish, additional, Denic, Hayley, additional, Sword, Jane, additional, Curwen, Ross, additional, James, Martin, additional, Mudd, Paul, additional, Hall, Fiona, additional, Cageao, Julie, additional, Keenan, Samantha, additional, Roughan, Caroline, additional, Kingwell, Hayley, additional, Hemsley, Anthony, additional, Lohan, Christoph, additional, Davenport, Sue, additional, Bowring, Angela, additional, Chapter, Tamika, additional, Hough, Max, additional, Strain, David, additional, Gupwell, Karin, additional, Miller, Keniesha, additional, Goff, Anita, additional, Cusack, Ellie, additional, Todd, Shirley, additional, Partridge, Rebecca, additional, Jennings, Georgiana, additional, Thorpe, Kevin, additional, Stephenson, Jacquelyn, additional, Littlewood, Kelly, additional, Barber, Mark, additional, Brodie, Fiona, additional, Marshall, Steven, additional, Esson, Derek, additional, Coburn, Irene, additional, Mcinnes, Caroline, additional, Ross, Fiona, additional, Bowie, Emma, additional, Barcroft, Heather, additional, Withers, Victoria, additional, Miller, Laura, additional, Willcoxson, Paul, additional, Donninson, Michelle, additional, Evans, Richard, additional, Daniel, Di, additional, Coyle, John, additional, Keeling, Michael, additional, Wanklyn, Peter, additional, Elliott, Mark, additional, Wightman, John, additional, Iveson, Elizabeth, additional, Dyer, Natasha, additional, Porteous, Anne-Marie, additional, Haritakis, Monica, additional, Ward, Mandy, additional, Doughty, Lucy, additional, Carr, Lisa, additional, O Neill, Mark, additional, Anazodo, Cosmas, additional, Wood, Paul, additional, Cottrell, Poppy, additional, Donne, Cheryl, additional, Rodriguez, Romina, additional, Mir, Ruhail, additional, Westmoreland, Jax, additional, Bell, Judith, additional, Emms, Christopher, additional, Wright, Lorraine, additional, Clark Brown, Pearl, additional, Bamford, Elizabeth, additional, Stanners, Andrew, additional, Carpenter, Mike, additional, Datta, Prabal, additional, Davey, Richard, additional, Needle, Ann, additional, Eastwood, Marjorie Jane, additional, Razik, Fathima Zeena, additional, Ghouri, Imran, additional, Bateman, Gavin, additional, Archer, Judy, additional, Balasubramanian, Venkatesh, additional, Bowers, Richard, additional, Ball, Julie, additional, Benton, Louise, additional, Jackson, Linda, additional, Ellam, Julie, additional, Norton, Kate, additional, Guyler, Paul, additional, Dowling, Terry, additional, Tysoe, Sharon, additional, Harman, Paula, additional, Kundu, Ashish, additional, Omodunbi, Ololade, additional, Loganathan, Thayalini, additional, Chandler, Stuart, additional, Noor, Shanas, additional, Siddiqui, Anwer, additional, Siddiqui, Amber, additional, Kunhunny, Swapna, additional, Sinha, Devesh, additional, Sheppard, Martin, additional, Rashmi, Sindhu, additional, France, Elena, additional, Orath Prabakaran, Rajalakshmi, additional, Wilson, Laura, additional, Ropun, Amiirah, additional, Kelavkar, Shyam, additional, Ng, Kheng Xiong, additional, Kamuriwo, Lucy, additional, Shah, Sweni, additional, Mangion, David, additional, Constantin, Camen, additional, De Michele Hock, Luigi, additional, Hardwick, Anne, additional, Borley, Jayne, additional, Markova, Skarlet, additional, Netherton, Kimberley, additional, Lawrence, Tara, additional, Fletcher, Jo, additional, Spencer, Rebecca, additional, Palmer, Helen, additional, Cullen, Claire, additional, Hamill, Dolores, additional, Durairaj, Ramesh, additional, Mellor, Zoe, additional, Fluskey, Tanya, additional, Wood, Diane, additional, Keeling, Alison, additional, Hankin, Victoria, additional, Peters, Jennifer, additional, Shackcloth, Daniela, additional, Hlaing, Thant, additional, Tangney, Rebecca, additional, Ewing, Jordan, additional, Harrison, Melanie, additional, Stevenson, Sarah, additional, Sutton, Victoria, additional, Soliman, Mohamed, additional, Hindle, Julia, additional, Watson, Elizabeth, additional, Hewitt, Claire, additional, Butler, Susie, additional, Wahishi, Ibrahim, additional, Arif, Sarwat, additional, Fields, Amy, additional, Sharma, Jagdish, additional, Brown, Rose, additional, Taylor, Caroline, additional, Bell, Sarah, additional, Leach, Simon, additional, Patterson, Chris, additional, Khan, Sophia, additional, Wilson, Helen, additional, Price, Joanne, additional, Ramadan, Hawraman, additional, Maguire, Stuart, additional, Bellfield, Ruth, additional, Hooley, Michaela, additional, Hamid, Umair, additional, Gaba, Waqar, additional, Ghulam, Robina, additional, Masters, Leslie, additional, Quinn, Outi, additional, Sekaran, Lakshmanan, additional, Tate, Margaret, additional, Mohammed, Niaz, additional, Bharaj, Kiranjit, additional, Justin, Frances, additional, Pattni, Rajan, additional, Alwis, Lanka, additional, Sethuraman, Sakthivel, additional, Robinson, Rianne, additional, Eldridge, Lianne, additional, Mintias, Susan, additional, Chauhan, Meena, additional, Tam, Chi-Kai, additional, Palmones, Jeremias, additional, Holmes, Clare, additional, Guthrie, Lucy Belle, additional, Osborn, Mairead, additional, Ball, Lindsay, additional, Caine, Sarah, additional, Steele, Amy, additional, Murphy, Peter, additional, Devitt, Nikki, additional, Leonard, Jayne, additional, Patel, Ronak, additional, Penwarden, Ian, additional, Dodd, Emily, additional, Holloway, Amy, additional, Baker, Pauline, additional, Clarke, Samantha, additional, Williams, Sandra, additional, Dow, Lindsey, additional, Wynn-Williams, Roland, additional, Kennedy, James, additional, Teal, Rachel, additional, Schulz, Ursula, additional, Ford, Gary, additional, Mathieson, Philip, additional, Reckless, Ian, additional, Deveciana, Ana, additional, Mccann, Paige, additional, Cluckie, Gillian, additional, Howell, Geoffrey, additional, Ayer, Jonathan, additional, Moynihan, Barry, additional, Ghatala, Rita, additional, Clarke, Brian, additional, Cloud, Geoffrey, additional, Patel, Bhavini, additional, Khan, Usman, additional, Al-Samarrai, Nia, additional, Trippier, Sarah, additional, Chopra, Neha, additional, Adedoyin, Temi, additional, Watson, Fran, additional, Jones, Val, additional, Zhang, Liqun, additional, Choy, Lillian, additional, Williams, Rebecca, additional, Clarke, Natasha, additional, Blight, Adrian, additional, Kennedy, Kate, additional, Dainty, Alice, additional, Selvarajah, Johann, additional, Kalladka, Dheeraj, additional, Cheripelli, Bharath, additional, Smith, Wilma, additional, Moreton, Fiona, additional, Welch, Angela, additional, Huang, Xuya, additional, Douglas, Elizabeth, additional, Lush, Audrey, additional, Day, Nicola, additional, El Tawil, Salwa, additional, Montgomery, Karen, additional, Hamilton, Helen, additional, Ritchie, Doreen, additional, Ramachandra, Sankaranarayanan, additional, Mcleish, Kirsty, additional, Thavanesan, Kamy, additional, Loganathan, Sathyabama, additional, Roberts, Josh, additional, Cox, Chantel, additional, Orr, Sarah, additional, Hogan, Alison, additional, Tiwari, Divya, additional, Hann, Gail, additional, Longland, Barbara, additional, David, Owen, additional, Bell, Jo, additional, Ovington, Catherine, additional, Rogers, Emily, additional, Bower, Rachel, additional, Keltos, Marketa, additional, Cohen, David, additional, Devine, Joseph, additional, Alwis, Lankantha, additional, Southworth, Lucy, additional, Burgess, Laura, additional, Lang, Matilda, additional, Badiani, Bhavna, additional, Guo, Fenglin, additional, Oshodi, Anne, additional, Owoyele, Emmanuelle, additional, Epie, Norah, additional, David, Anette, additional, Mpelembue, Mushiya, additional, Bathula, Rajaram, additional, Abdul-Saheb, Mudhar, additional, Chamberlain, Angela, additional, Sudkeo, Varthi, additional, Rashed, Khalid, additional, Williams-Yesson, Barbara, additional, Board, Joanne, additional, De Bruijn, Sarah, additional, Buckley, Clare, additional, Board, Sarah, additional, Allison, Joanna, additional, Keeling, Elizabeth, additional, Duckett, Tracey, additional, Donaldson, Dave, additional, Vickers, Carinna, additional, Barron, Claire, additional, Balian, Linda, additional, Wilson, Jodhi, additional, Edwards, Adam, additional, England, Timothy, additional, Hedstrom, Amanda, additional, Bedford, Elizabeth, additional, Harper, Margaret, additional, Melikyan, Elina, additional, Abbott, Wendy, additional, Subramanian, Kashmira, additional, Goldsworthy, Marie, additional, Srinivasan, Meena, additional, Yeomans, Angela, additional, Donaldson, Denise, additional, Hurford, Frances, additional, Chapman, Riquella, additional, Shahzad, Sana, additional, Motherwell, Nicki, additional, Tonks, Louise, additional, Young, Rachel, additional, Ghani, Usman, additional, Mukherjee, Indranil, additional, Dutta, Dipankar, additional, Obaid, Mudhar, additional, Brown, Pauline, additional, Davis, Fiona, additional, Ward, Deborah, additional, Turfrey, Jennifer, additional, Cartwright, Bethan, additional, Topia, Bilal, additional, Spurway, Judith, additional, Collins, Kayleigh, additional, Bakawala, Rehana, additional, Hughes, Chloe, additional, Oconnell, Susan, additional, Hill, Linda, additional, Chatterjee, Kausik, additional, Webster, Tim, additional, Haider, Syed, additional, Rushworth, Pamela, additional, Macleod, Fiona, additional, Nallasivan, Arumugam, additional, Perkins, Charlotte, additional, Burns, Edel, additional, Leason, Sandra, additional, Carter, Tom, additional, Seagrave, Samantha, additional, Sami, Eman, additional, Armstrong, Lisa, additional, Naqvi, Syed Naseem, additional, Hassan, Muhammad, additional, Parkinson, Sharron, additional, Mawer, Samantha, additional, Darnbrook, 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additional, Self, Clare Marie, additional, Crofts, Melissa, additional, Chakrabarti, Annie, additional, Hmu, Chit, additional, Ravenhill, Garth, additional, Grimmer, Charmaine, additional, Soe, Thandar, additional, Keshet-Price, Jocelyn, additional, Langley, Margaret, additional, Potter, Ian, additional, Tam, Pui-Lin, additional, Macleod, Mary Joan, additional, Cooper, Patricia, additional, Christie, Michael, additional, Irvine, Janice, additional, Annison, Faye, additional, Christie, David, additional, Meneses, Celia, additional, Johnson, Amber, additional, Joyson, Anu, additional, Nelson, Sandra, additional, Taylor, Vicky, additional, Reid, John, additional, Clarke, Rebecca, additional, Furnace, Jacqueline, additional, Gow, Heather, additional, Abousleiman, Youssif, additional, Beadling, Tania, additional, Collins, Sally, additional, Jones, Stuart, additional, Purcell, Jessica, additional, Bloom, Samantha, additional, Goshawk, Shelly, additional, Landicho, Marcial, additional, 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additional, Krishnan, Manju, additional, Lynne, Dacey, additional, Thomas, Lisa, additional, Lynda, Connor, additional, Hughes, Catherine, additional, Clements, Clare, additional, Williams, Rhys, additional, Anjum, Tal, additional, Sharon, Storton, additional, Tucker, Susan, additional, Jones, Paul, additional, Colwill, Deanne, additional, Thompson Jones, Helen, additional, Chadha, Dinesh, additional, Fairweather, Mark, additional, Walstow, Deborah, additional, Fong, Rosanna, additional, Johnston, Stuart, additional, Almadenboyle, Christine, additional, Ross, Sarah, additional, Carson, Shona, additional, Nair, Priya, additional, Tenbruck, Emily, additional, Stirling, Mairi, additional, Pusalkar, Aparna, additional, Beadle, Hannah, additional, Chan, Kelly, additional, Dangri, Puneet, additional, Asokanathan, Asaipillai, additional, Rana, Anita, additional, Gohil, Sunita, additional, Massyn, Mark, additional, Aruldoss, Prabhu, additional, Cook, Angela, additional, Crabtree, Karen, additional, Dabbagh, Sura, additional, Black, Toby, additional, Clarke, Caroline, additional, Mead, Denise, additional, Fennelly, Ruth, additional, Anthony, Alpha, additional, Nardone, Linda, additional, Dimartino, Victoria, additional, Tribbeck, Michele, additional, Broughton, David, additional, Tryambake, Dinesh, additional, Dixon, Lynn, additional, Skotnicka, Agnieszka, additional, Thompson, Jane, additional, Whitehouse, Sarah, additional, Sigsworth, Andrew, additional, Wong, Jason, additional, Annamalai, Arunkumar, additional, Pagan, Julie, additional, Affley, Brendan, additional, Sunderland, Caroline, additional, Goldenberg, Lynda, additional, Khan, Atif, additional, Wilkinson, Peter, additional, Nari, Raad, additional, Abbott, Lucy, additional, Young, Emma, additional, Shakhon, Amritpal, additional, Lock, Sally, additional, Stewart, Jack, additional, Pereira, Rita, additional, Dsouza, Margaret, additional, Dunn, Sally, additional, Mckenna, Anne-Marie, additional, Cron, Nina, 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additional, Burton, Karen, additional, Brookes, Lisa, additional, Bailey, Linda, additional, Lindley, Chris, additional, Murray, Abbi, additional, Waltho, Karen, additional, Holland, Maureen, additional, Kumar, Pradeep, additional, Harlekar, Purnima, additional, Booth, Laura, additional, Culmsee, Charlotte, additional, Drew, Jade, additional, Khan, Mohammad, additional, Mackenzie, Nicola, additional, Thomas, Carmel, additional, Ritchie, Jane, additional, Barker, James, additional, Haley, Michael, additional, Cotterill, Donna, additional, Lane, Lynne, additional, Little, Christine, additional, Simmons, Dawn, additional, Saunders, Glenn, additional, Dymond, Harvey, additional, Kidd, Sarah, additional, Warinton, Rachel, additional, Neves-Silva, Yara, additional, Nevajda, Branimir, additional, Villaruel, Michael, additional, Umasankar, Udayaraj, additional, Patel, Seema, additional, Man, Anna, additional, Christmas, Natasha, additional, Rangasamy, Ravi, additional, Ladner, Richard, 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additional, Bhargava, Maneesh, additional, Bhome, Girish, additional, Johnson, Venetia V, additional, Chesser, Dara, additional, Bridger, Hayley, additional, Murali, Elodie, additional, Scott, Jon, additional, Morrison, Susan, additional, Burns, Amy, additional, Graham, Julie, additional, Duffy, Madeline, additional, Ali, Khalid, additional, Pitcher, Emma, additional, Gaylard, Jane, additional, Newman, Julie, additional, Punnoose, Sunil, additional, Besley, Sarah, additional, Purohit, Kirtan, additional, Rees, Amy, additional, Davy, Mark, additional, Chohan, Osman, additional, Khan, Muhammad Fozan, additional, Walker, Rachel, additional, Murray, Vicky, additional, Bent, Charlotte, additional, Oakley, Susan, additional, Peixoto, Cassilda, additional, Jones, Suzanne, additional, Livingstone, Gaybrielle, additional, Butler, Fiona, additional, Bradfield, Sally, additional, Gordon, Laura, additional, Schmit, Jenneke, additional, Wijewardane, Anika, additional, Edmunds, Tineke, additional, 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Published
2019
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49. Study design and methods of the BoTULS trial: a randomised controlled trial to evaluate the clinical effect and cost effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

Author

Graham Laura, Barnes Michael, van Wijck Frederike, Price Christopher, Shaw Lisa, Rodgers Helen, Ford Gary, Shackley Phil, and Steen Nick

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Following a stroke, 55–75% of patients experience upper limb problems in the longer term. Upper limb spasticity may cause pain, deformity and reduced function, affecting mood and independence. Botulinum toxin is used increasingly to treat focal spasticity, but its impact on upper limb function after stroke is unclear. The aim of this study is to evaluate the clinical and cost effectiveness of botulinum toxin type A plus an upper limb therapy programme in the treatment of post stroke upper limb spasticity. Methods Trial design : A multi-centre open label parallel group randomised controlled trial and economic evaluation. Participants : Adults with upper limb spasticity at the shoulder, elbow, wrist or hand and reduced upper limb function due to stroke more than 1 month previously. Interventions : Botulinum toxin type A plus upper limb therapy (intervention group) or upper limb therapy alone (control group). Outcomes : Outcome assessments are undertaken at 1, 3 and 12 months. The primary outcome is upper limb function one month after study entry measured by the Action Research Arm Test (ARAT). Secondary outcomes include: spasticity (Modified Ashworth Scale); grip strength; dexterity (Nine Hole Peg Test); disability (Barthel Activities of Daily Living Index); quality of life (Stroke Impact Scale, Euroqol EQ-5D) and attainment of patient-selected goals (Canadian Occupational Performance Measure). Health and social services resource use, adverse events, use of other antispasticity treatments and patient views on the treatment will be compared. Participants are clinically reassessed at 3, 6 and 9 months to determine the need for repeat botulinum toxin type A and/or therapy. Randomisation : A web based central independent randomisation service. Blinding : Outcome assessments are undertaken by an assessor who is blinded to the randomisation group. Sample size : 332 participants provide 80% power to detect a 15% difference in treatment successes between intervention and control groups. Treatment success is defined as improvement of 3 points for those with a baseline ARAT of 0–3 and 6 points for those with ARAT of 4–56. Trial registration ISRCTN78533119 EudraCT 2004-002427-40 CTA 17136/0230/001 Funding National Institute for Health Research, Health Technology Assessment Programme. Ipsen Ltd provide botulinum toxin type A (Dysport®).

Published
2008
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50. Prompting arm activity after stroke : A clinical proof of concept study of wrist-worn accelerometers with a vibrating alert function

Author

Da-Silva, Ruth H., van Wijck, Frederike, Shaw, Lisa, Rodgers, Helen, Balaam, Madeline, Brkic, Lianne, Ploetz, Thomas, Jackson, Dan, Ladha, Karim, Price, Christopher I., Da-Silva, Ruth H., van Wijck, Frederike, Shaw, Lisa, Rodgers, Helen, Balaam, Madeline, Brkic, Lianne, Ploetz, Thomas, Jackson, Dan, Ladha, Karim, and Price, Christopher I.

Abstract

Background: Frequent practice of functional movements after stroke may optimise motor recovery; however, it is challenging for patients to remember to integrate an impaired limb into daily activities. We report the activity responses of stroke patients receiving a vibrating alert delivered by a tri-axial accelerometer wristband to prompt movement of the impaired arm if hourly activity levels fell. Methods: Adults with upper limb impairment <= 28 days post-stroke wore the device for four weeks. Therapists and patients reviewed movement activity data twice weekly to agree ongoing rehabilitation activities and programme the wristband with a personalised prompt threshold (median baseline activity + 5%, 25% or 50%). Results: Seven patients completed the programme (five males; meanstandard deviation (age) 64 +/- 5 years; days post-stroke 13 +/- 7; baseline/four-week Action Research Arm Test median (Interquartile range (IQR)) 39 (8, 44)/56 (11, 57)). Wristbands were worn for 89% of programme duration. A total of 1,288 prompts were delivered, with a median of four (IQR 3,7) prompts per patient per day. Mean activity increases following a prompt ranged from 11% to 29%. Conclusions: Feedback delivered by a programmable accelerometer increased impaired arm activity. Improvements are required in device reliability before conducting a pragmatic clinical trial to examine the impact upon recovery., QC 20191021

Published
2018
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