http://westminsterresearch.wmin.ac.uk/16057/
|
PDF
Citkovitz_Claudia_thesis.pdf Download (13MB) | Preview |
Abstract
BACKGROUND
AND AIMS
Evidence on acupuncture during stroke rehabilitation is inconsistent,
with methodological problems including inappropriately standardized
treatment protocols. This project developed and assessed feasibility of
methods to
study an individualized acupuncture intervention during acute stroke
rehabilitation.
DESIGN AND METHODS
This three-part project aimed to 1) develop a manual for post-stroke
acupuncture therapy; 2) determine feasibility of methods for future
study and 3) explore stakeholder perceptions of acupuncture’s impact.
First, a treatment manual was developed. Second, a cohort study used the
manual to treat 48 inpatients, who had elected acupuncture
treatment(n=25) or usual care only (n=23). Acupuncture was given 3-4
times weekly for 2-4 weeks. Outcomes assessed for feasibility included
the Functional Independence Measure (FIM), Modified Rankin Scale of
global disability (mRS) and assessments of sleep, swallowing and bowel
function(at baseline and discharge, with mRS also at 6-month follow-up).
Confidence intervals were compared across mild, moderate and severe
subgroups. The third study assessed stakeholder perceptions of
acupuncture impact. Acupuncture patients were briefly interviewed, with
surveys given to family, rehabilitation therapists, nurses and
physicians. Impacts of acupuncture were identified using thematic
analysis, and compared quantitatively across severity groups.
RESULTS
Improvement in FIM scores was similar in self-selected cohorts choosing
acupuncture (Mdn=37.5) and usual care (Mdn=35), 95% CI [-6, 6]. FIMiii
motor domain scores trended higher in the moderate subgroup only.
Feasibility criteria were met for the outcomes of 6-month mRS, bowel
function, and sleep. Findings of Project 3 included a wide range of
perceived benefits, with no negative impact. Benefits included improved
upper and lower extremity motor function, walking, relaxation, and pain
reduction. Staff reported better mood and participation in physical and
occupational therapy. Reported benefits differed across severity
subgroups, but proportion of stakeholders perceiving benefit was
similar.
CONCLUSIONS
Further research on acupuncture during stroke rehabilitation is
feasible, given mutually appropriate intervention, patient population
and outcome measures. The widely used FIM appears inappropriate for
future study, except possibly for patients in the moderate range of
severity. No outcome reached statistical significance in this small
non-randomized study. Trends favored the acupuncture group on most
secondary outcomes including 6-month mRS, sleep and bowel function.
Additional directions for further study include the relationship between
cortical damage and acupuncture responsiveness, and possible benefit to
the
rehabilitation process itself.
| Item Type: | Thesis (PhD) |
|---|---|
| SWORD Depositor: | repository@westminster.ac.uk |
| Depositing User: | repository@westminster.ac.uk |
| Date Deposited: | 30 Nov 2015 16:24 |
| Last Modified: | 30 Nov 2015 16:24 |
| URI: | http://westminsterresearch.wmin.ac.uk/id/eprint/16057 |
No comments:
Post a Comment