The interaction between policy and education using stroke as an example

Craig, Louise; Smith, Lawrence D.

doi:10.1016/j.nedt.2007.02.011

Cited by 4 publications

(3 citation statements)

References 34 publications

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“…First of all, because physical therapy as part of complex interdisciplinary stroke rehabilitation, contains several interrelated components that may be targeted at different levels (i.e., at service, operator, and/or treatment level) [8], [575], [576]. Second, physical therapy typically entails a cyclical process involving (1) assessment, to identify and quantify the patient’s needs; (2) goal setting, to define realistic and attainable goals for improvement; (3) intervention, to assist in the achievement of goals; and (4) reassessment, to assess progress against agreed goals [8].…”

Section: Discussionmentioning

confidence: 99%

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundPhysical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT.Methods and FindingsRandomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5–7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03–0.70; I2 = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84–4.11; I2 = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02–0.39; I2 = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41–0.82; I2 = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing.ConclusionsThere is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.

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Section: Discussionmentioning

confidence: 99%

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

et al. 2014

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“…However while the importance of stroke education has been highlighted by policy makers (Craig & Smith 2007) little has been done to establish a strategic UK approach to stroke education. Instead the provision of stroke education has been left to the discretion of the health service, consortia and higher education wherein stroke education competes for finite training resources with other UK health priorities such as cancer and heart disease.…”

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confidence: 99%

Stroke education for healthcare professionals: Making it fit for purpose

Smith

Craig

Weir

et al. 2008

Nurse Education Today

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TitleStroke Education for Healthcare Professionals: Making it Fit for Purpose Research Questions1. What are healthcare professionals' (HCPs) educational priorities regarding stroke care? 2. Do stroke care priorities vary across the primary and secondary sectors? 3. How do HCPs conceive stroke care will be delivered in 2010? Study DesignThis was a two-year study using focus groups and interviews for instrument development, questionnaires for data collection and workshops to provide study feedback. Data were collected in 2005-06. Study SiteOne Scottish health board. Inclusion CriteriaAll National Health Service healthcare professionals working wherever stroke care occurred. Population and SampleParticipants were drawn from four university teaching hospitals, 2 community hospitals, 1 geriatric medicine Day Hospital, 48 General Practices (GPs), 12 care homes and 15 community teams. The sample comprised 155 doctors, 313 nurses, 133 therapists [physiotherapists, occupational therapists, speech and language therapists], and 29 'other HCPs' [14 dieticians, 7 pharmacists, 2 podiatrists and 6 psychologists]. ResultsHCPs prefer fact-to-face, accredited education but blended approaches are required that accommodate uni and multidisciplinary demands. Doctors and nurses are more inclined towards discipline-specific training compared to therapists and other healthcare professionals (HCPs) HCPs in primary care and stroke units want more information on the social impact of stroke while those working in stroke units in particular are concerned with leadership in the multidisciplinary team. Nurses are the most interested in teaching patients and carers.1 ConclusionsStroke requires more specialist stroke staff, the upskilling of current staff and a national education pathway given that stroke care is most effectively managed by specialists with specific clinical skills. The current government push towards a flexible workforce is welcome but should be educationally-sound and recognise the career aspirations of healthcare professionals.

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“…Academic and medical training must include methods for translation of research into clinical delivery. 44 The examples of policy-relevant research on stroke given above demonstrate the breadth of research questions and approaches being used to understand and act on stroke. This work has yielded policy-relevant outcomes, as well as outputs such as new research approaches related to stroke strategies and elements of care, optimizing policy investments in stroke, and knowledge translation.…”

Section: Predictive Modelingmentioning

confidence: 99%