Does feedback on daily activity level from a Smart watch during in-patient stroke rehabilitation increase physical activity levels? Study protocol for a randomized controlled trial

Background. Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activities in hospital inpatients. This study’s goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels during inpatient stroke rehabilitation and the short-term effects on simple functional activities, primarily mobility. Methods/design. A randomized controlled trial will be undertaken within the stroke rehabilitation wards of the 2nd affiliated hospital of Anhui University of Traditional Chinese Medicine, Hefei, China. The study participants will be stroke survivors who meet inclusion criteria for the study, primarily: able to participate, no more than four months after stroke, and walking independently before stroke. Participants will all receive standard local rehabilitation and will be randomly assigned either to receive regular feedback about activity levels, relative to a daily goal tailored by the smart watch over five time periods throughout a working day, or to no feedback, but still wearing the Smart watch. The intervention will last up to three weeks, ending sooner if discharged. The data to be collected in all participants includes measures of: daily activity (Smart watch measure); mobility (Rivermead Mobility Index and ten metre walking time); independence in personal care (the Barthel ADL index); overall activities (the WHO Disability Assessment Scale, 12-item version); and quality of life (the Euro-Qol 5L5D). Data will be collected by masked assessors at baseline, three weeks or at discharge (whichever is the sooner); and a reduced data set at 12 weeks by telephone interview. The primary outcome will be change in daily accelerometer activity scores. Secondary outcomes are compliance and adherence to wearing the watch, and changes in mobility, independence in personal care activities, and health-related quality of life. Discussion. This project is being implemented in a large city hospital with limited resources and limited research experience. There has been a pilot feasibility study using the Smart Watch, which highlighted some areas needing change and these are incorporated in this protocol

Can practice undertaken by patients be increased simply through implementing agreed national guidelines?' An observational study

Objective: To increase autonomous practice time of patients on the stroke unit of a nursing home. Intervention: Nurses stimulated and coached patients with the help of four interventions (muscle strengthening, sitting balance and reach, getting up from a chair, walking) from the evidence-based Clinical Nursing Rehabilitation Stroke Guidelines. Design: An observational study. Practice time of elderly stroke patients in this study was compared with the time observed in our previous study in the same setting. Setting: Rehabilitation units of a nursing home in the Netherlands. Subjects: Seventeen frail stroke patients, including 8 men, 9 women, with a mean age of 75.8 (SD ± 9) and 17 subjects with the same characteristics who participated in a previous observational study. Main measures: Time spent on therapeutic activities was measured using the Behavioral Mapping method. Results: The time spent on therapeutic activities increased significantly from 103.5 minutes measured in our previous study to 156.5 minutes in this study (Z = 2.86; P < 0.005; d' = 1.09) The mean Barthel Index score was 8.8 (SD ± 4.1). The patients with more possibilities were more active, resulting in a significant positive Barthel Indextherapy time relationship (r = 0.73, P ≤ 0.001). Conclusions: The autonomous practice time of older fragile comorbid stroke patients increased during the weekdays. Patients, stimulated and challenged by nurses, exercise harder and more according to their possibilities. Since this guideline was developed especially for nurses, nurses can stimulate stroke patients to contribute more to autonomous practice and therefore help their recovery. © The Author(s) 2012

Evalueren van zorg is niet zo eenvoudig.

Achtergrond: Om inzicht te krijgen in de ervaringen met betrekking tot de verslaglegging met het Omaha System is bij een wijkzorgorganisatie een kwalitatief, praktijkgericht onderzoek uitgevoerd. Bevindingen: Een groot deel van de verpleegkundigen en verzorgenden die hebben meegedaan aan het onderzoek geeft aan een kennistekort te ervaren en daardoor moeite te hebben met de verslaglegging van de evaluatie. Een belangrijk voordeel dat enkele geïnterviewden ervaren is dat zij door gebruik van het Omaha System een vollediger beeld hebben van de cliënten. Als nadeel wordt genoemd dat geïnterviewden nieuwe informatie die volgt uit een evaluatiegesprek zelf niet bij het assessmentdeel kunnen vastleggen. Hierdoor wordt het cyclische aspect van het verpleegkundig proces verstoord

How to analyze time and change in qualitative longitudinal materials? : Insights from a literature review of longitudinal qualitative studies in nursing.

Background Longitudinal qualitative research can give new insights in social processes and experiences over time. In recent years, there has been a growing interest in conducting longitudinal qualitative research within nursing. However, the definition of what constitutes longitudinal qualitative research is unclear, the methodological literature scarce, and the variation of procedures great. This review of longitudinal qualitative articles within the nursing field aims to identify and describe various types of qualitative longitudinal approaches. Materials and Method Searches in pubmed identified over a hundred qualitative nursing articles with data collection over time. These articles were analyzed regarding 1) described analysis procedure, 2) how the results related to aspects of time and change, and 3) if results were person oriented vs category oriented. Results Five different types of longitudinal qualitative approaches were identified. In total, a large part of the papers described as having a longitudinal design performed a data collection over time, but did not integrate ideas of time or change in their analysis or results. Four fruitful approaches to analyzing longitudinal qualitative data were identified; time-line, pool, phase and pattern-oriented approaches. Articles classified as using any of these approaches have a clear perspective of time or change in the results. However, depending on type of approach different aspects of time, change, and process are in focus. Further, using different approaches yielded different kinds of results. Conclusion All approaches have pros and cons and researchers need to make informed decisions when choosing which approach they will take when analyzing qualitative longitudinal material