Suzanne Hagen

Stroke Patients’ Informal Caregivers: Patient, Caregiver, and Service Factors That Affect Caregiver Strain

BACKGROUND AND PURPOSE Research has revealed that caring for a stroke patient can result in caregiver strain and a myriad of other difficulties for caregivers. This study aims to identify the level of strain experienced by caregivers in the early months after stroke and to assess the relationship between caregiver strain and caregiver characteristics, patient characteristics, and service inputs. METHODS Stroke patients were identified through a random stratified sample of general practices. Patients were asked to identify their principal informal caregiver. Strain was measured with the Caregiver Strain Index, and all data were collected from caregivers at 1, 3, and 6 months after the patients stroke. Multiple regression analysis was used to examine the factors associated with caregiver strain. RESULTS Six months after stroke, 37% of caregivers were experiencing considerable strain. The amount of time a caregiver spent helping a stroke patient, the amount of time the caregiver spent with the patient, and the caregivers health were all significantly associated with the level of strain experienced. Although none of the services or patient factors tested in this study were consistently associated with strain, an indicator of stroke severity was significant at each time point. CONCLUSIONS Caregivers are experiencing strain, which has implications for research and service provision. Service providers need to identify caregivers at risk of greater strain and to help caregivers work through situations that services cannot alter. Research is needed to identify services that are effective in strain alleviation. Future research should also aim to identify the interface between patient characteristics and strain, burden, and depression and particularly to assess the caregivers perception of these relationships.

Validity study of the severity index, a simple measure of urinary incontinence in women

Lack of a universally accepted, easily applied, outcome measure is one reason why urinary incontinence in women is poorly evaluated and treated.1 The severity index, developed by Sandvik et al, is short and simple enough for use in almost any context.2 We evaluated the reliability, validity, and sensitivity to change of the severity index in a wide range of women in Scotland. The severity index comprises the following two questions. How often do you experience urine leakage (0=never, 1=less than once a month, 2=one or several times a month, 3=one or several times a week, 4=every day and/or night)? How much urine do you lose each time (1=drops or little, 2=more)? The total score is the score for the first question multiplied by the score for the second question (0=dry, 1-2=slight, 3-4=moderate, 6-8=severe). We added the category “dry” for women whose urinary incontinence was cured. A version of the index splitting the “severe” …

A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse

Forty-seven women participated in a pilot study for a multi-centre randomized controlled trial of the effectiveness of pelvic floor muscle training (PFMT) for women with prolapse. Women with symptomatic stage I or II prolapse [measured by Pelvic Organ Prolapse Quantification (POP-Q)] were randomized to a 16-week physiotherapy intervention (PFMT and lifestyle advice; n = 23) or a control group receiving a lifestyle advice sheet (n = 24). Symptom severity and quality of life were measured via postal questionnaires. Blinded POP-Q was performed at baseline and follow-up. Intervention women had significantly greater improvement than controls in prolapse symptoms (mean score decrease 3.5 versus 0.1, p = 0.021), were significantly more likely to have an improved prolapse stage (45% versus 0%, p = 0.038) and were significantly more likely to say their prolapse was better (63% versus 24%, p = 0.012). The data support the feasibility of a substantive trial of PFMT for prolapse. A multi-centre trial is underway.

Childbirth and prolapse : long-term associations with the symptoms and objective measurement of pelvic organ prolapse

To investigate prolapse symptoms and objectively measured pelvic organ prolapse, 12 years after childbirth, and association with delivery mode history.

Abdominal massage for the alleviation of constipation symptoms in people with multiple sclerosis: a randomized controlled feasibility study

Background: Constipation affects many people with multiple sclerosis (MS), negatively impacting on their quality of life. The use of abdominal massage has been reported in several populations and has been shown to increase the frequency of defaecation. Objective: The objective of this study was to determine the feasibility of undertaking abdominal massage in people with MS. Methods: Following ethical approval, 30 patients with MS and constipation were recruited. After providing informed written consent and completion of baseline outcome measures, participants were randomly allocated to a massage group or a control group. The massage group participants were provided with advice on bowel management, and they or their carers were taught how to deliver abdominal massage and were recommended to perform it daily during the 4-week intervention period. The control group received bowel management advice only. Outcomes were measured pre (Week 0) and post treatment (Week 4), and at Week 8 and included: the Constipation Scoring System (CSS) (primary outcome), the Neurogenic Bowel Dysfunction Score, and a bowel diary. Results: Both groups demonstrated a decrease in CSS score from Week 0 to Week 4, indicating an improvement in constipation symptoms; however, the massage group improved significantly more than the control groups (mean difference between groups in score change −5.0 (SD 1.5), 95% CI −8.1, −1.8; t = −3.28, df = 28, p = 0.003). Conclusion: The results of this small study suggest a positive effect of the intervention on the symptoms of constipation, and support the feasibility of a substantive trial of abdominal massage for the alleviation of the symptoms of constipation in people with MS.

Does perineal suturing make a difference? The SUNS trial

Objective To examine differences in outcome between primiparous women who do and who do not have suturing to first or second degree perineal lacerations sustained during spontaneous vaginal births after 37 weeks of gestation.

A process for Decision-making after Pilot and feasibility Trials (ADePT): development following a feasibility study of a complex intervention for pelvic organ prolapse

BackgroundCurrent Medical Research Council (MRC) guidance on complex interventions advocates pilot trials and feasibility studies as part of a phased approach to the development, testing, and evaluation of healthcare interventions. In this paper we discuss the results of a recent feasibility study and pilot trial for a randomized controlled trial (RCT) of pelvic floor muscle training for prolapse (ClinicalTrials.gov: NCT01136889). The ways in which researchers decide to respond to the results of feasibility work may have significant repercussions for both the nature and degree of tension between internal and external validity in a definitive trial.MethodsWe used methodological issues to classify and analyze the problems that arose in the feasibility study. Four centers participated with the aim of randomizing 50 women. Women were eligible if they had prolapse of any type, of stage I to IV, and had a pessary successfully fitted. Postal questionnaires were administered at baseline, 6 months, and 7 months post-randomization. After identifying problems arising within the pilot study we then sought to locate potential solutions that might minimize the trade-off between a subsequent explanatory versus pragmatic trial.ResultsThe feasibility study pointed to significant potential problems in relation to participant recruitment, features of the intervention, acceptability of the intervention to participants, and outcome measurement. Finding minimal evidence to support our decision-making regarding the transition from feasibility work to a trial, we developed a systematic process (A process for Decision-making after Pilot and feasibility Trials (ADePT)) which we subsequently used as a guide. The process sought to: 1) encourage the systematic identification and appraisal of problems and potential solutions; 2) improve the transparency of decision-making processes; and 3) reveal the tensions that exist between pragmatic and explanatory choices.ConclusionsWe have developed a process that may aid researchers in their attempt to identify the most appropriate solutions to problems identified within future pilot and feasibility RCTs. The process includes three key steps: a decision about the type of problem, the identification of all solutions (whether addressed within the intervention, trial design or clinical context), and a systematic appraisal of these solutions.

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence

The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management.

Psychometric properties of the pelvic organ prolapse symptom score

Objective  To assess the internal consistency, construct validity and sensitivity to change of a pelvic organ prolapse symptom score (POP‐SS).

A United Kingdom-wide survey of physiotherapy practice in the treatment of pelvic organ prolapse

Background and purpose Pelvic organ prolapse is a common female condition. It is estimated that 50% of parous women experience some degree of prolapse and that 10–20% seek medical care [Br. Med. J. 324 (2002) 1258]. The aim of the survey was to investigate current physiotherapy practice in the treatment of pelvic organ prolapse, specifically the use of pelvic floor muscle training, across the United Kingdom. An additional aim was to gauge the level of interest of individuals and centres in becoming involved in planned multi-centre research exploring the effectiveness of pelvic floor muscle training in the treatment of pelvic organ prolapse. Methods A questionnaire was mailed out to 484 physiotherapist members of the Association of Chartered Physiotherapists in Women’s Health, and 54 non-member physiotherapists working in women’s health, which asked about current practice in the treatment of pelvic organ prolapse. Results A total of 364 physiotherapists completed the questionnaire (a response rate of 71%, after excluding 27 cases) representing a range of clinical experience and practice. Of the respondents 92% (n=333) were assessing or treating women with pelvic organ prolapse. The questionnaire data showed that the various elements of pelvic floor muscle training and outcome measurement were being practised by physiotherapists working across the United Kingdom. However, access to pelvic floor muscle training may be inconsistent, as more than three-quarters of the study respondents reported that they did not have access to clinical guidelines (n=264, 79.3%) or referral guidelines (n=296, 88.9%) for the management of pelvic organ prolapse. The majority of the sample expressed an interest in being involved in future research in this area of practice. There was interest at both an individual level (n=275, 82.5%) and as a centre (n=205, 86.1%). Conclusions This survey has revealed that physiotherapy treatment for prolapse is being offered throughout the country despite the poor evidence base and lack of clinical and referral guidelines. There is a gap in the research evidence and therefore a need for randomised controlled trials looking at the effectiveness of pelvic floor muscle training, in the management of pelvic organ prolapse. Evidence-based guidelines should follow on from this. Standardised referral guidelines are also required to ensure equal access to assessment and physiotherapy treatment.