Background: A significant part of neurological rehabilitation focuses on facilitating the learning of motor skills. Training can adopt either (more) explicit or (more) implicit forms of motor learning. Gait is one of the most practiced motor skills within rehabilitation in people after stroke because it is an important criterion for discharge and requirement for functioning at home. Objective: The aim of this study was to describe the design of a randomized controlled study assessing the effects of implicit motor learning compared with the explicit motor learning in gait rehabilitation of people suffering from stroke. Methods: The study adopts a randomized, controlled, single-blinded study design. People after stroke will be eligible for participation when they are in the chronic stage of recovery (>6 months after stroke), would like to improve walking performance, have a slow walking speed (<1 m/s), can communicate in Dutch, and complete a 3-stage command. People will be excluded if they cannot walk a minimum of 10 m or have other additional impairments that (severely) influence gait. Participants will receive 9 gait-training sessions over a 3-week period and will be randomly allocated to an implicit or explicit group. Therapists are aware of the intervention they provide, and the assessors are blind to the intervention participants receive. Outcome will be assessed at baseline (T0), directly after the intervention (T1), and after 1 month (T2). The primary outcome parameter is walking velocity. Walking performance will be assessed with the 10-meter walking test, Dynamic Gait Index, and while performing a secondary task (dual task). Self-reported measures are the Movement Specific Reinvestment Scale, verbal protocol, Stroke and Aphasia Quality of Life Scale, and the Global Perceived Effect scale. A process evaluation will take place to identify how the therapy was perceived and identify factors that may have influenced the effectiveness of the intervention. Repeated measures analyses will be conducted to determine significant and clinical relevant differences between groups and over time. Results: Data collection is currently ongoing and results are expected in 2019. Conclusions: The relevance of the study as well as the advantages and disadvantages of several aspects of the chosen design are discussed, for example, the personalized approach and choice of measurements.
BACKGROUND: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
Objective: To systematically review and critically appraise the literature on measurement properties of cardiopulmonary exercise test protocols for measuring aerobic capacity, VO2max, in persons after stroke. Data sources: PubMed, Embase and Cinahl were searched from inception up to 15 June 2016. A total of 9 studies were identified reporting on 9 different cardiopulmonary exercise test protocols. Study selection: VO2max measured with cardiopulmonary exercise test and open spirometry was the construct of interest. The target population was adult persons after stroke. We included all studies that evaluated reliability, measurement error, criterion validity, content validity, hypothesis testing and/ or responsiveness of cardiopulmonary exercise test protocols. Data extraction: Two researchers independently screened the literature, assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and extracted data on measurement properties of cardiopulmonary exercise test protocols. Data synthesis: Most studies reported on only one measurement property. Best-evidence synthesis was derived taking into account the methodological quality of the studies, the results and the consistency of the results. Conclusion: No judgement could be made on which protocol is “best” for measuring VO2max in persons after stroke due to lack of high-quality studies on the measurement properties of the cardiopulmonary exercise test.
Cliënten met een CVA (cerebrovascular accident of beroerte) hebben verschillende voorkeuren m.b.t. de training van arm-hand vaardigheden (AHV). Adelante heeft de laatste jaren effectieve behandelconcepten voor deze training ontwikkeld die op de laatste inzichten omtrent neurorevalidatie en motorisch leren zijn gebaseerd. Door de korte revalidatieduur blijft de training vaak beperkt tot een gering aantal AHV, wat tot een suboptimale uitkomst leidt. Ergo- en fysiotherapeuten van Adelante willen cliënten vaker, intensiever en in meer realistische omgevingen laten trainen. Belangrijk is dat cliënten veilig zelfstandig kunnen oefenen en van feedback voorzien worden en dat de inhoud van de training t.o.v. huidige programma’s verrijkt wordt. Een nieuw revalidatieprotocol voor immersive Virtual Reality (VR)-ondersteunde AHV training zou hiervoor een oplossingsrichting kunnen zijn, maar er bestaan nog geen commercieel verkrijgbare producten die aan de eisen van professionals en cliënten voldoen. De ergo- en fysiotherapeuten verwachten dat de toepassing van VR binnen een AHV training efficiënter is, tot snellere en betere resultaten (o.a. door betere generaliseerbaarheid/ een betere transfer), en tot lagere behandelkosten leidt. De toevoeging van immersieve virtuele omgevingen die zo (gepersonaliseerd) aanpasbaar zijn dat de cliënt zoveel mogelijk en zelfstandig in de eigen leefomgeving kan oefenen en feedback krijgt, is innovatief voor de revalidatie. Om deze innovatie te kunnen realiseren, wordt in het beoogde project de volgende onderzoeksvraag beantwoord: “Hoe dient een immersieve VR-applicatie vormgegeven te worden om revalidanten met een CVA zo optimaal mogelijk te ondersteunen bij het trainen van AHV?” Het uitgangspunt hierbij is Design Thinking. In vijf fases (Empathising, Defining, Ideating, Prototyping en Testing, met diverse iteraties) worden in co-creatie met alle stakeholders immersieve virtuele omgevingen en geschikte hardware/ interfaces voor toepassing in AHV training ontwikkeld en inzicht verkregen in de meerwaarde, hanteerbaarheid en implementatie van VR bij revalidanten met problemen op het gebied van AHV als gevolg van een CVA.
