From rehabilitation to recovery: protocol for a randomised controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post-stroke

<p>Abstract</p> <p>Background</p> <p>There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined.</p> <p>Methods/Design</p> <p>Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy.</p> <p>Discussion</p> <p>The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers, with emphasis on goal-directed practice to enhance home and community participation status. Facilitation of participation in valued activities may be effective in reducing the incidence or severity of post-stroke depression, as well as enhancing the individual's perception of their health-related quality of life. The engagement of carers in the rehabilitation process will enable review of the influence of the broader social context on recovery.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12608000042347.aspx">ACTRN12608000042347</a></p

Evaluation of a goal-based intervention to reduce depression post-stroke

© 2014 Dr. Christine Jane GravenThe main contentions of this thesis revolve around the multi-factorial concept of recovery after stroke. Stroke is a focal cerebrovascular event that remains a worldwide leading cause of death and permanent disability. Although the incidence of stroke is reducing, its overall prevalence is increasing due to an ageing demographic. Also, despite improvements in acute care management (resulting in reduced mortality rates and less severe levels of impairments), the event of a stroke still often results in complex sequelae, which may present across the spectrum of enduring body structure and function changes, activity limitations, and participation restrictions. The majority of people who have had a stroke will return to reside in the community, however, many of these people will continue to have a level of disability that necessitates ongoing assistance from their families, social networks, and formal community services in order to achieve daily tasks and engage in valued activities. Historically, post-stroke rehabilitation programs have essentially focussed on the amelioration of basic mobility and self-care deficits, with the subsequent published literature abundantly reporting these outcomes. However, over recent decades there has also been greater emergence of publications reporting more ‘holistic’ post-stroke outcomes, demonstrating that the event of a stroke may also frequently result in mood disorders, reduced participation status, gradual functional decline, a diminished quality of life, adverse carer outcomes, and lifestyle adjustment issues. In particular, about one third of people who have had a stroke will also have symptoms of depression, which may impede the recovery process and adversely affect post-stroke outcomes, including failure to resume previous activities. Many of these post-stroke complications and adverse sequelae may be potentially modifiable by targeted interventions. There are many theoretical models and frameworks that exist to try to inform rehabilitation practice. Within these models it is espoused that goal setting is a key component. However, to date, relatively little research has investigated the effectiveness of facilitating the pursuit of individualised goals on the ‘holistic’ outcomes. The first area of work in this thesis assessed the published body of literature that pertained to the effectiveness of community-based rehabilitation programmes on the specific post-stroke outcomes of interest - depression, participation status, and perception of health-related quality of life. Overall, there was evidence to support some community-based interventions in affecting the outcomes of participation and health-related quality of life post-stroke, especially when incorporating management strategies that specifically target participation and leisure domains. In addition, certain exercise programs were shown to have been of benefit in the reduction of post-stroke depressive symptoms The second area of work in this thesis aimed to investigate the effectiveness of a person-centred, integrated approach to facilitating goal achievement and recovery in the community in the first year post-stroke – via a randomised controlled trial. This main study incorporated a multi-modal protocol that used resources that were predominantly available within the existing community-based rehabilitation framework. The intervention included collaborative goal setting, review of goal achievement levels, written information provision, and further referral to relevant health services as required. Intermittent telephone contacts and face-to-face reviews via home visits enabled the clinical researcher to screen for the occurrence of adverse post-stroke sequelae and monitor the participants’ progress throughout the first year after the event – and implement further management options as required With respect to the study’s primary outcome variable, there was a significant difference between the two groups regarding the rates of depression at twelve months post-stroke – with the rate of depression in the intervention group being significantly lower than the rate of depression in the control group. Additionally, the intervention group achieved a higher level of attainment of the collaborative goals that were devised at discharge from inpatient rehabilitation – in both total number of goals, and goals rated to be in the participation domain. No significant group differences were identified for the quality of life outcomes, but interestingly, there was a difference identified between the groups for self-care self-efficacy - perhaps indicating that the intervention may have also altered the participants’ perception of their ability to adopt sufficient coping mechanisms, manage their stress, and deal with arising situations post-stroke. In addition, these results further support the contention that mood status may have an association with self-care self-efficacy after stroke. Learnings from the studies in this thesis suggest that positive effects can be achieved in the more ‘holistic’ post-stroke outcomes when they are specifically targeted. The interventions utilised in this study are readily applicable to community-based clinical practice, and the next challenge lies in how to successfully translate this evidence into routine post-stroke management strategies

First Year After Stroke: An Integrated Approach Focusing on Participation Goals Aiming to Reduce Depressive Symptoms

© 2016 American Heart Association, Inc. BACKGROUND AND PURPOSE: Depression is a common issue after stroke. A focus on assisting people to achieve their personal participation goals may reduce levels of depression. The aim of this study was to investigate the effectiveness of a person-centered, integrated approach on facilitating goal achievement in the first year poststroke on depressive symptoms. METHODS: This study was a randomized controlled trial that addressed ways to enhance participation in patient-valued activities and intermittently screen for adverse sequelae postdischarge from rehabilitation. Collaborative goal setting was undertaken in both groups at discharge from inpatient rehabilitation. The control group received standard management as determined by the treating team. In addition, the intervention group received a multimodal approach, including telephone contacts, screening for adverse sequelae, written information, home visits, review of goal achievement, and further referral to relevant health services. The main outcome measure was depressed mood, measured by the 15-item Geriatric Depression Scale. RESULTS: One hundred ten participants were recruited. No group differences were identified at baseline on any demographic and clinical variables. Using multiple linear regression analysis, there was a significant difference between the 2 groups with respect to the severity of depressive symptoms at 12 months poststroke (R2=0.366; F (6, 89)=8.57; P<0.005), with the intervention group recording lower depressive scores. CONCLUSIONS: This model of community-based rehabilitation proved effective in reducing poststroke depressive symptoms. An integrated approach using pursuit of patient-identified activities should form part of routine poststroke management

Mama Khanyi et les pots: Une histoire mathématique et un livre d’activités

Vale, P., Graven, M., Višňovská, J., & Ford, C. (2019). Mama Khanyi and the Pots. A mathematical story and activity book. Makhanda, Afrique du Sud: South African Numeracy Chair Project, Rhodes University. Consulté à l’adresse https://www.ru.ac.za/media/rhodesuniversity/content/sanc/documents/SANC_Storybook.pdfCet ouvrage est la traduction en français d'un album pour enfants dont l'histoire est adaptée de Cortina, J.L. & Višňovská, J. & Zúñiga, C. (2014). Unit fractions in the context of proportionality: supporting students' reasoning about the inverse order relationship. Mathematics Education Research Journal, 26 (1), 79-99.L'ouvrage original est Vale, P., Graven, M., Višňovská, J., & Ford, C. (2019). Mama Khanyi and the Pots. A mathematical story and activity book. Makhanda, Afrique du Sud: South African Numeracy Chair Project, Rhodes University. Consulté à l’adresse https://www.ru.ac.za/media/rhodesuniversity/content/sanc/documents/SANC_Storybook.pd

Learning the breast examination with Physical Exam Teaching Associates: development and evaluation of the teaching setup. An action research approach

Learning how to perform the clinical breast examination (CBE) as an undergraduate medical student is an important though complex activity, due to its intimate nature. A Physical Exam Teaching Associate (PETA) - based teaching session addresses this issue and is well founded in literature, though detailed information regarding its development is missing. In this study, we address this gap by providing a comprehensive description of the design and development of a PETA-based session for teaching the CBE. A qualitative study according to the principles of action research was done in order to develop the teaching session, using questionnaires and focus groups to explore participants’ experience. PETAs were recruited, trained and deployed for teaching the CBE to medical students in a small-scale, consultation-like setup. Next, the session was evaluated by participants. This sequence of actions was carried out twice, with evaluation of the first teaching cycle leading to adjustments of the second cycle. Students greatly appreciated the teaching setup as well as the PETAs’ immediate feedback, professionalism, knowledge and attitude. In this study, we successfully designed a PETA-based session for teaching the CBE to undergraduate medical students. We recommend using this strategy for teaching the CBE

Additional file 1 of Feasibility of implementing an innovative manual handling risk assessment training program for staff working in long-term care

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