Embodiment, altered perception and comfort after stroke

After stroke, changes to body perception are common. However, little is known about what these disturbed perceptions feel like to the stroke survivor. This programme of work used embodiment theory to explore stroke survivors’ experiences of altered body perception and whether these perceptions were uncomfortable from a biopsychosocial perspective. It explored whether participants indicated a need for clinical interventions and the feasibility of using assessment tools to collate information about the body. A range of methodologies were used. A scoping review of the literature identified 28 studies exploring first-person accounts of altered body perception. Stroke survivors described the body across conditions as strange and unfamiliar; reflecting a changed awareness and means of relating to the body. Concurrently, a phenomenological study was conducted. A purposive sample of 16 stroke survivors able to communicate verbally, at least six-months post-stroke and experiencing motor and sensory impairments, were selected. Semi-structured interviews were conducted and analysed using interpretative phenomenological analysis. Participants described uncomfortable altered perceptions. The body did not exist, was hindered by strange perceptions and uncontrollable. The body was isolated, but participants were hopeful for improvement. Altered perceptions were difficult to comprehend and describe. From this, a feasibility and acceptability study explored the use of three assessment tools to communicate the altered body. Ten participants experiencing including a proportion with communication problems, were purposively selected. Participants wanted to communicate the experience of altered body perception and discomfort to health professionals and their preferred visual tools to achieve this. Stroke causes a complex sense of physical and psychosocial disembodiment, which is uncomfortable and of concern to survivors. Embodiment research suggests these domains may interact with one another. Clinical recognition and support to communicate altered body perception and discomfort from a holistic perspective may elucidate the multimodal experience of altered perceptions and foster new approaches for rehabilitation

Exploring altered body perception and comfort after stroke: An interpretive phenomenological analysis

Background: After stroke, changes to body perception are common. However, little is known about what these disturbed perceptions feel like to the stroke survivor. This study took a phenomenological approach to explore experiences ofaltered body perception, whether these perceptions were uncomfortable, and whether participants indicated a need for clinical interventions.Method: A purposive sample of 16 stroke survivors were predominantly recruited from community support groups for stroke. All participants were at least six months post-stroke, experiencing motor and sensory impairments and able to communicate verbally. In-depth, semi-structured interviews were conducted in participants’ homes. Interviews were audio-recorded, transcribed verbatim, and analysed alongside reflexive notes using an interpretativephenomenological approach. Ethical approval was obtained from University of the West of England.Results/Findings: Four themes emerged. Participants described a body which did not exist; a body hindered by strange sensations and distorted perceptions; an uncontrollable body; and a body isolated from health professionals and clinical interventions. Participants expressed discomfort and feelings of conflict towards the body. They found their experiences difficult to understandand hard to describe.Discussion: Altered body perceptions left survivors feeling disembodied: their bodies perceived as strange, uncooperative, uncomfortable, and isolated from support. This is the first study to look at altered body perceptions in terms of patient comfort.Conclusion: These findings highlight the need for health professionals to recognize and support the communication of stroke survivors’ experiences of altered body perceptions and discomfort. Further research is needed to determine new ways to communicate about altered body perception and develop interventions to improve body comfort

Outcomes for children and young people affected by modern slavery: An analysis of Independent Child Trafficking Guardianship service support in England and Wales

This report summarises research commissioned through a UKRI funded Fellowship from the Modern Slavery and Human Rights Policy and Evidence Centre (Modern Slavery PEC) on ‘Support for children1 with lived experience of modern slavery’. It explores the benefits and limitations of the Barnardo’s delivered Independent Child Trafficking Guardianship (ICTG) service on children and young people’s outcomes, situates this amidst the nature of modern slavery affecting children in England and Wales and sets out what this might mean for policy and practice

‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke

An evaluation of Independent Child Trafficking Guardians – early adopter sites

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3This evaluation, conducted by the Home Office and the University of Bedfordshire has assessed the ICTG service in the three original early adopter sites (Greater Manchester, Hampshire, and Wales). The evaluation, conducted across a two-year period from February 2017 – January 2019, considers the original model for the ICTG service which provided one-to-one ICTG support for all children. The overall aim of the evaluation is to answer the question: What is the ‘added value’ of the ICTG service, and is this different for different groups of children and in different early adopter sites

Unusual past dry and wet rainy seasons over Southern Africa and South America from a climate perspective

Southern Africa and Southern South America have experienced recent extremes in dry and wet rainy seasons which have caused severe socio-economic damages. Selected past extreme events are here studied, to estimate how human activity has changed the risk of the occurrence of such events, by applying an event attribution approach (Stott et al., 2004)comprising global climate models of Coupled Model Intercomparison Project 5 (CMIP5). Our assessment shows that models' representation of mean precipitation variability over Southern South America is not adequate to make a robust attribution statement about seasonal rainfall extremes in this region. Over Southern Africa, we show that unusually dry austral summers as occurred during 2002/2003 have become more likely, whereas unusually wet austral summers like that of 1999/2000 have become less likely due to anthropogenic climate change. There is some tentative evidence that the risk of extreme high 5-day precipitation totals (as observed in 1999/2000) have increased in the region. These results are consistent with CMIP5 models projecting a general drying trend over SAF during December–January–February (DJF) but also an increase in atmospheric moisture availability to feed heavy rainfall events when they do occur. Bootstrapping the confidence intervals of the fraction of attributable risk has demonstrated estimates of attributable risk are very uncertain, if the events are very rare. The study highlights some of the challenges in making an event attribution study for precipitation using seasonal precipitation and extreme 5-day precipitation totals and considering natural drivers such as ENSO in coupled ocean–atmosphere models

First contact physiotherapy: An evaluation of clinical effectiveness and costs.

First Contact Physiotherapy Practitioners (FCPPs) are embedded within general practice, providing expert assessment, diagnosis and management plans for patients with musculoskeletal disorders (MSKDs), without the prior need for GP consultation. To determine the clinical effectiveness and costs of FCPP-led compared to GP-led models of care. Multiple site case study design. UK GP practices. General Practice sites were recruited representing three models: 1. GP-led care; 2. FCPPs who could not prescribe/inject (Standard (St)); 3. FCPPs who could prescribe/inject (Additional Qualifications (AQ)). Patient participants from each site completed clinical outcome data at baseline, 3 and 6 months. The primary outcome was the SF-36v.2 Physical Component Score (PCS). Healthcare usage was collected for 6 months. N=426 adults were recruited from 46 practices across the UK. Non-inferiority analysis showed no significant difference in physical function (SF36-PCS) across all three arms at 6 months (p=0.999). At 3 months a significant difference in numbers improving was seen between arms: 54.7% GP consultees; 72.4% FCPP-St, 66.4% FCPP-AQ; (p=0.037). No safety issues were identified. Following initial consultation, a greater proportion of patients received medication (including opioids) in the GP-led arm (44.7%) compared with FCPP-St (17.5%) and FCPP-AQ (22.8%); (p<0.001). NHS costs (initial consultation and over 6 months follow up) were significantly higher in the GP-led model (median £105.50) vs FCPP-St (£41) and FCPP-AQ (£44); (p<0.001). FCPP led models provide safe, clinically effective and cost-beneficial management for patients with MSKDs in general practice and reduced opioid use in this cohort. [Abstract copyright: Copyright © 2024, The Authors.

Cost-effectiveness of therapist-assisted internet-delivered psychological therapies for PTSD differing in trauma focus in England: an economic evaluation based on the STOP-PTSD trial

Background: Although there are effective psychological treatments for post-traumatic stress disorder (PTSD), they remain inaccessible for many people. Digitally enabled therapy is a way to overcome this problem; however, there is little evidence on which forms of these therapies are most cost effective in PTSD. We aimed to assess the cost-effectiveness of the STOP-PTSD trial, which evaluated two therapist-assisted, internet-delivered cognitive behavioural therapies: cognitive therapy for PTSD (iCT-PTSD) and a programme focusing on stress management (iStress-PTSD). Methods: In this health economic evaluation, we used data from the STOP-PTSD trial (n=217), a single-blind, randomised controlled trial, to compare iCT-PTSD and iStress-PTSD in terms of resource use and health outcomes. In the trial, participants (aged ≥18 years) who met DSM-5 criteria for PTSD were recruited from primary care therapy services in South East England. The interventions were delivered online with therapist support for the first 12 weeks, and three telephone calls over the next 3 months. Participants completed questionnaires on symptoms, wellbeing, quality of life, and resource use at baseline, 13 weeks, 26 weeks, and 39 weeks after randomisation. We used a cost-effectiveness analysis to assess cost per quality-adjusted life year (QALY) at 39 weeks post-randomisation, from the perspective of the English National Health Service (NHS) and personal social services and on the basis of intention-to-treat for complete cases. Treatment modules and the platform design were developed with extensive input from service users: service users also advised on the trial protocol and methods, including the health economic measures. This is a pre-planned analysis of the STOP-PTSD trial; the trial was registered prospectively on the ISRCTN Registry (ISRCTN16806208). Findings: NHS costs were similar across treatment groups, but clinical outcomes were superior for iCT-PTSD compared with iStress-PTSD. The incremental cost-effectiveness ratio for NHS costs and personal social services was estimated as £1921 per QALY. iCT-PTSD had an estimated 91·6% chance of being cost effective at the £20 000 per QALY threshold. From the societal perspective, iCT-PTSD was cost saving compared with iStress-PTSD. Interpretation: iCT-PTSD is a cost-effective form of therapist-assisted, internet-delivered psychological therapy relative to iStress-PTSD, and it could be considered for clinical implementation

Preference versus performance: Investigating the dissociation between objective measures and subjective ratings of usability for schematic metro maps and intuitive theories of design

Three experiments are reported in which objective measures and subjective ratings of schematic metro map usability were investigated. Experiment 1 used a within-subjects design to compare octolinear and curvilinear Paris Metro maps. This replicated and extended Roberts et al. (2013); the curvilinear map was associated with faster journey planning times, and yet preference between the two was unrelated to this measure. In Experiment 2, nine matched versions of the London Underground map were rated for usability and attractiveness, and a clear octolinear bias was displayed. It was also possible to identify individuals who held a simplicity theory of effective design, versus an octolinearity theory. Experiment 3 investigated the relationship between usability ratings and journey planning times for three Berlin network maps, all optimized for simplicity of line trajectories. No differences in times were found, and yet usability ratings after experience at using the maps differed significantly, in line with the findings for the London designs in Experiment 2. Overall, the dissociation between objective measures of performance and subjective ratings of usability is robust, and appears to reflect expectations and prejudices concerning effective design. The octolinearity as a gold standard conjecture for achieving optimum usability continues to be refuted