Quality of Life & 3-Year Outcomes

July 2018: Rudberg et al (2018) Long-term health-related quality of life, survival and costs by different levels of functional outcome six-months after stroke, European Stroke Journal, 3(2), 157-164. https://doi.org/10.1177/2396987317753444

OK, so I admit, I’m on a bit of a roll! This is my second article on “quality of life” (QoL) and they’ve been in consecutive months. Therefore, I promise that I won’t do QoL again, in 2018, at least. However, I’m certainly not apologising for my selection because essentially, isn’t this is what all healthcare relating to stroke is about? Whatever we do or don’t do in the management of those diagnosed with stroke, must have something to do with the person’s quality of life. I would propose that the most important outcome after stroke must be QoL. What’s interesting about Rudberg et al’s (2018) article is that functional level at 6 months was highly predictive of QoL and long-term survival at 3 years. This longitudinal study makes for very interesting reading, and it is readily available at http://journals.sagepub.com/doi/abs/10.1177/2396987317753444

To view the Abstract, go to the Journal Club 2018 link. To find just “Humble Opinion”, please see my comment below.

Quality of Life and Disability

June 2018: Rangaraju et al (2017) Comparison of 3-month stroke disability and quality of life across modified Rankin Scale categories. Interventional Neurology, 6, 36-41. https://doi.org/10.1159/000452634

One of the issues that continues to concern me is that we fail to consistently and routinely measure outcomes across a survivor’s recovery journey after stroke. If I were to experience a stroke here in Australia, would I have my own baseline data and/or measures across time documenting my recovery or otherwise? It’s highly, highly unlikely! Why is this the case, and in turn, how can we expect health funders to support what’s happening in facilities that support those affected by stroke?

Often health professionals will argue that the reason they’re not doing it is because of time: it just takes too much time to use standardised assessments! They may also argue that its better to spend time on interventions, not assessments! Whatever the excuse, here’s an article that has investigated a standardised assessment that takes just a split-second to reliably measure disability after stroke! The modified Rankin score (mRS), a very raw score, could be your “for starters” choice! Rangaraju et al (2017) investigated its association with quality of life. To find out what an mRS of 3 means, read what they found!

The article is freely available at  https://doi.org/10.1159/000452634. Please find my “humble opinion” below, or under the Journal Club 2018 pages with the same title.

Vision and Stroke

May 2018: Rowe, F. J., the VIS writing group. (2017). Vision In Stroke cohort: Profile overview of visual impairment. Brain and Behavior7(11), e00771. http://doi.org/10.1002/brb3.771

Since attending the UK Stroke Forum in November 2016, I’ve found myself asking why therapists, particularly occupational therapists, are involved in the assessing and treating of visual impairment after stroke. My question has been around the fact that therapists are not, in fact, experts in visual impairment. I understand the logic that because vision impacts occupational performance, therapists, particularly occupational therapists, need to give it consideration, but why are they so actively involved in its assessment and management? At the UK Stroke Forum there were presentations about the involvement of orthoptic services in stroke units – what an “ah ha” moment that was! Of course, why not involve those who have the expertise?

In this month’s article, Rowe and her colleagues report findings in relation to vision after stroke. They profile “the full range of visual disorders from a large, prospective, observation cohort study of stroke survivors with suspected visual impairment, referred by stroke multidisciplinary teams to orthoptic services”.

This article is freely available and incredibly interesting to read. To find the abstract and “humble opinion”, please select the drop down option under Journal Club 2018.

Stroke and Family Grief

April 2018: Coppock et al (2018) ‘It’s nothing you could ever prepare anyone for’: the experiences of young people and their families following parental stroke, Brain Injury, 32:4, 474-486, DOI: 10.1080/02699052.2018.1426879

I’ve recently experienced the loss of a close family member and in turn, I’m experiencing a natural, but heart-wrenching, grief and loss response. My loss has brought with it unanticipated change, and has challenged my resilience and ability to adjust. So, for me, it seems appropriate that this month I consider the grief and loss associated with stroke.

Surprisingly, there’s very little, recently-published, evidence on this, which, in and of itself, seems almost to dismiss this as an issue of clinical significance. So my thanks to Coppock et al (2018), because their “research offers an insight into the processes that may contribute to patterns of interpersonal relating that could negatively impact on adjustment. Provision of adequate information, psychological and practical support during recovery may therefore be crucial elements of supporting young people and their families in adjusting to the challenges posed by stroke”.

This article is not freely available, but if you’d like a copy, you can always email the corresponding author. To find the abstract and “humble opinion”, please select the drop down option under Journal Club 2018.

PT, OT & the Upper Limb

March 2018: de Jong et al (2018) Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice. Physiotherapy Research International, 23, e1683. https://doi.org/10.1002/pri.1683

I’m back on one of my very favourite topics, upper limb recovery after stroke, but I promise I won’t stay on it for the rest of the year! I’m also reviewing an study authored by one of my very favourite research teams, Frederike van Wijck and her colleagues in the Netherlands, and I certainly won’t promise not to review another of their articles this year – that’s for sure!

These researchers investigated what treatment physiotherapists and occupational therapists prescribe and apply to patients with a severely, stroke-affected upper limb. If you’re interested, this article is freely available from http://onlinelibrary.wiley.com/enhanced/exportCitation/doi/10.1002/pri.1683

To find the abstract and “humble opinion”, select the PT, OT & the Upper Limb option from the articles under Journal Club 2018.

Global Burden of Stroke

February 2018: Feigin et al (2016) Global burden of stroke and risk factors in 188 countries, during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurology, 15(9), 913–24 http://dx.doi.org/10.1016/ S1474-4422(16)30073-4

I thought I should start off this year talking about stroke prevention. As the old adage says: “Prevention is better than cure”, and this is certainly the case for stroke. Sure, I have digressed from stroke recovery in its purest sense, but actually, all those who have experienced stroke and/or transient ischemic attack or TIA, are at high risk of experiencing another stroke. Therefore, although risk and prevention are not ordinarily a component of the stroke recovery programs discourse, perhaps it should be, because, as Feigin et al found, “90.5% (95% UI 88.5-92.5) of the stroke burden was attributable to the modifiable risk factors analysed, including 74.2% (95% UI 70.7-76.7) due to behavioural factors (smoking, diet and low physical activity)”. If you think the blame lies mainly at the feet of those who appear to have unhealthy lifestyles, you may be surprised to read that these researchers found nearly 30% of all strokes are attributable to air pollution!

It’s important that all health professionals have an understanding of the factors that place some people at higher risk of stroke than others. The articles published by this research collaboration are, in my humble opinion, the most significant publications that those of us working in stroke, could be reading.  As with all Journal Club reviews, you’ll find the abstract and my Humble Opinion, under Journal Club 2018 and under the Global Burden of Disease option in the drop-down menu. This article is freely available from http://www.sciencedirect.com/science/article/pii/S1474442216300734

I’m excited about starting the year on such a significant article. I’m also looking forward to our journeying together in 2018, Isobel

Mindfulness After Stroke

We’re in December again, the festive season of Christmas is fast approaching for some of us, and 2018 will arrive in less than four weeks! The Christmas “message” is about joy and peace. Perhaps this is the craziest thing I have ever done, but this month, I found myself searching for a scholarly article using the search terms of “stroke”, “peace” and “joy”! I’m sure you won’t be surprised to find that my search was not hugely successful, if you’re just talking number of finds! However, it was successful in that it led me across a “small and rickety” bridge that took me to a place where I have now lots to think about, when it comes to spirituality, peace, joy and stroke! This article is such an interesting read. If you can’t read all of it, at least read pages 409-415. It is not publicly available, but don’t forget, you can always contact the author for a copy.

Do you and your family celebrate Christmas, and if so, I wonder what you’ll be doing? My family will be getting together for Christmas lunch at our house. With young children present, it will be noisy, chaotic, messy and exhausting; but oh, so much fun! I suspect joy will win out over peace, but eventually peace will come. On the turn of 2017 to 2018, I have three wishes for you:

  1. Some enjoyable, peaceful and relaxing time with those previous to you
  2. A rewarding and interesting year in 2018, no matter how challenging and/or blessed.
  3. All the very best in wherever your professional journey takes you.

For me, 2017 has been a busy year with the launch of the book, so here’s hoping 2018 is a little less busy. I’ll be taking a break over Christmas/New Year, so there will be no Journal Club in January. It will re-start in February.

A very special thank you to all my faithful blog followers. I look forward to continuing our “changing stroke” journey together in 2018.

Cognitive Rehabilitation

November 2017 Gamito et al (2017) Cognitive training on stroke patients via virtual reality-based serious games, Disability and Rehabilitation, 39(4), 385-388, DOI: 10.3109/09638288.2014.934925

I’m often asked: What interventions have proven efficacy to improve cognition outcomes after stroke? Or, put another way, if I need to do cognitive rehabilitation, what should I be doing? Good questions! There are many who claim to be doing cognitive rehabilitation, and they are keen to tell you what they do and why; however, there is very little research into what works and what doesn’t work. But fortunately, this is starting to change. This month’s journal article demonstrates that prescribing virtual reality-based serious games can improve attention and memory outcomes after stroke. If you’re interested in cognitive rehabilitation after stroke, this article is worth reading. For “humble opinion”, please go to Journal Club 2017 and select Cognitive Recovery from the drop down box. This article is not publicly available, but don’t forget that you can always email the corresponding author for a copy.

Stroke Clinical Guidelines

For this month’s journal club, I’ve chosen to feature the Australian Stroke Foundation’s Clinical Guidelines (2017) which were released in September. Clinical guidelines play a very important role in clinical practice and they are increasingly seen by the general public as what should and should not be doing as healthcare professionals.

When we have a question about clinical practice, rather than having to work through all the most recent evidence for ourselves, we can be thankful that an army of colleagues have already done this work for us. I disclose that I was involved in one of the sections relating to activities of daily living, but this does not result in any financial gains. Many countries have their own clinical guidelines, so keep in mind that the ones being featured here in the October Journal Club, are specific to the Australian context.

If you’re a health professional working with people directly affected by stroke, then you should be familiar with the clinical guidelines that are most relevant to your work place. For “humble opinion”, please go do this month’s Journal Club page.

Caregivers and Stroke

September 2017: Krieger et al. (2017) Developing a complex intervention program for informal caregivers of stroke survivors: The Caregivers’ Guide. Scandinavian Journal of Caring Sciences, 31(1), 146-156. DOI 10.1111/scs.12344

Yet again, I had the honour of presenting to therapists on stroke recovery; this time in Sydney. One of the questions we discussed at some length was the answer to the following question: “Whose stroke is it?” This is something I’ve been thinking a lot about in recent years. The processes of documenting stroke in health facilities clearly identifies the stroke as “belonging” to the facility, and yet, the actual stroke leaves the facility inside the head of the survivor. In fact, the long-term impact of stroke eventually falls almost entirely to the survivors and their families and carers. They are the people who carry the burden, who grieve the loss and who live with the stroke’s consequences and complications. As I say, “Whose stroke is it?”

I’ve selected this month’s journal article because these authors are reporting evidence about the impact of stroke on families and the benefits of well organised support framework for families and carers. You’ll find the article’s abstract and “Humble Opinion” in its usual place under this topic on the 2017 Journal Club page. This article is freely available at http://onlinelibrary.wiley.com/doi/10.1111/scs.12344/full

Changing Stroke book

It is my very great pleasure to let you know that my new book titled: Changing Stroke: Radical Rethink of Recovery, is now available!

The book costs AUD$45 and, for Australian customers, this includes GST. Please note, there are additional costs for packaging and postage which are dependent on where you live. To purchase it online, go to: http://www.cpdlife.com/changing-stroke-book/

I tried to write a book that wasn’t too long or too technical. I hope I’ve achieved this, and I hope you enjoy reading it. Regards, Isobel

“Changing Stroke is a must-read for clinicians who work with stroke survivors and who want to make a real difference. It is an essential read for clinicians passionate about optimising stroke recovery using evidence-based therapy, and doing so with empathy.”

Dr Heidi Janssen

Nordic Walking After Stroke

August 2017:  Kang et al., (2016). Six-week Nordic Treadmill Training compared with Treadmill Training on balance, gait, and activities of daily living for stroke patients: A randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases25(4), 848-856. doi:10.1016/j.jstrokecerebrovasdis.2015.11.037

This month’s Journal Club is a first!! It’s the very first time that someone else has written the JC post and “humble opinion”. If you’d like to be next, please contact me via the CPDLife® contact page. My thanks to Mandy Shintani and Gabriella De Nino who nominated the article and wrote the following post. They have also added their comments (humble opinion) to the August 2017 journal club page. Thanks Mandy and Gabriella.

Post authored by Mandy and Gabriella: While awareness is increasing among therapists of the potential benefits of Nordic Walking (NW) for gait and balance retraining, there appears to be limited use of this treatment approach for those recovering from stroke, which may be attributed in part to the lack of research in this population.  To date, NW has been well researched with more than 200 studies posted on PubMed regarding other conditions affecting balance, including Parkinson’s disease. Based on these studies, which found significant improvements in balance, gait speed, posture, stride length and Activities of Daily Living (ADL), the researchers hypothesize that Nordic Treadmill Training (NTT) could be tremendously effective for gait retraining after stroke.  Kang et al (2016) are the first to demonstrate the benefits of NTT in terms of balance, gait and activities of daily living for participants with hemiparesis. They present results demonstrating the benefits of NTT when compared to regular treadmill training (TT).  However, it is important to note that their study used a modified technique of simulating NW with the constant assistance of a therapist.

The findings of Kang et al (2016) are well worth reading. They highlight the importance of arm swing and contralateral leg movement for balance and gait. This study will hopefully pave the way for further research on regular NW which in my opinion may be safer for independent use than NTT and more cost effective in a clinical setting. NW is an exciting new treatment approach that has the potential to promote active living for those on the road to recovery. For the abstract and my comments, go to Journal Club 2017. You can access this article at https://www.ncbi.nlm.nih.gov/pubmed/26796052

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