Clinical Rehabilitation最新文献

{"title":"Effect of acetic acid shockwave phonophoresis on spur morphology, foot pain and function in patients with calcaneal spur: A randomised controlled trial.","authors":"Nabil Mahmoud Abdel-Aal, Fatma Seddek Amen, Ahmad Hamdi Azzam, Mostafa Ali Elwan","doi":"10.1177/02692155241306072","DOIUrl":"https://doi.org/10.1177/02692155241306072","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of acetic acid shockwave phonophoresis on spur morphology, foot pain, and function in patients with calcaneal spurs.</p><p><strong>Design: </strong>A double-blinded, randomised clinical trial.</p><p><strong>Setting: </strong>Outpatients physical therapy clinics.</p><p><strong>Participants: </strong>One hundred forty-seven patients with calcaneal spurs, 18-65 years old, were randomly allocated to three equal groups.</p><p><strong>Intervention: </strong>The study group (A) received acetic acid shockwave phonophoresis plus conventional physical therapy. The study group (B) received shockwave therapy plus conventional physical therapy. The control group received conventional physical therapy programme only. Interventions were applied twice a week for 3 weeks.</p><p><strong>Outcome measures: </strong>Calcaneal spur width, calcaneal spur length, pain intensity level, pain pressure threshold and foot and ankle ability measure activities of daily living subscale were measured at baseline, after 3 weeks of interventions and after 4 weeks of follow-up with no intervention.</p><p><strong>Results: </strong>Between-group differences were observed for calcaneal spur width and length, pain intensity, pain pressure threshold and function after 3 weeks favouring Group A (<i>p</i> < 0.001). Mean differences (95% CI) between study groups were -1.11 mm (-1.46, -0.77) for spur width; -1.34 mm (-1.67, -1.01) for spur length; -20.71 mm (-24.66, -16.77) for pain; 1.45 kg/cm² (1.05, 1.85) for pain pressure threshold; and 12.16 points (9.24, 15.09) for function after 3 weeks.</p><p><strong>Conclusions: </strong>Acetic acid shockwave phonophoresis combined with exercise clinically and statistically improves calcaneal spur width, length, pain intensity, pain pressure threshold and foot function more than shockwave therapy alone or conventional physical therapy. This method might be considered an effective, feasible, safe, non-invasive and locally applicable treatment for heel spurs.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241306072"},"PeriodicalIF":2.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and Optimal Cut-Off Points of the Test for Upper Limb Apraxia (TULIA) for Spanish-Speaking Post-Stroke Patients.","authors":"Laura Sánchez-Bermejo, Pedro Jesús Milla-Ortega, José Manuel Pérez-Mármol","doi":"10.1177/02692155241305250","DOIUrl":"https://doi.org/10.1177/02692155241305250","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the reliability, identify the optimal cut-off points, and determine the diagnostic accuracy of the TULIA Apraxia test in a sample of Spanish-speaking post-stroke patients.</p><p><strong>Design: </strong>Cross-sectional.</p><p><strong>Setting: </strong>Public primary care.</p><p><strong>Participants: </strong>201 post-stroke patients.</p><p><strong>Main measures: </strong>Reliability was assessed using Cronbach's alpha. Cut-off points were identified for each TULIA Apraxia sub-test and stratified for age (≤65 years, > 65 years) using ROC curve analysis, area under the curve, and Youden index. Diagnostic accuracy was evaluated using sensitivity, specificity, and predictive values.</p><p><strong>Results: </strong>Cronbach's alpha of the sub-tests varied from 0.716 (95% CI 0.653-0.772) for pantomime intransitive to 0.824 (95% CI 0.784-0.858) for imitation non-symbolic. Cut-off points ranged from ≤25 to ≤35 points. For individuals aged ≤65 years, the cut-offs that best balanced sensitivity and specificity were ≤25 points for detecting alterations in imitation transitive and ≤33 points for pantomime non-symbolic. For individuals over 65 years, the imitation transitive cut-off (≤26 points) presented the most adjusted balance. The minimum positive predictive value was 0.667 (95% CI 0.542-0.777), indicating that the TULIA Apraxia tests correctly classified more than 67% of patients with apraxia. The minimum negative predictive value was 0.763 (95% CI 0.644-0.859), showing that the test accurately identified more than 76% of patients without apraxia.</p><p><strong>Conclusions: </strong>The TULIA Apraxia test is reliable in Spanish-speaking post-stroke patients. Optimal cut-off points, along with their respective sensitivity and specificity values, exhibit adequate test accuracy. Predictive values indicate that the test correctly identifies individuals with and without apraxia.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241305250"},"PeriodicalIF":2.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children's amputee mobility predictor-Assessing the functional capability of children with leg length discrepancy.","authors":"Sharon Eylon, Nurit Stern, Itai Schurr, Itzhak Siev-Ner, Patrice L Weiss, Anat Kristal","doi":"10.1177/02692155241295991","DOIUrl":"https://doi.org/10.1177/02692155241295991","url":null,"abstract":"<p><strong>Objective: </strong>The study purpose was twofold: (1) to develop the Children's Amputee Mobility Predictor and establish its content and social validity and (2) to determine its intra and inter-rater reliability.</p><p><strong>Design: </strong>A reliability and validity study.</p><p><strong>Setting: </strong>Pediatric rehabilitation hospital.</p><p><strong>Participants: </strong><i>Content validity study</i>: 10 clinical experts; <i>Social validity study</i>: 24 stakeholders (i.e., children's parents); <i>Reliability study</i>: 3 physical therapists.</p><p><strong>Intervention: </strong>Not applicable.</p><p><strong>Main measure: </strong>The functional capability of 30 children with leg length discrepancy was evaluated using the Children's Amputee Mobility Predictor. The Intraclass Correlation Coefficient, two-way mixed model, and absolute agreement for a single measure were used to establish intra and inter-rater reliability.</p><p><strong>Results: </strong>Experts reached a consensus on the relevancy and clarity of all 26 tasks included in the Children's Amputee Mobility Predictor. The intra- and inter-rater reliability were excellent, Intraclass Correlation Coefficient (ICC)_2,1= .95, with 95% CI ranging from 0.88-0.98; and ICC_3,1 = 0.96 with 95% CI ranging from 0.93-0.98, respectively. Parent feedback indicated the relevancy of tasks for children with leg length discrepancies.</p><p><strong>Conclusions: </strong>The Children's Amputee Mobility Predictor is a comprehensive outcome measure that requires minimal equipment or space. It appears stable over time when used by the same physical therapist and results suggest that it may be used by multiple physical therapists. The Children's Amputee Mobility Predictor appears to measure important and relevant aspects of functional capability and be a meaningful and relevant assessment tool, helping to guide the determination of medical necessity for specific prosthetic and physical therapy interventions.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241295991"},"PeriodicalIF":2.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the World Health Organization Rehabilitation Competency Framework: An illustration using physiotherapy.","authors":"Marieke Mocke, Marianne Unger, Susan Hanekom","doi":"10.1177/02692155241300271","DOIUrl":"https://doi.org/10.1177/02692155241300271","url":null,"abstract":"<p><strong>Objective: </strong>The World Health Organization's Rehabilitation 2030 initiative represents a new strategic direction for the worldwide rehabilitation community and their Rehabilitation Competency Framework (RCF) was designed to describe the requirements of a rehabilitation workforce. This study aimed to identify and review global physiotherapy competencies and explore their congruence with the WHO-RCF.</p><p><strong>Design: </strong>A document review and thematic analysis were conducted on competency documents sourced from World Physiotherapy member countries.</p><p><strong>Methods: </strong>A three-pronged search strategy was used to identify physiotherapy competencies in all World Physiotherapy members that were listed on their website at the time of the study. All competency statements identified were sorted using the definitions of the five domains of the WHO-RCF. A desktop inductive thematic analysis of competencies was conducted to derive a conceptual framework for future competency framework development.</p><p><strong>Results: </strong>Two thousand and one competency statements were extracted from 20 documents, all accommodated within the WHO-RCF. From the dataset, a conceptual framework was developed consisting of 17 themes and 59 sub-themes across five domains. Technological competence, entrepreneurship and broader competencies to advance the social justice agenda were identified as gaps.</p><p><strong>Conclusion: </strong>To promote homogeneity, it is recommended that all rehabilitation professionals utilise a similar methodology using the WHO-RCF to develop future frameworks that are contextually relevant. Competencies needed for change in support of equitable access and better health for all should be included.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241300271"},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coaching stroke survivors to persevere with practice: An observational behavioural mapping study.","authors":"Bridee Neibling, Moira Smith, Ruth N Barker, Kathryn S Hayward","doi":"10.1177/02692155241304340","DOIUrl":"https://doi.org/10.1177/02692155241304340","url":null,"abstract":"<p><strong>Objective: </strong>To quantitatively describe therapists' use of coaching with stroke survivors, in a hospital-based rehabilitation setting, to promote perseverance with longer-term practice.</p><p><strong>Design: </strong>Prospective observational behavioural mapping study.</p><p><strong>Setting: </strong>Rehabilitation unit of a regional public hospital in Queensland, Australia.</p><p><strong>Main measures: </strong>A custom-designed behavioural mapping tool was used to collect rehabilitation session contextual data and therapists' use of coaching. Data were captured in 3-minute epochs for a maximum of 30 minutes. Data were analysed using descriptive statistics.</p><p><strong>Results: </strong>Thirty-six rehabilitation sessions, including 34 participants (therapists <i>n</i> = 22, stroke survivors <i>n</i> = 12) were observed. Rehabilitation sessions were mostly inpatient (<i>n</i> = 33, 91.7%), one-on-one (<i>n</i> = 30, 83.3%), and conducted in the physiotherapy (<i>n</i> = 160, 45.5%) or occupational therapy (<i>n</i> = 155, 44.0%) gym. Strategies to promote perseverance were used in 76.7% (<i>n</i> = 267) of observed epochs. The most frequently used strategy was <i>monitoring the quality of practice</i> and the least frequently used strategy was <i>utilising a support person to facilitate practice.</i></p><p><strong>Conclusion: </strong>Coaching that may promote perseverance with practice was regularly used by therapists during hospital-based rehabilitation sessions. Coaching that may enable longer-term perseverance beyond a therapist-dependent rehabilitation model was less commonly observed.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241304340"},"PeriodicalIF":2.6,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation Patterns After Hospitalization: Results from a Danish Registry.","authors":"Lars Morsø, Mette Birk-Olsen, Søren Bie Bogh","doi":"10.1177/02692155241302720","DOIUrl":"https://doi.org/10.1177/02692155241302720","url":null,"abstract":"<p><strong>Objective: </strong>Conditions that could benefit from rehabilitation contribute to 310 million years of life lived with disability. Internationally rehabilitation could be part of the solution to the growing global disease burden. This register based study wanted to explore differences in patterns of rehabilitation among patients discharged from the hospital with a rehabilitation plan, explore rehabilitation initiation, and assess the activation of rehabilitation plans within legal requirements.</p><p><strong>Setting: </strong>The study was conducted at Odense University Hospital in the Region of Southern Denmark.</p><p><strong>Participants: </strong>The study investigated acute contacts by utilising rehabilitation referrals, demographic and municipal data from Odense Municipality residents from 2015 to 2020.</p><p><strong>Main measures: </strong>Descriptive statistics, logistic regressions, cox regression and cumulative incidence rate were used to explore rehabilitation the activation of rehabilitation plans.</p><p><strong>Results: </strong>The cohort consisted of 225,653 hospital contacts. Overall, 10,327 (5%) received a rehabilitation plan. Contacts were more often female or had increased co-morbidity. Prescription increased with age and for ethnical Danes. Initiation of prescribed plans increased within the first weeks, levelling from 30 to 60 days. Delayed initiation of the rehabilitation plan beyond 30 days raised the likelihood of non-initiating altogether.</p><p><strong>Conclusions: </strong>Although evidence acknowledges the benefits of rehabilitation, this study showed that more than 25% of all referred municipality rehabilitation plans were never initiated. If the initiation of a rehabilitation plan was delayed beyond 30 days, it significantly reduced the likelihood of initiation. Therefore, the international community need to keep focus on early rehabilitation and increase the use of rehabilitation in the future.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241302720"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and validity of the Tampa Scale for Kinesiophobia in patients with traumatic hand-forearm injuries.","authors":"Umut Eraslan, Ali Kitis, Hande Usta Ozdemir, Hande Senol, Ahmet Fahir Demirkan, Ramazan Hakan Ozcan, Emral Ozgur","doi":"10.1177/02692155241303041","DOIUrl":"https://doi.org/10.1177/02692155241303041","url":null,"abstract":"<p><strong>Objective: </strong>Fear of movement in patients with traumatic hand-arm injuries can negatively affect functional outcomes. Therefore, it is important to evaluate fear of movement in this patient population. The aim of this study was to investigate the validity and reliability of the Tampa Scale for Kinesiophobia in patients with traumatic hand-forearm injuries.</p><p><strong>Design: </strong>Cross-sectional.</p><p><strong>Setting: </strong>Hand rehabilitation unit in a university hospital.</p><p><strong>Participants: </strong>The study included 170 patients with traumatic hand-arm injuries and a mean age of 37.57 (11.85) years.</p><p><strong>Main measures: </strong>Tampa Scale for Kinesiophobia<b>,</b> Pain Catastrophizing Scale, Beck Anxiety Inventory and pain severity rating (via Visual Analog Scale) were completed by interview in the first session. In addition, Modified Hand Injury Scoring System was used to determine severity of the injury. Tampa Scale for Kinesiophobia was re-administered 15 days after the first session. Test-retest reliability, internal consistency, and construct validity of the Tampa Scale for Kinesiophobia were evaluated. In addition, exploratory factor analysis was completed using baseline data.</p><p><strong>Results: </strong>Cronbach's alpha for the scale was 0.604, and test-retest reliability was acceptable (ICC = 0.646). Tampa Scale for Kinesiophobia had a significant relationship with Beck Anxiety Inventory (<i>r</i> = 0.269, <i>p</i> < 0.001), Pain Catastrophizing Scale (<i>r</i> = 0.457, <i>p</i> < 0.001) and pain severity at rest (<i>r</i> = 0.168, <i>p</i> = 0.029). Factor analysis estimated the scale represented five subsections in this population.</p><p><strong>Conclusions: </strong>Psychometric properties of the Tampa Scale for Kinesiophobia were acceptable in patients with hand-forearm injuries. However, since our results were weaker than those in the literature, this should be considered when interpreting the results.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241303041"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The health economic analysis of surgery versus rehabilitation in non-traumatic musculoskeletal shoulder disorders: A systematic review of trial-based studies.","authors":"Thomas Lathiere, Anouck Jaubert, Jeremy Lewis, Sandra David-Tchouda, David Beard, Nicolas Pinsault","doi":"10.1177/02692155241300121","DOIUrl":"https://doi.org/10.1177/02692155241300121","url":null,"abstract":"<p><strong>Objective: </strong>Non-traumatic musculoskeletal shoulder disorders are common. Their treatment, surgical or non-surgical, is associated with a considerable financial burden to health systems. The aim of this study was therefore to investigate the cost-effectiveness of surgical or rehabilitative treatments in this population.</p><p><strong>Data sources: </strong>PubMed, Embase, NHS Economic Evaluation Database, Cost-Effectiveness Analysis registry, PEDro Database, Cochrane Library, and Google Scholar.</p><p><strong>Review methods: </strong>Trial-based economic evaluations assessing nonoperative and/or operative interventions for the management of non-traumatic shoulder disorders, published from January 2000 to October 2024, were searched. The selection process, data extraction and quality assessment (carried out with the Quality of Health Economic Studies instrument) were independently conducted by two reviewers.</p><p><strong>Results: </strong>Four studies (883 patients) were included in the review. Subacromial decompression for rotator cuff-related shoulder pain was found not to be cost-effective when compared with physiotherapy. Although it was not as cost-effective, Physiotherapy could be a socially beneficial alternative to mobilisation under anaesthesia in the early management of a frozen shoulder, due to lower costs and the delays in accessing surgical management in the pain-predominant phase. Productivity loss was the main driver of costs. It was not possible to determine the cost-effectiveness of other shoulder-related disorders due to sparsity of evidence.</p><p><strong>Conclusion: </strong>Priority should be given to interventions that reduce productivity loss and facilitate patients' return to work as soon as possible. There is a definite need for multiplication and standardization of high-quality economic studies (and the trials they are based on) regarding the management of non-traumatic musculoskeletal shoulder disorders.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241300121"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of digitally supported home exercise for people with Parkinson's disease: A qualitative study.","authors":"Jenny Sedhed, Hanna Johansson, Elisabet Åkesson, Erika Franzén, Breiffni Leavy","doi":"10.1177/02692155241298859","DOIUrl":"https://doi.org/10.1177/02692155241298859","url":null,"abstract":"<p><strong>Background: </strong>Digitally supported home exercise offers the potential to expand accessibility to rehabilitation. However, little is known about how people with Parkinson's disease experience performing home exercise programs using digital delivery.</p><p><strong>Objective: </strong>To explore and describe how people with Parkinson's disease perceive digital home-based exercise that is not supported in real-time, and how it affected their everyday lives.</p><p><strong>Methods: </strong>This study was qualitative in nature, using qualitative content analysis with an inductive approach. In-depth, individual, semi-structured interviews were held with 14 participants with Parkinson's disease.</p><p><strong>Results: </strong>Two overarching themes were formed: \"Active agency in the face of uncertainty\" and \"The home - safe space or disability on display\". The overarching themes were formed by four themes: 1) resisting the disease - a hope and a burden, 2) interpreting mixed messages, 3) home exercise - consideration and responsibility, and 4) the social context - judgement and support. Participants with Parkinson's disease believe that home exercise enables them to actively counter the disease, and this belief serves as both a source of hope but also a burden. Although perceived as advantageous, digitally supported home exercise may also incur becoming vulnerable to exposing one's disability.</p><p><strong>Conclusions: </strong>People with Parkinson's disease struggle to reconcile their beliefs about exercise with that which is encouraged or discouraged by those around them. Exercise in the home involves a dynamic interplay between achieving self-directed goals while trying to balance social consideration and maintaining integrity of identity.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241298859"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors.","authors":"Sarah Pyne, Tracey H Sach, Rory Cameron, Helen Risebro, Alexandra Wright-Hughes, Ellen Thompson, Dame Caroline Watkins, Audrey Bowen, Judith Stevens, Amanda J Farrin, Christopher McKevitt, John D Murray, Rory J O'Connor, Julie Phillips, Kate A Radford","doi":"10.1177/02692155241299372","DOIUrl":"https://doi.org/10.1177/02692155241299372","url":null,"abstract":"<p><strong>Objective: </strong>To compare costs and consequences of Early Stroke Specialist Vocational Rehabilitation (ESSVR) with usual care in working age, stroke survivors over 12 months.</p><p><strong>Design: </strong>An economic evaluation nested within the pragmatic, multi-centre, randomised, controlled RETurn to work After stroKE (RETAKE) study.</p><p><strong>Setting: </strong>Twenty-one English and Welsh National Health Service (NHS) hospital-based stroke units. A UK NHS and Personal Social Services perspective was taken in the base-case and a wider perspective (participant, family, employer and other public services) in a secondary analysis.</p><p><strong>Participants: </strong>A total of 583 stroke survivors age ≥18 years (mean 54.0 years, 69% male).</p><p><strong>Interventions: </strong>Participants were randomised to ESSVR, an early, individually tailored (in content, dose, intensity and duration) intervention, plus usual care or usual care alone.</p><p><strong>Main measures: </strong>Disease-specific resource-use data and EQ-5D-5L (health-related quality of life) collected at baseline, 3, 6 and 12 months. Resource-use items were valued using unit costs in UK£ 2021/22. EQ-5D-5L was used to estimate Quality-adjusted life-years (QALYs). If ESSVR was found effective, an incremental cost-utility analysis was planned, otherwise a cost-consequence analysis.</p><p><strong>Results: </strong>The clinical study found no evidence of a between-group difference in the proportion of participants returning to work at 12 months. This, and the level of missing data, means a cost-consequence analysis is reported. Using imputed data, ESSVR plus usual care is estimated to be more expensive with slightly higher QALYs compared with usual care.</p><p><strong>Conclusions: </strong>Early Stroke Specialist Vocational Rehabilitation is unlikely to be considered cost-effective over 12 months, which fits with the clinical finding of no between-group difference in return-to-work rates post-stroke.</p><p><strong>Clinical trial registration information: </strong>The ISRCTN registry: ISRCTN12464275 https://doi.org/10.1186/ISRCTN12464275.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241299372"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}