Roshan das Nair

Evaluation of Rehabilitation of Memory in Neurological Disabilities (ReMiND): a randomized controlled trial:

Objective: The evidence for the effectiveness of memory rehabilitation is inconclusive. The aim was to compare the effectiveness of two group memory rehabilitation programmes with a self-help group control. Design: Single-blind randomized controlled trial. Participants: Participants with memory problems following traumatic brain injury, stroke or multiple sclerosis were recruited from community settings. Interventions: Participants were randomly allocated, in cohorts of four, to compensation or restitution group treatment programmes or a self-help group control. All programmes were manual-based and comprised two individual and ten weekly group sessions. Main measures: Memory functions, mood, and activities of daily living were assessed at baseline and five and seven months after randomization. Results: There were 72 participants (mean age 47.7, SD 10.2 years; 32 men). There was no significant effect of treatment on the Everyday Memory Questionnaire (P = 0.97). At seven months the mean scores were comparable (restitution 36.6, compensation 41.0, self-help 44.1). However, there was a significant difference between groups on the Internal Memory Aids Questionnaire (P = 0.002). The compensation and restitution groups each used significantly more internal memory aids than the self-help group (P < 0.01). There were no statistically significant differences between the groups on measures of mood, adjustment and activities of daily living (P > 0.05). Conclusions: There results show few statistically significant effects of either compensation or restitution memory group treatment as compared with a self-help group control. Further randomized trials of memory rehabilitation are needed.

An Interpretative Phenomenological Analysis of Posttraumatic Growth in Adults Bereaved by Suicide

This study explored experiences of posttraumatic growth in adults bereaved by suicide. Six participants were interviewed using a semi-structured interview schedule. Transcribed interviews were analyzed from an interpretative phenomenological framework. Two superordinate themes, with three ordinate themes in each, were identified: (a) positive growth (“life view,” “knowledge of self,” and “relation to others”) and (b) social context (“gaze of others,” “public guise,” and “solace of other survivors”). Suicide survivors gain extra insights due to their experiences, but are reluctant to acknowledge that they do. This requires consideration in theoretical and clinical settings.

Group memory rehabilitation for people with multiple sclerosis: a feasibility randomized controlled trial

Objective: To assess the feasibility and effectiveness of a group memory rehabilitation programme combining compensation and restitution strategies. Design: Randomized controlled trial. Setting: Community. Participants: People with multiple sclerosis who reported memory difficulties were recruited. Interventions: A group memory rehabilitation programme, comprising ten 1.5-hour sessions, was compared with a waiting list control. Main measures: The primary outcome was the Everyday Memory Questionnaire. Secondary outcomes included the General Health Questionnaire 28 and MS Impact Scale administered four and eight months after randomization. In addition, those in the intervention group gave feedback about the intervention. Results: Forty-eight participants were recruited. They were aged 34–72 years (mean 54.3, SD 11.0) and 33 (69%) were women. There were no significant differences between the two groups on the Everyday Memory Questionnaire or MS Impact Scale (P > 0.05) at four or eight months after randomization. However, the intervention group reported significantly better mood than controls on the GHQ-28 at eight months (P = 0.04). Participants showed minimal benefit from the memory rehabilitation programme on quantitative measures but the intervention was well received, as indicated by positive feedback at the end of the intervention. Conclusions: There was no significant effect of the intervention on memory but there was a significant effect on mood. The results suggest a larger scale study is justified.

The effectiveness of memory rehabilitation following neurological disabilities: a qualitative inquiry of patient perspectives.

The evidence for the effectiveness of memory rehabilitation following neurological conditions, mainly studied through quantitative methodologies, has been equivocal. This study aimed to examine feedback from participants who had been through a randomised controlled trial (RCT) comparing two types of memory rehabilitation with a self-help control. It was envisaged that this information would offer a detailed understanding of patient experience of going through a trial and the perceived effects of having attended group sessions. Through 31 in-depth interviews, data collected were thematically analysed. The seven themes identified highlighted improvements in insight and awareness of memory problems and their neurological conditions, knowledge and skills about using memory aids; and as a consequence, improvements in cognitive functions, mood, and confidence, assertiveness and control over their condition. Participants also reported an altered perspective of life that helped them deal with their problems, and the therapeutic effects of attending group sessions. While these improvements were mainly reported in the intervention groups, even those in the control group reported some benefits. This study highlights that it is both feasible and advantageous to embed qualitative research within the traditional RCT methodology to arrive at a more nuanced understanding of patient experiences and intervention outcomes.

The psychosocial outcomes of anoxic brain injury following cardiac arrest

AIM OF THE STUDY This exploratory study aimed to investigate the psychosocial outcomes for cardiac arrest survivors and explore if there is a greater impact on psychosocial outcome for individuals experiencing anoxic brain injury as a result of the cardiac arrest. METHODS Self-report measures were used to compare the quality of life, social functioning and symptoms of anxiety, depression and post-traumatic stress of individuals with and without anoxic brain injury. Secondary measures of subjective memory and executive difficulties were also used. Fifty-six participants (27 with anoxia, 29 without anoxia) took part in the study between six months and four years after experiencing cardiac arrest. RESULTS A MANOVA identified a significant difference between the two groups, with the anoxia group reporting more psychosocial difficulties. They reported more social functioning difficulties and more anxiety, depression and post-traumatic stress symptoms. There was, however, no significant difference in self-reported quality of life between the two groups. CONCLUSION As the first known study to compare psychosocial outcomes for cardiac arrest survivors experiencing anoxic brain injury with those without anoxia, the current results suggest that cardiac arrest survivors with subsequent acquired brain injury experience more psychosocial difficulties. This could be due to a combination of neuropsychological, social and psychological factors.

The experience of living with knee osteoarthritis: exploring illness and treatment beliefs through thematic analysis

Abstract Purpose: Knee osteoarthritis (OA) is a major cause of disability in older adults. However, there is limited research on the daily experience of living with knee OA. We aimed to offer insight into the beliefs of patients with knee OA about their illness and treatment. Method: Twenty-four semi-structured interviews were conducted with 17 women and 7 men with physician-diagnosed knee OA, aged between 48 and 84 years (mean = 62, SD = 7). The audio-taped interviews lasted from 30 min to 1 h, and were transcribed verbatim. The data were subjected to thematic analysis. The transcripts were independently coded by two researchers to increase reliability of coding. Results: Six themes were developed and two of these are examined in further detail: (i) Illness representation and (ii) Beliefs about the medical and surgical control of pain. Illness representation comprised beliefs about people’s understanding of OA and their pain experience, as well as expectations about the course of illness. The second theme presented experiences of limited pain relief and concerns about the use of drugs and surgery. Conclusion: Exploring illness representations and beliefs about medical and surgical control of pain may provide the basis for initiating psychological interventions for people with knee OA. Implications for Rehabilitation People with knee OA place pain at the core of their living, and hold beliefs about knee OA being an incurable disease of a progressive nature, linked to specific causal factors. People with OA have concerns and worries about use of medication to control pain, and are ambivalent towards relying on medical or surgical interventions. Exploring and addressing patient illness beliefs and treatment expectations may help improve concordance with and outcomes from intervention.

RASCH ANALySIS oF THE NoTTINGHAM ExTENdEd ACTIvITIES oF dAILy LIvING SCALE

BACKGROUND AND PURPOSE The Nottingham Extended Activities of Daily Living (EADL) Scale is frequently used in clinical practice and research in rehabilitation to assess patients’ independence in activities of daily living. Summative scores are used for this purpose, but this is problematic because the EADL is an ordinal level measurement scale. OBJECTIVES To examine the fit of data to the Rasch model and to determine how the fit could be improved by making changes to the scale. The appropriateness of using total and subscale (Mobility, Kitchen, Domestic and Leisure) scores in determining change over time was evaluated. METHODS EADL data (n = 210 stroke patients, 55% male, age range 27–93 years) from a randomized trial of a Stroke family support organiser service were analysed using the Partial Credit model. RESULTS Rasch analysis did not support the total scale as a unidimensional measure of activities of daily living. However,the subscales exhibited reasonable fit to the Rasch model following re-scoring and removal of items. Item 16 exhibited differential item functioning for age and item 22 differential item functioning for gender. CONCLUSION The results endorse the use and psychometric properties of the 4 EADL subscales, but not the total scale.Further work to corroborate these findings would be useful.

Talking about sex after traumatic brain injury: perceptions and experiences of multidisciplinary rehabilitation professionals

Abstract Purpose: Research indicates that although 50–60% of people who have had a traumatic brain injury (TBI) experience changes in sexual functioning, sexuality issues remain largely unaddressed in rehabilitation. This study aimed to explore rehabilitation professionals’ perceptions and experiences of discussing sexuality with service-users who have had a TBI. Method: Purposeful sampling was used to recruit 24 participants from two local National Health Service trusts and from a national charity. Four focus groups were conducted with pre-existing groups of professionals, using a semi-structured interview schedule. Focus group data were transcribed verbatim and analysed using thematic analysis. Results: Six main themes were derived from the analysis: (1) sexuality after TBI is a specialist issue; (2) sexuality is a sensitive subject; (3) practicalities of discussing sexuality; (4) roles and responsibilities; (5) dilemmas about risk and vulnerabilities; and (6) organisational and structural issues. Conclusions: Our findings suggest that a more proactive approach to addressing sexuality issues be taken by incorporating sexuality into assessments and by having sexuality information available for service-users. Support for professionals is also needed in the form of the development of policy, on-going training and supervision. Implications for Rehabilitation Rehabilitation professionals find it difficult to deal with issues of sexuality following TBI, and the reasons for this are complex and interrelated. To provide holistic care, a more proactive approach to addressing sexuality issues should be taken. Professionals do not need to be an expert in sexual issues to open dialogue. Sexuality discussions should be incorporated into assessments, and written information should be available for service-users. Further training for professionals and organisational policy change is sometimes required to effectively deal with sexuality issues.

Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.

Exploring recruitment barriers and facilitators in early cancer detection trials: the use of pre-trial focus groups

BackgroundRecruiting to randomized controlled trials is fraught with challenges; with less than one third recruiting to their original target. In preparation for a trial evaluating the effectiveness of a blood test to screen for lung cancer (the ECLS trial), we conducted a qualitative study to explore the potential barriers and facilitators that would impact recruitment.MethodsThirty two people recruited from community settings took part in four focus groups in Glasgow and Dundee (UK). Thematic analysis was used to code the data and develop themes.ResultsThree sub-themes were developed under the larger theme of recruitment strategies. The first of these themes, recruitment options, considered that participants largely felt that the invitation to participate letter should come from GPs, with postal reminders and face-to-face reminders during primary care contacts. The second theme dealt with understanding randomization and issues related to the control group (where bloods were taken but not tested). Some participants struggled with the concept or need for randomization, or for the need for a control group. Some reported that they would not consider taking part if allocated to the control group, but others were motivated to take part even if allocated to the control group by altruism. The final theme considered perceived barriers to participation and included practical barriers (such as flexible appointments and reimbursement of travel expenses) and psychosocial barriers (such as feeling stigmatized because of their smoking status and worries about being coerced into stopping smoking).ConclusionsFocus groups provided useful information which resulted in numerous changes to proposed trial documentation and processes. This was in order to address participants information needs, improve comprehension of the trial documentation, enhance facilitators and remove barriers to participation. The modifications made in light of these findings may enhance trial recruitment and future trials may wish to consider use of pretrial focus groups.