Cost-effectiveness of physical fitness training for stroke survivors

Background Physical fitness is impaired after stroke, yet fitness training after stroke reduces disability. Several international guidelines recommend that fitness training be incorporated as part of stroke rehabilitation. However, information about cost-effectiveness is limited. Methods A decision tree model was used to estimate the cost-effectiveness of a fitness programme for stroke survivors vs. relaxation (control group). This was based on a published randomised controlled trial, from which evidence about quality of life was used to estimate Quality Adjusted Life Years. Costs were based on the cost of the provision of group fitness classes within local community centres and a cost per Quality Adjusted Life Year was calculated. Results The results of the base case analysis found an incremental cost per Quality Adjusted Life Year of £2,343. Conclusions Physical fitness sessions after stroke are a cost-effective intervention for stroke survivors. This information will help make the case for the development of new services

Objective identification of upper limb tremor in multiple sclerosis using a wrist-worn motion sensor: establishing validity and reliability

Introduction Over 25% of people with multiple sclerosis experience tremor, which may impact on activities of daily living and quality of life. Yet there is no method to objectively measure tremor and effectiveness of interventions on tremor. This study aimed to test validity and reliability of a new objective measurement for upper limb tremor in people with multiple sclerosis. Method Twelve participants with multiple sclerosis who self-reported tremor were observed performing standardised tasks. Validity and reliability of a new method to detect tremor from wrist movement was established against occupational therapist observation of tremor (FAHN). Concurrent validity of severity (displacement) of tremor was assessed. Responsiveness to change in tremor characteristics was explored in a sub-set of participants using weighted wrist-cuffs. Results The new method correctly predicted 98.2% of tremor cases identified by the occupational therapist, with high sensitivity (0.988) and specificity (0.976). Calculated displacement of tremor correlated with FAHN tremor severity scores moderately (rs = .452, p = .004). The new measure was responsive to changes in tremor characteristics due to change in weight of wrist-cuffs. Conclusion The new method of characterising tremor in those with multiple sclerosis demonstrated excellent validity and reliability in relation to tremor identified by an occupational therapist, and could provide valuable objective insight into the efficacy of interventions. </jats:sec

Simultaneous bilaternal training for improving arm function after stroke

Background Simultaneous bilateral training, the completion of identical activities with both arms simultaneously, is one intervention to improve arm function and reduce impairment. Objectives To determine the effects of simultaneous bilateral training for improving arm function after stroke. Search strategy We searched the Cochrane Stroke Trials Register (last searched August 2009) and 10 electronic bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2009), MEDLINE, EMBASE, CINAHL and AMED (August 2009). We also searched reference lists and trials registers. Selection criteria Randomised trials in adults after stroke, where the intervention was simultaneous bilateral training compared to placebo or no intervention, usual care or other upper limb (arm) interventions. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended activities of daily living and motor impairment of the arm. Data collection and analysis Two authors independently screened abstracts, extracted data and appraised trials. Assessment of methodological quality was undertaken for allocation concealment, blinding of outcome assessor, intention-to-treat, baseline similarity and loss to follow up. Main results We included 18 studies involving 549 relevant participants, of which 14 (421 participants) were included in the analysis (one within both comparisons). Four of the 14 studies compared the effects of bilateral training with usual care. Primary outcomes: results were not statistically significant for performance in ADL (standardised mean difference (SMD) 0.25, 95% confidence interval (CI) -0.14 to 0.63); functional movement of the arm (SMD -0.07, 95% CI -0.42 to 0.28) or hand (SMD -0.04, 95% CI -0.50 to 0.42). Secondary outcomes: no statistically significant results. Eleven of the 14 studies compared the effects of bilateral training with other specific upper limb (arm) interventions. Primary outcomes: no statistically significant results for performance of ADL (SMD -0.25, 95% CI -0.57 to 0.08); functional movement of the arm (SMD -0.20, 95% CI -0.49 to 0.09) or hand (SMD -0.21, 95% CI -0.51 to 0.09). Secondary outcomes: one study reported a statistically significant result in favour of another upper limb intervention for performance in extended ADL. No statistically significant differences were found for motor impairment outcomes. Authors' conclusions There is insufficient good quality evidence to make recommendations about the relative effect of simultaneous bilateral training compared to placebo, no intervention or usual care. We identified evidence that suggests that bilateral training may be no more (or less) effective than usual care or other upper limb interventions for performance in ADL, functional movement of the upper limb or motor impairment outcome

How to increase public support for policy: understanding citizens’ perspectives

Policy-makers, we presume, want to solve social problems. Therefore, they select policy measures. In practice, these measures tend to trigger different reactions in society. How might a government avoid bad reactions, such as the tuition fees protests and ‘bedroom tax’ campaigns? Peter van Wijck and Bert Niemeijer present a framework which looks to align the perspectives of policymakers and citizens