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  1. Article ; Online: Wellbeing After Stroke (WAterS): Feasibility Testing of a Co-developed Acceptance and Commitment Therapy Intervention to Support Psychological Adjustment After Stroke.

    Patchwood, Emma / Foote, Hannah / Vail, Andy / Cotterill, Sarah / Hill, Geoff / Bowen, Audrey

    Clinical rehabilitation

    2024  , Page(s) 2692155241239879

    Abstract: Objective: Feasibility test a co-developed intervention based on Acceptance and Commitment Therapy to support psychological adjustment post-stroke, delivered by a workforce with community in-reach.: Design: Observational feasibility study utilising ... ...

    Abstract Objective: Feasibility test a co-developed intervention based on Acceptance and Commitment Therapy to support psychological adjustment post-stroke, delivered by a workforce with community in-reach.
    Design: Observational feasibility study utilising patient, carer, public involvement.
    Setting: Online. UK.
    Participants: Stroke survivors with self-reported psychological distress 4  +  months post-stroke.
    Interventions: The co-developed Wellbeing After Stroke (WAterS) intervention includes: 9-weekly, structured, online, group sessions for stroke survivors, delivered via a training programme to upskill staff without Acceptance and Commitment Therapy experience, under Clinical Psychology supervision.
    Main measures: Feasibility of recruitment and retention; data quality from candidate measures; safety. Clinical and demographic information at baseline; patient-reported outcome measures (PROMs) via online surveys (baseline, pre- and post-intervention, 3 and 6 months after intervention end) including Mood (hospital anxiety and depression scale (HADS)), Wellbeing (ONS4), Health-Related Quality of Life (EQ5D5L), Psychological Flexibility (AAQ-ABI) and Values-Based Living (VQ).
    Results: We trained eight staff and recruited 17 stroke survivors with mild-to-moderate cognitive and communication difficulties. 12/17 (71%) joined three intervention groups with 98% attendance and no related adverse events. PROMS data were well-completed. The HADS is a possible future primary outcome (self-reported depression lower on average by 1.3 points: 8.5 pre-group to 7.1 at 3-month follow-up; 95% CI 0.4 to 3.2).
    Conclusion: The WAterS intervention warrants further research evaluation. Staff can be trained and upskilled to deliver. It appears safe and feasible to deliver online to groups, and study recruitment and data collection are feasible. Funding has been secured to further develop the intervention, considering implementation and health equality.
    Language English
    Publishing date 2024-03-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 639276-3
    ISSN 1477-0873 ; 0269-2155
    ISSN (online) 1477-0873
    ISSN 0269-2155
    DOI 10.1177/02692155241239879
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2297: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: A scoping review to identify process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions.

    Foote, Hannah / Bowen, Audrey / Cotterill, Sarah / Hill, Geoff / Pieri, Matilde / Patchwood, Emma

    Clinical rehabilitation

    2022  Volume 37, Issue 6, Page(s) 808–835

    Abstract: Background: Acceptance and Commitment Therapy interventions are increasing in use in neurological populations. There is a lack of information on the measures available.: Purpose: To identify and classify the measures used in Acceptance and Commitment ...

    Abstract Background: Acceptance and Commitment Therapy interventions are increasing in use in neurological populations. There is a lack of information on the measures available.
    Purpose: To identify and classify the measures used in Acceptance and Commitment Therapy research studies with adults with acquired neurological conditions.
    Methods: PRISMA-ScR guided scoping review. MEDLINE, PsycInfo and CINAHL databases searched (up to date 29/06/2022) with forward and backward searching. All study types included. Extraction of Acceptance and Commitment Therapy process-of-change and health-related outcome measures. Outcomes coded using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy.
    Results: Three hundred and thirty three papers found on searching. Fifty four studies included and 136 measurement tools extracted. Conditions included multiple sclerosis, traumatic brain injury and stroke. Thirty-eight studies measured processes of change, with 32 measures extracted. The process measure most often used was the Acceptance and Action Questionnaire (
    Conclusions: This study provides a resource to support future identification of candidate measures. This could aid development of a Core Outcome Set to support both research and clinical practice. Further research to identify the most appropriate and relevant targets and tools for use in these populations should include expert consensus, patient, carer and public involvement and psychometric examination of measures.
    MeSH term(s) Humans ; Adult ; Quality of Life ; Acceptance and Commitment Therapy ; Outcome Assessment, Health Care ; Anxiety/therapy ; Health Status
    Language English
    Publishing date 2022-12-20
    Publishing country England
    Document type Systematic Review ; Review ; Journal Article
    ZDB-ID 639276-3
    ISSN 1477-0873 ; 0269-2155
    ISSN (online) 1477-0873
    ISSN 0269-2155
    DOI 10.1177/02692155221144554
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2297: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Six-month reviews for stroke survivors: a study of the modified Greater Manchester Stroke Assessment Tool with care home residents.

    Patchwood, Emma / Woodward-Nutt, Kate / Rothwell, Katy / Perry, Catherine / Tyrrell, Pippa / Bowen, Audrey

    Clinical rehabilitation

    2020  Volume 34, Issue 5, Page(s) 677–687

    Abstract: Objectives: To explore the feasibility of using a stroke-specific toolkit for six-month post-stroke reviews in care homes to identify unmet needs and actions.: Design: An observational study including qualitative interviews to explore the process and ...

    Abstract Objectives: To explore the feasibility of using a stroke-specific toolkit for six-month post-stroke reviews in care homes to identify unmet needs and actions.
    Design: An observational study including qualitative interviews to explore the process and outcome of reviews.
    Setting: UK care homes.
    Participants: Stroke survivors, family members, care home staff (review participants) and external staff involved in conducting reviews (assessors).
    Interventions: Modified Greater Manchester Stroke Assessment Tool (GM-SAT).
    Results: The observational study provided data on 74 stroke survivors across 51 care homes. In total, out of 74, 45 (61%) had unmet needs identified. Common unmet needs related to blood pressure, mobility, medicine management and mood. We conducted 25 qualitative interviews, including 13 review participants and 12 assessors. Three overarching qualitative themes covered acceptability of conducting reviews in care homes, process and outcomes of reviews, and acceptability of modified GM-SAT review toolkit. The modified GM-SAT review was positively valued, but stroke survivors had poor recall of the review event including the actions agreed. Care home staff sometimes assisted with reviews and highlighted their need for training to support day-to-day needs of stroke survivors. Assessors highlighted a need for clearer guidance on the use of the toolkit and suggested further modifications to enhance it. They also identified organizational barriers and facilitators to implementing reviews and communicating planned actions to GPs and other agencies.
    Conclusion: The modified GM-SAT provides a feasible means of conducting six-month reviews for stroke survivors in care homes and helps identify important needs. Further modifications have enhanced acceptability. Full implementation into practice requires staff training and organizational changes.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Outcome and Process Assessment, Health Care ; Patient Satisfaction ; Quality Assurance, Health Care ; Stroke/diagnosis ; Stroke/psychology ; Stroke/therapy ; Stroke Rehabilitation ; Survivors/psychology ; Time Factors ; United Kingdom
    Language English
    Publishing date 2020-03-23
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 639276-3
    ISSN 1477-0873 ; 0269-2155
    ISSN (online) 1477-0873
    ISSN 0269-2155
    DOI 10.1177/0269215520912515
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2297: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  4. Article ; Online: Challenges implementing a carer support intervention within a national stroke organisation: findings from the process evaluation of the OSCARSS trial.

    Darley, Sarah / Knowles, Sarah / Woodward-Nutt, Kate / Mitchell, Claire / Grande, Gunn / Ewing, Gail / Rhodes, Sarah / Bowen, Audrey / Patchwood, Emma

    BMJ open

    2021  Volume 11, Issue 1, Page(s) e038129

    Abstract: Objectives: To examine the implementation of an intervention to support informal caregivers and to help understand findings from the Organising Support for Carers of Stroke Survivors (OSCARSS) cluster randomised controlled trial (cRCT).: Design: ... ...

    Abstract Objectives: To examine the implementation of an intervention to support informal caregivers and to help understand findings from the Organising Support for Carers of Stroke Survivors (OSCARSS) cluster randomised controlled trial (cRCT).
    Design: Longitudinal process evaluation using mixed methods. Normalisation process theory informed data collection and provided a sensitising framework for analysis.
    Setting: Specialist stroke support services delivered primarily in the homes of informal carers of stroke survivors.
    Participants: OSCARSS cRCT participants including carers, staff, managers and senior leaders.
    Intervention: The Carer Support Needs Assessment Tool for Stroke (CSNAT-Stroke) intervention is a staff-facilitated, carer-led approach to help identify, prioritise and address support needs.
    Results: We conducted qualitative interviews with: OSCARSS cRCT carer participants (11 intervention, 10 control), staff (12 intervention, 8 control) and managers and senior leaders (11); and obtained 140 responses to an online staff survey over three separate time points. Both individual (carer/staff) and organisational factors impacted implementation of the CSNAT-Stroke intervention and how it was received by carers. We identified four themes: staff understanding, carer participation, implementation, and learning and support. Staff valued the idea of a structured approach to supporting carers, but key elements of the intervention were not routinely delivered. Carers did not necessarily identify as 'carers', which made it difficult for staff to engage them in the intervention. Despite organisational enthusiasm for OSCARSS, staff in the intervention arm perceived support and training for implementation of CSNAT-Stroke as delivered primarily by the research team, with few opportunities for shared learning across the organisation.
    Conclusions: We identified challenges across carer, staff and organisation levels that help explain the OSCARSS cRCT outcome. Ensuring training is translated into practice and ongoing organisational support would be required for full implementation of this type of intervention, with emphasis on the carer-led aspects, including supporting carer self-identification.
    Trial registration number: ISRCTN58414120.
    MeSH term(s) Caregivers ; Humans ; Needs Assessment ; Stroke/therapy ; Surveys and Questionnaires ; Survivors
    Language English
    Publishing date 2021-01-12
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2020-038129
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Organising Support for Carers of Stroke Survivors (OSCARSS): study protocol for a cluster randomised controlled trial, including health economic analysis.

    Patchwood, Emma / Rothwell, Katy / Rhodes, Sarah / Batistatou, Evridiki / Woodward-Nutt, Kate / Lau, Yiu-Shing / Grande, Gunn / Ewing, Gail / Bowen, Audrey

    Trials

    2019  Volume 20, Issue 1, Page(s) 19

    Abstract: Background: Stroke often results in chronic disability, with partners and family members taking on the role of informal caregiver. There is considerable uncertainty regarding how best to identify and address carers' needs. The Carer Support Needs ... ...

    Abstract Background: Stroke often results in chronic disability, with partners and family members taking on the role of informal caregiver. There is considerable uncertainty regarding how best to identify and address carers' needs. The Carer Support Needs Assessment Tool (CSNAT) is a carer-led approach to individualised assessment and support for caregiving that may be beneficial in palliative care contexts. CSNAT includes an implementation toolkit. Through collaboration, including with service users, we adapted CSNAT for stroke and for use in a UK stroke specialist organisation providing long-term support. The main aims of OSCARSS are to investigate the clinical and cost-effectiveness of CSNAT-Stroke relative to current practice. This paper focuses on the trial protocol, with the embedded process evaluation reported separately.
    Methods: Longitudinal, multi-site, pragmatic, cluster randomised controlled trial with a health economic analysis. Clusters are UK services randomised to CSNAT-Stroke intervention or usual care, stratified by size of service. Eligible carer participants are: adults aged > 18 years; able to communicate in English; referred to participating clusters; and seen face-to-face at least once by the provider, for support. The 'date seen' for initial support denotes the start of intervention (or control) and carers are referred to the research team after this for study recruitment. Primary outcome is caregiver strain (FACQ - Strain) at three months after 'date seen'. Secondary outcomes include: caregiver distress; positive caregiving appraisals (both FACQ subscales); Pound Carer Satisfaction with Services; mood (HADs); and health (EQ-5D5L) at three months. All outcomes are followed up at six months. Health economic analyses will use additional data on caregiver health service utilisation and informal care provision.
    Discussion: OSCARSS is open to recruitment at the time of article submission. Study findings will allow us to evaluate the clinical and cost-effectiveness of the CSNAT-Stroke intervention, directed at improving outcomes for informal carers of stroke survivors. Trial findings will be interpreted in the context of our embedded process evaluation including qualitative interviews with those who received and provided services as well as data on treatment fidelity. OSCARSS will contribute to knowledge of the unmet needs of informal stroke caregivers and inform future stroke service development.
    Trial registration: ISRCTN Registry, ISRCTN58414120 . Registered on 26 July 2016.
    MeSH term(s) Adult ; Caregivers ; Cost-Benefit Analysis ; Humans ; Multicenter Studies as Topic ; Needs Assessment ; Pragmatic Clinical Trials as Topic ; Sample Size ; Stroke/economics ; Stroke/mortality ; Stroke/therapy ; Survivors
    Language English
    Publishing date 2019-01-07
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1468-6708
    ISSN (online) 1745-6215 ; 1468-6694
    ISSN 1468-6708
    DOI 10.1186/s13063-018-3104-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Organising Support for Carers of Stroke Survivors (OSCARSS): a cluster randomised controlled trial with economic evaluation.

    Patchwood, Emma / Woodward-Nutt, Kate / Rhodes, Sarah A / Batistatou, Evridiki / Camacho, Elizabeth / Knowles, Sarah / Darley, Sarah / Grande, Gunn / Ewing, Gail / Bowen, Audrey

    BMJ open

    2021  Volume 11, Issue 1, Page(s) e038777

    Abstract: Objective: Investigated clinical effectiveness and cost-effectiveness of a person-centred intervention for informal carers/caregivers of stroke survivors.: Design: Pragmatic cluster randomised controlled trial (cRCT) with economic and process ... ...

    Abstract Objective: Investigated clinical effectiveness and cost-effectiveness of a person-centred intervention for informal carers/caregivers of stroke survivors.
    Design: Pragmatic cluster randomised controlled trial (cRCT) with economic and process evaluation.
    Setting: Clusters were services, from a UK voluntary sector specialist provider, delivering support primarily in the homes of stroke survivors and informal carers.
    Participants: Adult carers in participating clusters were referred to the study by cluster staff following initial support contact.
    Interventions: Intervention was the Carer Support Needs Assessment Tool for Stroke: a staff-facilitated, carer-led approach to help identify, prioritise and address the specific support needs of carers. It required at least one face-to-face support contact dedicated to carers, with reviews as required. Control was usual care, which included carer support (unstructured and variable).
    Outcome measures: Participants provided study entry and self-reported outcome data by postal questionnaires, 3 and 6 months after first contact by cluster staff.
    Primary outcome: 3-month caregiver strain (Family Appraisal of Caregiving Questionnaire, FACQ).
    Secondary outcomes: FACQ subscales of caregiver distress and positive appraisals of caregiving, mood (Hospital Anxiety and Depression Scale) and satisfaction with stroke services (Pound). The economic evaluation included self-reported healthcare utilisation, intervention costs and EQ-5D-5L.
    Randomisation and masking: Clusters were recruited before randomisation to intervention or control, with stratification for size of service. Cluster staff could not be masked as training was required for participation. Carer research participants provided self-reported outcome data unaware of allocation; they consented to follow-up data collection only.
    Results: Between 1 February 2017 and 31 July 2018, 35 randomised clusters (18 intervention; 17 control) recruited 414 cRCT carers (208 intervention; 206 control). Study entry characteristics were well balanced.
    Primary outcome measure: intention-to-treat analysis for 84% retained participants (175 intervention; 174 control) found mean (SD) FACQ carer strain at 3 months to be 3.11 (0.87) in the control group compared with 3.03 (0.90) in the intervention group, adjusted mean difference of -0.04 (95% CI -0.20 to 0.13). Secondary outcomes had similarly small differences and tight CIs. Sensitivity analyses suggested robust findings. Intervention fidelity was not achieved. Intervention-related group costs were marginally higher with no additional health benefit observed on EQ-5D-5L. No adverse events were related to the intervention.
    Conclusions: The intervention was not fully implemented in this pragmatic trial. As delivered, it conferred no clinical benefits and is unlikely to be cost-effective compared with usual care from a stroke specialist provider organisation. It remains unclear how best to support carers of stroke survivors. To overcome the implementation challenges of person-centred care in carers' research and service development, staff training and organisational support would need to be enhanced.
    Trial registration number: ISRCTN58414120.
    MeSH term(s) Adult ; Caregivers ; Cost-Benefit Analysis ; Humans ; Quality of Life ; Stroke ; Surveys and Questionnaires ; Survivors
    Language English
    Publishing date 2021-01-12
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2020-038777
    Database MEDical Literature Analysis and Retrieval System OnLINE

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