Thank you!

A huge thank you to the 63 Occupational Therapists who completed the SurveyMonkey questionnaire about the work that you do in Australian Residential Aged Care facilities. What an amazing response! Your data are providing a strong, collective “voice” that expresses your concerns and experiences. Two colleagues and I are now analysing the data and writing up the findings. Please be assured that when it’s ready, I’ll provide you with the link.

Shoulder Pain

October 2018 Journal Club: Lindgren et al (In Press) Pain management strategies amount persons with long-term shoulder pain after stroke – a quantitative study. Clinical Rehabilitation, Online early

How do survivors manage persistent shoulder pain after stroke? In 2007 [1], this same research group published findings indicating that 22% of all patients with stroke experienced shoulder pain and of these, at least three-quarters classified it as moderate to severe. One year later, some experienced no pain, but others, who started experiencing shoulder pain further down the track, were added to this cohort. What a complicated issue this is for those experiencing it and for health professionals managing it!

Since 2007, this research group has continued to investigate shoulder pain after stroke and their findings include a 2018 publication [2], which is also worth reading, if this is a topic of interest to you.

The October 2018 Journal Club publication reports the strategies the “experts” use to manage their shoulder pain in the long-term. This article is not freely available; but as I always say, if you contact the “corresponding author”, they’re usually only too happy to send it to you.

To find “humble opinion” see my posted comment and to read the abstract, use the Journal Club 2018 link.

[1] Lindgren et al (2007) Shoulder pain after stroke: A prospective population-based study. Stroke, 38, 343-348. https://www.ahajournals.org/doi/pdf/10.1161/01.STR.0000254598.16739.4e

[2] Lindgren et al (2018) Shoulder pain after stroke: Experiences, consequences in daily life and effects of interventions: a qualitative study. Disability and Rehabilitation, 40(10), 1176-1182. https://www.ncbi.nlm.nih.gov/pubmed/28637154

Future of Upper Limb Therapy

September 2018: Biasiucci et al (2018) Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke. Nature Communications, 2421 https://www.nature.com/articles/s41467-018-04673-z

This is most definitely an article that all those with an interest in upper limb recovery should read. Not only is this because it has been published in “Nature” (a “dream” that every scientist has, but very, very few achieve!), it is also revolutionary! Yes, that’s right. Evidence like this will revolutionise future upper limb management!! This is not an easy article to read or understand, but it will be worth persisting.

At the start of their discussion, the authors claim that: “BCI–FES therapy resulted in a statistically significant, clinically important, and lasting reduction of impairment in chronic moderate-to-severe stroke patients. In particular, the preservation of clinically relevant improvements at least 6 months after end of therapy is remarkable”. This is “watershed” evidence that closes a loop, that to date, had not been closed. I often refer to stroke as a “brain-based problem that needs a brain-based solution”, and, for the first time, we have evidence that closing the feedback loop between the brain and the upper limb is worthwhile. A remarkable finding indeed!

This article is fully available and well worth reading in my humble opinion. Select the Journal Club 2018 page if you want to view the abstract. The rest of my humble opinion is added as a comment to this post.

Are you an…

Australian Occupational Therapist working in the Residential Aged Care sector? If so,

Request: Hi! My name is Dr Isobel Hubbard. I’ve created an anonymous “Fact Finding Mission” that targets Australian Occupational Therapists working in the Residential Aged Care Sector.

If this applies to you, please use this link or go to https://www.surveymonkey.com/r/NSNPLB8 to “have your say”. It should take around 6-10 minutes of your time and it will be available until September 28th, 2019.

If you have colleagues working in this sector, please share this link with them and ask them to share it with their colleagues. The more data we collect, the stronger the “voice”.

Background: From conversations that many of us have had, it appears that in the Residential Aged Care sector, there may be a mismatch between what our profession has to offer and what Occupational Therapists are being asked to do.

If so, using data collected from this survey, we’d like to garner evidence of this potential mismatch and in turn, give “voice” to the concerns. For example, I’d present the findings of this survey at the next Australian Stroke Coalition in November, and, if there is evidence of a mismatch, the coalition could use the findings as evidence to support letters to relevant national institutions.

Thank you: For your interest in this issue, for forwarding this on to your colleagues and, if relevant, for posting your responses.

Walking After Stroke

Berg Balance Scale Predicts Walking

Louie DR & Eng JJ (2018) Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation. Journal of Rehabilitation Medicine, 50 (1), 37-44, DOI: https://doi.org/10.2340/16501977-2280

One of my very favourite academic researchers is Janice Eng and I’m so excited, because, guess what; she’s a keynote speaker at the Stroke 2018 conference in Sydney next week. If you-re going, let’s try and catch up! Although I do realise this is a hugely challenging thing to do at scientific conferences.

Two of my very favourite topics, as CS followers will already know, are using standardised assessments to measure recovery after stroke and predicting recovery potential on the basis of stroke assessments.

So, in my humble opinion, this article is a hit for three very good reasons!

Why don’t we do this more? Why don’t we measure function at baseline or on admission to our services, and then, when we can, use that data to predict what is most likely to occur in most patients? We do this in almost every other aspect of our personal and professional lives. For example, when we calculate a housing loan with the bank, or put in the time and effort to apply for a job on the basis of our estimates on the chances we have of success. There’s more and more reason to do this in those recovering from stroke! These researchers have demonstrated you can use admission Berg Balance Scale data to predict mobility at discharge from inpatient rehabilitation.

This article is freely available. You can find the abstract in the 2018 Journal Club, and I’ve posted “humble opinion” below.  If you’re in Sydney next week, why not attend the Stroke 2018 conference? Hopefully I’ll see some of you there!

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.