Stroke Rehabilitation and CPD

June 2020: Luconi et al (2020). A multifaceted continuing professional development intervention to move stroke rehabilitation guidelines into professional practice: A feasibility study, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2019.1711339

Humble Opinion: As has been the case since the introduction of evidence-based practice back in the late 1990’s, research continues to demonstrate the significant challenges facing the bridging of the evidence-practice or know-do gap. As Luconi et al state:

“Continuing professional development (CPD) is a promising knowledge translation strategy that can address research-practice gaps in stroke rehabilitation. The goal of CPD is to offer opportunities for lifelong learning that can sustain clinical competence and the use of best practices….”

This statement also applies to nationally-agreed clinical guidelines and incentivised funding algorithms. Both have been introduced as a means of increasing the likelihood that clinicians will more readily apply evidence into practice, and in turn, more readily do the right thing, in the right person, at the right time and in the right way.

Also, the challenges to bridging the know-do gap have resulted in the introduction of new science specialities such as knowledge translation and implementation science. Yet, despite strategies, initiatives and funding “levers”, the challenges persist, which is why it’s encouraging to see researchers undertaking investigations, such as this study, undertaken by Luconi et al.

Participants in this study were sent “12 stroke best-practice recommendations…via email over 12 weeks”. Selected by a team of stroke rehab experts, the recommendations were from Canada’s nationally-agreed clinical guidelines, pertinent to more than one profession, based on high-level evidence, and targeted known research-practice gaps. These researchers concluded their push-CPD intervention can be implemented and evaluated and positively impacted on therapists’ acquisition and confirmation of knowledge.

This issue needs more investigations before we’re to more fully understand, and in turn, problem-solve the challenges of doing the right thing, in the right person, at the right time and in the right way, in healthcare. As always, this is just my humble opinion. Its up to you to read the article to generate your own opinion. This article is not publicly available, but I’ve posted the abstract under Journal Club 2020 and the same heading.

Predicting Recovery After Stroke

April 2020 Journal Club

Reference: Stinear et al (2019) Prediction tools for stroke rehabilitation, Stroke 50(11), 3314-3322 DOI: 10.1161/STROKEAHA.119.025696

Humble Opinion: I know! I’m back on one of my favourite topics again! Please forgive me – but, as these authors rightly point out:

“Clinicians rate the patient’s prognosis for functional recovery as the most important factor when considering discharge destination from the acute setting.”

I’ve often presented on the need to be able to predict recovery potential after stroke, and sometimes at my own peril! As those of you who have followed me for some time will know, its one of the reasons I’ve always kept a close eye on the publications of Cathy Stinear and Winston Byblow. The other reason is that both of them, alongside many others researchers, have focussed much of their academic careers investigating recovery after stroke. This publication is not research, but a narrative review. However, I think many of you will find it very interesting indeed. Not only do the authors work their way through many areas of potential dysfunction after stroke, they also explain, along the way, the nuances of what predicting recovery potential is, and is not, about. As is usually the case, the authors keep their discussion firmly set in the “real world” of clinicians, therapy, and most importantly, the people directly affected by stroke. Answers to the “so what” question is an ever-present thread in their discussion.

This review synthesises the evidence related to predicting recovery in independence and disability, upper limb function, walking, independent walking, community ambulation and swallowing. As the authors rightly point out, there’s not enough evidence yet, to review communication, cognition, depression, return to work and driving. If you’re interested in how best to predict recovery after stroke, then this is an article well worth reading in my humble opinion. At the very least, it will point you in the right direction. The article is not publicly available; therefore, if you can’t gain access via other means you may need to purchase it or contact the corresponding author. Because there’s no abstract, you’ll find the opening paragraph of the article posted under the Journal Club 2020 tab.

Stroke Recovery & Rehab

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October 2019: Bernhardt, Borshmann, Kwakkel et al (2019) Setting the scene for the second stroke recovery and rehabilitation roundtable. International Journal of Stroke, 4(5), 450-456, DOI ttps://doi.org/10.1177/1747493019851287

It’s hugely, hugely encouraging to hear about the work of international collaboratives like this one. I’ve been involved in one of the sub-groups and again, this is also hugely encouraging and energising. After all, why not approach stroke recovery from an international perspective; taking what is done best in one country and applying it in another, and learning lessons from the less effective practices and models of care? When it comes to improving outcomes for those directly affected by stroke, an international “team” approach should be underpinning the clinical practices of every local team. To stay up-to-date on what is happening at an international level, this is the team to follow.

As the authors rightly state, this team includes those who are working with people recovering from stroke right through to researchers like Andrew Clarkson, who are investigating animal models of stroke. This broader perspective and collective provides a richer source of what is, and is not, the very best practice that we can deliver to those directly affected. It also provides the broadest platform on which future research and change can occur. If you have a professional and/or personal interest in stroke recovery and rehabilitation, I commend the work and output of this group to you. If we liken stroke recovery to a ship sailing international waters, this group acts as the rudder mechanisms directing and plotting its course.

This article is freely available. Although it is not reporting original research, it is nevertheless an important publication for those with an interest in stroke recovery.

Neuroplasticity, Stroke Recovery & Learning

August 2019: Carey et al (2019) Finding the intersection of neuroplasticity, stroke recovery, and learning: Scope and contributions to stroke rehabilitation. Neural Plasticity, Article ID 5232374, https://doi.org/10.1155/2019/5232374

My congratulations to Leeanne and her colleagues on this incredible piece of research. The fact that an initial search identified just over 400,000 publications gives you some idea of just how much work was involved in this investigation. The temptation to stop right there must have been very strong indeed. Not only is this research innovative in its research question and methods, it is intriguing in its findings. As the title indicates, the investigators set out to find the intersection between neuroplasticity, stroke recovery and learning, and what they found is portrayed in Figure 3. Interestingly, the findings don’t quite intersect, which may say more about where research is up to, in the evolution of this evidence; because, the connectivity between these three issues is in no doubt at all. That “cognition was the major theme identified”, does not come as any surprise. Other identified themes like “task-based….and activity-based learning” and “experience-dependent learning” provides the therapeutic perspective. This watershed evidence is a “must read” for all those involved in recovery after stroke, I’d suggest. This article is freely available. As always, this is just my “humble opinion”.

PS: To make my blog less complicated, as of this month, I’m only going to post. I’ll leave it to others to comments if they want to.

Carers’ Unmet Needs

July 2019: Denham et al (2019) “This is our life now. Our new normal”: A qualitative study of the unmet needs of carers of stroke survivors. PLoS ONE 14(5): e0216682. https://doi.org/10.1371/journal.pone.0216682

Its always special to reference an article published by authors I have some connection with. This article, which incidentally, is open access, provides unique insight into the care needs of those who care for people recovering from and/or living with stroke. The authors introduce their research reflecting on the fact that stroke is a “family disease”. They’re right, aren’t they? It’s not just the survivor who is directly affected, but those who they share their lives with – hence the “family” description. What’s unique to this study, is its investigation of the unmet needs of carers across diverse settings. Previous research has mainly focussed on the rehabilitation phase of care. Although this study used qualitative methods and the majority of responders were female, it nevertheless provides unique insights into these members of our communities. You’ll find the abstract under Journal Club 2019 and “humble opinion” as a comment to this post.

Post-stroke Function: First 5 Years

June 2019: Rejnö et al  (In Press) Changes in functional outcome over five years after stroke. Brain and Behaviour https://doi.org/10.1002/brb3.1300

As the authors rightly claim, there is little evidence about the long-term, functional outcomes in survivors of stroke; which, when you think about it, is surprising! Stroke is a chronic disease, one that survivors will live with for the rest of their lives, yet we know very little about its long-term, functional impact. What I also find very surprising, is the lack of ongoing support that those with stroke, receive in the long-term. Australian researcher, Dr Jeni White, found that, once discharged, many feel “abandoned” by the healthcare system. So, its timely that we review an article about the long-term needs of people living with stroke. This article is freely available. Please find the abstract under Journal Club 2019, and my “humble opinion” attached as a comment to this post.