Arming our patients: Empowering patients to increase self-directed upper-limb activity at the Oxfordshire Stroke Rehabilitation Unit

More importantly,what are your doctor and therapists doing to create EXACT RECOVERY PROTOCOLS LEADING TO 100% RECOVERY? All this is punting responsibility from the doctor to the patient and thus allowing blaming the patient for lack of recovery. Totally the opposite has to occur, no recovery, the doctor is EXPLICITLY BLAMED.

Arming our patients: Empowering patients to increase self-directed upper-limb activity at the Oxfordshire Stroke Rehabilitation Unit

• E. Garratt
• D. Mistry
• C. Boyle
• M. Fellerdale
• V. Southcott
• S. King

DOI:https://doi.org/10.1016/j.physio.2021.10.007

Purpose: The Oxfordshire Stroke Rehabilitation Unit (OSRU) is a 20-bed inpatient service, delivering specialist rehabilitation to patients following acute stroke.

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Article Info

Identification

DOI: https://doi.org/10.1016/j.physio.2021.10.007

Copyright

© 2021 Published by Elsevier Inc.

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A Self-Empowered Upper Limb Repetitive Engagement Program to Improve Upper Limb Recovery Early Post-Stroke: Phase II Pilot Randomized Controlled Trial

Feasible, yes. But you don't tell us the most important part. What the fuck was recovery like?  And you punt and tell us further research is needed which means you didn't set up your research correctly.

A Self-Empowered Upper Limb Repetitive Engagement Program to Improve Upper Limb Recovery Early Post-Stroke: Phase II Pilot Randomized Controlled Trial

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Lay Fong Chin, PhD, Kathryn S. Hayward, PhD, Audrey Lik Ming Chai, BSc,

First Published July 19, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/15459683211032967

Article information

Abstract

Background. 

Time outside therapy provides an opportunity to increase upper limb (UL) use during post-stroke hospitalization.  

Objective. 

To determine if a self-directed UL program outside therapy (Self-Empowered UL Repetitive Engagement, SURE) was feasible and to explore the potential effect of the SURE program on UL use and recovery.  

Methods. 

Twenty-three patients from an inpatient rehabilitation center who were ≤21 days post-stroke and had a Fugl Meyer UL (FMUL) score ≤50 and a positive motor evoked potential (MEP+) response were randomized (stratified by impairment) to either experimental group (SURE: individualized, UL self-exercise and use outside therapy for 6 hours/week for 4 weeks) or control group (education booklet). Feasibility was evaluated by program adherence, dropout rate, adverse events, and satisfaction. Potential effect was measured by paretic UL use via accelerometry weekly during the intervention, FMUL and Action Research Arm Test (ARAT) at baseline (Week 0), post-intervention (Week 4), and follow-up (Week 8 and Week 16).  

Results. Adherence to SURE was high: 87% program completion (mean 313±75 repetitions/day). There were no dropouts, no adverse events related to SURE, and patient satisfaction averaged 7.8/10. Experimental participants achieved an additional hour of UL use daily (range: .3–1.2 hours/day) compared to control. Significant improvements in FMUL and ARAT were observed in both groups from Week 0 to Week 4 and to Week 8 (P ≤ .002), which were maintained to Week 16. There were no differences between groups (P ≥ .119).  

Conclusions. SURE was a feasible self-directed program that increased UL use in MEP+ individuals with moderate-severe impairment early post-stroke. Further studies with larger sample sizes and potentially higher dose are required to determine efficacy.

Keywords

stroke rehabilitation, recovery, self-administered, upper limb, use

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Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

But what EXACTLY is your doctor doing to ensure you can do these extra exercxises? Like 100% recovery protocols? Oh s/he doesn't have any? Well then you are totally fucking screwed because your doctors are completely failing at their job.  The board of directors needs to be fired if that is the case. You can't let failure to continue forever in your hospital. Your children and grandchildren just might want better recovery than you did.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

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Michelle Broderick, BSc, Leeza Almedom, MSc, Etienne Burdet, PhD, ...

First Published August 27, 2021 Research Article 

https://doi.org/10.1177/15459683211041313

Article information

Abstract

Background. 

One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy.  

Methods. 

Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission.  

Results. 

From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001).  

Conclusion. 

Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

Keywords

stroke, rehabilitation, physiotherapy, upper limb, exercise gaming, rehabilitation technology

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Taking Charge after stroke - a person centred approach to life after stroke

So solving stroke by the medical profession is too damn hard, so we'll just throw our hands up in defeat and dump it on the survivors.  Nothing on 100% recovery, so this was a complete failure. Go back to the drawing board and design research that gets to 100% recovery.  LEADERS SOLVE PROBLEMS, THEY DON'T RUN AWAY.

WHAT A FUCKING PILE OF SHIT!

Taking Charge after stroke - a person centred approach to life after stroke

 

Taking Charge after Stroke: A randomized controlled trial of a person-centered, self-directed rehabilitation intervention

So solving stroke by the medical profession is too damn hard, so we'll just throw our hands up in defeat and dump it on the survivors.  Nothing on 100% recovery, so this was a complete failure. Go back to the drawing board and design research that gets to 100% recovery.  LEADERS SOLVE PROBLEMS, THEY DON'T RUN AWAY.

WHAT A FUCKING PILE OF SHIT!

Taking Charge after Stroke: A randomized controlled trial of a person-centered, self-directed rehabilitation intervention 

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Vivian Fu, Mark Weatherall, Kathryn McPherson, ...

First Published April 15, 2020 Research Article

https://doi.org/10.1177/1747493020915144

Article information

Abstract

Background and purpose

“Take Charge” is a novel, community-based self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. In a previous randomized controlled trial, a single Take Charge session improved independence and health-related quality of life 12 months following stroke in Māori and Pacific New Zealanders. We tested the same intervention in three doses (zero, one, or two sessions) in a larger study and in a broader non-Māori and non-Pacific population with stroke. We aimed to confirm whether the Take Charge intervention improved quality of life at 12 months after stroke in a different population and whether two sessions were more effective than one.

Methods

We randomized 400 people within 16 weeks of acute stroke who had been discharged to institution-free community living at seven centers in New Zealand to a single Take Charge session (TC1, n = 132), two Take Charge sessions six weeks apart (TC2, n = 138), or a control intervention (n = 130). Take Charge is a “talking therapy” that encourages a sense of purpose, autonomy, mastery, and connectedness with others. The primary outcome was the Physical Component Summary score of the Short Form 36 at 12 months following stroke comparing any Take Charge intervention to control.

Results

Of the 400 people randomized (mean age 72.2 years, 58.5% male), 10 died and two withdrew from the study. The remaining 388 (97%) people were followed up at 12 months after stroke. Twelve months following stroke, participants in either of the TC groups (i.e. TC1 + TC2) scored 2.9 (95% confidence intervals (CI) 0.95 to 4.9, p = 0.004) points higher (better) than control on the Short Form 36 Physical Component Summary. This difference remained significant when adjusted for pre-specified baseline variables. There was a dose effect with Short Form 36 Physical Component Summary scores increasing by 1.9 points (95% CI 0.8 to 3.1, p < 0.001) for each extra Take Charge session received. Exposure to the Take Charge intervention was associated with reduced odds(NOT GOOD ENOUGH) of being dependent (modified Rankin Scale 3 to 5) at 12 months (TC1 + TC2 12% versus control 19.5%, odds ratio 0.55, 95% CI 0.31 to 0.99, p = 0.045).

Conclusions

Confirming the previous randomized controlled trial outcome, Take Charge—a low-cost, person-centered, self-directed rehabilitation intervention after stroke—improved(NOT GOOD ENOUGH) health-related quality of life and independence.

Clinical trial registration-URL

http://www.anzctr.org.au. Unique identifier: ACTRN12615001163594

Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life--a randomized controlled trial

So the stroke medical world wants to wash their hands of the complete failure of everything in stroke and just dump it on stroke survivors. They all need to be keel hauled.  This should only be allowed AFTER THEY HAVE CREATED 100% RECOVERY PROTOCOLS.  Nothing less that that.

Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life--a randomized controlled trial

Harwood M¹, Weatherall M, Talemaitoga A, Barber PA, Gommans J, Taylor W, McPherson K, McNaughton H.

Author information

Abstract

OBJECTIVE:

Few community interventions following stroke enhance activity, participation or quality of life. We tested two novel community interventions designed to promote self-directed rehabilitation following stroke.

DESIGN:

This was a randomized, controlled parallel group 2×2 trial.

SETTING:

Community.

PARTICIPANTS:

Maori and Pacific New Zealanders, >15 years old, randomized within three months of a new stroke.

INTERVENTIONS:

A DVD of four inspirational stories by Maori and Pacific people with stroke and a 'Take Charge Session'--a single structured risk factor and activities of daily living assessment, designed to facilitate self-directed rehabilitation.

MAIN MEASURES:

Primary outcomes were Health-related Quality of Life (Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form 36 (SF-36)) 12 months from randomization. Secondary outcomes were Barthel Index, Frenchay Activities Index, Carer Strain Index and modified Rankin score.

RESULTS:

One hundred and seventy-two people were randomized with 139 (80.8%) followed up at 12 months post randomization. The effect of the Take Charge Session on SF-36 PCS at 12 months was 6.0 (95% confidence interval (CI) 2.0 to 10.0) and of the DVD was 0.9 (95% CI -3.1 to 4.9). Participants allocated to the Take Charge Session were less likely to have a modified Rankin score of >2 (odds ratio (OR) 0.42, 95% CI 0.2 to 0.89) and their carers had lower (better) Carer Strain Index scores (-1.5, 95% CI -2.8 to -0.1).

CONCLUSION:

A simple, low-cost intervention in the community phase of stroke recovery aiming to promote self-directed rehabilitation improved outcomes.

PMID:

22087047

DOI:

10.1177/0269215511426017