Stroke rehabilitation. A mixed method study evaluating a novel physiotherapy intervention and patients’ experiences

In this thesis, the possible benefits and challenges regarding taking part in a comprehensive individualized physiotherapy intervention, called I-CoreDIST and usual care physiotherapy following an acute stroke, along with patient perceptions of participation along the rehabilitation continuum are addressed. This is a mixed method study consisting of a randomised controlled trial (RCT) and an in-depth interview study. Sixty participants with acute strokes were recruited for the RCT and randomised into receiving I-CoreDIST or usual care physiotherapy for 12 weeks in equal doses. Assessments of postural control, levels of physical activity, balance gait and health related quality of life were undertaken at baseline and at 12 weeks post inclusion. Between- and within-group effects were calculated. From the full sample, 19 participants were purposely selected for interviews. The interviews were transcribed and analysed using systematic text condensation. The findings from the quantitative and qualitative analysis were integrated through extracting the main findings and identifying common themes, divergences, and inconsistencies. In doing so we aimed to highlight aspects related to the overall aim of the study that either study could not have alone. The analysis was informed by the International Classification of Functioning, Disability and Health framework and enactive theory. There were no differences between groups in term of effect of I-CoreDIST or usual care physiotherapy except for significant gains in health-related quality of life in the usual care group. The integrated findings show improvements in postural control, balance and gait that align with experiences of becoming able, indicating that partaking in 12 weeks of intensive physiotherapy was beneficial regardless of group allocation. Variations in organisational structures and cultures shape opportunities for active patient participation in post-stroke rehabilitation. Meaning and motivation is connected to experiencing bodily changes and tailored treatment. Sustained inactivity despite functional improvements is a challenge in long-term care

Barneansvarlige i psykisk helsevern - barnas stemme?

Masteroppgave i praktisk kunnskap - Nord universitet, 201

Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial

Background: Research on stroke rehabilitation often addresses common difficulties such as gait, balance or physical activity separately, a fragmentation contrasting the complexity in clinical practice. Interventions aiming for recovery are needed. The purpose of this study was to investigate effects of a comprehensive low-cost physical therapy intervention, ICoreDIST, vs. usual care on postural control, balance, physical activity, gait and health related quality of life during the first 12 weeks post-stroke. Methods: This prospective, assessor-masked randomized controlled trial included 60 participants from two stroke units in Norway. Participants, who were randomized to I-CoreDIST (n = 29) or usual care physical therapy (n = 31), received 5 sessions/week when in-patients or 3 sessions/week as out-patients. Primary outcomes were the Trunk Impairment Scale-modified Norwegian version (TISmodNV) and activity monitoring (ActiGraphsWgt3X-BT). Secondary outcomes were the Postural Assessment Scale for Stroke, MiniBesTEST, 10- meter walk test, 2-minute walk test, force-platform measurements and EQ5D3L. Stroke specific quality of life scale was administered at 12 weeks. Linear regression and non-parametric tests were used for statistical analysis. Results: Five participants were excluded and seven lost to follow-up, leaving 48 participants in the intention-to-treat analysis. There were no significant between-group effects for primary outcomes: TIS-modNV (p = 0,857); daily average minutes of sedative (p = 0.662), light (p = 0.544) or moderate activity (p = 0.239) and steps (p = 0.288), or secondary outcomes at 12 weeks except for significant improvements on EQ5D-3L in the usual care group. Withingroup changes were significant for all outcomes in both groups except for activity levels that were low, EQ5D-3L favoring the usual care group, and forceplatform data favoring the intervention group. Conclusions: Physical therapy treatment with I-CoreDIST improved postural control, balance, physical activity and gait during the first 12 weeks after a stroke but is not superior to usual care

The precarity of patient participation - a qualitative interview study of experiences from the acute stroke and rehabilitation journey

Introduction: Active patient participation is an important factor in optimizing post-stroke recovery, yet it is often low, regardless of stroke severity. The reasons behind this trend are unclear. Purpose: To explore how people who have suffered a stroke, perceive the transition from independence to dependence and whether their role in post-stroke rehabilitation influences active participation Methods: In-depth interviews with 17 people who have had a stroke. Data were analyzed using systematic text condensation informed by the concept of autonomy from enactive theory. Results: Two categories emerged. The first captures how the stroke and the resultant hospital admission produces a shift from being an autonomous subject to “an object on an assembly line.” Protocol-based investigations, inactivity, and a lack of patient involvement predominantly determine the hospital context. The second category illuminates how people who have survived a stroke passively adapt to the hospital system, a behavior that stands in contrast to the participatory enablement facilitated by community. Patients feel more prepared for the transition home after inpatient rehabilitation rather than following direct discharge from hospital. Conclusion: Bodily changes, the traditional patient role, and the hospital context collectively exacerbate a reduction of individual autonomy. Thus, an interactive partnership between people who survived a stroke and multidisciplinary professionals may strengthen autonomy and promote participation after a stroke

Embodiment, tailoring, and trust are important for co-construction of meaning in physiotherapy after stroke: A qualitative study.

Background and Purpose: Physiotherapy, with an emphasis on high intensity, individually tailored, and person-centered treatment, is an effective route for recovery after a stroke. No single approach, however, has been deemed paramount, and there is limited knowledge about the patient experience of assessment, goal-setting, and treatment in physiotherapy. In this study, we seek to report patient experiences of I-CoreDIST-a new physiotherapy intervention that targets recovery-and those of usual care. The purpose is to investigate how individuals with stroke experience the bodily and interactive course of physiotherapy during their recovery process. Methods: A qualitative study, nested within a randomized controlled trial, consisting of in-depth interviews with 19 stroke survivors who received either I-CoreDIST or usual care. Data were analyzed using systematic text condensation, and this analysis was informed by enactive theory. Results: Interaction with the physiotherapist, which was guided by perceived bodily changes, fluctuated between being, on the one hand, formal/explicit and, on the other, tacit/implicit. The experiences of participants in the intervention group and the usual care group differed predominantly with regards to the content of therapy sessions and the means of measuring progress; divergences in levels of satisfaction with the treatment were less pronounced. The perception of positive bodily changes, as well as the tailoring of difficulty and intensity, were common and essential features in generating meaning and motivation. An embodied approach seemed to facilitate sense-making in therapy situations. In the interaction between the participants and their physiotherapists, trust and engagement were important but also multifaceted, involving both interpersonal skills and professional expertise. Conclusion: The embodied nature of physiotherapy practice is a source for sense-making and meaning-construction for patients after a stroke. Trust in the physiotherapist, along with emotional support, is considered essential. Experiencing progress and individualizing approaches are decisive motivators.The study was funded by the Northern Norway Regional Health Authority

Utprøving av intervensjon for optimalisering av funksjon, fysisk aktivitet og arbeidsdeltakelse ved multippel sklerose

publishedVersio

The effect of exercise and physical activity-interventions on step count and intensity level in individuals with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials

BackgroundReduced physical activity is a worldwide challenge in individuals with multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to identify devise-measured effects of physical activity, exercise and physiotherapy-interventions on step count and intensity level of physical activity in individuals with MS.MethodsA systematic search of the databases of PubMed (including Medline), Scopus, CINHAL and Web of Science was carried out to retrieve studies published in the English language from the inception to the first of May 2023. All trials concerning the effectiveness of different types of exercise on step count and intensity level in people with MS were included. The quality of the included studies and their risk of bias were critically appraised using The modified consolidated standards of reporting trials and the Cochrane Risk of Bias tool, respectively. The pooled standardized mean difference (SMD) and 95% CI of the step-count outcome and moderate to vigorous intensity level before versus after treatment were estimated in both Intervention and Control groups using the random effect model. The Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results.ResultsA total of 8 randomized clinical trials (involving 919 individuals with MS) were included. The participants (including 715 (77.8%) female and 204 (22.2%) male) had been randomly assigned to the Intervention (n = 493) or Control group (n = 426). The pooled mean (95% CI) age and BMI of participants were 49.4 years (95% CI: 47.4, 51.4 years) and 27.7 kg/m2 (95% CI: 26.4, 29 kg/m2), respectively. In terms of the comparison within the Intervention and the Control groups before and after the intervention, the results of the meta-analysis indicate that the pooled standardized mean difference (SMD) for step-count in the Intervention group was 0.56 (95% CI: -0.42, 1.54), while in the Control group it was 0.12 (95% CI: -0.05, 0.28). Furthermore, there was no significant difference in the pooled SMD of step-count in the physical activity Intervention group compared to the Controls after the intervention (pooled standard mean difference = 0.19, 95% CI: -0.36,0.74). Subgroup analysis on moderate to vigorous intensity level of physical activity revealed no significant effect of the physical activity intervention in the Intervention group compared to the Control group after the intervention, or within groups before and after the intervention. Results of meta regression showed that age, BMI, duration of disease and Expanded Disability Status Scale (EDSS) score were not the potential sources of heterogeneity (all p > 0.05). Data on the potential harms of the interventions were limited.ConclusionThe results of this meta-analysis showed no significant differences in step count and moderate to vigorous physical activity level among individuals with MS, both within and between groups receiving physical activity interventions. More studies that objectively measure physical activity are needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD4202234362

Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders 1 . They are heritable 2,3 and etiologically related 4,5 behaviors that have been resistant to gene discovery efforts 6–11 . In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures

Å bli tatt av orkanen : en kvalitativ studie om opplevd hverdagsliv etter en traumatisk hodeskade

Traumatisk hodeskade er den ledende årsaken til langvarig funksjonshemninger hos unge voksne i dag. Skadene er ofte spredt og av diffus art, noe som gjør pasienter med traumatisk hodeskade til en svært heterogen gruppe. I denne studien har jeg har belyst hvordan hverdagslivet oppleves minimum ett år etter en traumatisk hodeskade. Dette i den hensikt å skape en bedre forståelse for de utfordringer disse menneskene møter i sin hverdag. Studien har en overordnet fenomenologisk forståelsesramme. Tre personer som har vært igjennom alvorlige hodeskader ble intervjuet. Med kropp, selv og hverdagsliv som analytiske begreper viser studien hvordan en traumatisk hodeskade forårsaker kroppslige endringer som på et grunnleggende plan endrer forutsetningene for hverdagslivet, forståelsen av selvet og relasjonene med andre mennesker. Rehabiliteringsprosessen er individuell og tidkrevende. Deltakerne trenger tid, rom og støtte til å utforske sine muligheter, til å finne sine nye selv og bygge opp et hverdagsliv som kjennes akseptabelt. De legger stor vekt i å komme seg tilbake til skole eller arbeidsliv. Ved å grundig utforske målsetninger og interesser sammen med sine klienter kan man som helsearbeidere finne relevante tiltak som gir mening for klienten og som dermed kan bidra positivt inn mot identitetsarbeidet og re-integrering i samfunnet