Evaluating stroke patients' awareness of risk factors and readiness to change stroke risk-related behaviors in a randomized controlled trial

To identify the effects of a brief educational intervention on stroke patients' recall and recognition of risk factors and performance of and stage of change for stroke risk-related behaviors.Sixty-six patients with stroke participated in a multisite randomized controlled trial. The intervention group (n = 35) received a brief education intervention (tailored written stroke information, verbal reinforcement of information for 3 months after discharge, and provision of a telephone number). The control group (n = 31) received usual care. Unprompted recall (personal and general), prompted recognition of risk factors (0-13), and performance of (0-10) and stage of change for up to 7 stroke risk-related behaviors were assessed before and 3 months after discharge.No significant between-group differences were found. For all participants over time, there were significant improvements for personal (mean difference [MD], 0.3; 95% CI, 0.004-0.69; P = .05) and general (MD, 0.6; 95% CI, 0.09-1.16; P = .02) risk factor recall; performance of stroke risk-related behaviors (MD, 0.8; 95% CI, 0.28-1.26; P < .01); and progression from a nonaction to an action stage of change for 4 of 7 behaviors over time. There was a significant decline in total risk factor recognition scores (MD, -0.8; 95% CI, 0.39-1.13; P < .01).Stroke patients' unprompted recall of risk factors and performance of risk-related behaviors improved over time; readiness to change risk-related behaviors progressed for some behaviors. A brief educational intervention did not improve risk factor awareness or behavior change more than usual care

Evaluation of brief interventions for managing depression and anxiety symptoms during early discharge period after stroke: a pilot randomized controlled trial

Background: Prevalence estimates for depression and anxiety in individuals post-stroke are approximately 33 and 29%, yet there are few effective preventive interventions. Interventions which commence pre-discharge and continue during the early post-discharge period may support individuals during the critical transition to home adjustment period. This study aimed to evaluate the efficacy of a self-management intervention and a coping skills intervention, compared to usual care, on anxiety and depression post-stroke.Methods: A pilot, three-arm randomized trial involving 33 stroke patients (coping skills: n=11, self-management: n=12, usual care: n=10) recruited from an Australian stroke unit. Both interventions were eight 1-hour weekly sessions, with the first two pre-discharge and the remainder at home; targeted both anxiety and depression; and tailored content to individuals. Primary outcome was severity of depressive and anxiety symptoms (measured using Montgomery andAsberg Depression Rating Scale and Hospital Anxiety and Depression Scale). Secondary measures were: self-efficacy, stroke knowledge, basic and extended activities of daily living, and quality of life. Outcome measures were administered at baseline, one week post-intervention, and at a three month follow-up by a blinded assessor.Results: Thirty (91%) participants completed the trial. Immediately post-intervention there was a small improvement in stroke knowledge and a small increase in depression symptoms (on one of the two measures of depression symptoms) in the coping skills group compared to usual care. These differences did not remain significant at the 3-month follow-up, nor were there any other significant differences.Conclusion: Neither a coping skills nor self-management intervention reduced anxiety nor depression symptoms early post-stroke more than usual care. Lack of statistical power may have contributed to the non-significant findings in this pilot study

Stroke patients' awareness of risk and readiness to change behaviors

Purpose: Behavior change is an important component of secondary stroke prevention. The transtheoretical model, which describes behavior change as occurring through a series of stages, may be a useful way of assessing patients' readiness to change behavior. The model has been successfully applied to other chronic conditions and argues that people progressing "forward" through the stages are more likely to successfully change their behavior. The aim of this study was to describe stroke patients' readiness to change behaviors for stroke-related risk factors using this model, in the absence of a behavior modification intervention. Method: Patients (n = 27) from an acute stroke ward of a major metropolitan hospital in Brisbane, Australia, were interviewed prior to and at 3 months following hospital discharge regarding their awareness of stroke risk factors and their readiness to change stroke risk related behaviors. Results: At both points in time, 30% of patients could not spontaneously nominate one or more stroke risk factors. Despite a trend of "forward" progression in stages of change between the 2 interviews for behaviors relating to hypertension, heart disease, and high cholesterol, there were no statistically significant changes over time for any of the behaviors. Patients' readiness to change stroke risk related behaviors differed for each risk factor. Conclusion: Acknowledging that patients' readiness to change may differ for each risk factor may promote more effective facilitation of stroke secondary prevention behaviors

The suitability of written education materials for stroke survivors and their carers

This study evaluated the suitability of written materials for stroke survivors and their carers. Twenty stroke survivors and 14 carers were interviewed about the stroke information they had received and their perceptions of the content and presentation of materials of increasing reading difficulty. The mean readability level of materials (grade 9) was higher than participants’ mean reading ability (grade 7–8). Satisfaction with materials decreased as the content became more difficult to read. Seventy-five percent reported that their information needs were not met in hospital. More stroke survivors with aphasia wanted support from health professionals to read and understand written information, and identified simple language, large font size, color, and diagrams to complement the text as being important features of written materials. Simple materials that meet clients’ information needs and design preferences may optimally inform them about stroke

Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

Funder: Addenbrooke's Charitable Trust, Cambridge University Hospitals; FundRef: http://dx.doi.org/10.13039/501100002927Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff

Design and evaluation of a post-discharge education and support package for stroke clients and their carers

Numerous clinical guidelines acknowledge the provision of information to clients and their carers as a crucial component of post-stroke care (Intercollegiate Stroke Working Party, 2004; National Stroke Foundation, 2010a). The Cochrane review of stroke information provision found that information can improve stroke client and carer knowledge, reduce client depression, and increase some aspects of client satisfaction (Smith et al., 2008). It is clear that clients and their carers need and want more information following a stroke (Hanger, Walker, Paterson, McBride, & Sainsbury, 1998; O'Mahony, Rodgers, Thomson, Dobson, & James, 1997), but the most effective ways for health professionals to provide this is less clear. The aim of this thesis was to design, and then evaluate an education and support package for clients with stroke and their carers, building on previous research into tailored written stroke information (Hoffmann, McKenna, Worrall, & Read, 2007). The thesis starts with a review of the literature, presenting current practice and recommendations for the content, format, delivery style and timing of stroke information provision. This is followed by Study 1, which was a survey of community services (n=57) available to clients with stroke and their carers that aimed to identify the way in which these services provide stroke information. The research questions for Study 1 were: 1. What content, format, delivery style and timing are currently being used to educate and support community-based stroke clients and carers? 2. What post-discharge supports and educational opportunities exist for stroke clients and carers? This study found that services provided information to clients and carers using a range of formats and delivery styles, and that areas for improvement included: the provision of secondary prevention information; appropriate design, and use, of written material; and provision of opportunities to reinforce stroke information. Study 2 surveyed clients with stroke (n=27) and their carers (n=17) prior to, and 3 months following, acute stroke unit discharge. The survey explored clients’ and carers’ content, format and delivery style preferences for receiving information. The three research questions for Study 2 were: 1. What are stroke clients’ and carers’ preferences for information prior to, and 3 months following, acute stroke unit discharge, specifically content, format, delivery style and timing? 2. What do clients and carers perceive as barriers to accessing stroke information, prior to, and 3 months following, acute stroke unit discharge? 3. What are stroke clients’ awareness of stroke risk factors and readiness to modify behaviour related to these, prior to, and 3 months following, acute stroke unit discharge? Results indicated that clients and carers preferred a combination of face-to-face, written and telephone formats, and a mix of active and passive delivery styles. Client and carers also described barriers to the process of stroke information provision including: the limited availability of information; hospital-related barriers; and client- and carer-related barriers. Finally, one third of clients could not spontaneously nominate one or more stroke risk factors and there were no statistically significant changes in performance of stroke risk-related behaviours between discharge and 3 months following discharge. The results of these two studies were combined with recommendations from the literature to design an education and support package. The package consisted of tailored written information and verbal reinforcement provided face-to-face prior to acute stroke unit discharge and via telephone contact for 3 months following discharge. Its provision to clients with stroke and their carers was compared against usual acute stroke unit care in a single-blind, multi-site randomised controlled trial with 119 participants. The research questions for Study 3 were: 1. Does a tailored education and support package improve the knowledge, health and psychosocial outcomes of stroke clients and carers? 2. What demographic and clinical characteristics are associated with stroke knowledge? Outcome measures were assessed just prior to acute stroke unit discharge and 3 months following discharge, and included measures of stroke knowledge, self-efficacy, anxiety and depression, client quality of life, caregiver burden, satisfaction with information received and a rating of feeling informed. Clients’ awareness of risk factors and risk-related behaviour change were also assessed and multilevel modeling was undertaken to address the second of Study 3’s research questions. At follow-up, participants in the intervention group had significantly better: stroke knowledge (p=0.013); self-efficacy for accessing information (p=0.013); and satisfaction with medical (

Current practice trends of oedema management in the hands of people with tetraplegia in Australia

Study design: Survey research design. Objectives: To describe current practice methods for oedema management in people with tetraplegia. Setting: Australia. Methods: Online survey with open and closed questions regarding clinical practice trends in the assessment and treatment of oedema in the hands in people with tetraplegia. Results: Seventeen occupational therapists working in spinal cord injury (SCI) in Australia completed the survey. Oedema was identified by visual inspection (n = 17, 100%) and recorded using circumferential tape measurement (n = 13, 76%). Elevation was used by all participants in conjunction with compression gloves (n = 13, 76%), retrograde massage (n = 13, 76%), compression bandaging (n = 12, 71%) and the boxing glove splint (n = 9, 53%). Participants stated that oedema presented challenges to patients with difficulty exercising (n = 11, 65%), changes to body image (n = 5, 29%) and pain (n = 4, 24%). Conclusion: Assessment and treatment practices were not consistent. Oedema in the hands in people with tetraplegia was perceived to have various impacts on a person’s rehabilitation and hand function. The findings highlight the need for research evidence to guide practice

Building capacity for knowledge translation in occupational therapy: learning through participatory action research

There has been widespread acknowledgement of the need to build capacity in knowledge translation however much of the existing work focuses on building capacity amongst researchers rather than with clinicians directly. This paper's aim is to describe a research project for developing a knowledge translation capacity building program for occupational therapy clinicians.Participatory action research methods were used to both develop and evaluate the knowledge translation capacity-building program. Participants were occupational therapists from a large metropolitan hospital in Australia. Researchers and clinicians worked together to use the action cycle of the Knowledge to Action Framework to increase use of knowledge translation itself within the department in general, within their clinical teams, and to facilitate knowledge translation becoming part of the department's culture. Barriers and enablers to using knowledge translation were identified through a survey based on the Theoretical Domains Framework and through focus groups. Multiple interventions were used to develop a knowledge translation capacity-building program.Fifty-two occupational therapists participated initially, but only 20 across the first 18\ua0months of the project. Barriers and enablers were identified across all domains of the Theoretical Domains Framework. Interventions selected to address these barriers or facilitate enablers were categorised into ten different categories: educational outreach; teams working on clinical knowledge translation case studies; identifying time blocks for knowledge translation; mentoring; leadership strategies; communication strategies; documentation and resources to support knowledge translation; funding a knowledge translation champion one day per week; setting goals for knowledge translation; and knowledge translation reporting strategies. Use of these strategies was, and continues to be monitored. Participants continue to be actively involved in learning and shaping the knowledge translation program across the department and within their specific clinical areas.To build capacity for knowledge translation, it is important to involve clinicians. The action cycle of the Knowledge to Action framework is a useful guide to introduce the knowledge translation process to clinicians. It may be used to engage the department as a whole, and facilitate the learning and application of knowledge translation within specific clinical areas. Research evaluating this knowledge translation program is being conducted