Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study

Background and purposeThe effects of therapy and patient characteristics on rehabilitation outcomes in patients with acute stroke are unclear. We investigated the effects of intensive occupational therapy (OT) on patients with acute stroke.MethodsWe performed a retrospective cohort study using the 2005–2016 Japan Rehabilitation Database, from which we identified patients with stroke (n = 10,270) who were admitted to acute care hospitals (n = 37). We defined active OT (AOT) and non-AOT as OT intervention times (total intervention time/length of hospital stay) longer or shorter than the daily physical therapy intervention time, respectively. The outcomes assessed were the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS) scores, duration of hospitalization, and rate of discharge. Propensity scores and inverse probability of treatment weighting analyses adjusted for patient characteristics were performed to investigate the effects of AOT on patient outcomes.ResultsWe enrolled 3,501 patients (1,938 and 1,563 patients in the AOT and non-AOT groups, respectively) in the study. After inverse probability of treatment weighting, the AOT group had a shorter length of hospitalization (95% confidence interval: −3.7, −1.3, p < 0.001), and the FIM (95% confidence interval: 2.0, 5.7, p < 0.001) and NIHSS (95% confidence interval; 0.3, 1.1, p < 0.001) scores improved significantly. Subgroup analysis showed that lower NHISS scores for aphasia, gaze, and neglect and lower overall NIHSS and FIM scores on admission led to a greater increase in FIM scores in the AOT group.ConclusionsAOT improved the limitations in performing activities of daily living (ADL) and physical function in patients with acute stroke and reduced the length of hospitalization. Additionally, subgroup analysis suggested that the increase in FIM score was greater in patients with severe limitations in performing ADLs and worse cognitive impairment, such as neglect, on admission

Musculoskeletal Disorders, Pain and Fatigue among String and Wind Music Students

Music students are more likely to get Musculoskeletal Disorders (MSDs), fatigue, and pain. However, limited studies compared MSDs, pain and fatigue between different types of musical instrument players. This study compared MSDs, pain, and fatigue among music students who play wind and string instruments. A cross-sectional study was conducted with a group of music students in one of the universities in Malaysia. No statistical differences in pain and fatigue were found, but more wind players experience MSD at the wrist and hand than string players. Therefore, students who play string instruments should be more watchful with MSD symptoms. Keywords: Musical instruments, pain, fatigue, musculoskeletal disorder eISSN: 2398-4287 © 2022. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v7i20.345

A three-talk model for shared decision making: multistage consultation process

© 2017 The Authors. Published by BMJ. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1136/bmj.j4891Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences

Longitudinal Process of Setting and Achieving Activity- and Participation-Level Goals in Home Rehabilitation in Japan: A Qualitative Study Using Trajectory Equifinality Modeling

This study aimed to clarify the longitudinal goal negotiation and collaboration process of achieving activity- and participation-level goals. We conducted a qualitative study using the trajectory equifinality model. Nine occupational therapists with experience in setting and achieving activity- and participation-level goals were recruited and interviewed about their clients. We identified two phases and four pathways in the setting and attainment process for activity- and participation-level goals. Throughout the longitudinal goal-setting process, when the occupational therapist and client had difficulty discussing activity- and participation-level goals, the therapist respected the client’s expectations, explained the purpose of occupational therapy in detail, and conducted individual face-to-face interviews. When it was difficult to provide work-based interventions, the occupational therapist made flexible use of functional training, elemental movement training, occupation-based practice, and environmental modifications. The results of this study may assist in supporting clients to improve their activity and participation in home rehabilitation

Use of technology in supporting goal setting in rehabilitation for adults: a scoping review

Objective To map the extant literature evaluating the use of technology for goal setting in adult rehabilitation and the impact of technology for patient outcomes.Design Scoping review.Methods MEDLINE (via Ovid), CINAHL (via EBSCO), AMED and Scopus were searched for articles describing observational or interventional studies. ProQuest Dissertations and Theses database were searched for grey literature. Two review authors independently screened all titles and abstracts for potentially relevant articles. We included articles describing studies that had evaluated the development or application of technology to facilitate goal setting in rehabilitation for adults. Articles were excluded if the technology described did not include features to facilitate goal setting or were not in English. Narrative reviews, opinion pieces and editorials were also excluded.Results After screening 1640 publications of potential interest, we identified 27 studies for inclusion. These 27 articles described studies involving a total of 16 different technologies including, seven mobile apps, three websites, two mobile apps/website hybrids, two apps and two websites connected to a pedometer. We found that most technologies described were designed to facilitate self-management with goal setting as a feature and that only five included a shared decision moment around goal setting. Only six of the 16 technologies had research providing evidence of effectiveness in terms of improved patient outcomes, with the best evidence of beneficial effects associated with technologies that linked goal setting to pedometer use.Conclusions The identified technologies for use in adult rehabilitation that included goal setting as a feature were largely accepted and valued by patients and health professionals. The limited data suggest that there is a need for further research; specific foci may include the impact of incorporation of a shared decision-making moment and evaluation of effectiveness on patient outcomes