Occupational advice for Patients undergoing Arthroplasty of the Lower limb: An intervention development and feasibility study (The OPAL Study)

Background Hip and knee replacements are regularly performed for patients who work. There is little evidence about these patients’ needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. Objective(s) To develop an occupational advice intervention to support early recovery to usual activities including work which is tailored to the requirements of patients undergoing hip and knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks Design An intervention mapping (IM) approach was used to develop the intervention. The research methods employed were: rapid evidence synthesis; qualitative interviews with patients and stakeholders; prospective cohort study; survey of clinical practice; modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the IM process. Setting Orthopaedic departments within NHS secondary care. Participants Patients in work, and intending to return to work following primary elective hip and knee replacement surgery; healthcare professionals and employers. Interventions Occupational advice intervention. Main outcome measures Development of an occupational advice intervention. Fidelity of the developed intervention when delivered in a clinical setting. Patient and clinician perspectives of the intervention. Preliminary assessments of intervention effectiveness and cost. Results A cohort study (154 patients), 110 stakeholder interviews, survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, personalized return to work plan and co-ordination from the healthcare team to support the delivery of 13 patient and 20 staff performance objectives (POs). To support delivery, a range of tools (e.g. occupational checklists, patient workbooks, employer information), roles (e.g. return-to-work coordinator) and training resources were created. Feasibility was assessed in 21 of the 26 patients recruited from 3 NHS trusts. Adherence with the defined performance objectives was 75% for patient POs and 74% for staff POs. The intervention was generally well received although the short timeframe available for implementation and concurrent research evaluation led to some confusion amongst patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. Limitations Implementation and uptake of the intervention was not standardized and was limited by the study timeframe. Evaluation of the intervention involved a small number of patients which limited the ability to assess it. Conclusions The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention Future work The intervention warrants a randomised controlled trial to assess its clinical and cost effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure adoption is sustained. Funding This project was funded by the NIHR Health Technology Assessment programme (project number 15/28/02) Trial Registrations International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982 International prospective register of systematic reviews (PROSPERO) Registration: CRD4201604523

بررسی تأثیر افزونی تحریک الکتریکی مستقیم جمجمه (TDCS) همراه با کاردرمانی معمول روی انعطاف‌پذیری کودکان مبتلا به اختلال طیف اوتیسم با کارکرد بالا در گروه سنی 12-7 ساله

Background and aim: The ability to rehabilitate people with autism is another aspect of occupational therapy that plays an important role in improving the quality of life of these people. Direct cranial electrical stimulation (TDCS) is used as a complementary therapy in patients. This study was performed to investigate the increased effect of TDCS of the skull combined with routine occupational therapy on the flexibility of children with high-functioning autism spectrum disorder (7-12 years). Methods: The type of research was a double-blind randomized pre/post-test clinical trial. The sample consisted of 20 boys with high-functioning autism spectrum disorder. Subjects were randomly divided into two groups of 10 intervention and control. The intervention group received 10 sessions of occupational therapy with 10 sessions of TDCS for three weeks and the control group received 10 sessions of occupational therapy and 10 sessions of TDCS as sham. In this study, flexibility variables were measured and compared with the Wisconsin Manual Cards Test. Paired t-test, analysis of covariance (ANOVA) was used to compare the studied variables. Results: The results showed that the mean and standard deviation of the studied variables in the intervention group were not significantly different from the control group. However, the above intervention was significantly effective in improving flexibility (P<0.001) in the intervention group. Conclusion: Direct electrical stimulation of the skull with routine occupational therapy on the executive functions of children with high-functioning autism spectrum disorder is not significantly different from conventional occupational therapy.سابقه و هدف: توان‌بخشی افراد مبتلا به طیف اوتیسم یکی از جبهه‌های کاردرمانی است که امروزه نقش مهمی در بهبود کیفیت زندگی این افراد دارد. تحریک الکتریکی مستقیم جمجمه (TDCS) به عنوان روش درمانی مکمل در برخی از بیماران استفاده می‌شود. این پژوهش به منظور بررسی تأثیر فزونی تحریک الکتریکی مستقیم جمجمه همراه با کاردرمانی معمول بر روی انعطاف‌پذیری کودکان مبتلا به اختلال طیف اوتیسم با کارکرد بالا در گروه سنی 12-7 ساله انجام شد. روش کار: نوع پژوهش از نوع کار آزمایی بالینی تصادفی دوسوکور پیش آزمون/ پس آزمون بود. نمونه پژوهش شامل 20 کودک پسر با اختلال طیف اوتیسم با عملکرد بالا بودند. افراد به‌طور تصادفی در دو گروه 10 نفری مداخله و کنترل تقسیم‌بندی شدند. گروه مداخله 10 جلسه کاردرمانی به همراه 10 جلسه TDCS طی مدت سه هفته و گروه کنترل 10 جلسه کاردرمانی و 10 جلسه TDCS به صورت شم طی همان مدت سه هفته دریافت کردند. در این مطالعه متغیر انعطاف‌پذیری که یکی از آیتم‌های کارکردهای اجرایی محسوب می‌شود با آزمون کارت‌های دستی ویسکانسین اندازه‌گیری و مقایسه شدند. به‌ منظور مقایسه متغیرهای مورد مطالعه از آزمون t زوجی، تحلیل کوواریانس (ANOVA) استفاده شد. یافته­‌ها: نتایج تحلیل کوواریانس نشان داد میانگین و انحراف معیار متغیرهای مورد مطالعه در گروه مداخله تفاوت معناداری نسبت به گروه کنترل نداشته است، اما مداخله فوق بر بهبود انعطاف‌پذیری (P<0/001) در گروه مداخله مؤثر بوده است. نتیجه‌­گیری: تحریک الکتریکی مستقیم جمجمه همراه با کاردرمانی معمول بر روی کارکردهای اجرایی کودکان مبتلا به اختلال طیف اوتیسم با کارکرد بالا تفاوت معناداری نسبت به کاردرمانی معمول ندارد

The effect of a Biofeedback Training Course and Transcranial Direct Current Stimulation (tDCS) on Balance, Proprioception‎, and Performance of Athletes 18 to 30 Years Old

Introduction: Balance is one of the basic required components for daily life activities, which is as one of the functional independent indicators. Proprioception plays a key role in maintaining balance and optimally doing exercise skills and preventing injury. In this research, the effect of biofeedback and TDCS was compared along with the promotion of balance, proprioception, and performance. Method: In the present experimental study, 36 athletes were randomly divided into three groups of biofeedback (12), TDCS (12), and control (12). Balance assessment was performed by force-plate, proprioception was done with digital photography, and the functional balance was determined by star testing before and after the intervention. Anova and T-stent pair tests were used at a significance level of 0.05 to analyze information. Results: The results show a significant difference in the absolute error rate of the reconstruction of the target angle following the biofeedback intervention at angles of 30° (P=0.01), 45° (P=0.03), and 90° P=0.002) as well as improving the balance in the biofeedback group after intervene in the anterior, external, external, posterior, posterior, and TDCS groups in the anterior, posterior, posterior, internal, and internal posterior directions. Conclusion: The findings showed that the use of biofeedback and TDCS along with proprioception exercises could be recommended to athletes to improve their proprioception and functional balance. Keywords: Electromyographic Biofeedback, Transcranial Direct Current Stimulation, proprioception, Balance, Functional Balanc

Effect of Gait Retraining on Balance, Activities of Daily Living, Quality of Life and Depression in Stroke Patients

Objectives: Stroke is one of the most common neurological disease and it is the main cause of physical and mental disability and staying in house. Gait difficulties have high incidence in patients with stroke. So the aim of this study was to investigate the effect of gait retraining on balance, activities of daily living, quality of life and depressionin stroke patients. Methods: This study was a clinical trial without control group. Sampling was performed by convenience sampling method and 18 patients participated. After recording demographic data, Berg Balance Scale, Barthel Index, SF36 questionnaire and Beck Depression Inventory-II used in pre-test and post-test to assess balance, activities of daily living, quality of life and depression, respectively .Data were analyzed using Pearson correlation coefficient and paired T-test. Results: The results showed statistically significant correlation in pre-test and difference between mean score of the all instruments before and after the intervention. Discussion: According to high prevalence of gait difficulties in stroke patients, it seems interventions in this area is necessary. Statistical results showed that the gait retraining intervention may have a positive effect on improving balance, activities of daily living, quality of life and depression of these patients. According to lack of information in this area, further research is needed