Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

Did your doctor implement the results of this trial 16 years ago? Or is s/he still incompetent today for doing nothing? 

Do you prefer your doctor and hospital incompetence NOT KNOWING OR NOT DOING anything on this?

Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

• Susy M Braun,
• Anna J Beurskens,
• Susanne M van Kroonenburgh,
• Jeroen Demarteau,
• Jos M Schols &
• Derick T Wade 

BMC Neurology volume 7, Article number: 34 (2007) Cite this article

• 11k Accesses

• 17 Citations

• Metrics details

Abstract

Background

Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation. A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain. This trial investigates whether mental practice can contribute to a quicker and/or better recovery of stroke in two Dutch nursing homes. The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual. In addition, we will investigate prognostic variables and feasibility (process evaluation).

Methods

A randomised, controlled, observer masked prospective trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery. Over a six weeks intervention period the control group will receive multi professional therapy as usual. Patients in the experimental group will be instructed how to perform mental practice, and will receive care as usual in which mental practice is embedded in physical, occupation and speech therapy sessions. Outcome will be assessed at six weeks and six months. The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale. Secondary outcomes are: Motricity Index, Nine Hole Peg Test, Barthel Index, Timed up and Go, 10 metres walking test, Rivermead Mobility Index. A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility. All patients are asked to keep a log to determine unguided training intensity.

Discussion

Advantages and disadvantages of several aspects of the chosen design are discussed.

Trial registration

ISRCTN27582267

Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

Were your doctor and hospital incompetent in not following thru and implementing any successes from this research?

Do you prefer your doctor and hospital incompetence NOT KNOWING? OR NOT DOING anything on this?

Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

• Susy M Braun,
• Anna J Beurskens,
• Susanne M van Kroonenburgh,
• Jeroen Demarteau,
• Jos M Schols &
• Derick T Wade 

BMC Neurology volume 7, Article number: 34 (2007) Cite this article

• 11k Accesses

• 17 Citations

• Metrics details

Abstract

Background

Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation. A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain. This trial investigates whether mental practice can contribute to a quicker and/or better recovery of stroke in two Dutch nursing homes. The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual. In addition, we will investigate prognostic variables and feasibility (process evaluation).

Methods

A randomised, controlled, observer masked prospective trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery. Over a six weeks intervention period the control group will receive multi professional therapy as usual. Patients in the experimental group will be instructed how to perform mental practice, and will receive care as usual in which mental practice is embedded in physical, occupation and speech therapy sessions. Outcome will be assessed at six weeks and six months. The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale. Secondary outcomes are: Motricity Index, Nine Hole Peg Test, Barthel Index, Timed up and Go, 10 metres walking test, Rivermead Mobility Index. A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility. All patients are asked to keep a log to determine unguided training intensity.

Discussion

Advantages and disadvantages of several aspects of the chosen design are discussed.

Trial registration

ISRCTN27582267

Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

In the 16 years since has your stroke hospital applied the learnings from this? NO? THEN WHY HAVEN'T YOU FIRED THE BOARD OF DIRECTORS?

Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

 Published: 15 October 2007
BMC Neurology
 2007,
7
:34doi:10.1186/1471-2377-7-34
 
BioMed
 
Central
Page 1 of 13
(page number not for citation purposes)
BMC Neurology
Open Access
Study protocol
Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial
SusyMBraun*
1,2,3,4
, AnnaJBeurskens 2,3, 

SusanneMvan Kroonenburgh 5, 

JeroenDemarteau 6, 

JosMSchols 5,7,8
 and DerickTWade 9,10
 Address:
1  The centre of expertise in life sciences, Zuyd University, Heerlen, The Netherlands,
2  The department of health and technique, Zuyd University, Heerlen, The Netherlands,
3  The research centre autonomy and participation, Zuyd University, Heerlen, The Netherlands,
4  The care & public health institute, Maastricht University, Maastricht, The Netherlands,
5 Klevarie nursing home, Vivre foundation, Maastricht, The Netherlands,
6 Nursing home St. Camillus, Land van Gelre en Gulick, Roermond, The Netherlands,
7 Department of general practice, Maastricht University, The Netherlands,
8 Department Tranzo, Tilburg University, Tilburg, The Netherlands,
9 Department of rehabilitation, Maastricht University, Maastricht, The Netherlands and
10 Oxford centre for enablement, Oxford, UK Email: SusyMBraun*-s.braun@hszuyd.nl; AnnaJBeurskens-s.beurskens@hszuyd.nl; SusanneMvan Kroonenburgh-svankroonenburgh@vivre.nl; JeroenDemarteau-jeroendemarteau@home.nl; JosMSchols-jos.schols@HAG.unimaas.nl; DerickTWade-derick.wade@noc.anglox.nhs.uk * Corresponding author

Abstract

Background:
 

Mental practice as an additional cognitive therapy is getting increased attention instroke rehabilitation. A systematic review shows some evidence that several techniques in whichmovements are rehearsed mentally might be effective but not enough to be certain. This trialinvestigates whether mental practice can contribute to a quicker and/or better recovery of strokein two Dutch nursing homes. The objective is to investigate the therapeutic potential of mentalpractice embedded in daily therapy to improve individually chosen daily activities of adult strokepatients compared to therapy as usual. In addition, we will investigate prognostic variables andfeasibility (process evaluation).
 

Methods:
 

A randomised, controlled, observer masked prospective trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery. Over a six weeks intervention period the control group will receive multi professional therapy as usual. Patients in the experimental group will be instructed how to perform mental practice, and will receive care as usual in which mental practice is embedded in physical, occupation and speech therapy sessions.Outcome will be assessed at six weeks and six months. The primary outcome measure is the patient perceived effect on performance of daily activities as assessed by an 11-point Likert Scale.Secondary outcomes are: Motricity Index, Nine Hole Peg Test, Barthel Index, Timed up and Go,10 metres walking test, Rivermead Mobility Index. A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility. All patients are asked to keep a log to determine unguided training intensity.
Discussion:
Advantages and disadvantages of several aspects of the chosen design are discussed.
Trial registration:
ISRCTN27582267

Neurologists report infrequent cognitive, emotional screening after TIA, ischemic stroke

If your stroke hospital doesn't have protocols requiring this you need to fire the whole hospital, starting at the top  with the board of directors. They aren't even a stroke hospital.

Neurologists report infrequent cognitive, emotional screening after TIA, ischemic stroke

Nearly half of Dutch neurologists surveyed reported “sometimes or never” screening for emotional or cognitive problemts following transient ischemic attack or ischemic stroke, according to research published in BMJ Open.

“After stroke, many patients experience cognitive and/or emotional problems, which affect their quality of life and participation,” Jos Slenders, of the neurology department at OLVG in Amsterdam, and colleagues wrote. “Therefore, national guidelines recommend screening and care for cognitive and emotional problems after stroke.”

Slenders and colleagues conducted a nationwide, cross-sectional online survey of 52 Dutch neurologists (women, 37%; median age, 45 years) between October 2018 and October 2019 about screening, information provision and follow-up care for cognitive and emotional problems after TIA and ischemic stroke.

Researchers asked 1 neurologist with stroke care experience per neurology department to complete the survey, which included 20 multiple choice questions about screening and follow-up care for cognitive and emotional consequences of TIA and ischemic stroke. They allowed survey forwarding within units.

Survey results demonstrated that 31 clinicians (59%) reported mostly or always conducting cognitive screening following TIA or ischemic stroke; (41%) sometimes or never screened for cognitive function. Neurologists described the most frequently used instruments for these assessments, which included the Montreal Cognitive Assessment (MoCA; 83%), the Mini-Mental State Examination (MMSE; 50%) and the Checklist for Cognitive and Emotional Consequences following Stroke (CLCE-24; 14%).

Regarding the prevalent use of the MMSE, the researchers noted that “two reviews have demonstrated that the MMSE is not sufficiently sensitive to the cognitive consequences of stroke, as it was originally designed to screen for the presence of dementia.” They recommended use of the MoCA instead.

For emotional screening, 29 participants (56%) said they mostly or always screened patients after TIA or ischemic stroke, while 23 reported sometimes or never screening for emotional problems. Thirty-one neurologists (63%) used validated screening tools, 27 (87%) of whom used the Hospital Anxiety Depression Scale.

Screening for cognitive problems occurred most commonly at hospital admission (n = 31; 62%), while 19 hospitals (38%) screened for emotional issues 4 to 8 weeks after the event. The researchers also reported that 14 hospitals (27%) screened multiples times for cognitive issues and 15% of hospitals screened multiple times for emotional issues.

Though a “satisfactory percentage” of neurologists responded, limitations included the survey design and a focus on neurologists’ and their teams’ perspectives. Moving forward, Slenders and colleagues emphasized increased guideline adherence.

“Fortunately, attention is increasingly being drawn to the cognitive and emotional consequences of stroke, and screening rates seem to be increasing,” they wrote. “Still, our results suggest that further improvement is possible and, in our opinion, desirable.”

 

Outcome measures in physiotherapy management of patients with stroke: a survey into self-reported use, and barriers to and facilitators for use

This is chapter 6 in a 236 page thesis. You can read it yourself and see that PTs in the Netherlands don't follow the Dutch clinical practice guidelines. So even if we were to get actual protocols we would be lucky to get someone who actually implements them. 

Outcome measures in physiotherapy management of patients with stroke: a survey into self-reported use, and barriers to and facilitators for use

The Effects of Implicit and Explicit Motor Learning in Gait Rehabilitation of People After Stroke: Protocol for a Randomized Controlled Trial

A research study for walking for you, you will need to know Dutch.  I don't know what implicit vs. explicit means in this case.
The Effects of Implicit and Explicit Motor Learning in Gait Rehabilitation of People After Stroke: Protocol for a Randomized Controlled Trial