Biomedical subjects

E Diane Playford

Publications and source records attributed to E Diane Playford.

11 recordsLinked to original sources

PubMed2006

Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit.

OBJECTIVES: The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting. DESIGN: The study was an AB optimised balance block design with each block lasting 3 months, over an 18 month period. SETTING AND PARTICIPANTS: Patients (n = 201) were recruited from an inpatient neurological rehabilitation unit. INTERVENTIONS: Patients (n = 100) recruited in phase A were involved in "usual practice" goal setting. Patients (n = 101) recruited in phase B were involved in "increased participation" goal setting, which included a protocol to help them define and prioritise their own goals. MAIN OUTCOME MEASURES: Patients' perceptions of the relevance of goal setting and their autonomy within the process; the number, type and outcome of goals; and level of functional ability. RESULTS: Phase B patients ("increased participation") set fewer goals, of which significantly more were participation related. These patients perceived the goals to be more relevant, and expressed greater autonomy and satisfaction with goal setting. There were no differences in functional outcomes between the groups. CONCLUSION: This study has shown that patients prefer increased participation in the goal setting process over standard procedures, perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains. Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities. As such, our findings suggest patients would benefit from greater participation in this aspect of clinical decision making.

Clinical Protocols↗

PubMed2005

Factors influencing work retention for people with multiple sclerosis: cross-sectional studies using qualitative and quantitative methods.

OBJECTIVE: To identify factors that impact on the ability of patients with multiple sclerosis (MS) to remain in work in order to make recommendations for future clinical management. METHODS: Cross-sectional studies using qualitative (phase one) and quantitative (phase two) methods. In phase one, 62 patients were interviewed and completed an exploratory questionnaire regarding the impact of MS on employment. In phase two, 100 patients attending an MS outpatient clinic completed an impact on work questionnaire, the self-report Barthel index, and the General Health Questionnaire (GHQ-28). RESULTS: In phase one, 17 areas were identified as impacting on MS patients' ability to remain in work, either relating to MS or environment. In phase two, both MS related factors and environmental factors were reported to have a major impact on ability to work. Only 20% of patients had received any advice about work retention. Unemployed patients (N = 64) had greater disability than employed patients on the Barthel index (difference 5.1; p < 0.001), but similar psychological wellbeing on the GHQ-28. CONCLUSION: The issues that prevent people with MS from working tend to be disease-related, as well as work-related. Many patients are isolated, as they are unaware of sources of help. Effective management by healthcare professionals has a potentially important role in helping people with multiple sclerosis to remain employed.

Adolescent↗

PubMed2005

The impact of inpatient neurorehabilitation on psychological well-being on discharge and at 3 month follow-up.

INTRODUCTION: Neurological rehabilitation aims to improve quality of life of patients with acute and chronic neurological conditions. Much of the existing research focuses on the impact of rehabilitation on physical functioning, with less emphasis on emotional wellbeing. This study assessed changes in psychological functioning in patients on discharge from rehabilitation and three months after discharge. METHODS: Patients admitted over a six-month period to a neurological rehabilitation unit were recruited prospectively to this study. Psychological functioning was measured by the self-report General Health Questionnaire and the Hospital Anxiety and Depression Scale. In addition, physical functioning was measured by the Barthel index and Functional Independence Measure. RESULTS: Psychological functioning was found to be significantly improved with rehabilitation. However, after three months, patients' scores returned to pre-treatment values. Anxiety was consistently elevated on admission, discharge and follow-up. In contrast, physical functioning improved from admission to discharge and was maintained at follow-up assessment. CONCLUSION: Rehabilitation services need to focus more on psychological functioning after discharge and identify effective strategies to maintain wellbeing.

Activities of Daily Living↗

PubMed2005

Spatial working memory capacity in unilateral neglect.

It has been proposed recently that a deficit in keeping track of spatial locations may contribute to the severity of unilateral neglect in some right hemisphere stroke patients. However, performance on traditional spatial working memory (SWM) tasks (e.g. Corsi blocks) might be confounded by failure to encode leftward locations, rather than a true deficit of maintaining locations in SWM. Here we introduced new procedures for circumventing this to measure SWM capacity in neglect. In a first experiment, 20 right hemisphere stroke patients (10 with and 10 without neglect) were tested on a computerized vertical variant of the Corsi task. Sequences of spatial locations in a vertical column were displayed and participants had to tap out the remembered sequence on a touchscreen. Patients with left neglect were impaired on this vertical SWM task compared with all control groups. However, poor performance on this task (as for Corsi blocks) might involve impaired memory for stimulus sequence, or poor visuomotor control of manual responding, rather than reduced SWM capacity per se. A second experiment therefore employed a purer measure of vertical SWM. After the displayed sequence, a single location was now probed visually, with observers judging verbally (yes/no) if it had been in the preceding sequence. Hence order no longer mattered, and no spatial motor response was required. Again, the neglect group was impaired relative to all others, now with very little overlap between the performances of individual neglect patients versus individuals in control groups. Poor performance on the second task, which provides a purer measure of SWM capacity, correlated with severity of left neglect on cancellation tasks (but not on line bisection), consistent with recent proposals that SWM deficits can exacerbate left neglect on visual search tasks when present conjointly. Lesion anatomy indicated that neglect patients with a SWM deficit were most likely to have damage to parietal white matter, plus, in the second experiment, to the insula also. These findings demonstrate that an impairment in SWM capacity can contribute to the neglect syndrome in patients with stroke involving regions within the right parietal lobe and insula.

Adult↗

PubMed2005

A survey of goal-setting methods used in rehabilitation.

OBJECTIVES: This survey provides a description of the goal-setting methods that are currently being used in community and inpatient rehabilitation centers across the United Kingdom. Given current policy, emphasis was placed on finding out how much patient involvement in the goal-setting process exists, concentrating on how such involvement may be facilitated. DESIGN: A postal survey design was used to access a large sample size over a broad geographical area. The questionnaire was piloted at a British Society for Rehabilitation Medicine (BSRM) meeting; subsequently, some response categories were expanded. The questionnaire was approved by the BSRM Research and Clinical Standards committee. Questionnaires were coded to track responses from individuals. The received data were anonymized and analyzed using a statistics package for social science (SPSS) database. Subjects. Members of the BSRM were selected for this survey because this represents one of the most comprehensive listings of rehabilitation services in the United Kingdom. RESULTS: The survey had a 60% response rate. A problem-orientated approach to goal setting was most commonly reported, with rehabilitation teams defining, formulating, and evaluating the goals. Patients were supplied with limited information about goal setting during their rehabilitation admission, although 60% of respondents reported giving patients a copy of their goals. Thirty percent of respondents used goals as a measure of rehabilitation effectiveness. Standardized goal-setting measures were not commonly used. CONCLUSION: These data demonstrate that individual disciplines tend to discuss potential goals with their patients during treatment sessions and then formulate goals on the basis of the discussion. There is scope to develop and refine the approach to goal setting so the patients have more opportunities to engage in the goal-setting process.

Case Management↗

PubMed2004

Occupational therapy in multiple system atrophy: a pilot randomized controlled trial.

There is some evidence that rehabilitation therapies may be useful in progressive neurological conditions, but this usefulness has not been studied in multiple system atrophy (MSA) to date. The aim of this small pilot study was to identify the feasibility of a larger randomized controlled trial of occupational therapy and to report preliminary data on the impact of occupational therapy on disability, mood, and health-related quality of life in patients with MSA. Patient groups were comparable for age, gender distribution, type of MSA, and severity. The active occupational therapy intervention group experienced a significant reduction of Unified Parkinson's Disease Rating Scale (total score and Activities of Daily Living [ADL] section), and PDQ-39 scores (total scores and ADL subsection). An occupational therapy program may improve functional abilities in patients with mild to moderate MSA. A larger multicenter study is needed.

Activities of Daily Living↗

PubMed2004

Patient dissatisfaction: insights into the rehabilitation process.

Most patients admitted for inpatient rehabilitation find it beneficial even when there is little change in physical disability. The aim of this study was to determine the characteristics of patients who felt that they had not benefited from inpatient rehabilitation and to delineate the underlying reasons for this perception. From a database of 331 patients admitted to a neurological rehabilitation unit over a three-year period, we ascertained those with a low score (< 5) on a self-rated visual analogue scale (VAS) regarding their perception of the benefit of rehabilitation. We investigated their disability outcomes, aspects of the rehabilitation process through analysis of integrated care pathways, and from inspection of the multidisciplinary record identified specific adverse factors which might contribute to dissatisfaction. Low VAS scores were detected in 6% of patients (n = 19). These did not correlate with baseline demographic factors or disability levels, but were associated with unresolved external problems regarding community care and accommodation, and conflicts between patients and therapists. We conclude that from the patients' perspective, successful inpatient rehabilitation depends on adequate attention given to community-based issues and health care professionals recognising patients' needs. When these two conditions are not fulfilled, patients are more likely to express a lack of satisfaction with their rehabilitation.

Humans↗

PubMed2004

Rehabilitation of the cancer patient: experience in a neurological unit.

We performed a retrospective review of all patients admitted to a neurological rehabilitation unit over a 5-year period to identify the benefits and problems associated with inpatient rehabilitation of patients with a life-limiting illness. Twenty-one patients (14 men; mean age 54 years) with primary or nonprimary neurological malignancy resulting in disability were studied. For each patient the following data was extracted: gender, age, diagnosis, source of referral, mechanism of disability, prognosis at time of referral, length of inpatient stay, disability on admission and discharge, and the place of discharge. All patients made functional gains, and all but 2 were discharged home. One patient died and 4 required readmission to an acute unit because of worsening discomfort or debility within a month of discharge. Patients with life-limiting illness resulting in neurological disability can benefit from inpatient rehabilitation. Optimal management of such patients demands careful liaison with palliative care teams.

Adult↗

PubMed2003

Does neurorehabilitation have a role in relapsing-remitting multiple sclerosis?

Patients with relapsing-remitting multiple sclerosis (RR MS) often make incomplete recovery from disabling exacerbations, despite corticosteroid treatment. Inpatient rehabilitation has been shown to be valuable in progressive MS, but its role in RR MS is less clear. We evaluated the effect of rehabilitation in consecutive patients with RR MS admitted to a neurological rehabilitation unit. Outcome measures applied on admission and discharge included the Expanded Disability Status Scale (EDSS), the Barthel Index (BI) and the Functional Independence Measure (FIM), as well as a visual analogue scale (VAS) of the patients' perception of rehabilitation impact. Confounding factors including the timing of steroid therapy and re-admissions were also examined. RR patients showed considerable improvement following rehabilitation, with a median change of -0.5 on EDSS, +4 on BI and +12 on FIM (mean change of -0.8 EDSS, +4.5 BI and +15.6 FIM points; effect sizes of -1.01, 0.97 and 0.86, respectively), which was significantly greater than other MS subtypes. RR patients rated their admissions highly (median VAS 8.9, interquartile range 7.5-9.9), and the VAS scores correlated modestly with disability measures (Spearman's rho = -0.42, 0.31 and 0.24 versus EDSS, BI and FIM, respectively; p = 0.007-0.040). Repeat admissions and the timing of steroid treatment did not have a significant effect on outcome. This suggests that inpatient rehabilitation is useful in RR MS, particularly in patients with incomplete recovery from relapses who have accumulated moderate to severe disability.

Adult↗

PubMed2002

Systematic review of paramedical therapies for Parkinson's disease.

We evaluated the efficacy of physiotherapy, occupational therapy, and speech and language therapy in Parkinson's disease by synthesizing six Cochrane systematic reviews. All randomised, controlled trials examining the efficacy of a paramedical therapy versus control intervention and all those comparing the efficacy of two forms of active therapy in Parkinson's disease were included. Trials were identified by searching biomedical databases, reference lists, hand searching, and contacting investigators. The main outcome measures were quality of life, speech intelligibility, activities of daily living, and individual measures of motor and speech impairment. We identified 16 physiotherapy randomised controlled trials (399 patients), two occupational therapy trials (84 patients), and five speech and language therapy for dysarthria trials (154 patients). None of these studies examined nonpharmacological swallowing therapy for dysphagia. We were unable to perform meta-analysis of the results because the trials used heterogeneous therapy methods and outcome measures. The trials also had marked methodological flaws that could have introduced bias. In summary, we failed to find conclusive evidence of benefit for any form of paramedical therapy sufficient to recommend them in routine clinical practice. However, this lack of evidence is not proof of a lack of effect. Further large pragmatic randomised controlled trials are required to determine the effectiveness of paramedical therapies in Parkinson's disease.

Activities of Daily Living↗

PubMedDate not supplied

Integrated care pathways: disease-specific or process-specific?

BACKGROUND/AIM: conventional teaching on integrated care pathways (ICP) suggests that they have to be specific both to a particular setting and to a specific diagnosis. We wished to explore the potential for a generic process-based care pathway. STUDY DESIGN: we evaluated three different, disease-specific ICPs in use on a neurological rehabilitation unit to identify prompts common to and differing between them. Variance types and goal outcomes in all three diagnostic groups were compared. RESULTS: 93% of prompts on the care pathway were common to all three diagnostic groups. The prompts that differed were unique to each diagnostic group and provided important guidelines about management. CONCLUSION: in neurorehabilitation, where the process of multidisciplinary care is well defined, it is possible to develop a process-based ICP. Process-based ICPs may not be unique to rehabilitation but may also be relevant to other settings in which patients with differing diagnoses share similar needs.

Adolescent↗