Outcome from total hip replacement : From standardised measures to patient-focused narrative-based assessment.

The dynamic construct of quality of life (QoL) and evidence of the response shift phenomenon in longitudinal studies can lead to biased and incomplete evaluation of change over time. This study examines the current approach to measurement of QoL, particularly the validity of measures routinely used in health care, using three different types of standardised measurements in association with narrative interviews of patients following total hip replacement: To explore the outcome from patients' perspectives by obtaining highly individualised data and encouraging them to identify domains of concern in their lives. To compare patients' expectations of outcome with their measured functional ability on the standardised measures. To establish whether there is a relationship between patients' expectations and characteristics and perceived QoL prior to surgery. To determine how well standardised generic measures fulfil patients' particular needs by comparing data obtained using them with individualised data.Narrative interviews were conducted with 25 participants, nine of whom participated in follow-up interviews. Different aspects of their lives, such as values, feelings, job, attitudes and relationships, were explored and analysed using content analysis and narrative analysis. The findings from content analysis were categorised into two major components, themes related to life dimensions and coping-related themes. Core concepts related to life dimensions were collated to develop an instrument representing participants' perspective of hip condition. Performance analysis of narrative showed that understanding of an experience relies on the structure of narrative rather than the content. Participants used different coping strategies not to get rid of pain and physical limitations but to alleviate the damaging effects of hip-related problems, supporting the notion of re-interpretation of life experiences through employing psychological mechanisms.The main recommendations are that (a) health outcomes should be evaluated through models of communication and (b) individualised, qualitative methods be used to generate further understanding of the impact of response shift on self-report measures

Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

© 2015 Nijenhuis et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. METHODS: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. RESULTS: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. CONCLUSIONS: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings. TRIAL REGISTRATION: This study has been registered at the Netherlands Trial Registry (NTR): NTR3669 .Peer reviewe

Stroke patients' utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation

Background Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Methods Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Results Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. Conclusions Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery

Outcome from total hip replacement : from standardised measures to patient-focused narrative-based assessment

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Novel spatial harmonic magnetrons and their potential applications

This paper provides an overview of our recent progresses in theory, design, simulation, and fabrication of novel metamaterial based spatial harmonic magnetrons. The approximate analysis which provides the guidelines for the design and predicts the important characteristics of these devices will be presented. This analysis shows that the metamaterial loaded SHMs can start generating power with very small cathode current densities which is very important for designing THz sources based on SHMs. A design example with the operation frequency of 43 GHz together with the PIC simulation and measurement results will be examined

Low-current cathode spatial harmonic magnetrons: analysis and realization based on metamaterial loaded slow wave structures

AbstractThis paper provides an overview of theory, design, simulation, and fabrication of novel spatial harmonic magnetrons (SHMs). An approximate analysis which provides the guidelines for the design and predicts the important characteristics of these devices will be presented. This analysis shows that the metamaterial loaded SHMs can start generating power with very small cathode current densities which is very important for designing THz sources based on SHMs. A design example with the operation frequency of 43 GHz together with the design procedure, PIC simulations, and measurement results will be examined

A qualitative exploration of a health trainer programme in two UK Primary Care Trusts

Aims: World Health Organization data illustrate a worldwide re-emergence of interest in the scope of lay health workers for extending services to ‘hard-to-reach’ community groups. In the UK, the health trainer model of service delivery represents one such innovative way of working, first described in the White Paper Choosing Health: Making Healthier Choices Easier and more recently in the Kings Fund report. The scheme was introduced into selected primary care settings in England from 2005 and rolled out nationally from 2007. The aim of this study was to examine the perceived value of the health trainer scheme. Methods: This paper describes qualitative data from two studies undertaken in 2007–2009, comprising in-depth consultations with key primary care stakeholders, health trainers and their clients in two primary care trusts in northern and central England. Data was collected via 12 semi-structured interviews with key stakeholders and service users and from 8 focus groups with a total of 33 trainee and qualified health trainers. Results: The UK health trainer approach was regarded as effective in contributing to the support of a broad spectrum of health and welfare issues across widely diverse communities in the two primary care trusts evaluated. Study data also indicated a wide-ranging impact of the health trainer service, extending not only to the lay health workers themselves, but also to their families, friends and colleagues. Conclusions: The health trainer service appears to be not only ‘fit for purpose’, but also to bring with it certain ‘added value’, which was not predicted by the two primary care service providers at the outset. A critical factor in this success appears to be the unique combination of time, the ‘person next door’ and a ‘one-to-one’ approach, which facilitated an innovative and highly productive connection between the health trainer and client. However, participants in this evaluation perceived that the current format and constituents of service performance data were significantly failing to credit the health trainer scheme with the full extent of this impact