An audit of dressing practice by occupational therapists in acute stroke settings in England

Introduction Dressing independence is commonly affected after stroke, with clinical guidelines recommending that dressing practice should routinely be provided for those with dressing difficulties. The aim of this study was to update the literature on current practice in the treatment of dressing problems in stroke rehabilitation units. Method A questionnaire survey of occupational therapists experienced in stroke care was sent to 157 stroke units in England. Results Responses were received from 70 stroke units. Frequency and duration of dressing practice varied substantially between units, with respondents typically providing dressing practice for six to 10 patients per week and spending 30 to 45 minutes per treatment session. Only 17 respondents (24.3%) stated that they regularly used standardised assessments of dressing ability. The functional approach was used more widely than the remedial approach. Service priorities, working environment and limitations of time and staffing were reported to influence dressing practice. Conclusion There is widespread variability in dressing practice. There is a lack of use of standardised dressing assessments, and therapists’ rationale for their choice of approach is unclear

Cognitive rehabilitation for memory deficits after stroke

Memory problems are common after a stroke, leading to difficulties in everyday life. Memory rehabilitation aims to help retrain lost functions or to teach patients strategies to compensate for them. Although some studies have reported positive outcomes after memory rehabilitation, reviews have provided inconclusive evidence for effectiveness. This is an update of a Cochrane review first published in 2000 and subsequently updated in 200

Virtually home: Exploring the potential of virtual reality to support patient discharge after stroke

Introduction: The level of assessment and intervention received by patients prior to discharge varies widely across stroke services in the United Kingdom. This study aimed to explore the potential value of virtual reality in preparing patients for discharge following stroke. Method: Semi-structured interviews were carried out with 13 occupational therapists, eight patients with a stroke and four community stroke survivors. Views were sought of the perceived acceptability, potential utility and limitations of a ‘virtual home’ environment for use in pre-discharge education and assessment. Data were analysed thematically. Findings: Interviewees found the virtual home to be an acceptable and visual means of facilitating discussions about discharge. It was perceived as valuable in assessing patient insight into safety risks and exploring the implications of installing assistive equipment at home. Limitations were identified relating to specific software issues and the use of virtual reality with patients with cognitive or perceptual impairments. Conclusion: The results demonstrate the potential utility of the virtual home within stroke rehabilitation. Patients and therapists engaged with the virtual home and, moreover, made practical suggestions for future development. Feasibility and pilot testing in a clinical setting is required to compare the use of the virtual home with traditional approaches of pre-discharge assessment.Stroke Association (ref: TSA SRTF 2013/01) and Nottingham Hospitals Charity and NUH Department of Research and Development – Pump Priming Awar

Systematic review of the epidemiology of non-collision injuries occurring to older people during use of public buses in high income countries

Each year more than 6,000 people are injured on public buses in the UK, approximately half of whom are aged 65 or over. This review synthesises the published literature on the epidemiology of non-collision injuries occurring in older people using public buses, to enable understanding of the size and nature of the problem of injuries, and to explore strategies for improving the safety of public transport for older people. We searched PubMed, Embase, CINAHL, Web of Science, and Transport International Research Documentation (TRID). Studies were included if they were cross-sectional, case-control or cohort studies. Pairs of reviewers independently screened studies for inclusion, assessed risk of bias, and extracted data. Ten studies were included in the review. Older people and women were found to be over-represented in non-collision injuries. Most injuries occurred during daytime hours and on weekdays. Injuries most commonly occurred whilst passengers were standing and either moving around the bus, boarding, or alighting, and whilst the bus was accelerating or decelerating. Bruising was the most common injury amongst emergency department attenders, although between 18% and 33% suffered more serious injuries such as fractures or dislocations. Many injuries to older public transport users are potentially preventable. Public transport needs to be safe and accessible, and to be perceived as such by older people to ensure independence in outdoor mobility

Virtually home: feasibility study and pilot randomised controlled trial of a virtual reality intervention to support patient discharge after stroke

Introduction: Virtual reality has the potential to assist occupational therapists in preparing patients for discharge by facilitating discussions and providing education about relevant practical issues and safety concerns. This study aimed to explore the feasibility of using a virtual reality intervention to support patient discharge after stroke and pilot its use. Method: Practical aspects of delivering a virtual reality intervention prior to discharge were explored by means of a non-randomised feasibility study and a subsequent pilot randomised controlled trial. Factors considered included eligibility, recruitment, intervention delivery, attrition and suitability of outcome measures. Outcome measures included standardised assessments of stroke severity, mobility, health-related quality of life, functional ability, satisfaction with services and concerns about falling. Results: Thirty-three participants were recruited in total: 17 to the feasibility study and 16 to the pilot trial. At 1-month follow-up, 14 participants (82%) were re-assessed in the feasibility study and 12 (75%) in the pilot trial. The main difficulties encountered related to recruitment, particularly regarding post-stroke cognitive impairments, the presence of mild deficits or illness. Conclusion: It was feasible to recruit and retain participants, deliver the intervention and collect outcome measures, despite slow recruitment rates. These findings could inform the design of a definitive trial

The Nottingham Fatigue After Stroke (NotFAST) Study: results from follow-up six months after stroke

Background: Post-stroke fatigue is common and disabling. Objectives: The aim of NotFAST was to examine factors associated with fatigue in stroke 3 survivors without depression, six months after stroke. Methods: Participants were recruited from four UK stroke units. Those with high levels of 5 depressive symptoms (score ≥7 on Brief Assessment Schedule Depression Cards) or aphasia were excluded. Follow-up assessment was conducted at six months after stroke. They were assessed on the Fatigue Severity Scale, Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Barthel Index, Beck Anxiety Index, Brief Assessment Schedule Depression Cards, Impact of Event Scale-Revised, and Sleep Hygiene Index. Results: Of the 371 participants recruited, 263 (71%) were contacted at six months after stroke and 213 (57%) returned questionnaires. Approximately half (n=109, 51%) reported fatigue at six months. Of those reporting fatigue initially (n=88), 61 (69%) continued to report fatigue. ‘De novo’ (new) fatigue was reported by 48 (38%) of those not fatigued initially. Lower Nottingham Extended Activities of Daily Living scores and higher Beck Anxiety Index scores were independently associated with fatigue at six months. Conclusions: Half the stroke survivors reported fatigue at six months post-stroke. Reduced independence in activities of daily living and higher anxiety levels were associated with the level of fatigue. Persistent and delayed onset fatigue may affect independence and participation in rehabilitation, and these findings should be used to inform the development of appropriate interventions

Return-to-work outcomes and usefulness of actual fit notes received by employers

Background: GPs can use the fit note to advise that a patient ‘may be fit’ or is ‘not fit’ for work. Previous employer-based research on the fit note is largely qualitative and based on general perceptions and past experience. Knowledge of the return-to-work outcomes and usefulness of actual fit notes is needed to strengthen the evidence-base and inform practice. Objective: To investigate the return-to-work outcomes of fit notes issued to employed patients, and their employers’ opinions as to the usefulness of each note. Methods: Participating organizations collecting fit notes were asked to rate the outcome and usefulness of each fit note via postal questionnaires. Quantitative data were analysed descriptively; qualitative data were analysed using thematic content analysis. Results: Five hundred and sixteen questionnaires were posted, with a 97% return rate (n = 498). More than 80% of employees (n = 44) returned to work after the expiry date of a ‘may be fit’ note compared with 43% (n = 167) of those issued with a ‘not fit’ note. Fit notes were considered more useful if they provided information on the condition and its effect on the employee’s ability to work, if they stated whether or not the employee needed reassessment and if clear advice regarding return-to-work had been provided. Conclusions: ‘May be fit’ notes are useful in helping employees return to work. However, this option is infrequently used, and the completion and content of many fit notes does not meet employers’ needs. These factors need to be urgently addressed if the fit note is to reach its full potential

The Nottingham Fatigue After Stroke (NotFAST) study: factors associated with severity of fatigue in stroke patients without depression

Objective: To identify factors associated with post-stroke fatigue in a sample of stroke survivors without depression.Design: Cross-sectional cohort study. Setting: Recruitment was from four stroke units in the UK.Subjects: Participants were assessed within four weeks of first stroke; those with high levels of depressive symptoms (score ≥7 Brief Assessment Schedule Depression Cards) were excluded.Main measures: Participants were assessed four to six weeks after stroke on the Fatigue Severity Subscale of the Fatigue Assessment Inventory, the Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Beck Anxiety Index, Sleep Hygiene Index, 6m walk test, and measures of cognitive ability.Results: Of the 371 participants recruited, 103 were excluded and 268 were assessed. Of the latter, the mean age was 67.7 years (SD 13.5) and 168 (63%) were men. The National Institutes of Health Stroke Scale mean score was 4.96 (SD 4.12). Post-stroke fatigue was reported by 115 (43%) of participants, with 71 (62%) reporting this to be a new symptom since their stroke. Multivariate analysis using the Fatigue Severity Scale as the outcome variable found pre-stroke fatigue, having a spouse/partner, lower Rivermead Mobility Index score, and higher scores on both the Brief Assessment Schedule Depression Cards and Beck Anxiety Index were independently associated with post-stroke fatigue, accounting for approximately 47% of the variance in Fatigue Severity Scale scores. Conclusions: Pre-stroke fatigue, lower mood, and poorer mobility were associated with post-stroke fatigue

The Nottingham Fatigue After Stroke (NotFAST) study: factors associated with severity of fatigue in stroke patients without depression

Objective: To identify factors associated with post-stroke fatigue in a sample of stroke survivors without depression. Design: Cross-sectional cohort study. Setting: Recruitment was from four stroke units in the UK. Subjects: Participants were assessed within four weeks of first stroke; those with high levels of depressive symptoms (score ≥7 Brief Assessment Schedule Depression Cards) were excluded. Main measures: Participants were assessed four to six weeks after stroke on the Fatigue Severity Subscale of the Fatigue Assessment Inventory, the Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Beck Anxiety Index, Sleep Hygiene Index, 6m walk test, and measures of cognitive ability. Results: Of the 371 participants recruited, 103 were excluded and 268 were assessed. Of the latter, the mean age was 67.7 years (SD 13.5) and 168 (63%) were men. The National Institutes of Health Stroke Scale mean score was 4.96 (SD 4.12). Post-stroke fatigue was reported by 115 (43%) of participants, with 71 (62%) reporting this to be a new symptom since their stroke. Multivariate analysis using the Fatigue Severity Scale as the outcome variable found pre-stroke fatigue, having a spouse/partner, lower Rivermead Mobility Index score, and higher scores on both the Brief Assessment Schedule Depression Cards and Beck Anxiety Index were independently associated with post-stroke fatigue, accounting for approximately 47% of the variance in Fatigue Severity Scale scores. Conclusions: Pre-stroke fatigue, lower mood, and poorer mobility were associated with post-stroke fatigue

RealTalk ‘Train the Trainer’ workshops: evaluation report

A report on workshops delivered in May and June 2021 for UK-based professionals working in the NHS, social care, independent hospices and higher education institutions.</p