Introduction Kitchen-related tasks are widely used in occupational therapy for adults with acquired brain injury. This study aimed to investigate the effectiveness of kitchen-related, task-based occupational therapy interventions for improving clinical and functional outcomes in the rehabilitation of adults with acquired brain injury. Method A systematic review of the literature was conducted with narrative synthesis (PROSPERO registration CRD42019141898), by searching relevant electronic databases (BNI, CINAHL Plus, MEDLINE, DORIS, OT Seeker etc.), registries of ongoing studies (ISRCTN, PROSPERO, etc.), and grey literature (OpenGrey, etc.). English-language studies that evaluated kitchen-related tasks in the rehabilitation of adults with acquired brain injury were included and independently appraised for their methodological quality by two reviewers. Results Seventeen primary studies met the eligibility criteria. Studies were heterogeneous in methods, methodological quality, setting, sample size, purpose, and design of kitchen-related tasks. Fifteen studies evaluated kitchen-related, task-based treatments for improving function, and two studies examined kitchen-related task assessments for safety and task performance. This provides very limited evidence for the effectiveness of kitchen-related, task-based interventions compared to interventions not based on kitchen-related tasks. Conclusion While kitchen-related, task-based occupational therapy interventions in acquired brain injury rehabilitation are common practice, there is currently limited research evidence to support this. Further studies are warranted to strengthen the evidence base.
There is a paucity of research into self-management strategies employed by stroke survivors outside of formal rehabilitation. This study aimed to explore stroke survivors' experiences of, and strategies for self-managing their severely impaired upper limb. MATERIALS AND METHODS: English-speaking stroke survivors whose upper limb had been non-functional at 3 months post-stroke took part in interviews (n=16), a focus group (n=6) and a survey (n=20). Quantitative data were analysed descriptively. Qualitative data were analysed through thematic framework analysis using NVivo© software. RESULTS: Participants' median (range) age group was 50-59 years (30-39, 70+). Median (range) time post-stroke was 39 months (4 months, 46 years). The overarching theme across the data was 'choosing and expanding'. Participants enacted professionally driven management strategies for their affected arm, and then chose to continue with what worked for them. Strategies were expanded through self-discovery and interaction with peers. There was sadness and frustration at the loss of arm function, but also satisfaction and self-confidence when progress was being made. Participants described an attitude of not giving up and remaining hopeful. CONCLUSIONS: These findings extend our understanding about how individuals manage their severely impaired upper limb and can be used to inform a novel stroke self-management intervention.
Efficient decision-making is crucial to ensure adequate rehabilitation with optimal use of healthcare resources. Establishing the factors associated with making decisions concerning rehabilitation provision is important to guide clinical staff towards person-centred decisions for rehabilitation after severe stroke. In this study we conduct a best–worst scaling (BWS) experiment to identify the most important factors and their relative weight of importance for deciding the type of ongoing rehabilitation services a person with severe stroke might receive post hospital discharge. Fractional, efficient designs are applied regarding the survey design. Key multidisciplinary staff regularly involved in making decisions for rehabilitation in a stroke unit will be recruited to participate in an online BWS survey. Hierarchical Bayes estimation will be used as the main analysis method, with the best–worst count analysis as a secondary analysis. The survey is currently being piloted prior to commencing the process of data collection. Results are expected by the end of September 2021. The research will add to the current literature on clinical decision-making in stroke rehabilitation. Findings will quantify the preferences of factors among key multi-disciplinary clinicians working in stroke units in the UK, involved in decision-making concerning rehabilitation after stroke.
Introduction: An accurate assessment of the severity of impairment and prediction of prognosis following stroke is important for determining rehabilitation needs. This study investigates predictive ability of the Orpington Prognostic Scale (OPS) administered within 72 hours of stroke onset, in determining discharge destination post admission to a Hyper Acute Stroke Unit (HASU).Method: Prospective analysis of OPS data collected from 219 patients with confirmed diagnosis of stroke admitted to King's College Hospital, HASU. OPS scores were recorded between 0-72hours of admission and compared to discharge destination at 72 hours. Baseline OPS scores were categorised into three groups for comparison of variables. Predictive ability of the tool and associations with other variables were analysed using logistic regression and multivariate analysis.Results: Low OPS score (<3.2) had high positive predictive value (PPV 88.63%) for determining discharge home and high OPS score (>3.2) had high predictive ability (PPV 98.39%) for further inpatient management in specialist stroke or medical rehabilitation units. The OPS showed good predictive ability (Odds ratio 27.691 with 95% confidence interval 9.852 -77.825) to determine outcome after admission to HASU independent of the age, gender, type and site of stroke, previous social support and co-morbidity. Conclusion:OPS could be a valuable tool in predicting the discharge destination from a HASU by early identification of rehabilitation needs 72 hours after stroke following initial screening. OPS <3.2 are highly likely to go home with or without support/therapy, whereas OPS > 3.2 are highly likely to require further medical/therapy input in an inpatient setting.
Introduction: An accurate assessment of the severity of impairment and prediction of prognosis following stroke is important for determining rehabilitation needs of stroke patients. The study investigated the predictive ability of the Orpington Prognostic Scale (OPS) administered within 72 hours of stroke onset, in determining discharge destination post admission to a Hyper Acute Stroke Unit (HASU) in the United Kingdom. Method: Prospective analysis of OPS data were collected from 247 patients with confirmed diagnosis of stroke admitted to HASU. OPS scores were recorded between 0 to 72hours of admission and compared to discharge destination at 72 hours. Predictive ability of the tool and association with other variables were analysed using logistic regression and multivariate analysis. Results: Low OPS score (<3.2) had high positive predictive value (PPV 88.63%)for discharge home and high OPS score (>3.2) had high predictive value (PPV 98.39) for patients requiring further inpatient rehabilitation. OPS had high specificity and sensitivity for the above, independent of age, gender, type and site of stroke, stroke severity, previous social support and co-morbidity. Conclusions: OPS could be a valuable tool in predicting the discharge destination from a HASU and thereby facilitate the identification of early rehabilitation needs, 72 hours post stroke by predicting the need for further management. OPS < 3.2 were highly likely to go home with or without support/therapy. Whereas OPS > 3.2 were highly likely to require further medical/therapy input in an inpatient setting.
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